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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.
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
3.
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
4.
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
5.
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
6.
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
7.
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
8.
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
9.
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
10.
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
11.
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
13.
Rev inf cient ; 90(2)2015. ilus
Artigo em Espanhol | CUMED | ID: cum-65329

RESUMO

Se presenta un caso con el objetivo de presentar la sobrevida real de un paciente de 58 años de edad que acude por primera vez a nuestro Servicio de Cirugía por presentar dificultad al tragar. Algunos meses después presenta sialorrea sobre todo nocturna Se le realiza estudio radiológico es esófago, estómago y duodeno, observándose, defecto de relleno en el esófago distal. Se le realiza esófago gastrectomía con esofagogastroplastia, omentectomiapiloroplastia y esplenectomía complementaria. Después de 26 años de operado y, luego de quimioterapia, se le han realizado chequeos periódicos radiológicos y endoscópicos y hasta el momento no hay muestra de recidiva tumoral. Por lo infrecuente de una sobrevida tan prolongada de esta entidad, es por lo cual se decide presentar este caso así como los aspectos más relevantes y actuales respecto a esta afección(AU)


A case is presented with the aim of presenting the actual survival of a 58 year old who comes first to our Department of Surgery to present difficulty at the time of swallowing. Some months later presents drooling over all night .Radiological study is done in esophagus, stomach and duodenum, observing, filling defect in the distal esophagus. It was made esophagogastrectomy with esophagogastroplasty, omentectomiapiloroplastia and additional splenectomy. After 26 years of surgery and after chemotherapy, the patient has performed regular, radiological and endoscopic check up and so far there is no sign of tumor. So uncommon in prolonged survival. It is decided to present this case as well as the most relevant and current issues regarding this condition(AU)


Assuntos
Adulto , Adenocarcinoma/cirurgia , Junção Esofagogástrica/cirurgia , Neoplasias Esofágicas/reabilitação , Neoplasias Esofágicas/cirurgia
14.
J Cancer Res Clin Oncol ; 140(5): 817-21, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24531974

RESUMO

PURPOSE: Esophageal squamous cell carcinoma (ESCC) remains a significant cause of morbidity and mortality worldwide. The aim of the study was to investigate the effects of shorter dinner-to-bed time and post-dinner walk on ESCC risk. METHODS: A matched case-control study with 232 ESCC patients and 286 age- and gender-matched healthy controls enrolled was conducted. Conditional logistic regression was used to calculated odds ratio (OR) and 95 % confidence intervals (95 % CI). RESULTS: The adjusted ORs of ESCC for subjects with shorter dinner-to-bed time (<3 h) were 2.84 (95 % CI 1.64-4.29), relative to those with longer dinner-to-bed time (≥4 h). While post-dinner walk was associated with a decreased ESCC risk (adjusted OR 0.64; 95 % CI 0.41-0.89). What's more, when reflux symptom was added into the multivariate models, risk estimate for shorter dinner-to-bed time still remained statistically significant (p = 0.003), and risk estimate for post-dinner walk changed slightly. In the subgroup analysis stratified by post-dinner walk, subjects with shorter dinner-to-bed time experienced similar risk (adjusted ORs 2.71 vs. 2.82). CONCLUSIONS: Shorter dinner-to-bed time is a potential risk factor for ESCC and post-dinner walk is a protective factor, providing evidence for the effect of lifestyle factors on ESCC risk.


Assuntos
Carcinoma de Células Escamosas/epidemiologia , Neoplasias Esofágicas/epidemiologia , Refeições , Caminhada , Idoso , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/reabilitação , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/reabilitação , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
15.
J Clin Ethics ; 24(2): 135-43, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23923812

RESUMO

With the aging of the general population and the ability of intensivists to support patients using ventilator support, tracheostomy has become a vital tool in the medical management of critically ill patients. While much of the medical literature on tracheostomy has focused on the optimal timing of and indications for performing this procedure, little is written on the ethical tensions that can revolve around decisions by patients, surrogates, and physicians on its use.This article will elucidate the ethical dilemmas that can arise surrounding the use of tracheostomy in critically ill patients and how ethics consultants and committees can approach these cases to allow resolution.


