Monday 3rd December 2012
A change to dietary protocol improves recovery after surgical resection of oesophageal cancer - Fiona Macharg explains.
Oesophageal cancer is the fifth most common cancer in the UK. Despite improvements in diagnosis and treatment, only 20% of people diagnosed are suitable for curative treatment. The best chance of survival is with an oesophageal resection. This major surgical procedure has a high mortality risk, a 9-12 month recovery time, and results in life-long changes to basic dietary habits.
Oesophageal resection significantly alters the gastrointestinal tract, not only reducing a person’s capacity for food, but also digestive capabilities and psychological associations with food. Inadequate nutritional intake can have significant consequences, including: impaired immune function, weakness and fatigue, immobility and social isolation, poor quality of life, and an increased burden on the NHS.
I support patients through diagnosis, treatment and recovery from surgery. They will have a feeding tube (jejunostomy) sited at the time of their surgery to provide access for nutrition support post-operatively, and be given detailed dietary advice to support the re-introduction of an oral diet.
Our previous practice was to remove the feeding tube shortly after discharge. We audited this practice and found that 51% of patients were unable to meet their nutritional requirements orally, subsequently losing a significant amount of weight and needing to recommence enteral nutrition support in the first three months following discharge. This was clearly impacting on the patients’ recovery.
In April 2011, we changed our postoesophagectomy nutrition support protocol, extending the period of time patients received supplementary nutrition.
We monitored patients’ weights and readmission rates and compared it to the results prior to changing our practice.
Sixty-seven consecutive patients undergoing oesophageal resection for cancer of the oesophagus were analysed.
This included 46 patients prior to our change in practice, and 21 following the new protocol. Patients who did not routinely continue their supplementary nutrition on discharge experienced a mean weight loss of 6kg (range of 14.7kg-2.1kg) in the first three months following discharge, with 16 patients experiencing clinically significant weight loss (>10%).
51% of these patients recommenced supplementary nutrition at some point during this time and nine (24%) were readmitted to the unit.
Patients who continued receiving supplementary nutrition support after discharge experienced a mean weight loss of 3.8kg (range of 10.3kg-4.8kg) with four maintaining or gaining weight.
Three (17%) patients were readmitted to the unit. The readmission rate was 24% in the first group and 17% in the second group.
Our results showed that patients who had continued on supplementary nutrition had significantly less weight loss than those who didn't have planned feeding (p=0.03). The readmission rate was also reduced. By auditing our practice and making changes to our management protocols, our patients’ post-oesophagectomy recovery has improved, allowing patients to recover quicker and get back to their normal lives.
Thanks to an education grant from Macmillan, I presented our research at the International Society of Diseases of the Esophagus Annual Conference in October.
Video - oesophageal cancer explained by an oncologist
Email Fiona Macharg, Macmillan Oesophago-Gastric Specialist Dietitian, Royal Surrey County Hospital & St Luke's Cancer Centre.