Nurse Counseling for Physical Activity in Patients Undergoing Esophagectomy.

Strong evidence exists regarding multiple benefits of physical activity among cancer patients. Patients undergoing esophagectomy received counseling for physical activity by a nurse and instructions to keep a diary of physical activities before surgery, followed by 2 counseling sessions after surgery. Physical activity, body mass index, psychological distress, and quality of life were measured at baseline, 2-4 weeks, and 3 and 6 months after discharge. Of 29 participants (mean age = 65.9 years), 72.5% underwent thoracoscopic esophagectomy in the prone position with 3-field lymphadectomy. The results of the International Physical Activity Questionnaire indicated that postoperative physical activity returned to nearly preoperative level, and the number of inactive patients gradually decreased by half at 6 months after discharge. Quality of life scores, except those for role function and social function, tended to return to the baseline at 6 months after discharge. Psychological distress measured by the Kessler 6 remained lower than the baseline, whereas the mean score of body mass index gradually declined after discharge. Patients undergoing esophagectomy and receiving nurse counseling can return to preoperative physical activity level in their daily lives after surgery. Nurses should integrate physical activity promotion into cancer care.

A System-Based Nursing Approach to Improve Outcomes in the Postoperative Esophagectomy Patient.

OBJECTIVE: To review essential nursing implications in the care of postoperative esophagectomy patients. DATA SOURCES: Peer-reviewed literature, institutional experience, journal articles. CONCLUSION: Utilizing a system-based approach to assess the post-esophagectomy patient will assist the nurse in ensuring safe and comprehensive care. IMPLICATIONS FOR NURSING PRACTICE: Nursing care measures to reduce perioperative esophagectomy morbidity includes aggressive fluid management, pain management, use of epidural analgesia, and early ambulation. Therefore, nurses play a significant role in improving the outcomes for the esophagectomy patient.

Factors relating to quality of life after esophagectomy for cancer patients in Taiwan.

BACKGROUND: Little is known regarding the short-term quality of life (QoL) and predictive factors for QoL after esophagectomy for cancer in Eastern countries. OBJECTIVE: The aims of this study were to assess QoL and symptoms within 1 and 6 months after surgery for esophageal cancer (EC) and to identify factors predictive of QoL within 6 months after esophagectomy in Taiwan. METHODS: A longitudinal, prospective design was used, where convenience samples of 99 patients who had undergone esophagectomy for cancer were recruited from 2 medical centers in northern Taiwan. All participants responded to a questionnaire with a QLQ-C30 (Quality of Life Questionnaire-Cancer) core and a QLQ-OES18 (esophageal module of the European Organization for Research and Treatment [EORTC] QLQ-C30) module in structured interviews at baseline and 1 and 6 months after surgery. RESULTS: The results showed significant decline in social function and global QoL; fatigue, insomnia, eating problems, reflux, and dry mouth were major problems within 6 months. Body mass index, body weight loss before surgery, activity performance status, and anastomosis site showed no significant association with the function and symptom aspect of QoL. Surgical complications, advanced cancer, neoadjuvant therapy before surgery, and tumor location other than at the EC junction had significant deleterious effects on several aspects of QoL. CONCLUSIONS: This study describes the demographics of EC and short-term changes in QoL and also the predictive impact factor for QoL after surgery for EC. IMPLICATIONS FOR PRACTICE: Knowledge of risk factors for poor postoperative QoL would be useful for health providers in detecting and prioritizing problems and treatment options in a busy clinical site.

Patterns of symptoms following surgery for esophageal cancer.

PURPOSE/OBJECTIVE: To explore patterns of symptoms before and after surgery for cancer of the esophagus. DESIGN: Longitudinal, descriptive study. SETTING: An urban comprehensive cancer center in the northeastern United States. SAMPLE: 218 patients with cancer of the esophagus undergoing esophagectomy. METHODS: Symptoms were assessed by self-report before surgery, at the first postoperative visit, and at 6 and 12 months postsurgery. MAIN RESEARCH VARIABLES: Symptoms and demographic and clinical variables, including stage, treatment, gender, and comorbidities. FINDINGS: Patients with esophageal cancer reported numerous symptoms before and after esophagectomy. Several patterns of symptoms were identified. General cancer symptoms (e.g., pain, cough, shortness of breath, weight loss) were reported as worse after surgery but recovered to baseline by one year. A second pattern of esophageal-specific symptoms (feeling full too quickly, feeling bloated, nausea, and diarrhea) worsened after surgery and did not recover to baseline by one year. Reflux was the only symptom that did not worsen after surgery but did worsen significantly during the first year of recovery. CONCLUSIONS: Patients with esophageal cancer experienced multiple prolonged symptoms following surgical treatment for their disease. General cancer symptoms resolved by one year post-treatment, whereas esophageal-specific symptoms worsened after surgery and did not recover to baseline. IMPLICATIONS FOR NURSING: Identification of symptom patterns preoperatively and during recovery can assist nurses in developing intervention protocols to minimize long-term complications for patients with esophageal cancer. KNOWLEDGE TRANSLATION: Patients with esophageal cancer are at risk for multiple prolonged symptoms following surgery. Symptom assessment should occur often after surgery and include a broad range of symptoms.

Road map to esophagectomy for nurses.

Esophageal cancer, although considered uncommon in the United States, continues to exhibit increased incidence. Esophageal cancer now ranks seventh among cancers in mortality for men in the United States. Even as treatment continues to advance, the mortality rate remains high, with a 5-year survival rate less than 35%. Esophageal cancer typically is discovered in advanced stages, which reduces the treatment options. When disease is locally advanced, esophagectomy remains the standard for treatment. Surgery remains challenging and complicated. Multiple surgical approaches are available, with the choice determined by tumor location and stage of disease. Recovery is often fraught with complications-both physical and emotional. Nursing care revolves around complex care managing multiple body systems and providing effective education and emotional support for both patients and patients' families. Even after recovery, local recurrence and distant metastases are common. Early diagnosis, surgical advancement, and improvements in postoperative care continue to improve outcomes.

