Skip to main content

Advertisement

SpringerLink
Log in

Risk Factors for Weight Loss Among Patients Surviving 5 Years After Esophageal Cancer Surgery

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

An Erratum to this article was published on 05 February 2015

Abstract

Background

This study aimed to identify factors influencing postoperative weight loss ≥15 % in long-term survivors after esophageal cancer surgery.

Methods

A population-based study was conducted in Sweden between 2001 and 2005, with regular follow-up for 5 years. Current weight, weight at operation, and average weight were assessed and dichotomized as weight loss of ≥15 %. Logistic regression estimated relative risks of weight loss between pre- and 5 years postoperatively, expressed as odds ratios (ORs) with 95 % confidence intervals (CIs). Statistically significant differences in nutritional symptoms between weight loss groups were analyzed using linear regression models to likewise test as risk factors.

Body mass index (BMI) at operation (< or ≥25), sex, and preoperative weight loss (< or ≥10 %) were tested as risk factors. Nutritional symptoms were selected from the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-OES18, including fatigue, nausea and vomiting, dyspnoea, appetite loss, diarrhea, and dysphagia, eating difficulties, reflux and pain.

Results

A total of 117 patients were included. Patients with preoperative BMI ≥25 were at a threefold increased risk (OR 3.2; 95 % CI 1.4–7.3) for postoperative weight loss of ≥15 % 5 years after operation. Moreover, eating difficulties, pain, fatigue, nausea and vomiting, and appetite loss were clinically relevant and statistically significantly worse symptoms experienced among those with a weight loss of ≥15 % (all at p < 0.05).

Conclusions

Overweight at the time of operation is associated with postoperative weight loss from a long-term perspective. Several nutritional symptoms are associated with weight loss of >15 % 5 years postoperatively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Lindblad M, Rodriguez LA, Lagergren J. Body mass, tobacco and alcohol and risk of esophageal, gastric cardia, and gastric non-cardia adenocarcinoma among men and women in a nested case-control study. Cancer Causes Control. 2005;16:285-94.

    Article  PubMed  Google Scholar 

  2. O’Doherty MG, Freedman ND, Hollenbeck AR, et al. A prospective cohort study of obesity and risk of oesophageal and gastric adenocarcinoma in the NIH-AARP diet and health study. Gut. 2012;61:1261-8.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Bollschweiler E, Herbold T, Plum P, et al. Prognostic relevance of nutritional status in patients with advanced esophageal cancer. Expert Rev Anticancer Ther. 2013;13:275-8.

    Article  CAS  PubMed  Google Scholar 

  4. Gupta R, Ihmaidat H. Nutritional effects of oesophageal, gastric and pancreatic carcinoma. Eur J Surg Oncol. 2003;29:634-43.

    Article  CAS  PubMed  Google Scholar 

  5. Lagergren J, Lagergren P. Oesophageal cancer. BMJ. 2010;341:c6280.

    Article  PubMed  Google Scholar 

  6. Laviano A, Meguid MM, Rossi-Fanelli F. Cancer anorexia: clinical implications, pathogenesis, and therapeutic strategies. Lancet Oncol. 2003;4:686-94.

    Article  CAS  PubMed  Google Scholar 

  7. Bozzetti F. Nutritional support in patients with oesophageal cancer. Support Care Cancer. 2010;18 Suppl 2:S41-50.

    Article  PubMed  Google Scholar 

  8. Ravasco P, Monteiro-Grillo I, Vidal PM, et al. Nutritional deterioration in cancer: the role of disease and diet. Clin Oncol (R Coll Radiol). 2003;15:443-50.

    Article  CAS  Google Scholar 

  9. Djarv T, Lagergren J, Blazeby JM, et al. Long-term health-related quality of life following surgery for oesophageal cancer. Br J Surg. 2008;95:1121-6.

    Article  CAS  PubMed  Google Scholar 

  10. Darling GE. Quality of life in patients with esophageal cancer. Thorac Surg Clin. 2013;23:569-75.

    Article  PubMed  Google Scholar 

  11. Martin L, Lagergren P. Long-term weight change after oesophageal cancer surgery. Br J Surg. 2009;96:1308-14.

    Article  CAS  PubMed  Google Scholar 

  12. Viklund P, Lindblad M, Lu M, et al. Risk factors for complications after esophageal cancer resection: a prospective population-based study in Sweden. Ann Surg. 2006;243:204-11.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Lagergren J, Bergstrom R, Lindgren A, et al. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med. 1999;340:825-31.

    Article  CAS  PubMed  Google Scholar 

  14. Sobin LH, Wittekind C. TNM classification of malignant tumours. New Jersey: Wiley; 2002.

    Google Scholar 

  15. Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg. 1998;85:1457-9.

    Article  CAS  PubMed  Google Scholar 

  16. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365-76.

    Article  CAS  PubMed  Google Scholar 

  17. Blazeby JM, Conroy T, Hammerlid E, et al. Clinical and psychometric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer. Eur J Cancer. 2003;39:1384-94.

    Article  CAS  PubMed  Google Scholar 

  18. Martin L, Jia C, Rouvelas I, et al. Risk factors for malnutrition after oesophageal and cardia cancer surgery. Br J Surg. 2008;95:1362-8.

    Article  CAS  PubMed  Google Scholar 

  19. Martin L, Lagergren J, Lindblad M, et al. Malnutrition after oesophageal cancer surgery in Sweden. Br J Surg. 2007;94:1496-500.

    Article  CAS  PubMed  Google Scholar 

  20. Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN Guidelines on enteral nutrition: terminology, definitions and general topics. Clin Nutr. 2006;25:180-6.

