Symptom clusters and related factors in oesophageal cancer patients 3 months after surgery.

AIM: To explore symptom clusters experienced by patients with oesophageal cancer 3 months after surgery and examine whether symptom clusters are related to demographic, clinical and quality of life variables. BACKGROUND: There are multiple symptoms in patients with oesophageal cancer after surgery, which seriously affect their quality of life. Exploring the mechanics of concurrent symptoms such as symptom clusters may facilitate the development of strategies to reduce the impact of these symptoms and improve quality of life. DESIGN: Cross-sectional survey. The STROBE Statement was chosen as the EQUATOR checklist. METHODS: A convenience sample of 128 oesophageal cancer patients was followed up at 3 months after surgery. Participants completed the demographic questionnaire, the M. D. Anderson Symptom Inventory for Gastrointestinal Cancer, the Functional Assessment of Cancer Therapy-General and the Connor-Davidson Resilience Scale. Exploratory factor analysis, stepwise regression and correlation analysis were applied. RESULTS: Four symptom clusters were identified: dysphagia-psychological, chemoradiotherapy side-effect, digestive tract reconstruction and fatigue-sleep. Gender, stage of disease and resilience influenced the dysphagia-psychological symptom cluster. Gender, stage of disease, resilience and treatment were significant factors affecting the chemoradiotherapy side-effect and fatigue-sleep symptom clusters. Gender, stage of disease, resilience and anastomotic position were significant factors influencing the digestive tract reconstruction symptom cluster. The correlations between symptom clusters and quality of life were significant, with the highest correlation between the dysphagia-psychological cluster and quality of life. CONCLUSIONS: Nurses should pay more attention to symptom management in patients with oesophageal cancer 3 months after surgery by focusing on four symptom clusters. It is necessary to implement individualised care depending on the influence factors including gender, stage of disease, resilience, treatment and anastomotic position. RELEVANCE TO CLINICAL PRACTICE: These findings will help develop targeted interventions to facilitate further symptom management for transitional nursing from the peri-operative phase to long-term rehabilitation.

[Esophageal cancer: common health problems and health management].

Esophageal cancer is the 9th leading cause of cancer death in Taiwan. Lack of obvious symptoms or signs during its early stages means that patients are often already in the terminal stage or metastasis at their first diagnosis. A diagnosis of cancer greatly impacts both patients and their families. The purpose of this paper is to explore the current diagnostic methods and treatments used for esophageal cancer. We discuss the effects of physical, psychological and social problems such as dysphagia, fatigue, pain, uncertainty, and social isolation. We also explore the nursing interventions related to these problems. Understanding the health issues related to esophageal cancer will not only help nurses who take care of patients with esophageal cancer provide holistic care, it will also reduce patients' suffering through the treatment and recovery process. By applying interventions that effectively address the physical, psychological, and social realms, healthcare professionals can help patients feel more secure when dealing with related problems. This will improve patients' dignity, value and quality of life through their cancer journey.

Oesophageal cancer: symptoms, treatment and nursing role.

This article examines the symptoms and treatment of oesophageal cancer. The article focuses on the nurse's role in post-operative care of oesophagectomy patients. Alternative treatments available when surgery is not an option are also identified.

[Applying hospice care concepts on a patient with terminal stage esophageal carcinoma: a nurse's experience].

This report describes a nursing care experience with a patient diagnosed with terminal stage esophageal carcinoma. Nursing care was administered from November 8th to 30th, 2007. Patient data was collected and evaluated using direct caring, observation, medical reports and patient interviews covering the physical, psychological, social, and spiritual realms. Patient health problems included pain, ineffective airway clearance, anticipatory grieving and spiritual distress. In line with hospice care concepts, the author employed empathy, companionship, listening, and support to assist the patient to overcome fear and face death. Comfort care and pain control skills were also used to relieve the patient's physical suffering. As such, the author assisted patient to achieve the essence of "good death", i.e., peace of achieved in the physical, psychological, social and spiritual realms.

Psychological impact of high-quality nursing care on patients with esophageal cancer during perioperative period: A protocol of systematic review.

