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Profiling patient-reported symptom recovery from oesophagectomy for patients with oesophageal squamous cell carcinoma: a real-world longitudinal study

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Abstract

Purpose

Oesophageal squamous cell carcinoma (ESCC) patients have severe symptom burden after oesophagectomy; however, longitudinal studies of symptom recovery after surgery are scarce. This study used longitudinal patient-reported outcome (PRO)-based symptoms to identify severe symptoms and profile symptom recovery from surgery in patients undergoing oesophagectomy.

Methods

Oesophageal cancer patients (N = 327) underwent oesophagectomy were consecutively included between April 2019 and March 2020. Data were extracted from the Sichuan Cancer Hospital’s Esophageal Cancer Case Management Registration Database. Symptom assessment time points were pre-surgery and 1, 3, 5, 7, 14, 21, 30, and 90 days post-surgery using the Chinese version of the MD Anderson Symptom Inventory. And each symptom was rated on an 11-point scale, with 0 being ‘not present’ and 10 being ‘as bad as you can imagine’. The symptom recovery trajectories were profiled using mixed effect models and Kaplan–Meier analysis.

Results

The most-severe symptoms on day 1 after oesophagectomy were pain, fatigue, dry mouth, disturbed sleep, and distress. The severity of symptoms peaked on day 1 after surgery. The top two symptoms were fatigue (mean: 5.44 [SD 1.88]) and pain (mean: 5.23 [SD 1.29]). Fatigue was more severe 90 days after surgery than at baseline (mean: 1.77 [SD 1.47] vs 0.65 [SD 1.05]; P < .0001). Disturbed sleep and distress persisted from pre-surgery to 90 days post-surgery; average sleep recovery time was up to 20 days, and 50.58% of patients had sleep disturbances 90 days post-surgery.

Conclusions

Early post-operative pain management after oesophagectomy should be considered. Characteristics and intervention strategies of post-operative fatigue, distress, and disturbed sleep in oesophageal cancer patients warrant further studies.

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Availability of data and material

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Code availability

Data were analysed using SAS 9.4 (SAS Institute Inc., Cary, NC, USA).

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Acknowledgements

The authors wish to thank all the participating patients and Wei Xu for her efforts in the statistical graph edit.

Funding

This work was supported by the Sichuan Science and Technology Program (grant numbers 2020YFH0169) and Nursing Research Project of Sichuan Province (grant numbers H20007).

Author information

Author notes

  1. Xi Luo and Qin Xie have contributed equally to this work.

Authors and Affiliations

  1. Department of Thoracic Surgery, Sichuan Cancer Hospital and Research Institution, School of Medicine, University of Electronic Science and Technology of China, No.55, Section 4, South Renmin Road, Chengdu, 610041, China

    Xi Luo, Qin Xie, Yan Miao, Hong Yin, Xuefeng Leng, Yongtao Han & Hong Zhou

  2. School of Public Health and Management, Chongqing Medical University, Chongqing, China

    Qiuling Shi, Qingsong Yu & Hongfan Yu

  3. Center for Cancer Prevention Research, Sichuan Cancer Hospital and Research Institution, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China

    Qiuling Shi

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  1. Xi Luo
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Contributions

Conceptualisation: Qiuling Shi; formal analysis and investigation: Xi Luo, Qin Xie, Yan Miao, Hong Yin, Qingsong Yu, Hongfan Yu; writing — original draft preparation: Xi Luo; writing — review and editing: Qiuling Shi, Xi Luo; funding acquisition: Xuefeng Leng, Hong Zhou; resources: Yongtao Han, Hong Zhou; supervision: Hong Zhou.

Corresponding author

Correspondence to Hong Zhou.

Ethics declarations

Ethical approval

The study was approved by the Medical Ethics Committee and Clinical Trial Review Committee of the Sichuan Cancer Hospital (SCCHEC-02–2020-036).

Consent to participate

As this was a retrospective review of de-identified data, the requirement for informed consent was waived.

Consent for publication

Not applicable.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The Chinese version of the MD Anderson Symptom Inventory is copyrighted and licensed by the University of Texas MD Anderson Cancer Center. The authors report no other conflicts of interest in this work.

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The study was registered on ChiCTR.org.cn Web site (ChiCTR2000040780 Date 12/10/2020).

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Luo, X., Xie, Q., Shi, Q. et al. Profiling patient-reported symptom recovery from oesophagectomy for patients with oesophageal squamous cell carcinoma: a real-world longitudinal study. Support Care Cancer 30, 2661–2670 (2022). https://doi.org/10.1007/s00520-021-06711-x

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