| 1. |
- Anandavadivelan, Poorna, et al.
(author)
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Prevalence and intensity of dumping symptoms and their association with health-related quality of life following surgery for oesophageal cancer
- 2021
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In: Clinical Nutrition. - : Elsevier. - 0261-5614 .- 1532-1983. ; 40:3, s. 1233-1240
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Journal article (peer-reviewed)abstract
- BACKGROUND & AIMS: This study aimed to investigate the prevalence and intensity of symptoms of dumping syndrome (early and late) experienced by oesophageal cancer survivors one year after surgery and their association with health related quality of life (HRQL).METHODS: A prospective cohort study of patients who underwent surgery for oesophageal cancer in Sweden from January 2013 to April 2018, included at one year after surgery with follow-up at 1.5 years. Common symptoms of dumping syndrome were the exposure, classified as early and late onset, further divided into 'moderate' or 'severe' based on symptom intensity, and no dumping symptoms (reference group). The primary outcome was mean summary score of HRQL, and secondary outcomes were global quality of life, physical, role, emotional, cognitive and social function measured using the EORTC QLQ-C30 1.5 years after surgery. An ANCOVA model, adjusted for potential confounders was used to study the association between dumping symptoms and HRQL, presented as mean score differences (MD) with 95% confidence intervals (CI).RESULTS: Among 188 patients, moderate early dumping symptoms was experienced by 45% and severe early dumping by 9%. Moderate late dumping symptoms was reported by 13%, whereas 5% reported severe late dumping symptoms. Severe early dumping symptoms was associated with worse HRQL in 4 out of 7 aspects with worse global quality of life (MD -16, 95% CI: -27 to -4) and social function (MD -17, 95% CI: -32 to -3), which showed clinically large differences compared to having no such symptoms. Patients with moderate late dumping symptoms reported poorer HRQL in 6 out of 7 aspects compared to those with no dumping symptoms. Cognitive function (MD -27, 95% CI: -47 to -7) and emotional function (MD -24, 95% CI: -47 to -2) were significantly declined (clinically large relevance) in those with severe late dumping symptoms.CONCLUSIONS: Patients who have undergone curative treatment for oesophageal cancer experience reduced HRQL from early and late dumping symptoms at one year after surgery that indicate clear implications for clinical routine. Medical support and additional dietary counselling are required as potential ways to alleviate dumping symptoms on clinical repercussions.
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| 2. |
- Anandavadivelan, Poorna, et al.
(author)
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Profiles of patient and tumour characteristics in relation to health-related quality of life after oesophageal cancer surgery
- 2018
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:4
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Journal article (peer-reviewed)abstract
- Strong deterioration in health-related quality of life (HRQOL) is a major concern in a sub-group of long-term oesophageal cancer survivors. This study aimed to identify potential clustering of patients and tumour variables that predicts such deterioration. Patient and tumour variables were collected in a prospective cohort of patients who underwent surgery for oesophageal cancer in Sweden 2001–2005. Latent cluster analysis identified statistically significant clustering of these variables. Multivariable logistic regression adjusted for age, BMI, tumour stage and marital status was used to determine odds ratios (ORs) with 95% confidence intervals (CIs) between patient profiles and HRQOL at 3 and 5 years from surgery. Among 155 included patients at 3 years, three patient profiles were identified: 1) ‘reference profile’ (males, younger age, employed, upper secondary education, co-habitating, urban dwellers, adenocarcinoma and advanced tumour stage) (n = 47;30%), 2) ‘adenocarcinoma profile’ (middle age, unemployed/retired, males, low education, co-habitating, adenocarcinoma, advanced tumour stage, tumour in lower oesophagus/cardia, and co-morbidities (n = 79;51%), and 3) ‘squamous-cell carcinoma profile’ (unemployed/retired, middle-age, males, low BMI, urban dwellers, squamous-cell carcinoma, tumour in upper/middle oesophagus (n = 29;19%). These profiles did not differ regarding most HRQOL measures. Exceptions were the squamous-cell carcinoma profile, reporting more constipation (OR = 5.69; 95%CI: 1.34–24.28) and trouble swallowing saliva (OR = 4.87; 95%CI: 1.04–22.78) and the adenocarcinoma profile reporting more dyspnoea (OR = 2.60; 95%CI: 1.00–6.77) and constipation (OR = 3.31; 95%CI: 1.00–10.97) compared to the reference profile. Three distinct patient profiles were identified but these could not explain the substantial deterioration in HRQOL observed in the sub-sample of survivors.
