Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 80
Filtrar
1.
Eur J Cancer Care (Engl) ; 28(2): e12996, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30675740

RESUMO

OBJECTIVE: Oesophagectomy for cancer is associated with significant morbidity and mortality, and reduced quality of life. Structured rehabilitation potentially offers improved physical and psychological outcomes. We aimed to explore patient, carer and healthcare provider attitudes and preferences towards the role of rehabilitation. METHODS: We interviewed 15 patients who had undergone an oesophagectomy, 10 carers and 13 healthcare providers about perceived impacts of treatment; preferred components of a rehabilitation program; barriers/enablers of support provision; and participation in rehabilitation programs. Data were analysed using framework analysis. RESULTS: The overarching theme was "Getting back to normal." Diagnosis of disease signified a disruption to the normal trajectory of patients' lives and the post-treatment period was characterised as striving to return to normal. Patients and carers focused on rehabilitation needs post-treatment including dietary support, physiotherapy and healthcare provider support. Healthcare providers described rehabilitation as potentially beneficial from the pre-treatment phase and, along with carers, highlighted the importance of psychological support. Barriers included access to services, cost of service provision and appointment burden. CONCLUSION: A need for rehabilitation services was identified by healthcare providers from the point of diagnosis, rather than only after surgery. Implications include improved service provision by healthcare institutions for patients undergoing oesophagectomy.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/reabilitação , Lesões Pré-Cancerosas/cirurgia , Idoso , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Cuidadores/psicologia , Assistência à Saúde , Neoplasias Esofágicas/psicologia , Neoplasias Esofágicas/reabilitação , Esofagectomia/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Apoio Nutricional , Preferência do Paciente , Modalidades de Fisioterapia , Lesões Pré-Cancerosas/psicologia , Lesões Pré-Cancerosas/reabilitação , Retorno ao Trabalho , Apoio Social
2.
J Surg Res ; 235: 66-72, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30691852

RESUMO

BACKGROUND: Locally advanced esophageal cancer is often treated with neoadjuvant therapy followed by surgery. Many patients present with or experience clinical deconditioning during neoadjuvant therapy. Prehabilitation programs in other areas of surgery have demonstrated improved postoperative outcomes. The aims of this study were to evaluate the feasibility of a pilot prehabilitation program and determine preliminary effects on surgical and cancer-related outcomes. METHODS: A retrospective review of patients treated at a single institution with resectable esophageal cancer was performed (n = 22). Patients in the prehabilitation group received protocol-structured intervention in several clinical domains including nutrition, psychosocial support, and physical exercise. RESULTS: Clinical stage and comorbidities were well matched between groups. The structured prehabilitation program was feasible and well received by participants. Fewer patients required admission during neoadjuvant therapy in the prehabilitation group (27.3% versus 54.5%). Percentage weight loss during treatment was 3.0% in the prehabilitation group versus 4.3% in the control group. Compared with the control group, the prehabilitation group demonstrated 0.0% versus 18.2% 30-d postoperative readmission rate and 18.2% versus 27.3% 90-d postoperative readmission rate. There were no statistically significant differences between groups in regard to complications or mortality. CONCLUSIONS: The pilot prehabilitation program demonstrated feasibility of implementing a structured program for patients receiving neoadjuvant therapy for esophageal cancer. Although the small population limits evaluation of statistical significance, trends in the data suggest a potential benefit of the prehabilitation program on neoadjuvant hospital admission rates, postsurgical readmission rates, and nutritional status.


Assuntos
Neoplasias Esofágicas/reabilitação , Neoplasias Esofágicas/terapia , Esofagectomia , Idoso , Neoplasias Esofágicas/patologia , Esofagectomia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Projetos Piloto , Estudos Retrospectivos
3.
Ann Thorac Surg ; 107(3): 912-920, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30403976

RESUMO

BACKGROUND: The aim of the current study was to investigate the impact of early oral feeding (EOF) on inflammatory cytokine levels after McKeown minimally invasive esophagectomy (MIE) for cancer. METHODS: This study was based on a randomized controlled trial (NCT01998230). Patients with esophageal cancer who received McKeown MIE were randomly allocated into a group that started oral feeding on postoperative day (POD) 1 (EOF group) or a second group that received nil by mouth until 7 days after operation (late oral feeding [LOF] group). We chose 86 patients, 46 patients in the EOF group and 40 patients in the LOF group, in which to analyze inflammatory cytokine levels (interleukin [IL]-6, IL-8, tumor necrosis factor-a [TNF-α], and monocyte chemotactic protein-1 [MCP-1]). RESULTS: The EOF and LOF groups exhibited similar preoperative IL-6, IL-8 TNF-α, and MCP-1 levels. The levels of the four inflammatory cytokines at PODs 1 and 3 were significantly higher than the preoperative levels (all p < 0.001). At POD 5 the levels of all four inflammatory cytokines were decreased compared with those at PODs 1 and 3. At PODs 3 and 5 the levels of IL-6, IL-8, and TNF-α were significantly lower in the EOF group than in the LOF group (all p < 0.05). At POD 3 the MCP-1 levels in the EOF group were significantly lower than those in the LOF group (all p < 0.05). CONCLUSIONS: Compared with conventional rehabilitation programs the EOF protocol may decrease stress response after McKeown MIE.