BACKGROUND: This study is designed to systematically assess the psychological impact of high-quality nursing care (HQNC) on patients with esophageal cancer during perioperative period (ECPP). METHODS: Several electronic databases will be searched to collect randomized controlled trials (RCTs) or case-control studies (CCSs) on HQNC in the management of ECPP from inception to present: Cochrane Library, PUBMED, EMBASE, SinoMed, Web of Science, WANGFANG, and China National Knowledge Infrastructure. We will not apply any language limitation to all literature searches. Two authors will independently perform literature selection, data extraction and literature quality evaluation. All disagreements will be resolved by a third author through discussion. Cochrane risk of bias tool will be employed to assess trial quality, and RevMan 5.3 software will be utilized to carry out statistical analysis. RESULTS: This study will summarize the current evidence to appraise of the psychological impact of HQNC in the management of ECPP. CONCLUSION: The findings of this study may help to explicit whether HQNC is effective on psychological problem in ECPP. It will also provide scientific evidence for the clinical practice and future researches. STUDY REGISTRATION: INPLASY202080071.

Becoming a family caregiver of a patient living with cancer.

BACKGROUND: There is insufficient information on how the burden of caregiving is affected when the family caregiver is a health professional. Studies are needed to investigate this issue. AIMS: The purpose of this study was to reveal difficulties experienced by a nurse family caregiver offering care to a family member diagnosed with end-stage cancer and how she coped with these difficulties. METHODS: This was an autoethnographic study. FINDINGS: Findings were grouped under three headings: being both a researcher and a subject; effects of caregiving; and coping. CONCLUSIONS: Offering care to a cancer patient has many physiological and psychological effects. If a family caregiver is a health professional, his/her caregiving burden can be even higher. Cultural values affect both life and coping ways of caregivers. It should be kept in mind that family caregivers need support from health professionals whatever their occupations are. Support to caregivers plays an important role in their coping.

Perioperative Nursing of Patients with Reoperation of Recurrent Parathyroid Carcinoma Invading the Upper Digestive or Respiratory Tract.

OBJECTIVE: The aim of this study was to summarize the perioperative nursing care of patients with recurrent parathyroid carcinoma. METHODS: A retrospective analysis of 10 patients with recurrent parathyroid carcinoma was performed. The clinical data, diagnosis, treatment process, and nursing process (including clinical nursing intervention of various complications) were analyzed. The nursing experience and methods were discussed, summarized, and analyzed. RESULTS: A total of 10 patients were reviewed (male : female 7 : 3; aged 48.6 ± 14.60 years). The mean interval between the initial operation and reoperation was 2.23 ± 1.65 years. The mean number of operations was 4.00 ± 1.41. Invasion of the trachea or esophagus was evident in 7 patients, larynx in 6 patients, recurrent laryngeal nerve in 1 patient, and cyclic cartilage in 2 patients. Serum calcium range was 3.20-4.68 mmol/L, and parathyroid hormone (PTH) range was 860-2830 pg/ml at admission. 6 patients underwent prophylactic tracheostomy, 2 patients underwent partial laryngectomy, and 2 patients underwent total laryngectomy. 1 patient experienced temporary water-electrolyte disorder and hypoproteinemia. The median serum calcium was 2.28 mmol/L (1.66-3.18 mmol/L) and median PTH level was 82.60 pg/ml (63.70-900.00 pg/ml) postoperatively. Serum PTH and calcium were still higher than the upper limit of normal in 2 patients after surgery. 2 of the other 8 patients relapsed within 8-11 months, and 6 patients remained normal for 11-40 months. CONCLUSION: For patients with reoperation of recurrent parathyroid carcinoma, high-quality, reasonable, and careful perioperative nursing ensured a successful operation and optimized outcome.

[Nursing care in patients after thoracosurgical treatment especially esophageal tumor]. / Opieka pielegniarska nad pacjentem po zabiegu w obrebie klatki piersiowej ze szczególnym uwzglednieniem guzów przelyku.