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| 3. |
- Anandavadivelan, Poorna, et al.
(author)
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Role of dietitian support in improving weight loss and nutrition impact symptoms after oesophageal cancer surgery
- 2021
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In: European Journal of Clinical Nutrition. - : Springer Nature. - 0954-3007 .- 1476-5640. ; 75, s. 1134-1141
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Journal article (peer-reviewed)abstract
- Background: Oesophageal cancer is frequently accompanied with malnutrition. We aimed to evaluate if early support from dietitians and patient's level of satisfaction with the support from dietitians are associated with better outcomes for weight loss and nutrition impact symptoms (NIS).Methods: A nationwide and prospective cohort study on patients operated for oesophageal cancer in Sweden from 2013 onwards, included one year after surgery. Study exposures were (1) preoperative dietitian support (yes vs no) and, (2) patient reported satisfaction with dietitian support (high vs low) and outcomes were postoperative (1) percentage weight loss and (2) NIS score (range 0-24); one year after surgery. An ANCOVA model adjusted for predefined confounders was used and presented as mean differences (MD) with 95% confidence intervals (CI).Results: Among 245 patients, as many as 57% had received preoperative dietitian support. Preoperative dietitian support was not associated with statistically significant differences in mean postoperative weight loss (MD 0.2 [95% CI -2.6 to 2.9]) and mean NIS score (MD 0.1 [95% CI: -0.8 to 1.0]). Likewise, satisfaction with the dietitian support was not associated with significant differences in mean postoperative weight loss (MD 1.4 [95% CI: -1.5 to 4.3]) and NIS score (MD -0.1 [95% CI: -1 to 0.8]).Conclusions: Long-term postoperative weight loss and NIS were not influenced based on whether dietitian support was initiated preoperatively or not and patient's satisfaction level with dietitian support. Similarity in results may reflect effective screening of malnutrition and dietitian support in centres treating oesophageal cancer in Sweden.
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| 4. |
- Backemar, Lovisa, et al.
(author)
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Comorbidities and Risk of Complications After Surgery for Esophageal Cancer : A Nationwide Cohort Study in Sweden.
- 2015
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In: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 39:9, s. 2282-8
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Journal article (peer-reviewed)abstract
- BACKGROUND: The selection for surgery is multifaceted for patients diagnosed with esophageal cancer. Since it is uncertain how comorbidity should influence the selection, this study addressed comorbidities in relation to risk of severe complications following esophageal cancer surgery.METHODS: This population-based cohort study was based on prospectively included patients who underwent surgical resection for an esophageal or gastro-esophageal junctional cancer in Sweden during 2001-2005. The participation rate was 90%. Associations between pre-defined comorbidities and pre-defined post-operative complications occurring within 30 days of surgery were analyzed using multivariable logistic regression. The resulting odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for age, sex, tumor stage, tumor histology, neoadjuvant therapy, type of surgery, annual hospital volume, other comorbidities, and other complications.RESULTS: Among 609 included patients, those with cardiac disease (n = 92) experienced an increased risk of pre-defined complications in general (adjusted OR 1.81, 95% CI 1.13-2.90), while patients with hypertension (n = 137), pulmonary disorders (n = 79), diabetes (n = 67), and obesity (n = 66) did not. Patients with a Charlson comorbidity index score ≥2 had substantially increased risks of pre-defined complications (adjusted OR 2.44, 95% CI 1.60-3.72).CONCLUSION: Cardiac disease and a Charlson comorbidity index score ≥2 seem to increase the risk of severe and early post-operative complications in patients with esophageal cancer, while hypertension, pulmonary disorders, diabetes, and obesity do not. These findings should be considered in the clinical decision-making for improved selection of patients for surgery.
