Certain Symptom Clusters After Surgery for Esophageal Cancer Predict Poor Prognosis
A new study has found that several months after surgery for esophageal cancer, different symptoms cluster together in different types of patients. In addition, patients with certain symptom clusters have an increased risk of dying from their disease. The findings by Wikman et al were published early online in Cancer.
Esophageal cancer is an aggressive cancer with a very poor prognosis. Surgical resection of the esophagus offers the only chance of cure, but only about a quarter of patients are considered candidates for surgery—in the rest, the tumor is too advanced to remove or the patient is not fit for such extensive surgery. In patients who do undergo surgery, only 30% are alive 5 years after the surgery, and patients experience severe postoperative symptoms and limitations that affect their quality of life and daily living. Common symptoms include eating and swallowing problems, reflux, pain, and fatigue.
Study Details
Research of symptoms in other cancers suggests that symptoms experienced by patients may present in specific groupings or clusters, and that these clusters may have an important impact on patient outcomes. In the current study of 402 patients who underwent surgery for esophageal cancer, Anna Wikman, PhD, of the Karolinska Institutet in Stockholm, and colleagues found that symptoms reported by patients 6 months after surgery clustered together in three groups: fatigue/pain (characterized by symptoms of general and esophageal pain, fatigue, insomnia, and dyspnea), reflux/cough (characterized by symptoms of dry mouth, problems with taste, coughing, and reflux), and eating difficulties (characterized by symptoms such as appetite loss, dysphagia, eating difficulties, and nausea/vomiting).
Among the patients who responded to symptom assessment at 6-month follow-up, fatigue/pain was present in 30% of patients, with fatigue being the most prevalent symptom (97%). The reflux/cough cluster was present in 27% of patients, with each symptom occurring in approximately 60% of these patients. The eating difficulties cluster was present in 28% of patients, with the most prevalent symptoms being eating difficulties (95%) and appetite loss (84%).
Symptom Clusters and Mortality Risk
Approximately 30% of patients were alive at 5-year follow-up. Patients who experienced the reflux/cough symptom cluster (hazard ratio [HR] = 1.43, 95% confidence interval [CI] = 1.08–1.89) and the eating difficulties cluster (HR = 1.41, 95% CI = 1.06–1.87) were more likely to die within 5 years than were patients who did not experience these symptom clusters.
"As this is the first study of symptom clusters in surgically treated esophageal cancer patients, further work is needed to confirm the existence of these symptom clusters in this patient population; however, the present findings do suggest that postoperative symptoms should not be considered in isolation but that clusters of symptoms must be considered,” said Dr. Wikman. “It seems that patients who experience clustering of certain symptoms also have an increased mortality risk over and above the effect of other known prognostic factors. These findings suggest that it may be important to address these symptom clusters in the clinical setting in order to potentially reduce the increased mortality risk associated with them."
Anna Wikman, PhD, of Karolinska Institutet, is corresponding author for the article in Cancer.
This study received funding from The Swedish Research Council, the Swedish Cancer Society, and the Cancer Society in Stockholm. The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
