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

Abstract

Background Patients with esophageal cancer often experience clinically relevant deterioration of quality of life (QOL) after esophagectomy owing to malnutrition, lack of physical exercise, and psychological symptoms. Objective This study aimed to evaluate the feasibility, safety, and efficacy of a comprehensive intervention model using a mobile health system (CIMmH) in patients with esophageal cancer after esophagectomy. Methods Twenty patients with esophageal cancer undergoing the modified McKeown surgical procedure were invited to join the CIMmH program with both online and offline components for 12 weeks. The participants were assessed before surgery and again at 1 and 3 months after esophagectomy. QOL, depressive symptoms, anxiety, stress, nutrition, and physical fitness were measured. Results Of the 20 patients, 16 (80%) completed the program. One month after esophagectomy, patients showed significant deterioration in overall QOL (P=.02), eating (P=.005), reflux (P=.04), and trouble with talking (P<.001). At the 3-month follow-up, except for pain (P=.02), difficulty with eating (P=.03), dry mouth (P=.04), and trouble with talking (P=.003), all other QOL dimensions returned to the preoperative level. There were significant reductions in weight (P<.001) and BMI (P=.02) throughout the study, and no significant changes were observed for physical fitness measured by change in the 6-minute walk distance between baseline and the 1-month follow-up (P=.22) or between baseline and the 3-month follow-up (P=.52). Depressive symptoms significantly increased 1 month after surgery (P<.001), while other psychological measures did not show relevant changes. Although there were declines in many measures 1 month after surgery, these were much improved at the 3-month follow-up, and the recovery was more profound and faster than with traditional rehabilitation programs. Conclusions The CIMmH was feasible and safe and demonstrated encouraging efficacy testing with a control group for enhancing recovery after surgery among patients with esophageal cancer in China. Trial Registration Chinese Clinical Trial Registry (ChiCTR-IPR-1800019900); http://www.chictr.org.cn/showprojen.aspx?proj=32811.

Characterizing Breakthrough Cancer Pain Using Ecological Momentary Assessment with a Smartphone App: Feasibility and Clinical Findings

“…Specifically, 62% of the participants used the app during all the study period (30 days), while 81% used the app at least half of the days (≥17 days) that were indicated. This is consistent with previous findings using mobile applications for chronic and cancer pain management [ 38 , 66 ]. Recently, it was found that approximately 80% of participants respond to daily cancer symptom assessments, with adherence rates decreasing as the period of time using the app increased [ 67 ].…”

Impact of curative treatment on the physical fitness of patients with esophageal cancer: A systematic review and meta-analysis

“…Four studies described a preoperative exercise intervention with the duration of at least one week [30,33,37,40]. In two studies patients were only advised to be physically active [41,48], and in two studies patients only received breathing exercises [34,38]. In the postoperative phase, elements of the enhanced recovery after surgery (ERAS) protocol were described in five studies, including early mobilization and airway clearance techniques during hospital admission [9,33,35,38,47,49].…”

“…In the postoperative phase, elements of the enhanced recovery after surgery (ERAS) protocol were described in five studies, including early mobilization and airway clearance techniques during hospital admission [9,33,35,38,47,49]. In one study, patients followed a postoperative mobile health program after hospital admission [34].…”

“…The results for the change of exercise capacity showed high heterogeneity. In the analyses within one month after surgery and between one and three months after surgery, two studies included a preoperative exercise intervention [33,37], and one study included a postoperative exercise intervention [34]. To explore whether the impact of esophagectomy differed between studies with and without a pre-or postoperative exercise program, therefore, a subgroup analysis was performed.…”

Effect of family enteral nutrition on nutritional status in elderly patients with esophageal carcinoma after minimally invasive radical surgery: a randomized trial

“…The results of the present study indicated that the proportion of NRS 2002 scores ≥3 in the observation group was significantly higher than that in the control group (P<0.05). FEN after discharge from the hospital among elderly patients with EC following MIS could effectively improve patients' feeding and nutritional status, and reduce the risk of malnutrition (22,23).…”