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| 5. |
- Backemar, Lovisa, et al.
(author)
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The Influence of Comorbidity on Health-Related Quality of Life After Esophageal Cancer Surgery
- 2020
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In: Annals of Surgical Oncology. - : Springer Science and Business Media LLC. - 1068-9265 .- 1534-4681. ; 27:8, s. 2637-2645
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Journal article (peer-reviewed)abstract
- BackgroundEsophageal cancer surgery reduces patients’ health-related quality of life (HRQoL). This study examined whether comorbidities influence HRQoL in these patients.MethodsThis prospective cohort study included esophageal cancer patients having undergone curatively intended esophagectomy at St Thomas’ Hospital London in 2011–2015. Clinical data were collected from patient reports and medical records. Well-validated cancer-specific and esophageal cancer-specific questionnaires (EORTC QLQ-C30 and QLQ-OG25) were used to assess HRQoL before and 6 months after esophagectomy. Number of comorbidities, American Society of Anesthesiologists physical status classification (ASA), and specific comorbidities were analyzed in relation to HRQoL aspects using multivariable linear regression models. Mean score differences with 95% confidence intervals were adjusted for potential confounders.ResultsAmong 136 patients, those with three or more comorbidities at the time of surgery had poorer global quality of life and physical function and more fatigue compared with those with no comorbidity. Patients with ASA III–IV reported more problems with the above HRQoL aspects and worse social function and pain compared with those with ASA I–II. Cardiac comorbidity was associated with worse global quality of life and dyspnea, while pulmonary comorbidities were related to coughing. Patients assessed both before and 6 months after surgery (n = 80) deteriorated in most HRQoL aspects regardless of comorbidity status, but patients with several comorbidities had worse physical function and fatigue and more trouble with coughing compared with those with fewer comorbidities.ConclusionComorbidity appears to negatively influence HRQoL before esophagectomy, but appears not to severely impact 6-month recovery of HRQoL.
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| 6. |
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| 7. |
- Brusselaers, Nele, et al.
(author)
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Education level and survival after esophageal cancer surgery : a prospective population-based cohort study
- 2013
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In: BMJ Open. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2044-6055.
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Journal article (peer-reviewed)abstract
- Objectives: This study aimed to investigate whether a higher education level is associated with an improved long-term survival after oesophagectomy for cancer. Design: A prospective, population-based cohort study. Setting: Sweden—nationwide. Participants: 90% of all patients with oesophageal and cardia cancer who underwent a resection in Sweden in 2001–2005 were enrolled in this study (N=600; 80.3% male) and followed up until death or the end of the study period (2012). The study exposure was level of education, defined as compulsory (≤9 years), moderate (10–12 years) or high (≥13 years). Outcome measures The main outcome measure was overall 5-year survival after oesophagectomy. Cox regression was used to estimate the associations between education level and mortality, expressed as HRs with 95% CIs, with adjustment for sex, age, tumour stage, histological type, complications, comorbidities and annual surgeon volume. The patient group with highest education was used as the reference category. Results: Among the 600 included patients, 281 (46.8%) had compulsory education, 238 (39.7%) had moderate education and 81 (13.5%) had high education. The overall 5-year survival rate was 23.1%, 24.4% and 32.1% among patients with compulsory, moderate and high education, respectively. After adjustment for confounders, a slightly higher, yet not statistically significantly increased point HR was found among the compulsory educated patients (HR 1.08, 95% CI 0.80 to 1.47). In patients with tumour stage IV, increased adjusted HRs were found for compulsory (HR 2.88, 95% CI 1.07 to 7.73) and moderately (HR 2.83, 95% CI 1.15 to 6.95) educated patients. No statistically significant associations were found for the other tumour stages. Conclusions: This study provides limited evidence of an association between lower education and worse long-term survival after oesophagectomy for cancer.
