Quality of Life After Oesophageal or Gastric Cancer Surgery
Quality of Life After Oesophageal or Gastric Cancer Surgery
This study aim to assess quality of life of patients 0-5 years after oesophageal or gastric
 cancer surgery and to develop and test an information and support program aiming to enhance
 the patients quality of life (QOL) after surgery. The project contains 3 part-studies
 focusing on the patients life after surgery.

 Data will be collected through focus group interviews and a randomized controlled trial (RCT)
 study.
Introduction:

 Patients who have undergone oesophageal resections for cancer have shown reduced quality of
 life (QOL) during substantial time after surgery. Postoperatively, patients are faced with
 extensive changes in their daily life including reduced physical and sometimes psychological
 capacities, problems that may be underestimated by the health care providers.

 Worldwide oesophageal cancer is the 8th and gastric cancer the 4th most common cancer
 diagnoses (National Board of Health and Welfare, 2009). In 2009 in Sweden there were 443 new
 cases of oesophageal cancer and 882 of gastric cancer (total number of inhabitants in 2009,
 9.4 million). Surgery, alone or in combination with chemotherapy or radiotherapy, is the only
 established treatment and thus offers the only possibility of a cure. After oesophagectomy or
 gastrectomy the planned hospital stay is approximately two to three weeks, and the expected
 recovery period is at least one year. The prolonged recovery period is pointed out as an
 energy-requiring process including physiological, psychological, social and habitual
 recovery, which increases the challenges for this group of patients after surgery. Even
 though survival after surgery, for both oesophageal and gastric cancer, has gradually
 improved, the 5-year survival rate remains at only 28% respectively 27%.

 Aim:

 The aim of this project is to assess quality of life of patients 0-5 years after oesophageal
 or gastric cancer surgery and to develop and test an information and support program aiming
 to enhance the patients QOL after surgery.

 The project contains 3 part-studies that focus on the patients life after surgery.

 Method:

 In both studies patients that when through oesophagectomy or gastrectomy due to cancer is
 included. Patients that has suffered a relapse of their cancer disease, are unable to
 communicate in Swedish or has went through a acute surgery is not included.

 Study I and II:

 This studies is carried out in accordance with a descriptive explorative design focusing on
 I: The patients subjective experience of their QOL and II: The patients´ experience and need
 of supportive care, after surgery for oesophageal/gastric cancer. Data collection is carried
 out using semi-structured focus group interviews. A total of 17 participants divided into 4
 focus groups are included (2-5 years after elective surgery) in the study. Data are to be
 analysed with qualitative content analysis focusing on the patients experiences of their
 supportive care needs after surgery.

 Study III:

 This study is a randomized controlled trial that focus on testing a information and support
 programme to patients after oesophagectomy or gastrectomy due to cancer. The intervention
 group gets support from a specialized nurse after surgery which contacts the patients
 according to a given interval during the follow up period (6 months). The control group
 follows the regular follow up programme that are used at the hospital where the study is
 conducted.

 The information and support programme are evaluated through validated questionnaires that
 focus on quality of life (EORTC QLQ-C30 and OES-18), satisfaction whit care (EORTC
 INPATSAT32), sense of coherence (KASAM) and information needs (EORTC INFO 25). The patients
 also writes a diary regarding health care contacts after surgery.

 A total number of 80 are patients are planed to be included in the study.
Inclusion Criteria:

 -  Patients with any stage tumours in the distal third of the oesophagus including type
 II tumours at the gastro-oesophageal junction

 -  Transthoracic oesophageal resection with gastric tube reconstructions and circular
 stapled anastomoses in the upper right chest Postoperative clinical courses without
 complications, and postoperative anastomotic radiograms without anastomotic leakage

 -  Macro and microscopically tumour free upper resection margins Willingness, physical
 and mental capability to comply with the result of the randomization, and ability to
 follow the study protocol

 -  Adult >18 years

 -  Living in the southern of Sweden (Skåne county)

 Exclusion Criteria:

 -  Preoperative or planned postoperative chemotherapy or radiotherapy to the tumour area
 known at the time of discharge from the hospital.

 -  Postoperative need for continuous treatment with proton pump inhibitors (PPIs) or
 histamine-2 blockers. Treatment with steroidal or non steroidal anti inflammatory
 drugs other than occasionally

 -  Known allergy or side effects to PPIs preventing continuous treatment for one year

 -  Present drug or alcohol abuse

 -  Failure to attend at least one postoperative visit