Nutrition Impact Symptoms Are Prognostic of Quality of Life and Mortality after Surgery for Oesophageal Cancer.

Poorna Anandavadivelan,Therese Djärv,Pernilla Lagergren,Asif Johar,Lena Martin

doi:10.3390/cancers10090318

Poorna Anandavadivelan, Therese Djärv + Show 3 more

Open Access

https://doi.org/10.3390/cancers10090318

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Abstract

We aimed to clarify the influence of nutritional problems after surgery for oesophageal cancer on functional health related quality of life (HRQOL) and survival. A prospective nationwide cohort of oesophageal cancer patients operated 2001–2005 in Sweden with 6 months postoperative follow up was used. Nutritional problems were categorized as low/moderate/severe/very severe based on weight loss and nutrition impact symptoms. An ANCOVA model calculated mean score differences (MD) with 95% confidence intervals (CI) of global quality of life (QOL), social and physical function scores, stratified by preoperative body mass index (BMI) <25 and ≥25. A Cox proportional hazards model produced hazard ratios (HR) with 95% CI for overall 5-year survival. Of 358 patients, 196 (55%) had preoperative BMI ≥25. Very severe and severe nutritional problems were associated with worse HRQOL in both BMI groups. E.g. MD’s for global QOL among ‘very severe’ group was −29 (95% CI −39–−19) and −20 (95% CI −29–−11) for <25 and ≥25 BMI, respectively, compared to the ‘low’ group. Overall 5-year survival among ‘very severe’ and BMI ≥ 25 was worse; HR 4.6 (95% CI 1.4–15.6). Intense nutritional problems negatively impact postoperative HRQOL and combined with preoperative BMI ≥ 25 are associated with poorer 5-year overall survival representing a group needing greater clinical attention.

Highlights

Oesophageal cancer ranks ninth among the most common cancer types worldwide [1].The curative treatment includes extensive surgery typically preceded by chemotherapy or chemo radiotherapy
It is evident that the post-operative survivorship is challenging with decreased health related quality of life (HRQOL), eating difficulties, malnutrition and poor long-term survival [2]
It is imperative to determine factors that are associated with poor HRQOL and survival that are of prognostic value to identify patients at risk and in turn facilitate tailored interventions

Summary

Introduction

The curative treatment includes extensive surgery typically preceded by chemotherapy or chemo radiotherapy. It is evident that the post-operative survivorship is challenging with decreased health related quality of life (HRQOL), eating difficulties, malnutrition and poor long-term survival [2]. Significant weight loss defined as malnutrition are persistent problems after surgery [3]. Recovery of global quality of life (QOL), physical function and social function at 6 months are prognostic indicators of poor survival [4]. It is imperative to determine factors that are associated with poor HRQOL and survival that are of prognostic value to identify patients at risk and in turn facilitate tailored interventions. This study aimed to clarify if symptoms that impact oral intake, defined as nutrition impact symptoms and clinically significant weight loss can explain

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