Changes in exercise capacity, muscle strength, and health-related quality of life in esophageal cancer patients undergoing esophagectomy

Abstract

BackgroundSurgery for cancer of the thoracic esophagus is a challenging procedure associated with high morbidity and mortality. Perioperative rehabilitation has been introduced to promote early mobilization of the patients and to prevent postoperative pulmonary complications. The purpose of the present study was to characterize the preoperative functional exercise capacity, muscle strength, anxiety, depression, and health-related quality of life (QOL) in patients with esophageal cancer, and to evaluate the impact of radical esophagectomy on these parameters.MethodsWe performed a retrospective review of 34 consecutive patients with newly diagnosed resectable esophageal cancer who underwent esophagectomy followed by postoperative rehabilitation from January to December 2014. Patients were tested for 6-min walk distance (6MWD), knee-extensor muscle strength, hand grip strength, the Hospital Anxiety and Depression Scale (HADS), and the chronic obstructive pulmonary disease (COPD) assessment test (CAT) before and two weeks after the surgery. Before surgery, the pulmonary function test, and components of the MOS 36-item Short-Form Health Survey (SF-36) Questionnaire for general health were assessed.ResultsThe mean age was 67.3 ± 8.1 years. The patients were predominantly male (76.4 %), had high rates of smoking history (91.2 %), and squamous cell carcinoma (97.1 %). The predicted value for forced expiratory volume in 1 s was 94.0 ± 15.9 %, and 12 patients (35.3 %) had COPD. The clinical stage was 0-I in 12 patients, II in 4 patients, III in 16 patients, and IV in 2 patients. Thirty-one patients (91.2 %) underwent open surgery. At the baseline, components of the SF-36 scores significantly correlated with CAT and HADS scores, and the physical status was significantly poorer in patients with COPD than those without. Comparisons between the preoperative and postoperative values revealed significant decreases in 6MWD, hand grip strength, isometric knee extensor muscle strength, and a significant increase in CAT scores but not in HADS scores after surgery. In multiple regression analysis, decreases in 6MWD after the surgery significantly correlated with the preoperative physical component summary of SF-36.ConclusionsOur results indicate that surgery remained detrimental to health outcomes at two weeks. Further research should investigate whether prehabilitation would improve the postoperative outcomes, QOL, and physical fitness.Electronic supplementary materialThe online version of this article (doi:10.1186/s13102-016-0060-y) contains supplementary material, which is available to authorized users.

Development and Feasibility of a Mobile Health–Supported Comprehensive Intervention Model (CIMmH) for Improving the Quality of Life of Patients With Esophageal Cancer After Esophagectomy: Prospective, Single-Arm, Nonrandomized Pilot Study

“…Previous studies have shown the beneficial effects of interventions based on ERAS guidelines to improve the nutrition and physical status of patients with head, neck, and breast cancer after surgery [ 12 , 13 ]. For patients with esophageal cancer, existing interventions may be effective, but each intervention program usually focuses on one specific aspect of health such as nutrition or exercise [ 14 - 16 ]. To meet different needs, such as overcome postoperative complications and malnutrition, patients need to meet different professionals and to return to the hospital frequently for different appointments, creating potential obstacles for those who have been discharged from the hospital, especially those residing in rural or remote areas.…”

Patterns and Predictors of Recovery from Poor Health Status Measured with the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test in Patients with Stable COPD: A Longitudinal Study

“…To our knowledge, this longitudinal study was the first to find that both current non-smoker status and handgrip strength could predict recovery from a poor health status, measured with the CAT. Previous cross-sectional studies have identified these two determinants, but separately [7,20,21,22,23,24,25,26,27]. For example, Martínez et al found that CAT scores greater than 10 points identified subjects that were current smokers or had smoked in the past [20].…”

“…They found a strong relationship between COPD exacerbation frequency and that domain, which is related to the activities of daily life that require handgrip strength [25]. Similarly, Inoue et al found that the CAT score was inversely associated with handgrip strength [26]. It is well known that muscle dysfunction (muscular atrophy and weakness) is a recognized feature of COPD [27]; muscle dysfunction leads to inactivity, and consequently, a worse perception of health status and a negative prognosis [25].…”

Recent Advances in Minimally Invasive Esophagectomy

“…Nasogastric drainage of the gastric conduit is maintained in the first postoperative days. Early mobilization of patients prevents lung complications, influences muscle strength, anxiety and quality of life of the patient (57). Hemo-dynamic monitoring and blood oximetry are very important after esophagectomy.…”