The main target of this study is to create a model of after-surgery nursing care system in patients after thoracic operations, especial patients with lungs and esophagus tumors. The main task of thoracosurgery is surgical treatment of lungs cancer which is the most common cancer in polish society. The main trigger of this cancer is smoking. In nursing the patients after the thoracosurgery operations the most important is to take care of efficient pleural drainage. This group of patients need special supervision in the early postoperative period. In the further postoperative days nursing care concentrate on mobilization and respiratory rehabilitation. Postoperative care in patient after esophagus operations simply means: continuous monitoring of vital signs, pharmacological treatment, parenteral feeding and daily nursing activities.

Gastroesophageal cancer patients need earlier palliative intervention - Using data to inform appropriate care.

PURPOSE: To evaluate demographics of survival in patients with gastroesophageal cancer so that it informs nursing practice. METHOD: Data on 2215 patients diagnosed with gastroesophageal cancer who presented to a specialist referral centre between the years 2000 and 2011 were extracted from a Public Health repository. Survival time was calculated and analysed against clinical and lifestyle factors to reveal whether they had an impact on survival outcomes. RESULTS: Over 60% of patients had died within the first year, 39% of these died within the first 6 months. Survival outcomes were reduced in advancing age, and in those patients who present as 'emergency' cases. One quarter of patients were seen by a GP, but were not referred urgently through the two week wait system, to specialist care. Thus, gastroesophageal cancer patients need specific and appropriate treatment options, including earlier referrals to palliative care provision. There is also a need for cancer specific education and information at community and clinical levels. CONCLUSIONS: The globally applied one and five-year statistics applied to cancer survival studies do not adequately capture rates of early demise with gastroesophageal cancer. This study presents a novel approach to statistical analysis, based on patient derived data. It identifies factors linked to earlier deaths. However, rather than a focus on early presentation and diagnosis (which are essential) - it also reveals a significant need to consider early referrals for palliative care and nursing interventions to alleviate pain and suffering in patients with poor prognosis.

Proactive nurse management guidelines for managing intensive chemotherapy regimens in patients with advanced gastric cancer.

Patients with advanced gastric cancer have a poor prognosis. Intensive chemotherapy regimens may be effective for the treatment of this disease but may be associated with a significant number of severe adverse events. Optimal management of these adverse events can improve outcome for the patient. Currently, there is little information in the literature about the nursing management of this particular group of patients. This American study involved the nursing management of all patients with gastric or gastroesophageal cancer enrolled in clinical trials at a single center. Patients had close contact with research nurses and received education about adverse events and how to deal with them. Patients completed a detailed treatment diary for each cycle of treatment. Protocols were established for the management of emergent adverse events. The guidelines developed during this study could help to underpin the role of the specialist oncology nurse and improve the management of patients undergoing intensive chemotherapy for gastric and gastroesophageal cancer, with the potential of improving outcome, or at least quality of life, for the patients. The nurses' role should be pivotal in the management of intensive chemotherapy for gastric and gastroesophageal cancer.

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.

Supportive care for patients with oesophageal and other upper gastrointestinal cancers: The role of a specialist nurse in the team.

The care pathway of patients with upper gastrointestinal cancers is complex. We retrospectively evaluated the patients' opinions of support and supportive care given by a specialist nurse who led the care of such patients. A study-specific questionnaire addressed the support given by the specialist nurse and other professionals in the team before, during and after treatment. Virtually all 73 responders considered the support of the specialist nurse important (87-94%). This support seemed more appreciated than that of outpatient clinic (P = 0.00) and surgical ward staff (P = 0.01) during the diagnostic phase, and during the follow-up it became more important than that of all other team professionals. A second study-specific questionnaire assessed the supportive care. Of 49 patients, 71-94% completely agreed that the supportive care given by the specialist nurse was satisfactory, and 90-100% considered it important. Whereas 10% had difficulty in understanding physicians' information, none had such problems regarding information given by the nurse (P = 0.09). Review of documented contacts between the specialist nurse and 75 patients with oesophago-gastric cancer revealed that contacts were frequent during follow-up, and nutritional problems predominated. Thus, specialist nurses can be recommended as leaders of the care pathway of patients with upper gastrointestinal cancers.

Palliative treatments for patients with inoperable gastroesophageal cancers.