Assuntos
Citocinas/sangue , Nutrição Enteral/métodos , Neoplasias Esofágicas/reabilitação , Esofagectomia , Inflamação/sangue , Cuidados Pós-Operatórios/métodos , Idoso , Biomarcadores Tumorais/sangue , Neoplasias Esofágicas/sangue , Neoplasias Esofágicas/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
4.
Ann Thorac Surg ; 107(3): 903-911, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30444988

RESUMO

BACKGROUND: Wide variation is seen in the dosage of preoperative induction radiation therapy for esophageal cancer. We investigated associations between outcomes after esophagectomy and dosage of induction radiation therapy. METHODS: Patients undergoing induction radiation therapy (30 to 70 Gy), followed by esophagectomy, were identified from the National Cancer Database and classified as low (<40 Gy), standard (40 to 50.4 Gy), and high dose (>50.4 Gy). Perioperative outcomes and overall survival were compared. Subgroup analysis compared two common dosages: 45 Gy and 50.4 Gy. RESULTS: From 2004 to 2014, 10,738 patients (84.7%) received standard-dose radiation, increasing from 69.7% in 2004 to 93.6% in 2014 (p < 0.001), 1,329 (10.5%) received low-dose radiation, and 608 (4.8%) received high-dose radiation. Higher rates of pathologic complete response (pCR; low: 11.7%, standard: 16.2%, high: 21.0%; p < 0.001) and downstaging (low: 52.0%, standard: 56.4%, high: 63.1%, p = 0.001) were observed as the dosage increased. On multivariable analysis, compared with standard-dose, high-dose radiation was associated with higher 30-day mortality (odds ratio [OR], 2.11; p < 0.001) without a higher likelihood of downstaging or pCR. Low-dose radiation was associated with lower likelihood of downstaging (OR, 0.85; p = 0.04) and pCR (OR, 0.67; p < 0.001) without lowering the risk of 30-day mortality. The dose of 50.4 Gy was associated with higher likelihood of pCR (OR, 1.12; p = 0.04), without affecting 30-day mortality, compared with 45 Gy. CONCLUSIONS: High-dose induction radiation (>50.4 Gy) is associated with increased perioperative death after esophagectomy, without a significant improvement in tumor response. Low-dose radiation (<30 Gy) is associated with worse tumor response without a lower risk of perioperative death. Within standard dosages, 50.4 Gy is associated with higher likelihood of pCR without adversely affecting perioperative mortality compared with 45 Gy.


Assuntos
Neoplasias Esofágicas/reabilitação , Esofagectomia , Estadiamento de Neoplasias , Cuidados Pré-Operatórios/métodos , Relação Dose-Resposta à Radiação , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Missouri/epidemiologia , Terapia Neoadjuvante , Dosagem Radioterapêutica , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento
5.
BMJ Open ; 8(12): e023190, 2018 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-30580268

RESUMO

INTRODUCTION: Neoadjuvant therapy prior to oesophagogastric resection is the gold standard of care for patients with T2 and/or nodal disease. Despite this, studies have taught us that chemotherapy decreases patients' functional capacity as assessed by cardiopulmonary exercise (CPX) testing. We aim to show that a multimodal prehabilitation programme, comprising supervised exercise, psychological coaching and nutritional support, will physically, psychologically and metabolically optimise these patients prior to oesophagogastric cancer surgery so they may better withstand the immense physical and metabolic stress placed on them by radical curative major surgery. METHODS AND ANALYSIS: This will be a prospective, randomised, controlled, parallel, single-centre superiority trial comparing a multimodal 'prehabilitation' intervention with 'standard care' in patients with oesophagogastric malignancy who are treated with neoadjuvant therapy prior to surgical resection. The primary aim is to demonstrate an improvement in baseline cardiopulmonary function as assessed by anaerobic threshold during CPX testing in an interventional (prehab) group following a 15-week preoperative exercise programme, throughout and following neoadjuvant treatment, when compared with those that undergo standard care (control group). Secondary objectives include changes in peak oxygen uptake and work rate (total watts achieved) at CPX testing, insulin resistance, quality of life, chemotherapy-related toxicity and completion, nutritional assessment, postoperative complication rate, length of stay and overall mortality. ETHICS AND DISSEMINATION: This study has been approved by the London-Bromley Research Ethics Committee and registered on ClinicalTrials.gov. The results will be disseminated in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT02950324; Pre-results.


Assuntos
Neoplasias Esofágicas/reabilitação , Neoplasias Esofágicas/cirurgia , Terapia por Exercício/métodos , Terapia Neoadjuvante/métodos , Aptidão Física/fisiologia , Adulto , Idoso , Anastomose Cirúrgica/métodos , Quimiorradioterapia/métodos , Intervalo Livre de Doença , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Esofagectomia/métodos , Junção Esofagogástrica/patologia , Junção Esofagogástrica/cirurgia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida , Centros de Atenção Terciária , Reino Unido
6.
JAMA Surg ; 153(12): 1081-1089, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30193337

RESUMO

Importance: Preserving functional capacity is a key element in the care continuum for patients with esophagogastric cancer. Prehabilitation, a preoperative conditioning intervention aiming to optimize physical status, has not been tested in upper gastrointestinal surgery to date. Objective: To investigate whether prehabilitation is effective in improving functional status in patients undergoing esophagogastric cancer resection. Design, Setting, and Participants: A randomized clinical trial (available-case analysis based on completed assessments) was conducted at McGill University Health Centre (Montreal, Quebec, Canada) comparing prehabilitation with a control group. Intervention consisted of preoperative exercise and nutrition optimization. Participants were adults awaiting elective esophagogastric resection for cancer. The study dates were February 13, 2013, to February 10, 2017. Main Outcomes and Measures: The primary outcome was change in functional capacity, measured with absolute change in 6-minute walk distance (6MWD). Preoperative (end of the prehabilitation period) and postoperative (from 4 to 8 weeks after surgery) data were compared between groups. Results: Sixty-eight patients were randomized, and 51 were included in the primary analysis. The control group were a mean (SD) age, 68.0 (11.6) years and 20 (80%) men. Patients in the prehabilitation group were a mean (SD) age, 67.3 (7.4) years and 18 (69%) men. Compared with the control group, the prehabilitation group had improved functional capacity both before surgery (mean [SD] 6MWD change, 36.9 [51.4] vs -22.8 [52.5] m; P < .001) and after surgery (mean [SD] 6MWD change, 15.4 [65.6] vs -81.8 [87.0] m; P < .001). Conclusions and Relevance: Prehabilitation improves perioperative functional capacity in esophagogastric surgery. Keeping patients from physical and nutritional status decline could have a significant effect on the cancer care continuum. Trial Registration: ClinicalTrials.gov Identifier: NCT01666158.