Lived experiences of eating after esophagectomy: a phenomenological study.

BACKGROUND: Esophagectomy is the most common treatment for esophageal cancer (Pierie, Goedegebuure, Schuerman, & Leguit, 2000). Dysphagia is the most common symptom, after esophagectomy (Easterling et al., 2000; Ludwig, Thirlby, & Low, 2001; Pierie et al., 2000; Verschuur et al., 2006). The aim of this study was to describe patients' experiences of eating after esophagectomy. METHOD: A phenomenology approach was used to describe and understand eating experiences after esophagectomy. FINDINGS: Three major categories of experiences were extrapolated from informant verbal reports: physical, psychosocial, and psychological. Within these categories main themes were identified and included gastrointestinal feelings, fear of going home, and positive feelings toward eating. CONCLUSION: Most patients may not be able to eat exactly as they did prior to their operation (Ludwig et al., 2001). Findings from this study illustrate patients should be provided with a diet they perceive as socially acceptable with minimal eating discomforts.

Oesophageal cancer: Experiences of patients and their partners.

Oesophageal cancer (OC) is a debilitating disease with significant social, psychological and physical impacts on health and lifestyle (Mills and Sullivan, 2000). The research presented in this paper uses a survey method, and reveals that patients require honest communication and more help with everyday living from nurses to facilitate recovery. Each patient is unique but commonalities can be established that improve experience and outcome. Three themes emerged from the data: food, activity and positivity. To meet long-term needs, the Oesophageal Patients Association is fundamental for patients and carers in order adapt to this major life-changing event.

ICU nurse-to-patient ratio is associated with complications and resource use after esophagectomy.

OBJECTIVE: To determine if having a night-time nurse-to-patient ratio (NNPR) of one nurse caring for one or two patients (> 1:2) versus one nurse caring for three or more patients (< 1:2) in the intensive care unit (ICU) is associated with clinical and economic outcomes following esophageal resection. DESIGN: State-wide observational cohort study. Hospital discharge data was linked to a prospective survey of ICU organizational characteristics. Multivariate analysis adjusting for case-mix, hospital and surgeon volume was used to determine the association of NNPR with in-hospital mortality, length of stay (LOS), hospital cost and specific postoperative complications. SETTING: Non-federal acute care hospitals (n = 35) in Maryland that performed esophageal resection. PATIENTS AND PARTICIPANTS: Adult patients who had esophageal resection in Maryland, 1994 to 1998 (n = 366 patients). MEASUREMENTS AND RESULTS: Two hundred twenty-five patients at nine hospitals had a NNPR > 1:2;128 patients in 23 hospitals had a NNPR < 1:2. No significant association between NNPR and in-hospital mortality was seen. A 39 % increase in median in-hospital LOS (4.3 days; 95% CI, (2, 5 days); p < 0.001), and a 32% increase in costs ($4,810; 95 % CI, ($2,094, $7,952) was associated with a NNPR < 1:2. Pneumonia (OR 2.4; 95 % CI (1.2, 4.7); p = 0.012), reintubation (OR 2.6; 95% CI(1.4, 4.5);p = 0.001), and septicemia (OR 3.6; 95 % CI(1.1, 12.5); p = 0.04), were specific complications associated with a NNPR < 1:2. CONCLUSIONS: A nurse caring for more than two ICU patients at night increases the risk of several postoperative pulmonary and infectious complications and was associated with increased resource use in patients undergoing esophageal resection.

Esophageal cancer: therapeutic approaches and nursing care.

OBJECTIVES: To review the various treatment approaches, complications, and nursing management of patients with esophageal cancer. DATA SOURCES: Review articles, staging manual, textbook chapters, and research studies. CONCLUSIONS: The diagnosis and treatment of esophageal cancer is a complicated process. Combined multimodal therapy with chemotherapy, radiotherapy, and surgery is showing promising results. However, each treatment approach has complications and side effects that must be managed. IMPLICATIONS FOR NURSING PRACTICE: Nursing care is complicated and requires coordinating various support services, patient and family education, clinical assessment, nutritional management, management of side effects, and palliative care.

Esophageal cancer: multisystem nursing management.

Esophageal cancer is a challenging disease with a multisystem impact on patients. Critical care nurses, case managers, and advanced practice nurses manage these patients through an aggressive preoperative diagnostic phase, surgical intervention, and postoperative course. Coordination of care requires collaboration, with critical care and advanced practice nurses playing a central role. Patients need close post-operative assessments and interventions to minimize complications.

Esophagogastrectomy.

The diagnosis of esophageal cancer continues to stimulate much research to find the most effective methods of treatment. Combined radiotherapy and chemotherapy may produce results as good as if not better than those with operation plus radiotherapy and chemotherapy. Esophagogastrectomy is performed using any one of several surgical approaches. The individual status of the patient is an important determinant when selecting the surgical approach. There is no clear evidence that one approach is superior to another. Patients should be evaluated appropriately and prepared for operation so that they have the best chance for having a benign postoperative course. Postoperative nursing management requires complex assessment and intervention skills. The optimal approach to the management of esophageal cancer has yet to be defined. Esophagogastrectomy remains primarily a palliative, not curative, approach to patient management. The prevention of postoperative complications through astute assessment and intervention will improve the quality of patient outcomes.