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| 8. |
- Brusselaers, Nele, et al.
(author)
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Education level influences long-term survival after esophageal cancer surgery in a nationwide Swedish cohort study
- 2013
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In: BMJ Open. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2044-6055.
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Journal article (peer-reviewed)abstract
- Objectives: This study aimed to investigate whether a higher education level is associated with an improved long-term survival after oesophagectomy for cancer. Design: A prospective, population-based cohort study. Setting: Sweden—nationwide. Participants: 90% of all patients with oesophageal and cardia cancer who underwent a resection in Sweden in 2001–2005 were enrolled in this study (N=600; 80.3% male) and followed up until death or the end of the study period (2012). The study exposure was level of education, defined as compulsory (≤9 years), moderate (10–12 years) or high (≥13 years). Outcome measures: The main outcome measure was overall 5-year survival after oesophagectomy. Cox regression was used to estimate the associations between education level and mortality, expressed as HRs with 95% CIs, with adjustment for sex, age, tumour stage, histological type, complications, comorbidities and annual surgeon volume. The patient group with highest education was used as the reference category. Results: Among the 600 included patients, 281 (46.8%) had compulsory education, 238 (39.7%) had moderate education and 81 (13.5%) had high education. The overall 5-year survival rate was 23.1%, 24.4% and 32.1% among patients with compulsory, moderate and high education, respectively. After adjustment for confounders, a slightly higher, yet not statistically significantly increased point HR was found among the compulsory educated patients (HR 1.08, 95% CI 0.80 to 1.47). In patients with tumour stage IV, increased adjusted HRs were found for compulsory (HR 2.88, 95% CI 1.07 to 7.73) and moderately (HR 2.83, 95% CI 1.15 to 6.95) educated patients. No statistically significant associations were found for the other tumour stages. Conclusions: This study provides limited evidence of an association between lower education and worse longterm survival after oesophagectomy for cancer.
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| 9. |
- Brusselaers, Nele, et al.
(author)
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Marital status and survival after oesophageal cancer surgery : a population-based nationwide cohort study in Sweden
- 2014
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In: BMJ Open. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2044-6055.
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Journal article (peer-reviewed)abstract
- Objectives A beneficial effect of being married on survival has been shown for several cancer types, but is unclear for oesophageal cancer. The objective of this study was to clarify the potential influence of the marital status on the overall and disease-specific survival after curatively intended treatment of oesophageal cancer using a nationwide population-based design, taking into account the known major prognostic variables. Design Prospective, population-based cohort. Setting All Swedish hospitals performing surgery for oesophageal cancer during 2001–2005. Participants This study included 90% of all patients with oesophageal or junctional cancer who underwent surgical resection in Sweden in 2001–2005, with follow-up until death or the end of the study period (2012). Primary and secondary outcome measures Cox regression was used to estimate associations between the marital status and the 5-year overall and disease-specific mortality, expressed as HRs with 95% CIs, with adjustment for sex, age, tumour stage, histological type, complications, comorbidities and annual surgeon volume. Results Of all 606 included patients (80.4% men), 55.1% were married, 9.2% were remarried, 22.6% were previously married and 13% were never married. Compared with the married patients, the never married (HR 1.02, 95% CI 0.77 to 1.35), previously married (HR 0.90, 95% CI 0.71 to 1.15) and remarried patients (HR 0.79, 95% CI 0.55 to 1.13) had no increased overall 5-year mortality. The corresponding HRs for disease-specific survival, and after excluding the initial 90 days of surgery, were similar to the HRs for the overall survival. Conclusions This study showed no evidence of a better 5-year survival in married patients compared with non-married patients undergoing surgery for oesophageal cancer.
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