Abstract
BackgroundOesophagectomy remains the only curative intervention for oesophageal cancer, with defined nutritional and health-related quality of life (HR-QOL) consequences. It follows therefore that there is a significant risk of decline in physical wellbeing with oesophagectomy however this has been inadequately quantified. This study prospectively examines change in physical functioning and habitual physical activity participation, from pre-surgery through 6-months post-oesophagectomy.MethodsPatients scheduled for oesophagectomy with curative intent were recruited. Key domains of physical functioning including exercise tolerance (six-minute walk test (6MWT)) and muscle strength (hand-grip strength), and habitual physical activity participation, including sedentary behaviour (accelerometry) were measured pre-surgery (T0) and repeated at 1-month (T1) and 6-months (T2) post-surgery. HR-QOL was measured using the EORTC-QOL C30.ResultsThirty-six participants were studied (mean age 62.4 (8.8) years, n = 26 male, n = 26 transthoracic oesophagectomy). Mean 6MWT distance decreased significantly from T0 to T1 (p = 0.006) and returned to T0 levels between T1 and T2 (p < 0.001). Percentage time spent sedentary increased throughout recovery (p < 0.001) and remained significantly higher at T2 in comparison to T0 (p = 0.003). In contrast, percentage time spent engaged in either light or moderate-to-vigorous intensity activity, all reduced significantly (p < 0.001 for both) and remained significantly lower at T2 in comparison to T0 (p = 0.009 and p = 0.01 respectively). Patients reported deficits in multiple domains of HR-QOL during recovery including global health status (p = 0.04), physical functioning (p < 0.001) and role functioning (p < 0.001). Role functioning remained a clinically important 33-points lower than pre-operative values at T2.ConclusionHabitual physical activity participation remains significantly impaired at 6-months post-oesophagectomy. Physical activity is a measurable and modifiable target for physical rehabilitation, which is closely aligned with patient-reported deficits in role functioning. Rehabilitation aimed at optimising physical health in oesophageal cancer survivorship is warranted.
Highlights
Oesophagectomy remains the only curative intervention for oesophageal cancer, with defined nutritional and health-related quality of life (HR-QOL) consequences
20% of patients diagnosed with oesophageal cancer undergo oesophagectomy with curative intent [5]
Surgery is preceded by chemotherapy or combination chemoradiotherapy for the majority of patients who present with locally advanced disease [2]; an approach which has contributed to 5-year survival rates of up to 47% [7]
Summary
Oesophagectomy remains the only curative intervention for oesophageal cancer, with defined nutritional and health-related quality of life (HR-QOL) consequences. Oesophagectomy is an exemplar model of a complex operation, with a relatively high postoperative risk of major morbidity [1], and defined nutritional and health-related quality of life (HR-QOL) implications [2, 3]. 20% of patients diagnosed with oesophageal cancer undergo oesophagectomy with curative intent [5]. This complex procedure involving upper laparotomy usually in combination with thoracotomy and one lung anaesthesia, and is associated with significant postoperative morbidity. At a time when overall survival is improving, there is a growing emphasis on the nutritional, physical and emotional wellbeing of patients undergoing curative treatment for locally advanced disease [8]
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