Assuntos
Neoplasias Esofágicas/reabilitação , Exercício/fisiologia , Estado Nutricional/fisiologia , Cuidados Pré-Operatórios/reabilitação , Neoplasias Gástricas/reabilitação , Idoso , Neoplasias Esofágicas/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/fisiopatologia , Caminhada/fisiologia
7.
Ann Surg ; 268(5): 747-755, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30004915

RESUMO

OBJECTIVE: The Rehabilitation Strategies in Esophagogastric cancer (RESTORE) randomized controlled trial evaluated the efficacy of a 12-week multidisciplinary program to increase the cardiorespiratory fitness and health-related quality of life (HRQOL) of esophagogastric cancer survivors. BACKGROUND: Patients following treatment for esophagogastric cancer are at risk of physical deconditioning, nutritional compromise, and sarcopenia. Accordingly, compelling rationale exists to target these impairments in recovery. METHODS: Disease-free patients treated for esophagogastric cancer were randomized to either usual care or the 12-week RESTORE program (exercise training, dietary counseling, and multidisciplinary education). The primary outcome was cardiopulmonary exercise testing (VO2peak). Secondary outcomes included body composition (bioimpedance analysis), and HRQOL (EORTC-QLQ-C30). Outcomes were assessed at baseline (T0), postintervention (T1), and at 3-month follow-up (T2). RESULTS: Twenty-two participants were randomized to the control group [mean (standard deviation) age 64.14 (10.46) yr, body mass index 25.67 (4.83) kg/m, time postsurgery 33.68 (19.56) mo], and 21 to the intervention group [age 67.19(7.49) yr, body mass index 25.69(4.02) kg/m, time postsurgery 23.52(15.23) mo]. Mean adherence to prescribed exercise sessions were 94(12)% (supervised) and 78(27)% (unsupervised). Correcting for baseline VO2peak, the intervention arm had significantly higher VO2peak at both T1, 22.20 (4.35) versus 21.41 (4.49) mL ·â€Šmin ·â€Škg, P < 0.001, and T2, 21.75 (4.27) versus 20.74 (4.65) mL ·â€Šmin ·â€Škg, P = 0.001, compared with the control group. Correcting for baseline values, no changes in body composition or HRQOL were observed. CONCLUSIONS: The RESTORE program significantly improved cardiorespiratory fitness of disease-free patients after esophagogastric cancer surgery, without compromise to body composition. This randomized controlled trial provides proof of principle for rehabilitation programs in esophagogastric cancer. CLINICAL TRIAL REGISTRATION NUMBER: NCT03314311.


Assuntos
Aptidão Cardiorrespiratória/fisiologia , Aconselhamento , Dieta , Neoplasias Esofágicas/reabilitação , Exercício , Qualidade de Vida , Sobreviventes , Idoso , Composição Corporal , Neoplasias Esofágicas/terapia , Teste de Esforço , Feminino , Humanos , Masculino , Resultado do Tratamento
8.
J Cancer Surviv ; 12(4): 601-618, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29796931

RESUMO

PURPOSE: The management of oesophageal and gastric cancer can cause significant physical decline, impacting on completion rates and outcomes. This systematic review aimed to (i) determine the impact of chemotherapy, chemoradiotherapy and surgery on physical function; (ii) identify associations between physical function and post-operative outcomes; and (iii) examine the effects of rehabilitation on physical function. METHODS: We included randomised controlled trials (RCT), non-RCTs of interventions and cohort studies that measured physical function by objective means in patients with oesophageal or gastric cancer. EMBASE, PubMed, CINAHL, Cochrane Library, SCOPUS, PEDro and the WHO Trial Registry were searched up to June 2016. Risk of bias assessment was performed using a suite of validated tools. RESULTS: Twenty-five studies involving 1897 participants were included. A meta-analysis was not indicated due to the heterogeneity of the literature. Significant reductions in physical function occur in patients undergoing neoadjuvant treatment and in the first 3 months post-resection. Lower pre-operative exercise capacity is associated with an increased risk of post-operative pulmonary complications (PPCs). Evidence to support exercise prehabilitation and rehabilitation in these treatment pathways is currently lacking. CONCLUSIONS: Chemotherapy, chemoradiation and surgery lead to reduced physical function in patients with oesophageal and gastric cancer. High quality evidence is lacking to prove the benefit of interventions that improve physical function through the treatment pathway and in recovery, and well-designed studies are required. This review was limited due to the heterogeneity of the literature, high risk of bias in some articles and the lack of high quality research encompassing sufficient time points in the patient journey. IMPLICATIONS FOR CANCER SURVIVORS: Curative treatment for oesophago-gastric cancer can negatively impact on physical function. Rehabilitation programmes have considerable potential to enhance physical function across the oesophago-gastric cancer journey.