Assuntos
Cuidados Críticos/ética , Tomada de Decisões/ética , Família , Cuidados para Prolongar a Vida/ética , Complicações Pós-Operatórias/reabilitação , Respiração Artificial , Insuficiência Respiratória/reabilitação , Traqueostomia/ética , Idoso , Idoso de 80 Anos ou mais , Síndrome de Creutzfeldt-Jakob/complicações , Cuidados Críticos/métodos , Neoplasias Esofágicas/reabilitação , Neoplasias Esofágicas/cirurgia , Consultoria Ética , Família/etnologia , Família/psicologia , Humanos , Cuidados para Prolongar a Vida/métodos , Neoplasias Pulmonares/reabilitação , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Complicações Pós-Operatórias/etiologia , Insuficiência Respiratória/etiologia , Traqueostomia/normas
16.
Br J Surg ; 100(10): 1326-34, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23939844

RESUMO

BACKGROUND: Data are lacking to support the cost-effectiveness of enhanced recovery pathways (ERP) for oesophagectomy. The aim of this study was to investigate the impact of an ERP on medical costs for oesophagectomy. METHODS: This study investigated all patients undergoing elective oesophagectomy between June 2009 and December 2011 at a single high-volume university hospital. From June 2010, all patients were enrolled in an ERP. Clinical outcomes were recorded for up to 30 days. Deviation-based cost modelling was used to compare costs between the traditional care and ERP groups. RESULTS: A total of 106 patients were included (47 traditional care, 59 ERP). There were no differences in patient, pathological and operative characteristics between the groups. Median length of hospital stay (LOS) was lower in the ERP group (8 (interquartile range 7-18) days versus 10 (9-18) days with traditional care; P = 0·019). There was no difference in 30-day complication rates (59 per cent with ERP versus 62 per cent with traditional care; P = 0·803), and the 30-day or in-hospital mortality rate was low (3·8 per cent, 4 of 106). Costs in the on-course and minor-deviation groups were significantly lower after implementation of the ERP. The pathway-dependent cost saving per patient was €1055 and the overall cost saving per patient was €2013. One-way sensitivity analysis demonstrated that the ERP was cost-neutral or more costly only at extreme values of ward, operating and intensive care costs. CONCLUSION: A multidisciplinary ERP for oesophagectomy was associated with cost savings, with no increase in morbidity or mortality.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/economia , Redução de Custos , Análise Custo-Benefício , Procedimentos Clínicos/economia , Procedimentos Cirúrgicos Eletivos/economia , Neoplasias Esofágicas/reabilitação , Esofagectomia/reabilitação , Humanos , Tempo de Internação/economia , Estudos Prospectivos
17.
Int J Nurs Stud ; 50(1): 44-52, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22959588

RESUMO

BACKGROUND: After surgery for oesophageal or gastric cancer, patients suffer from a variety of problems that affect their physical and mental health. Most previous studies on quality of life after this type of surgery are based on quantitative methods, and no studies to date have focused on the patient's subjective experiences of their quality of life from a long-term perspective. OBJECTIVE: To illuminate patients' experiences of their quality of life, and how they handle their new life situation, from a long-term perspective, after oesophagectomy or gastrectomy for cancer. METHOD: This study was carried out in accordance with a descriptive explorative design focusing on the patients' quality of life after surgery for oesophageal/gastric cancer. Data collection was carried out using semi-structured focus group interviews. A total of 17 participants divided into 4 focus groups were included (2-5 years after elective surgery) in the study. Data was analysed with qualitative content analysis. RESULTS: The results show that the patients' lives are severely hampered by adverse symptoms long time after surgery. The patients experienced the recovery period as a struggle and the theme "When moving on becomes a struggle" was shown to capture the patients' experiences. The main problems that acts as barriers in the patients' new life situation are those connected with nutrition and diarrhea who was shown not only affecting the patients from a physical perspective but also on a social and emotional level. The feeling of losing control of life was shown as a prominent problem and resulted in anxiety and fear about the future. CONCLUSION: This study shows that the patients' quality of life is heavily influenced by the remaining symptoms for a long time after surgery. However the patients ability to handle their new life situation does not only depend on the remaining symptom but on their ability to take control of the new life situation and learn to live life with the symptoms instead of letting the symptoms limit their life. The complex new life situation that the patients meet after surgery motivates the needs of a supportive care programme, focusing on the patients' physical, mental and social needs.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/reabilitação , Gastrectomia/reabilitação , Qualidade de Vida , Neoplasias Gástricas/cirurgia , Adaptação Psicológica , Idoso , Neoplasias Esofágicas/reabilitação , Esofagectomia/efeitos adversos , Feminino , Grupos Focais , Seguimentos , Gastrectomia/efeitos adversos , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Neoplasias Gástricas/reabilitação , Suécia
18.
Support Care Cancer ; 21(3): 707-14, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22933129

