title: Dietary alterations and restrictions following surgery for upper gastrointestinal cancers: Key components of a health-related quality of life intervention.
abstract: OBJECTIVE
  The surgical treatment of upper gastrointestinal (GI) cancers, specifically esophageal and gastric cancers, often result in extensive health-related quality of life (HRQOL) concerns, particularly those associated with dietary adjustments. This paper provides a review of HRQOL changes following esophagectomy and gastrectomy, and describes key components of an intervention to improve dietary adjustments following surgery.
  
  
  METHODS
  Intervention development was informed by 1) current published evidence on HRQOL changes for patients following upper GI surgery, 2) examination of usual post-operative care related to dietary restrictions to identify areas for continued education and support and 3) the inclusion of a conceptual framework (the Chronic Care Model) to guide intervention design and inform the selection of appropriate outcome measures.
  
  
  RESULTS
  Three key components of an HRQOL intervention are identified, and should focus on HRQOL concerns associated with dietary alterations and restrictions following treatment, involve family caregivers, and be tailored and flexible to patient and family caregiver's needs and preferences.
  
  
  CONCLUSIONS
  Evidence-based interventions to support long-term dietary alterations and restrictions following upper GI surgery are lacking, despite evidence confirming its impact on morbidity and mortality. Interventions are needed to support dietary adjustments, prevent malnutrition and excessive weight loss, and enhance HRQOL following surgery for upper GI cancers.
authors.affiliation: Division of Nursing Research and Education, Department of Population Sciences, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA. Electronic address: vsun@coh.org.
authors.forename: Virginia
authors.initials: V
authors.lastname: Sun
authors.affiliation: Division of Surgical Oncology, Department of Surgery, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA. Electronic address: jokim@coh.org.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kim
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA. Electronic address: jaekim@coh.org.
authors.forename: Jae Y
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA. Electronic address: draz@coh.org.
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Raz
authors.affiliation: Division of Surgical Oncology, Department of Surgery, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA. Electronic address: smerchant@coh.org.
authors.forename: Shaila
authors.initials: S
authors.lastname: Merchant
authors.affiliation: Department of Medical Oncology and Therapeutics Research, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA. Electronic address: jchao@coh.org.
authors.forename: Joseph
authors.initials: J
authors.lastname: Chao
authors.affiliation: Department of Medical Oncology and Therapeutics Research, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA. Electronic address: vchung@coh.org.
authors.forename: Vincent
authors.initials: V
authors.lastname: Chung
authors.affiliation: Department of Clinical Nutrition, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA. Electronic address: tjimenez@coh.org.
authors.forename: Tracy
authors.initials: T
authors.lastname: Jimenez
authors.affiliation: Division of Nursing Research and Education, Department of Population Sciences, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA. Electronic address: ewittenberg@coh.org.
authors.forename: Elaine
authors.initials: E
authors.lastname: Wittenberg
authors.affiliation: Division of Nursing Research and Education, Department of Population Sciences, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA. Electronic address: mgrant@coh.org.
authors.forename: Marcia
authors.initials: M
authors.lastname: Grant
authors.affiliation: Division of Nursing Research and Education, Department of Population Sciences, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA. Electronic address: bferrell@coh.org.
authors.forename: Betty
authors.initials: B
authors.lastname: Ferrell
mesh_terms: D004032:Diet; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005743:Gastrectomy; D006801:Humans; D009748:Nutrition Disorders / Q000178:diet therapy* / Q000209:etiology*; D009752:Nutritional Status; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000601:surgery*
keywords: Diet; Esophagectomy; Gastrectomy; Health-related quality of life