Abstract
BackgroundPatients with esophageal cancer often experience clinically relevant deterioration of quality of life (QOL) after esophagectomy owing to malnutrition, lack of physical exercise, and psychological symptoms.ObjectiveThis study aimed to evaluate the feasibility, safety, and efficacy of a comprehensive intervention model using a mobile health system (CIMmH) in patients with esophageal cancer after esophagectomy.MethodsTwenty patients with esophageal cancer undergoing the modified McKeown surgical procedure were invited to join the CIMmH program with both online and offline components for 12 weeks. The participants were assessed before surgery and again at 1 and 3 months after esophagectomy. QOL, depressive symptoms, anxiety, stress, nutrition, and physical fitness were measured.ResultsOf the 20 patients, 16 (80%) completed the program. One month after esophagectomy, patients showed significant deterioration in overall QOL (P=.02), eating (P=.005), reflux (P=.04), and trouble with talking (P<.001). At the 3-month follow-up, except for pain (P=.02), difficulty with eating (P=.03), dry mouth (P=.04), and trouble with talking (P=.003), all other QOL dimensions returned to the preoperative level. There were significant reductions in weight (P<.001) and BMI (P=.02) throughout the study, and no significant changes were observed for physical fitness measured by change in the 6-minute walk distance between baseline and the 1-month follow-up (P=.22) or between baseline and the 3-month follow-up (P=.52). Depressive symptoms significantly increased 1 month after surgery (P<.001), while other psychological measures did not show relevant changes. Although there were declines in many measures 1 month after surgery, these were much improved at the 3-month follow-up, and the recovery was more profound and faster than with traditional rehabilitation programs.ConclusionsThe CIMmH was feasible and safe and demonstrated encouraging efficacy testing with a control group for enhancing recovery after surgery among patients with esophageal cancer in China.Trial RegistrationChinese Clinical Trial Registry (ChiCTR-IPR-1800019900); http://www.chictr.org.cn/showprojen.aspx?proj=32811.
Highlights
Esophageal cancer is the third most common cancer and the fourth most common cause of cancer death in China [1]
From baseline to the 3-month follow-up, most of the quality of life (QOL) dimensions returned to the preoperative level, except for pain (P=.02), diarrhea (P=.04), difficulty with eating (P=.03), and trouble with talking (P=.003)
Previous studies involving traditional postoperative rehabilitation showed a greater decrease in the 6-minute walk distance (6MWD) in the third month after surgery when compared with the finding in this study [51,52]
Summary
Esophageal cancer is the third most common cancer and the fourth most common cause of cancer death in China [1]. Anastomotic leakage is one of the most common postoperative complications, and it occurs in 5%-20% of patients with esophageal cancer [5,6] Complications such as this may increase hospital stay, delay oral feeding, lead to malnutrition, increase psychological burden, cause poor quality of life (QOL), and subsequently worsen the long-term survival of patients [7,8,9,10]. A comprehensive intervention program tailored to individual patients and designed to support patients holistically in all aspects, including nutrition, physical exercise, and psychosocial support, is urgently warranted for patients with esophageal cancer after esophagectomy. Patients with esophageal cancer often experience clinically relevant deterioration of quality of life (QOL) after esophagectomy owing to malnutrition, lack of physical exercise, and psychological symptoms
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