RESUMO

PURPOSE: The purpose of this article is to evaluate fast-track rehabilitation program and conventional care after esophagectomy using a retrospective controlled cohort study in esophageal cancer patients. METHODS: Fifty-five patients underwent fast-track rehabilitation program and 57 patients underwent conventional care after esophagectomy. Fast-track rehabilitation program was performed to patients who have early movement, epidural analgesia control, fluid infusion volume control and enteral nutrition for early discharge. The other 57 patients underwent conventional care after esophagectomy. The average of hospital stay and complications were calculated in the patients between the two groups. RESULTS: The median length of hospital stay in the patients was significantly shorter after fast-track rehabilitation program than after conventional care (7.7 vs 14.8 day, P < 0.01). The percentage of patients who developed complications was significantly lower 30 day after fast-track rehabilitation program than after conventional care (29.1 vs 47.4%, P < 0.05). 87.3% in patients of the fast-track rehabilitation program group and 54.4% in those of the conventional care group reported excellent to very good satisfaction with their pain control (P = 0.000). CONCLUSIONS: The fast-track rehabilitation program results in fewer complications, less postoperative pain, a reduction in the hospital length of stay, and quicker return to work and normal activities after esophagectomy.


Assuntos
Neoplasias Esofágicas/reabilitação , Esofagectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Estudos de Coortes , Neoplasias Esofágicas/cirurgia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Satisfação do Paciente , Estudos Retrospectivos , Retorno ao Trabalho/estatística & dados numéricos , Fatores de Tempo
19.
Asian Pac J Cancer Prev ; 14(12): 7359-66, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24460303

RESUMO

OBJECTIVE: To assess the effects of perioperative comprehensive supportive care interventions on outcome of Chinese esophageal cancer patients in a prospective study. METHODS: 60 patients with primary esophageal carcinoma were randomized into an intervention group (IG, n=31) and a control group (CG, n=29). The Chinese version of symptom checklist-90 (SCL-90) was adopted to assess their psychological status. The interventions, including health education, psychological support, stress management, coping strategies and behavior training, were carried out in 3 phases (preoperative, postoperative I and postoperative II), and psychological effects were thereafter evaluated accordingly before surgery, and 1 week, 4 weeks and 24 weeks post-surgery. Medical costs were estimated at discharge. Survival of patients was estimated each year post-surgery. General health status and satisfaction-with-hospital were surveyed by a follow-up questionnaire 4 years post-surgery. RESULTS: All the subjects demonstrated higher scores in the preoperative phase than the normal range of Chinese population concerning 7 psychological domains including somatization, obsessive-compulsive, depression, anxiety, hostility, phobic anxiety and paranoid ideation. Although no significant difference was observed between the two groups at admission, the scores of IG, which tended to decrease at a faster rate, were generally lower than those of CG at weeks 1, 4 and 24 post-surgery. The length of hospital stay and medical costs of IG were significantly less than those of CG and satisfaction-with-hospital was better. However, there was no significant difference in 4-year survival or health status between two groups. CONCLUSIONS: Appropriate perioperative comprehensive supportive care interventions help to improve the psychological state of Chinese patients with esophageal carcinoma, to reduce health care costs and to promote satisfaction of patients and their families with hospital.


Assuntos
Adaptação Psicológica , Ansiedade/prevenção & controle , Depressão/prevenção & controle , Neoplasias Esofágicas/psicologia , Estresse Psicológico/prevenção & controle , Adolescente , Adulto , Idoso , Ansiedade/psicologia , Estudos de Casos e Controles , China , Aconselhamento , Depressão/psicologia , Neoplasias Esofágicas/reabilitação , Neoplasias Esofágicas/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Paliativos , Assistência Perioperatória , Prognóstico , Estudos Prospectivos , Inquéritos e Questionários , Adulto Jovem
20.
Gastroenterol Nurs ; 35(5): 332-40, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23018169

RESUMO

In recent years, the number of quality-of-life (QOL) studies on patients with esophageal cancer has increased; however, the number of studies related to the effects of self-care education programs on QOL of these patients is scarce. This article reports on the effects of a self-care education program on QOL for patients with esophageal cancer in Babol, Iran. The quasi-experimental study had a convenience sample of 105 patients with esophageal cancer referred to oncology centers in Babol City. A quasi-random allocation technique was used to divide the sample into experimental (n = 55) and control (n = 50) groups. Appropriate instruments were used to measure QOL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-30 and Quality of Life Questionnaire-Oesophageal 18). Questionnaires were completed by the respondents before and 3 months after implementing the educational program that consisted of group discussion, lectures, and pamphlets. There was no significant difference between QOL mean score of both groups before the intervention; however, after implementing the educational program, the QOL significantly improved in the experimental group (p = .001), whereas QOL decreased in the controls. We conclude that self-care education programs have positive effects on the QOL of patients with esophageal cancer. Planning and implementing such self-care education programs, when patients are under treatment, can help them improve their QOL.


Assuntos
Neoplasias Esofágicas/reabilitação , Educação de Pacientes como Assunto/métodos , Cuidados Pós-Operatórios/enfermagem , Qualidade de Vida , Autocuidado , Idoso , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Irã (Geográfico) , Masculino
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