Assuntos
Neoplasias Esofágicas/terapia , Exercício/fisiologia , Cuidados Paliativos/métodos , Aptidão Física/fisiologia , Neoplasias Gástricas/terapia , Atividades Cotidianas/psicologia , Adulto , Idoso , Sobreviventes de Câncer/estatística & dados numéricos , Quimiorradioterapia , Neoplasias Esofágicas/epidemiologia , Neoplasias Esofágicas/reabilitação , Terapia por Exercício/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Indução de Remissão/métodos , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/reabilitação , Adulto Jovem
9.
Gan To Kagaku Ryoho ; 45(Suppl 1): 101-103, 2018 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-29650889

RESUMO

SUBJECTS AND METHODS: The subjects comprised 21 patients with esophageal cancer who underwent surgery, without adjuvant chemotherapy. Caloric intake, body weight loss, and biochemical parameters(serum albumin[Alb], hemoglobin[Hb], transthyretin[TTR], and total cholesterol[T-Cho])were measured up to 1 year after surgery, and relationships between all parameters were investigated. RESULTS: The caloric intake dropped to about 87% of base-line intake at 1 month after surgery and recovered to 100% at 1 year after the operation. Body weight also dropped to about 89% of baseline at 6 months after surgery and then was relatively stable. Caloric intake was significantly positively correlated with TTR(r=0.82, p=0.02), and it also tended to be positively correlated with T-Cho(r=0.70, p=0.14). Body weight loss was significantly negatively correlated with Alb(r=-0.82, p=0.01)and Hb(r=-0.87, p=0.01). CONCLUSION: Alb and Hb were recovered in the early postoperative period when body weight was still decreased. However, TTR appeared to be a good parameter of caloric intake in the short-term, postoperatively.


Assuntos
Neoplasias Esofágicas , Apoio Nutricional , Perda de Peso , Peso Corporal , Ingestão de Energia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/reabilitação , Humanos
10.
Brasília; CONITEC; mar. 2018. graf, ilus, tab.
Não convencional em Português | LILACS, BRISA/RedTESA | ID: biblio-905576

RESUMO

CONTEXTO: Estima-se a ocorrência de cerca de 10.810 novos casos por ano de neoplasias malignas do esôfago, sendo a maioria diagnosticado apenas em estágios avançados, com tratamento prioritariamente paliativo. A disfagia é o sintoma mais frequente e que mais compromete a qualidade de vida do paciente, impactando negativamente no desfecho dos tratamentos oncológicos e cirúrgicos que possam ser ministrados para esta condição. O tratamento disponível no SUS é a sonda nasoenteral para alimentar os pacientes. TECNOLOGIA: Implantação endoscópica da prótese esofageana metálica auto expansível (PEMAE). INDICAÇÃO: Alívio da disfagia nas obstruções malignas do esôfago e junção esofagogástrica. CARACTERIZAÇÃO DA TECNOLOGIA: A implantação endoscópica da prótese esofageana metálica auto expansível é um método comum para paliação dos cânceres esofágicos avançados, tendo a rápida resposta clínica e baixa incidência de recorrência da disfagia como principais vantagens. PERGUNTA: Para pacientes com câncer de esôfago avançado, a implantação endoscópica da prótese esofageana metálica auto expansível é a opção mais eficiente e segura para o alívio da disfagia em relação a outros métodos paliativos? EVIDÊNCIAS CIENTÍFICAS: Na busca de artigos que tivessem o alivio da disfagia como desfecho mensurado, primário ou secundário nas bases de dados, não foram encontrados estudos de comparação direta das PEMAE com a sonda nasoenteral, entretanto encontrou-se revisão sistemática (RS) comparando as PEMAE com todos os outros métodos de tratamento a fim de determinar sua eficácia e segurança. Neste estudo, as PEMAE demonstraram resultados significativamente melhores no controle da disfagia e menor taxa de recidiva do sintoma do que as próteses plásticas. A análise do tempo de hospitalização, mortalidade relacionada ao procedimento e eventos adversos maiores também se mostraram mais favoráveis no grupo PEMAE, com significância estatística. AVALIAÇÃO ECONÔMICA: Avaliação de custo-efetividade com horizonte temporal de 6 meses cujos eventos de saúde foram definidos com base na revisão sistemática da literatura e os custos foram estimados pela metodologia de microcusteio de acordo com os valores de compras públicas. A estratégia de implantação endoscópica da PEMAE apresentou um custo de R$6.888,96 com taxa de efetividade clínica de 0,91, e o custo do suporte nutricional com sonda e dieta enteral foi de R$22.564,78 com efetividade clínica de apenas 0,44 e uma RCEI de R$ -33.374,08 Na análise de sensibilidade, no pior cenário (50% dos pacientes utilizariam a PEMAE), a PEMAE demonstrou ser mais barata e mais efetiva do que a passagem da sonda. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: A quantidade de indivíduos com câncer esofágico (10.810 novos casos por ano) e os dados de mortalidade para câncer esôfago avançado (70%) foram estimados utilizando-se os dados do INCA em 2016. Dados de estudos nacionais foram utilizados para determinar a quantidade de pacientes com câncer esofágico que evoluem anualmente para condição avançada (75%), sendo 30% dos casos os candidatos ao tratamento paliativo por sonda nasoenteral ou PEMAE. O gasto orçamentário total em cinco anos calculado foi de R$ 109.456.481,25 e R$ 358.218.852,15 para a implantação endoscópica da prótese esofageana metálica auto expansível e suporte nutricional com passagem de sonda nasoenteral, respectivamente, com uma diferença de R$249.068.088,34, favorecendo a proposta de incorporação da tecnologia em demanda. CONSIDERAÇÕES: Os resultados da RS demonstraram a eficácia e segurança da implantação endoscópica da PEMAE para controle da disfagia em comparação com outros métodos. Na avaliação econômica, esse procedimento foi mais custo-efetivo do que a passagem da sonda nasoenteral. RECOMENDAÇÃO PRELIMINAR: Os membros do Plenário da CONITEC, em sua 61ª reunião ordinária, recomendaram que a matéria fosse enviada à Consulta Pública com manifestação preliminar favorável à incorporação. Considerou-se que o procedimento é substituto ao existente no SUS, apresenta uma técnica segura, é mais eficaz no controle e recidiva da disfagia, com elevado perfil de segurança e com menor custo. CONSULTA PÚBLICA: Foram recebidas duas contribuições no formulário de experiência ou opinião e uma técnico-científica, sendo todas da região sudeste, Estado de São Paulo e que concordaram totalmente com a recomendação inicial da CONITEC. As duas contribuições de experiências ou opinião foram de profissionais que relataram ter experiência com a tecnologia avaliada, sendo que um deles também relatou experiência profissional com outra tecnologia. Na 63ª reunião ordinária, após apreciação das contribuições encaminhadas pela consulta pública, o plenário da CONITEC entendeu que as argumentações apresentadas corroboram com a recomendação inicial. RECOMENDAÇÃO FINAL: Os membros da CONITEC presentes na 63ª reunião ordinária, no dia 01 de fevereiro de 2018, deliberaram, por unanimidade, por recomendar a incorporação no SUS do procedimento de implantação endoscópica da prótese esofageana metálica auto expansível para tratamento da disfagia decorrente dos tumores esofágicos avançados e obstrutivos. DECISÃO: Incorporar a implantação endoscópica da prótese esofageana metálica autoexpansível para tratamento da disfagia dos tumores esofágicos avançados e obstrutivos no âmbito do Sistema Único de Saúde SUS, dada pela Portaria nº 15, publicada no DOU nº 61, do dia 29 de março de 2018, seção 1, pág. 240.(AU)


