Yu-Ling Chang1, Yun-Fang Tsai2, Chien-Lung Hsu3, Yin-Kai Chao4, Chih-Chin Hsu5, Kuan-Chia Lin6. 1. School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan. Electronic address: ylchang@mail.cgu.edu.tw. 2. School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital in Keelung, Keelung, Taiwan. Electronic address: yftsai@mail.cgu.edu.tw. 3. Department of Information Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan. Electronic address: clhsu@mail.cgu.edu.tw. 4. Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Tao-Yuan, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan. Electronic address: chaoyk@cgmh.org.tw. 5. College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan. Electronic address: steele@cgmh.org.tw. 6. Institute of Hospital and Health Care Administration, Community Medicine Research Center, Preventive Medicine Research Center, National Yang-Ming University, Taipei, Taiwan. Electronic address: kuanchia@ym.edu.tw.
Abstract
BACKGROUND: Esophagectomy is the primary surgical treatment for esophageal cancer. However, patients often experience a decrease in physical activity, poor nutrition, and a reduction in quality of life following surgery. OBJECTIVES: The aim of this study was to examine the effects of an exercise and nursing education health informatics program on quality of life, exercise capacity, and nutrition among patients following esophagectomy for esophageal cancer. DESIGN: A randomized controlled trial. SETTINGS AND METHODS: Patients who had undergone an esophagectomy for cancer were recruited by purposive sampling from a medical center in Taiwan. Patients who met inclusion criteria and agreed to participate (N = 88) were randomly assigned to an exercise informatics program (intervention group, n = 44) or usual post-surgery care (control group, n = 44). Quality of life was assessed at baseline and 1, 3, and 6 months after discharge. Secondary outcomes of nutrition (albumin, body mass index), and exercise capacity (maximal oxygen uptake, the six-minute walking test) were conducted at baseline and 3 months following discharge. Differences in quality of life, nutrition and exercise capacity between the two groups were analyzed using generalized estimating equations. RESULTS: Analysis demonstrated significant improvements in outcome measures following hospital discharge for the intervention group compared to controls. Measures of quality of life were significantly better for the intervention group and varied with time following discharge. Functional scores for physical (1 and 3 months), role (1, 3, and 6 months), emotional (1 month), social (3 months) and global health (3 months) were significantly higher than controls. Cancer-related subscales improved for insomnia (1 and 3 months) and nausea/vomiting (3 and 6 months). Esophageal cancer-specific symptoms improved for dry mouth (1 month), dysphagia (3 months), and loss of taste (1 and 6 months). Three months following discharge, levels of albumin were significantly higher for the intervention group compared to controls (β=0.32, 95% CI 0.09, 0.54, p < .01); body mass index did not differ between groups. Exercise capacity was also significantly better; the intervention group had higher maximal oxygen consumption (β=2.61, 95% CI 1.54, 3.69, p < .001) and greater distance on the six-minute walking test (β=83.30, 95% CI 52.60, 113.99, p < .001). CONCLUSION: The intervention group experienced significant improvements in nutrition, exercise capacity, and variables related to quality of life. These findings suggest a nurse-led exercise and health education informatics program should be implemented for survivors of esophagectomy prior to hospital discharge.
BACKGROUND: Esophagectomy is the primary surgical treatment for esophageal cancer. However, patients often experience a decrease in physical activity, poor nutrition, and a reduction in quality of life following surgery. OBJECTIVES: The aim of this study was to examine the effects of an exercise and nursing education health informatics program on quality of life, exercise capacity, and nutrition among patients following esophagectomy for esophageal cancer. DESIGN: A randomized controlled trial. SETTINGS AND METHODS: Patients who had undergone an esophagectomy for cancer were recruited by purposive sampling from a medical center in Taiwan. Patients who met inclusion criteria and agreed to participate (N = 88) were randomly assigned to an exercise informatics program (intervention group, n = 44) or usual post-surgery care (control group, n = 44). Quality of life was assessed at baseline and 1, 3, and 6 months after discharge. Secondary outcomes of nutrition (albumin, body mass index), and exercise capacity (maximal oxygen uptake, the six-minute walking test) were conducted at baseline and 3 months following discharge. Differences in quality of life, nutrition and exercise capacity between the two groups were analyzed using generalized estimating equations. RESULTS: Analysis demonstrated significant improvements in outcome measures following hospital discharge for the intervention group compared to controls. Measures of quality of life were significantly better for the intervention group and varied with time following discharge. Functional scores for physical (1 and 3 months), role (1, 3, and 6 months), emotional (1 month), social (3 months) and global health (3 months) were significantly higher than controls. Cancer-related subscales improved for insomnia (1 and 3 months) and nausea/vomiting (3 and 6 months). Esophageal cancer-specific symptoms improved for dry mouth (1 month), dysphagia (3 months), and loss of taste (1 and 6 months). Three months following discharge, levels of albumin were significantly higher for the intervention group compared to controls (β=0.32, 95% CI 0.09, 0.54, p < .01); body mass index did not differ between groups. Exercise capacity was also significantly better; the intervention group had higher maximal oxygen consumption (β=2.61, 95% CI 1.54, 3.69, p < .001) and greater distance on the six-minute walking test (β=83.30, 95% CI 52.60, 113.99, p < .001). CONCLUSION: The intervention group experienced significant improvements in nutrition, exercise capacity, and variables related to quality of life. These findings suggest a nurse-led exercise and health education informatics program should be implemented for survivors of esophagectomy prior to hospital discharge.
Authors: Hardeep Singh; Terence Tang; Carolyn Steele Gray; Kristina Kokorelias; Rachel Thombs; Donna Plett; Matthew Heffernan; Carlotta M Jarach; Alana Armas; Susan Law; Heather V Cunningham; Jason Xin Nie; Moriah E Ellen; Kednapa Thavorn; Michelle LA Nelson Journal: JMIR Aging Date: 2022-05-19
Authors: Louise O'Connor; Emily Smyth; Annemarie E Bennett; Valerie Smith; Linda O'Neill; John V Reynolds; Juliette Hussey; Emer Guinan Journal: BMC Cancer Date: 2021-05-22 Impact factor: 4.430
Authors: Karina H Tukanova; Swathikan Chidambaram; Nadia Guidozzi; George B Hanna; Alison H McGregor; Sheraz R Markar Journal: Ann Surg Oncol Date: 2021-12-27 Impact factor: 5.344
Authors: C Simonsen; S Thorsen-Streit; A Sundberg; S S Djurhuus; C E Mortensen; C Qvortrup; B K Pedersen; L B Svendsen; P de Heer; J F Christensen Journal: BJS Open Date: 2020-08-28