    Article  CAS  PubMed  Google Scholar 

  21. Lis CG, Gupta D, Lammersfeld CA, et al. Role of nutritional status in predicting quality of life outcomes in cancer: a systematic review of the epidemiological literature. Nutr J. 2012;11:27.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Fayers PM, Aaronsson NK, Bjordal K, et al. The EORTC QLQ-C30 scoring manual. Brussels: European Organisation for Research and Treatment of Cancer; 2001.

    Google Scholar 

  23. King MT. The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30. Qual Life Res. 1996;5:555-67.

    Article  CAS  PubMed  Google Scholar 

  24. Osoba D, Rodrigues G, Myles J, et al. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998;16:139-44.

    CAS  PubMed  Google Scholar 

  25. Lagergren K, Mattsson F, Lagergren J. Abdominal fat and male excess of esophageal adenocarcinoma. Epidemiology. 2013;24:465-66.

    Article  PubMed  Google Scholar 

  26. Muscaritoli M, Molfino A, Gioia G, et al. The “parallel pathway”: a novel nutritional and metabolic approach to cancer patients. Intern Emerg Med. 2011;6:105-12.

    Article  PubMed  Google Scholar 

  27. Kiyama T, Mizutani T, Okuda T, et al. Postoperative changes in body composition after gastrectomy. J Gastrointest Surg. 2005;9:313-9.

    Article  PubMed  Google Scholar 

  28. Donohoe CL, McGillycuddy E, Reynolds JV. Long-term health-related quality of life for disease-free esophageal cancer patients. World J Surg. 2011;35:1853-60.

    Article  PubMed  Google Scholar 

  29. Derogar M, Lagergren P. Health-related quality of life among 5-year survivors of esophageal cancer surgery: a prospective population-based study. J Clin Oncol. 2012;30:413-8.

    Article  PubMed  Google Scholar 

  30. Jones LW, Demark-Wahnefried W. Diet, exercise, and complementary therapies after primary treatment for cancer. Lancet Oncol. 2006;7:1017-26.

    Article  PubMed  Google Scholar 

  31. Johns N, Greig C, Fearon KC. Is tissue cross-talk important in cancer cachexia? Crit Rev Oncog. 2012;17:263-76.

    Article  PubMed  Google Scholar 

  32. O’Flynn J, Peake H, Hickson M, et al. The prevalence of malnutrition in hospitals can be reduced: results from three consecutive cross-sectional studies. Clin Nutr. 2005;24:1078-88.

    Article  PubMed  Google Scholar 

  33. Baldwin C, Weekes CE. Dietary counselling with or without oral nutritional supplements in the management of malnourished patients: a systematic review and meta-analysis of randomised controlled trials. J Hum Nutr Diet. 2012;25:411-26.

    Article  CAS  PubMed  Google Scholar 

  34. Carey S, Storey D, Biankin AV, et al. Long term nutritional status and quality of life following major upper gastrointestinal surgery: a cross-sectional study. Clin Nutr. 2011;30:774-79.

    Article  PubMed  Google Scholar 

  35. Wainwright D, Donovan JL, Kavadas V, et al. Remapping the body: learning to eat again after surgery for esophageal cancer. Qual Health Res. 2007;17:759-71.

    Article  PubMed  Google Scholar 

  36. Stratton RJ, Green CJ, Elia M. Disease-related malnutrition: an evidence-based approach to treatment. Wallingford: Cabi Publishing; 2003.

    Google Scholar 

  37. Johansson J, Walther B. Clinical outcome and long-term survival rates after esophagectomy are not determined by age over 70 years. J Gastrointest Surg. 2000;4:55-62.

    Article  CAS  PubMed  Google Scholar 

  38. Deans DA, Tan BH, Wigmore SJ, et al. The influence of systemic inflammation, dietary intake and stage of disease on rate of weight loss in patients with gastro-oesophageal cancer. Br J Cancer. 2009;100:63-69.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Fontaine KR, Barofsky I. Obesity and health-related quality of life. Obes Rev. 2001;2:173-82.

    Article  CAS  PubMed  Google Scholar 

  40. Carey S, He L, Ferrie S. Nutritional management of patients undergoing major upper gastrointestinal surgery: a survey of current practice in Australia. Nutr Diet. 2010;67:219-23.

    Article  Google Scholar 

  41. Ravasco P, Monteiro-Grillo I, Vidal PM, et al. Cancer: disease and nutrition are key determinants of patients’ quality of life. Support Care Cancer. 2004;12:246-52.

    Article  PubMed  Google Scholar 

  42. Malmström M, Ivarsson B, Johansson J, et al. Long-term experiences after oesophagectomy/gastrectomy for cancer: a focus group study. Int J Nurs Stud. 2013;50:44-52.

    Article  PubMed  Google Scholar 

  43. Fearon KC, Jenkins JT, Carli F, et al. Patient optimization for gastrointestinal cancer surgery. Br J Surg. 2013;100:15-27.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None declared.

Author information

Authors and Affiliations

  1. Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden

    Lena Martin RD, PhD

  2. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Lena Martin RD, PhD & Pernilla Lagergren RN, PhD

Authors
  1. Lena Martin RD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pernilla Lagergren RN, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lena Martin RD, PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Martin, L., Lagergren, P. Risk Factors for Weight Loss Among Patients Surviving 5 Years After Esophageal Cancer Surgery. Ann Surg Oncol 22, 610–616 (2015). https://doi.org/10.1245/s10434-014-3973-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-3973-2

Keywords

Search

Navigation