Assuntos
Humanos , Endoscopia/métodos , Neoplasias Esofágicas , Neoplasias Esofágicas/reabilitação , Próteses e Implantes , Implantação de Prótese/métodos , Brasil , Análise Custo-Benefício , Avaliação em Saúde , Avaliação da Tecnologia Biomédica , Sistema Único de Saúde
11.
Mol Oncol ; 12(2): 196-207, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29160958

RESUMO

Here, we aimed to identify an immunohistochemical (IHC)-based classifier as a prognostic factor in patients with esophageal squamous cell carcinoma (ESCC). A cohort of 235 patients with ESCC undergoing radical esophagectomy (with complete clinical and pathological information) were enrolled in the study. Using the least absolute shrinkage and selection operator (LASSO) regression model, we extracted six IHC features associated with progression-free survival (PFS) and then built a classifier in the discovery cohort (n = 141). The prognostic value of this classifier was further confirmed in the validation cohort (n = 94). Additionally, we developed a nomogram integrating the IHC-based classifier to predict the PFS. We used the IHC-based classifier to stratify patients into high- and low-risk groups. In the discovery cohort, 5-year PFS was 22.4% (95% CI: 0.14-0.36) for the high-risk group and 43.3% (95% CI: 0.32-0.58) for the low-risk group (P = 0.00064), and in the validation cohort, 5-year PFS was 20.58% (95% CI: 0.12-0.36) for the high-risk group and 36.43% (95% CI: 0.22-0.60) for the low-risk group (P = 0.0082). Multivariable analysis demonstrated that the IHC-based classifier was an independent prognostic factor for predicting PFS of patients with ESCC. We further developed a nomogram integrating the IHC-based classifier and clinicopathological risk factors (gender, American Joint Committee on Cancer staging, and vascular invasion status) to predict the 3- and 5-year PFS. The performance of the nomogram was evaluated and proved to be clinically useful. Our 6-IHC marker-based classifier is a reliable prognostic tool to facilitate the individual management of patients with ESCC after radical esophagectomy.


Assuntos
Biomarcadores Tumorais/metabolismo , Neoplasias Esofágicas/metabolismo , Carcinoma de Células Escamosas do Esôfago/metabolismo , Esofagectomia/reabilitação , Idoso , Estudos de Coortes , Neoplasias Esofágicas/reabilitação , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/reabilitação , Carcinoma de Células Escamosas do Esôfago/cirurgia , Esôfago/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
12.
BMC Cancer ; 17(1): 552, 2017 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-28821284

RESUMO

BACKGROUND: Following esophagectomy, esophageal cancer patients experience a clinically relevant deterioration of health-related quality of life, both on the short- and long-term. With the currently growing number of esophageal cancer survivors, the burden of disease- and treatment-related complaints and symptoms becomes more relevant. This emphasizes the need for interventions aimed at improving quality of life. Beneficial effects of post-operative physical exercise have been reported in several cancer types, but so far comparable evidence in esophageal cancer patients is lacking. The aim of this study is to investigate effects of physical exercise on health-related quality of life in esophageal cancer patients following surgery. METHODS: The Physical ExeRcise Following Esophageal Cancer Treatment (PERFECT) study is a multicenter randomized controlled trial including 150 esophageal cancer patients after surgery with curative intent. Patients are randomly allocated to an exercise group or usual care group. The exercise group participates in a 12-week combined aerobic and resistance exercise program, supervised by a physiotherapist near the patient's home-address. In addition, participants in the exercise group are requested to be physically active for at least 30 min per day, every day of the week. Participants allocated to the usual care group are asked to maintain their habitual physical activity pattern. The primary outcome is health-related quality of life (EORTC-QLQ-C30). Secondary outcomes include esophageal cancer specific quality of life, fatigue, anxiety and depression, sleep quality, work-related factors, cardiorespiratory fitness (VO2peak), muscle strength, physical activity, malnutrition risk, anthropometry, blood markers, recurrence of disease and survival. All questionnaire outcomes, diaries and accelerometers are assessed at baseline, post-intervention (12 weeks post-baseline) and 24 weeks post-baseline. Physical fitness, anthropometry and blood markers are assessed at baseline and post-intervention. In addition, adherence and safety are monitored throughout the exercise program. DISCUSSION: This randomized controlled trial investigates effects of physical exercise versus usual care in esophageal cancer patients after surgery. As the design of the exercise program closely resembles daily practice, this study can contribute both to evidence on effects of exercise in esophageal cancer patients, and to potential implementation strategies. TRIAL REGISTRATION: Trial registration:Netherlands Trial Registry NTR5045 Date of trial registration: January 19th, 2015 Date and version study protocol: February 2017, version 1.


