A care pathway for patients with oesophageal cancer

Abstract

A well-functioning care pathway for oesophageal cancer patients is particularly important in view of the need for a multidisciplinary approach and of the complex diagnostic procedures, extensive treatment, increasing volume of patients at fewer centres, and poor prognosis. Nevertheless, the literature regarding organization of care pathways for cancer patients is sparse. We therefore present our newly developed care pathway for oesophageal cancer patients, created to optimize the organization, coordination and supportive care. Based on scientific evidence, the pathway includes all relevant diagnostic examinations and therapeutic options, multidisciplinary team meetings, programmes for follow-up, rehabilitation and after-hospital care, and organized supportive care throughout the pathway, all led by a specialist nurse. The specialist nurse maintains continuous contacts with the patient and family throughout the care pathway. The experience and evaluation of our care pathway indicate that it works well in clinical practice, and that the role of the specialist nurse seems to be the key to the success, from the colleagues', hospital's and patients' point of view. This pathway has therefore been established at our hospital, and we can recommend well-organized and nurse-led care pathways for oesophageal cancer patients.

Effects of neoadjuvant chemoradiotherapy vs chemotherapy alone on the relief of dysphagia in esophageal cancer patients: secondary endpoint analysis in a randomized trial

“…40,83 Treatment with chemotherapy and/or radiotherapy is related to substantial toxic adverse effects, and it is therefore of paramount importance to systematically monitor and evaluate symptoms during the disease trajectory. 9,[84][85][86][87] In order to evaluate treatment-related sideeffects in trials in particular, since 1983, the National Cancer Institute Common Toxicity Criteria (CTC) system has evolved. 88 The most recent version is CTCAE v5.0 (Common Terminology Criteria for Adverse Events).…”

“…152 Several papers, included in four previous theses from Sweden have highlighted the need for support for patients and their relatives when they are diagnosed with oesophageal cancer, including support by subspecialized nurses working in multidisciplinary teams. 85,86,133,153,[181][182][183][184][185][186] Andreassen et al, have focused on patients and family members need of information, [181][182][183] dysphagia, fatigue and uncertainty influenced patients everyday life, and information seeking was one strategy to manage illness. 182 Viklund et al investigated the complex care pathway and reported that patients experienced a need of supportive care given by a specialist nurse and especially the need of nutritional support was dominated.…”

Description and predictors of hospital costs of oesophageal cancer during the first year following diagnosis in Northern Ireland

“…However, two‐thirds of patients have inoperable disease and the majority require palliative interventions such as stents or laser treatment to relieve difficulty swallowing and other symptoms (NHS Improving Outcomes ). Patients may also receive chemotherapy and/or radiotherapy (Viklund & Lagergren ; NHS Choices ). Healthcare resource use in oesophageal cancer patients is potentially high due to the complex needs of patients during their disease and treatment process with a high number of diagnostic and monitoring investigations frequently performed (Soni & Sonnenberg ; Gordon et al .…”

Re-organisation of oesophago-gastric cancer care in England: progress and remaining challenges

“…The majority of patients present with advanced disease and many also have significant comorbidity and a poor level of overall fitness. As a result, the diseases' management, both curative and palliative, is complex and involves many different professional groups including surgeons, gastroenterologists, oncologists, palliative care physicians, radiologists, nurse specialists and dieticians [4-7]. …”