Most patients with cancers of the stomach, oesophagus or gastroesophageal junction ultimately develop metastatic or inoperable disease, rendering them incurable. They can, however, benefit from a variety of palliative interventions involving the multidisciplinary team, including chemotherapy, radiotherapy, endoluminal stenting, laser, or surgery. Often a combination of such strategies will be used to control symptoms, and maintain or improve quality of life. In this article, we review these multidisciplinary interventional approaches in patients with gastroesophageal cancers, and highlight future trends.

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.

Using the Liverpool Care Pathway for a dying patient.

This article describes the experience of staff in one acute hospital in Northern Ireland who adapted the Liverpool Care Pathway (LCP) for the dying patient to suit their organisation. It focuses on one patient's journey, from diagnosis to terminal care. The patient remained on the care pathway for 12 days. This reflection demonstrates that, as long as patients continue to meet the criteria for the LCP, some may be on the care pathway for more than the recognised average of two days.

The effect of a nurse led telephone supportive care programme on patients' quality of life, received information and health care contacts after oesophageal cancer surgery-A six month RCT-follow-up study.

BACKGROUND: Following oesophagectomy, a major surgical procedure, it is known that patients suffer from severely reduced quality of life and have an unmet need for postoperative support. Still, there is a lack of research testing interventions aiming to enhance the patients' life situation after this surgical procedure. AIM: The aim of the study was to evaluate the effect of a nurse led telephone supportive care programme on quality of life (QOL), received information and the number of healthcare contacts compared to conventional care following oesophageal resection for cancer. METHOD: The study was designed as a randomized controlled trial (RCT) aiming to test the effect of a nurse led telephone supportive care program compared to conventional care. Patient assessments were conducted at discharge, 2 weeks, 2, 4 and 6 months after discharge and comprised evaluation of QOL, received information and the number of health care contacts. Statistical testing were conducted with repeated measurements analysis of variance to test if there were differences between the groups during follow-up. RESULT: The results show that the intervention group was significantly more satisfied with received information for items concerning the information they received about things to do to help yourself, written information and for the global information score. The control group scored significantly higher on the item regarding wishing to receive more information and wish to receive less information. No effect of the intervention was shown on QOL or number of health care contacts. CONCLUSION: Proactive nurse-led telephone follow-up has a significant positive impact on the patients' experience of received information. This is likely to have a positive effect on their ability to cope with a life that may include remaining side effects and adverse symptoms for a long time after surgery.

[A nursing experience with a patient with esophagus cancer combined with tumor ulcer].

The purpose of this article is to describe a nursing experience with a patient with esophagus cancer combined with tumor ulcer. The author assessed the patient's health condition by observation, interview, medical history and the Gorden functional health assessment guide. The client had three nursing problems: impaired tissue integrity, diarrhea and body image disturbance. The author used the nursing process and empathy to assist the patient to face disease and treatment. Nursing intervention was also performed to enhance the patient's comfort and provide psychological support.

[Palliative home care of a breast cancer patient with esophageal metastasis after the operation of gastric fistula and tracheotomy--a case study].

A 66-year-old woman felt dysphagia gradually seven years after an operation of breast cancer. We diagnosed her with esophageal metastasis of the breast cancer, and carried out irradiation and outpatient chemotherapy. Because her general condition became worse after the treatment for about four years, we performed an operation of gastric fistula and tracheotomy to manage her nutrition and of an accidental swallowing. Although the patient and her family resisted a discharge from hospital due to the progressive nature of her illness and change in physical surroundings, she was eventually switched to take a homecare medical treatment with the support of a team care approach. The main purposes of the homecare treatment were to manage gastric fistula including the administration of anti-cancer drugs, cervicobrachial pain control and tracheal cannula exchange. Though she was mentally stable and got along well with the family during the home stay, she was hospitalized again two months after the homecare treatment because of aggravated symptoms and the family's fatigue. We respected the value of her quality of life and gave careful considerations to support her during the entire period of re-hospitalization. She gently died two months after re-hospitalization. We considered that this palliative home care could be realized with the palliative team care, nursing intervention visit and family support.