Assuntos
Protocolos Clínicos , Neoplasias Esofágicas/reabilitação , Terapia por Exercício , Exercício , Cuidados Pós-Operatórios , Neoplasias Esofágicas/cirurgia , Terapia por Exercício/métodos , Humanos , Qualidade de Vida , Projetos de Pesquisa , Treinamento de Resistência , Resultado do Tratamento
13.
Support Care Cancer ; 25(2): 381-389, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27726032

RESUMO

PURPOSE: Enhanced recovery program (ERP) was reported to be beneficial to patients undergoing esophageal surgery. However, evidence for ERP as a new standard perioperative pathway is insufficient. This meta-analysis aims to systematically investigate the differences between ERP and traditional care in terms of postoperative outcomes. METHODS: Studies comparing ERP with traditional care were searched in Pubmed and Ovid databases and subsequently analyzed. The primary outcome of interest was postoperative length of hospital stay (LOHS), and the secondary outcomes of interest were postoperative morbidity, mortality, and 30-day readmission rates. Statistical analysis was performed using weighted mean difference (WMD) and odds ratio (OR). Review Manager 5.3 was used to generate the eligible data. RESULTS: Thirteen studies with 2358 patients (1182 patients in the ERP group and 1176 patients in the control group) were included in this meta-analysis. The total LOHS (WMD -5.37; 95 % confidence interval (CI) -7.74 to -2.99; p < 0.00001) was significantly shorter in the ERP group than the control group. No statistically significant difference was found in morbidity (OR 0.78; 95 % confidence interval 0.58 to 1.05; p = 0.10), mortality (OR 0.76; 95 % CI 0.40 to 1.46; p = 0.41), and 30-day readmission rates (OR 1.01; 95 % CI 0.70 to 1.46; p = 0.97). CONCLUSIONS: This meta-analysis suggested that the implementation of ERP led to a reduction in LOHS, while morbidity, mortality, and 30-day readmission rates did not increase compared with traditional care in patients undergoing surgery for esophageal cancer.


Assuntos
Neoplasias Esofágicas/reabilitação , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/terapia , Humanos , Tempo de Internação , Período Pós-Operatório , Taxa de Sobrevida
14.
Support Care Cancer ; 25(3): 749-756, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27807666

RESUMO

PURPOSE: Physical, nutritional and quality-of-life compromises are known sequelae of oesophageal cancer (OC) treatment. Inflammation and oxidative stress may be relevant to adverse consequences. Multimodal rehabilitation involving exercise and diet prescription may attenuate some of the negative consequences and optimise survivorship, and this was assessed in this feasibility study in OC patients at least 1 year post-oesophagectomy. METHODS: The 12-week programme included supervised and home-based exercise, dietetic counselling to ensure energy balance and multidisciplinary education. Baseline and post-intervention assessments examined aerobic fitness, physical activity and body composition. Serum interleukin (IL)-1ß, tumour necrosis factor (TNF)-α, IL-6 and IL-8 were measured via multiplex arrays. Lactate secretion, lipid peroxidation (4-HNE) and oxidative stress (8-iso-PGF2α) were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: Twelve patients (mean (SD) age 64(1.29) years) participated. IL-8 reduced significantly from pre- to post-intervention (percentage change -11.25 % (95 % CI -20.98 to -1.51 %), p = 0.03), and there was a non-significant trend towards lower expression patterns of other inflammatory mediators. At baseline, inflammatory status correlated inversely with sedentary behaviour (IL-6 rho = -0.74, IL-8 rho = -0.59, TNF-α rho = -0.69; p < 0.05). While energy metabolism did not change, post-intervention lactate concentration correlated strongly and inversely with aerobic fitness (rho = -0.68, p = 0.02). Body composition was maintained throughout the intervention. CONCLUSIONS: Results suggest that multimodal rehabilitation following OC treatment reduced inflammatory status without compromising body composition. Findings will be further examined in a larger randomised controlled trial.


Assuntos
Dieta , Neoplasias Esofágicas/reabilitação , Exercício , Neoplasias Esofágicas/metabolismo , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Inflamação/sangue , Inflamação/patologia , Interleucinas/sangue , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo , Estudos Prospectivos , Qualidade de Vida , Sobreviventes
15.
Zhonghua Wei Chang Wai Ke Za Zhi ; 19(9): 965-970, 2016 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-27680060

RESUMO

Enhanced recovery after surgery (ERAS) is a patient-centered, surgeon-led system combining anesthesia, nursing, nutrition and psychology. It aims to minimize surgical stress and maintain physiological function in perioperative care, thereby expediting recovery. ERAS theory has been clinically applied for nearly 20 years and it is firstly used in colorectal surgery, then widely used in other surgical fields. However, ERAS is not used commonly in esophagectomy because of its surgical complexity and high morbidity of postoperative complications, which limits the application of ERAS in the field of esophagectomy. In recent years, with the increasing maturation of minimally invasive esophagectomy, attention to tissue and organ protection concept, improvement of making gastric tube, breakthrough of anastomosis technique, and the presentation and application of new concepts, ERAS has made great progress in the field of esophagectomy. This article summarizes some ERAS measures in the treatment of esophageal cancer based on evidence-based medicine, and performs an effective ERAS mode for clinical application of esophagectomy. During preoperative preparation and evaluation, we propose preoperative education and nutrition evaluation without regular intestinal preparation, and advocate preemptive analgesia without preanesthetic medication. During intra-operative management, anesthesia scheme should be optimized, fluid transfusion should be controlled properly, suitable operation mode should be chosen, and intraoperative hypothermia should be avoided. During postoperative management, sufficient analgesia should be administered with non-opioid analgesics, drainage tube placement must be decreased and removed earlier, urinary catheter and gastrointestinal decompression tube should be removed earlier, and oral intake and ambulation should be resumed as early as possible. "Received surgery yesterday, oral intake today, discharged home 5-7 days", ERAS program based on "non tube no fasting" has been applied in some medical centers and becomes more and more maturation. In the future, we will rely on the increasing improvement and systemic training of ERAS mode in order to promote such application in more medical centers. With the multi-center clinical trials, based on constant enrichments and improvements, a general expert consensus will be made finally.


