Symptom Clusters After Esophageal Cancer Surgery

Esophageal cancer postsurgical symptoms tended to appear in clusters

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Only about one in four esophageal cancer patients is eligible for surgery; the rest have an advanced disease that surgery can’t touch. But the operation is complex and may leave patients with life-altering symptoms.

Researchers have discovered that symptoms following esophageal cancer surgery tended to appear in clusters. For example, fatigue is usually accompanied by insomnia.

In a new study, these researchers saw three distinct symptom clusters among esophageal cancer patients following surgery, and some of these clusters are associated with higher death risks.

The authors of this study suggested that clinicians could address these groups of symptoms in a manner that may reduce death risks.

"Let your health team know if you're having treatment side effects."

This team of researchers, led by Anna Wikman, PhD, of the Karolinska Institutet in Stockholm, Sweden, evaluated the symptoms in 402 esophageal cancer patients who underwent surgery to treat the disease.

Esophageal cancer develops in the esophagus — the 10-inch tube that connects the throat to the stomach. It’s a particularly ruthless cancer that is exceedingly difficult to beat.

While surgery is the best treatment option, the operation itself is extensive, complex and leaves the patient with side effects that negatively affect what researchers call health-related quality of life (HRQOL).

Typical post-surgical symptoms can last for up to three years after the surgery and include painful swallowing, eating problems, reflux (swallowed food flowing back into the mouth) and pain.

A total 402 esophageal cancer patients in this study were interviewed six months after their surgery about general quality of life issues and specific cancer-related symptoms.

The researchers discovered three symptom clusters among esophageal cancer patients who had undergone surgery:

  • The “fatigue–pain” cluster was seen in 30 percent of patients and included fatigue, pain, insomnia and shortness of breath.
  • The “reflux-cough” cluster was experienced by 27 percent of study members and was characterized by dry mouth, taste problems, coughing and reflux.
  • The “eating difficulties” group of symptoms appeared in 28 percent of participants and included loss of appetite, eating difficulties, nausea-vomiting and difficulty swallowing.

Individuals experiencing the fatigue-pain cluster of symptoms had a median survival of 18 months, while those in the reflux-cough and eating difficulties cluster groups lived around 21 months.

About a third (31 percent) of all study participants were still alive five years after surgery.

“Symptoms experienced by surgically treated patients with esophageal cancer appear to cluster together, and the presence of these symptom clusters appears to have strong prognostic value,” the researchers concluded.

Dr. Wikman said in a statement, “These findings suggest that it may be important to address these symptom clusters in the clinical setting in order to potentially reduce the increased mortality risk associated with them."

This study was published November 25 in Cancer, a peer-reviewed journal of the American Cancer Society.

The funding for this project was provided by The Swedish Research Council, the Swedish Cancer Society and the Cancer Society in Stockholm.

No conflicts of interest were reported.

Review Date: 
November 22, 2013
Last Updated:
December 30, 2013