A rehabilitation program for patients with gastroesophageal cancer--a pilot study.
OBJECTIVE
Gastroesophageal carcinoma has a 5-year survival rate of 20%. Esophagogastrectomy is a significant life-altering operation which interferes with a patient's ability to eat food as a normal social interaction. Dumping syndrome, delayed gastric emptying, and reflux are encountered after surgery. In addition, loss of appetite and body weight occurs. Fatigue is universally encountered. We conducted this study to evaluate whether a structured cancer nutrition and rehabilitation program has an effect on the symptoms and quality of life of patients with gastroesophageal cancer.


METHODS
Fifty-three patients with histologically documented gastroesophageal carcinoma were evaluated before and after an 8-week multidisciplinary program consisting of physicians, oncology nurse, dietitian, physical and occupational therapists, social worker, and psychologist. Twenty-two patients completed all the following questionnaires pre- and post-program: The Edmonton Symptom Assessment Scale (ESAS), Patient-Generated Subjective Global Assessment (PG-SGA), Brief Fatigue Inventory (BFI), and the Distress Thermometer.


RESULTS
There were 42 male and 11 female patients. The median age was 63 years (22-80 years). Thirty patients had gastric cancer and 23 had esophageal cancer. On the ESAS, appetite, strength, shortness of breath, and constipation all improved (p = 0.01). The PG-SGA score decreased significantly (p = 0.05). Fatigue and general activity as measured on the BFI improved significantly. The 6-min walk increased from 384 to 435 m (p = 0.01).


CONCLUSIONS
The Cancer Nutrition and Rehabilitation program offers a multidimensional, holistic treatment approach emphasizing the patient as an individual. Participation in a cancer rehabilitation program ameliorates symptoms, improves nutrition, decreases global distress, and increases physical activities.
Chasen
Martin Robert
MR
Gerald Bronfman Centre for Clinical Research in Oncology, McGill University, 546 Pine Avenue West, Montreal, QC H2W 1S6, Canada. martin.chasen@mcgill.ca
Bhargava
Ravi
R
D000230:Adenocarcinoma / Q000150:complications / Q000534:rehabilitation / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000534:rehabilitation / Q000601:surgery; D004938:Esophageal Neoplasms / Q000150:complications / Q000534:rehabilitation* / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects; D005221:Fatigue / Q000209:etiology / Q000534:rehabilitation; D001068:Feeding and Eating Disorders / Q000209:etiology / Q000534:rehabilitation; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects; D006694:Holistic Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015397:Program Evaluation; D013274:Stomach Neoplasms / Q000150:complications / Q000534:rehabilitation* / Q000601:surgery; D011795:Surveys and Questionnaires; D055815:Young Adult