Assuntos
Neoplasias Esofágicas/reabilitação , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Esofagectomia/reabilitação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/reabilitação , Assistência Perioperatória/métodos , Analgesia/métodos , Anestesia Geral/métodos , Descompressão Cirúrgica/instrumentação , Descompressão Cirúrgica/métodos , Drenagem/instrumentação , Drenagem/métodos , Esofagectomia/psicologia , Medicina Baseada em Evidências , Métodos de Alimentação , Humanos , Tempo de Internação , Estado Nutricional , Educação de Pacientes como Assunto/métodos , Cateterismo Urinário/métodos , Caminhada
16.
Dis Esophagus ; 29(1): 62-9, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25074403

RESUMO

The defect of esophagus after surgical excision in patients is usually replaced by autologous stomach, jejunum, or colon. The operation brings severe trauma and complications. Using artificial esophagus to replace the defect in situ can reduce the operative trauma, simplify the operative procedures, and decrease the influence to digestive function. A variety of experiments have been designed for developing a practical artificial esophagus. Nevertheless, a safe and reliable artificial esophagus is not yet available. The objective is to evaluate the possibility of the artificial esophagus made of non-degradable polyurethane materials being used in reconstruction of the segmental defect of cervical esophagus in beagles, observe the regeneration of esophageal tissue, and gather experience for future study. The cervical esophageal defects in 13 beagles were designed to 2-cm long and were constructed by the artificial esophagus made of non-degradable polyurethane materials. Nutrition supports were given after the operation. The operative mortality, anastomotic leakage, migration of artificial esophagus, and dysphagia were followed up. The regeneration of the esophageal tissues was evaluated by histopathology and immunohistochemical labeled streptavidin-biotin method. The surgical procedures were successfully completed in all beagles, and 12-month follow-ups were done. Only one beagle died of severe infection, and all others survived until being killed. The anastomotic leakage occurred in nine beagles, most of them (8/9) were cured after supportive therapy. The migration of artificial esophagus occurred in all 12 surviving beagles, and one artificial esophagus stayed in situ after migration. All 12 surviving beagles showed dysphagia with taking only fluid or soft food. No beagle died of malnutrition. The neo-esophagus was composed of granulation tissue, and the inner surface was covered by epithelium in 2-3 months completely. But the inner surface of neo-esophagus with artificial esophagus staying in situ after migration was not covered by epithelium, and the granulation tissue was infiltrated by a great deal of inflammatory cells. Antibodies against cytokeratin were positively expressed in epithelium of neo-esophagus. Up to 12 months after operation, antibodies against smooth muscle actin and desmin were both negatively expressed in neo-esophagus. The artificial esophagus made of non-degradable polyurethane reconstructing cervical esophageal defect is practicable. Although there are some problems, including anastomotic leakage, migration, and dysphagia, they are not lethal following good supportive therapy. The esophageal epithelium can regenerate with the supporting role of artificial esophagus. In the future, deformable artificial esophagus should be improved, and a much longer follow-up will be performed to evaluate whether the esophageal gland and skeletal muscle can regenerate.


Assuntos
Fístula Anastomótica , Esofagectomia/reabilitação , Esôfago/cirurgia , Poliuretanos/farmacologia , Infecções Relacionadas à Prótese , Procedimentos Cirúrgicos Reconstrutivos , Fístula Anastomótica/diagnóstico , Fístula Anastomótica/terapia , Animais , Materiais Biocompatíveis/farmacologia , Modelos Animais de Doenças , Cães , Neoplasias Esofágicas/reabilitação , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Teste de Materiais/métodos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/terapia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reprodutibilidade dos Testes
17.
Surg Today ; 46(5): 543-51, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26077288

RESUMO

PURPOSE: Oropharyngeal swallowing dysfunction following esophagectomy has been associated with the surgical disruption of muscle strength and flexibility of the oropharyngeal structures. We assessed the value of perioperative swallowing rehabilitation (SR) in patients who underwent radical esophagectomy. METHODS: We instituted routine perioperative SR for patients with esophageal cancer and retrospectively compared postoperative swallowing function between the patients who received (n = 12) vs. those who did not receive (n = 14) SR. RESULTS: The average duration of pre- and postoperative SR was 23.0 and 26.0 days, respectively. Preoperatively, the functional outcome assessment of the swallowing (FOAMS) score was 7 (full marks) in all 26 patients, whereas the average score at hospital discharge was 6.3 vs. 5.5 in the patients who received vs. those who did not receive SR, respectively (p = 0.049). Videofluoroscopic examination (n = 12) demonstrated that the maximum superior excursion of hyoid bone increased significantly with preoperative SR (p = 0.030), as well as postoperative SR (p = 0.046). However, perioperative SR did not reduce the incidence of postoperative aspiration pneumonia or the duration of hospital stay. CONCLUSIONS: Swallowing function after radical esophagectomy was improved by perioperative SR; however, further investigations are needed to assess the clinical significance of SR in reducing surgical complications.


