Patient perspectives on key symptoms and preferences for follow-up after upper gastro-intestinal cancer surgery

Philip H Pucher,Jason Dunn,Joanna Taylor,Mark Kelly,Annabelle White,Jesper Lagergren,Andrew R Davies,Jonathan L Moore,James A Gossage,Annie Coombes,Orla Evans,Sebastian Zeki,Cara Baker,Jervoise Andreyev,Ben E Byrne

doi:10.1007/s00520-022-06922-w

Abstract

PurposeLong-lasting symptoms and reductions in quality of life are common after oesophago-gastric surgery. Post-operative follow-up has traditionally focussed on tumour recurrence and survival, but there is a growing need to also identify and treat functional sequelae to improve patients’ recovery.MethodsAn electronic survey was circulated via a British national charity for patients undergoing oesophago-gastric surgery and their families. Patients were asked about post-operative symptoms they deemed important to their quality of life, as well as satisfaction and preferences for post-operative follow-up. Differences between satisfied and dissatisfied patients with reference to follow-up were assessed.ResultsAmong 362 respondents with a median follow-up of 58 months since surgery (range 3–412), 36 different symptoms were reported as being important to recovery and quality of life after surgery, with a median of 13 symptoms per patient. Most (84%) respondents indicated satisfaction with follow-up. Satisfied patients were more likely to have received longer follow-up (5-year or longer follow-up 60% among satisfied patients vs 27% among unsatisfied, p < 0.001). These were also less likely to have seen a dietitian as part of routine follow-up (37% vs 58%, p = 0.005).ConclusionThis patient survey highlights preferences regarding follow-up after oesophago-gastrectomy. Longer follow-up and dietician involvement improved patient satisfaction. Patients reported being concerned by a large number of gastrointestinal and non-gastrointestinal symptoms, highlighting the need for multidisciplinary input and a consensus on how to manage the poly-symptomatic patient.

Highlights

IntroductionUpper gastro-intestinal cancer resection (oesophagectomy or gastrectomy) represents a major surgical insult that has a major impact on patients’ quality of life [1]
Upper gastro-intestinal cancer resection represents a major surgical insult that has a major impact on patients’ quality of life [1]
Results were dichotomised into satisfied or not satisfied (combining dissatisfied (1–3) and intermediately satisfied (4–6)) groups. These groups were compared for follow-up practices and symptoms using the chi-square or the Mann–Whitney U tests

Summary

Introduction

Upper gastro-intestinal cancer resection (oesophagectomy or gastrectomy) represents a major surgical insult that has a major impact on patients’ quality of life [1]. Up to 70% of patients experience long-term symptoms after surgery [2, 3]. Survival rates after surgery for oesophago-gastric cancer were poor, with limited treatment options in the case of disease recurrence. Follow-up practices have focused on survival and the management of tumour recurrence [4, 5]. With survival improving, there is a growing need to identify and treat the functional sequelae of oesophago-gastric surgery in order to improve patients’ quality of life [6, 7]. With ongoing developments in oncological therapies, the appropriate frequency

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