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van Egmond M1,2,3, van der Schaaf M1,3, Klinkenbijl J4, Twisk J5, Engelbert R1,3, van Berge Henegouwen M6
1Amsterdam UMC, Location AMC, Rehabilitation, Amsterdam, Netherlands, 2Amsterdam University of Applied Sciences, European School of Physiotherapy, Amsterdam, Netherlands, 3Amsterdam University of Applied Sciences, Amsterdam Center for Innovative Health Practice (ACHIEVE), Amsterdam, Netherlands, 4Gelre Hospital Apeldoorn-Zutphen, Surgery, Apeldoorn, Netherlands, 5Amsterdam UMC, Location VUmc, Epidemiology and Biostatistics, Amsterdam, Netherlands, 6Amsterdam UMC, Location AMC, Surgery, Amsterdam, Netherlands
Background: The prevalence of postoperative complications (POC) in patients with esophageal cancer undergoing esophagectomy is high (60%) and contributes to prolonged hospital stay and postoperative morbidity. Preoperative functional status has been identified as a major risk factor for POC in several surgical populations. However, knowledge on the pre- and postoperative course of functional status as well as on risk factors in patients after esophagectomy is limited. Physiotherapy is important to improve functional status in the pre- and postoperative stage.
Purpose: In order to optimally target the physiotherapy treatment, the objective of this study was to investigate the course of functional status in patients with esophageal cancer before and after esophagectomy.
Methods: In this prospective longitudinal study, we obtained functional status data of a consecutive series of patients with esophageal cancer who underwent surgery between March 2012 and June 2016. We measured outcomes of functional status, i.e. respiratory muscle strength, handgrip strength, walking capacity, functional strength of the lower extremity, fatigue, daily activities and Health Related Quality of Life 3 months and 1 day before (T1 and T2) and 1 week and 3 months after surgery (T3 and T4). We used analysis of repeated measurements with the mixed model approach to study changes over time in functional status outcome measures.
Results: We assessed 155 (100%) participants 3 months and 1 day before surgery, 109 (70.3%) 1 week after surgery and 60 (55%) 3 months later. Participants were not measured amongst others due to POC (12.9%) and refusal to further cooperate (5.8%), but they did not significantly differ in baseline characteristics from the participants who completed all measurements.
Mean level of functional status before surgery was higher than predicted, corrected for gender and age. Directly after surgery, all aspects of functional status were significantly decreased compared but 3 months after surgery all mean functional status measures restored to baseline levels.
The incidence of POC was 53.5% (n=83) and these patients had a significantly longer hospital stay of median (IQR) 17 (9-30) days (p≤0.01). However, there was no difference in course of functional status between patients with and without complications.
In patients with low functional status at baseline (T1), functional status remained low at T2, 3 and 4, however this group did not differ in the incidence of POC compared to the group that scored high on functional status at baseline.
Conclusion(s): This study showed that functional status of patients with esophageal cancer treated with esophagectomy was on average higher than compared to normative values 3 months and 1 day before surgery and restored to baseline levels 3 months postoperatively with an expected decline directly after surgery, irrespective of the incidence of POC.
Implications: This study shows the importance of investigating the pre- and postoperative course of functional status in different stages of recovery in order to determine who might suffer from a delayed postoperative recovery and could be indicated for tailored physiotherapy.
Keywords: Physiotherapy, functional status, surgery
Funding acknowledgements: This work was supported by a Doctoral Grant for Teachers in 2014 from the Netherlands Association for Scientific Research (NWO).
Purpose: In order to optimally target the physiotherapy treatment, the objective of this study was to investigate the course of functional status in patients with esophageal cancer before and after esophagectomy.
Methods: In this prospective longitudinal study, we obtained functional status data of a consecutive series of patients with esophageal cancer who underwent surgery between March 2012 and June 2016. We measured outcomes of functional status, i.e. respiratory muscle strength, handgrip strength, walking capacity, functional strength of the lower extremity, fatigue, daily activities and Health Related Quality of Life 3 months and 1 day before (T1 and T2) and 1 week and 3 months after surgery (T3 and T4). We used analysis of repeated measurements with the mixed model approach to study changes over time in functional status outcome measures.
Results: We assessed 155 (100%) participants 3 months and 1 day before surgery, 109 (70.3%) 1 week after surgery and 60 (55%) 3 months later. Participants were not measured amongst others due to POC (12.9%) and refusal to further cooperate (5.8%), but they did not significantly differ in baseline characteristics from the participants who completed all measurements.
Mean level of functional status before surgery was higher than predicted, corrected for gender and age. Directly after surgery, all aspects of functional status were significantly decreased compared but 3 months after surgery all mean functional status measures restored to baseline levels.
The incidence of POC was 53.5% (n=83) and these patients had a significantly longer hospital stay of median (IQR) 17 (9-30) days (p≤0.01). However, there was no difference in course of functional status between patients with and without complications.
In patients with low functional status at baseline (T1), functional status remained low at T2, 3 and 4, however this group did not differ in the incidence of POC compared to the group that scored high on functional status at baseline.
Conclusion(s): This study showed that functional status of patients with esophageal cancer treated with esophagectomy was on average higher than compared to normative values 3 months and 1 day before surgery and restored to baseline levels 3 months postoperatively with an expected decline directly after surgery, irrespective of the incidence of POC.
Implications: This study shows the importance of investigating the pre- and postoperative course of functional status in different stages of recovery in order to determine who might suffer from a delayed postoperative recovery and could be indicated for tailored physiotherapy.
Keywords: Physiotherapy, functional status, surgery
Funding acknowledgements: This work was supported by a Doctoral Grant for Teachers in 2014 from the Netherlands Association for Scientific Research (NWO).
Topic: Oncology, HIV & palliative care; Outcome measurement
Ethics approval required: No
Institution: Academic Medical Center
Ethics committee: Medical Ethics Commitee
Reason not required: The medical ethics committee of the Academic Medical Center Amsterdam waived the need for informed consent, because the measurements in this study were performed as part of standard physiotherapeutic care according to and in line with ‘Good Clinical Practice’.
All authors, affiliations and abstracts have been published as submitted.