Assuntos
Deglutição , Neoplasias Esofágicas/reabilitação , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Fluoroscopia , Avaliação de Resultados da Assistência ao Paciente , Idoso , Neoplasias Esofágicas/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Gravação em Vídeo
18.
World J Surg ; 39(8): 1986-93, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26037024

RESUMO

BACKGROUND: The minimally invasive esophagectomy (MIE) is widely being implemented for esophageal cancer in order to reduce morbidity and improve quality of life. Non-randomized studies investigating the mid-term quality of life after MIE show conflicting results at 1-year follow-up. Therefore, the aim of this study is to determine whether MIE has a continuing better mid-term 1-year quality of life than open esophagectomy (OE) indicating both a faster recovery and less procedure-related symptoms. METHODS: A one-year follow-up analysis of the quality of life was conducted for patients participating in the randomized trial in which MIE was compared with OE. Late complications as symptomatic stenosis of anastomosis are also reported. RESULTS: Quality of life at 1 year was better in the MIE group than in the OE group for the physical component summary SF36 [50 (6; 48-53) versus 45 (9; 42-48) p .003]; global health C30 [79 (10; 76-83) versus 67 (21; 60-75) p .004]; and pain OES18 module [6 (9; 2-8) versus 16 (16; 10-22) p .001], respectively. Twenty six patients (44%) in the MIE and 22 patients (39%) in the OE group were diagnosed and treated for symptomatic stenosis of the anastomosis. CONCLUSIONS: This first randomized trial shows that MIE is associated with a better mid-term one-year quality of life compared to OE.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Qualidade de Vida , Adolescente , Adulto , Idoso , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/reabilitação , Esofagectomia/efeitos adversos , Esofagectomia/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/reabilitação , Metástase Neoplásica , Recidiva Local de Neoplasia/etiologia , Estadiamento de Neoplasias , Psicometria , Adulto Jovem
19.
Khirurgiia (Mosk) ; (2): 37-43, 2015.
Artigo em Russo | MEDLINE | ID: mdl-26031818

RESUMO

Esophagectomy with simultaneous plasty in patient with esophageal cancer is still associated with a high incidence of postoperative complications and long-stay patient in the clinic. The purpose of our report is to inform the use of the program of accelerated rehabilitation after esophagectomy in a prospective study of 13 patients during the period from 2010 to 2011 year and the role of the anesthesiologist in its implementation. Methods aimed at the preoperative examination, minimally invasive surgery, thoracic epidural anesthesia/analgesia with local anesthetics as a component of anesthesia and postoperative analgesia, early extubation and mobilization of the patient with the implementation of breathing exercises, early enteral feeding, and the planned short postoperative stay in resuscitation and hospital were used. Postoperative complications were observed in 3 (23/1%) patients: one patient (7/7%) had right-side pneumonia, two patients (15/4%) had right-side pneumothorax requiring emergency re drainage. The average intensive care stay was 2 (1-4) days, postoperative hospital stay--9 (7-12) days. Further monitoring of the patients did not show any long-term complications. The results confirm that it is possible to optimize the healing perioperative process in patients after esophagectomy with simultaneous plasty by using of accelerated rehabilitation program without the risk of increasing the frequency of postoperative complications. it will provide the reduction of length of hospital stay. In view of multifaceted and controversial issue the following researches in this direction are necessary.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/reabilitação , Esofagoplastia/reabilitação , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/reabilitação , Adulto , Idoso , Neoplasias Esofágicas/reabilitação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
20.
Support Care Cancer ; 23(12): 3589-98, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25894882

RESUMO

OBJECTIVES: The aim of this study is to examine caregiver burden of spousal caregivers of patients with esophageal cancer after curative treatment with neoadjuvant chemoradiation followed by resection and to assess factors associated with caregiver burden. METHODS: In this exploratory, cross-sectional study, spousal caregivers and patients were eligible if the caregiver was the patient's spouse and the patient had been treated with chemoradiation followed by surgery after esophageal carcinoma diagnosis. Forty-seven couples were included. Spousal caregivers completed a questionnaire, examining caregivers' burden (Self-Perceived Pressure from Informal Care (SPPIC, Dutch)), caregiver unmet needs (SCNS-P&S), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), and marital satisfaction (Maudsley Marital Questionnaire (MMQ)). Patients completed the latter two questionnaires and a cancer specific quality of life questionnaire (EORTC-QLQ C30 and OES18 (oesophageal module). Logistic regression analysis was performed to identify correlates for caregiver burden. RESULTS: The median time after esophagectomy was 38 months. Thirty-four percent of the spousal caregivers reported moderate or high burden. Spousal caregivers most frequently reported unmet needs were managing concerns about the cancer coming back (43%), dealing with others not acknowledging the impact on your life of caring for a person with cancer (38%), and balancing the needs of the person with cancer and one's own needs. A comparable proportion of spousal caregivers and patients showed symptoms of anxiety (23 vs 17%) and depression (17 vs 17%). Spousal caregivers reported significantly more dissatisfaction than patients on the marital scale (p < 0.01). Factors independently associated with higher caregiver burden were fatigue of the patient (OR = 1.66, 95% CI 1.12-2.47) and depression of the spousal caregiver (OR = 1.44, 95% CI 1.11-1.86). CONCLUSIONS: More than a third of the spousal caregivers of patients with esophageal cancer treated with curative intent report moderate or high burden 3 years after treatment. Fatigue of the patient and depression of the spousal caregiver are associated with caregiver burden. To improve clinical care, identification of spousal caregivers at risk for experiencing higher caregiver burden and implementation of specific interventions is needed.


Assuntos
Cuidadores/psicologia , Neoplasias Esofágicas/reabilitação , Idoso , Ansiedade , Estudos Transversais , Depressão , Neoplasias Esofágicas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Qualidade de Vida , Cônjuges , Sobreviventes
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA