A new study from Sweden has found that several months after surgery for esophageal cancer, different symptoms cluster together in different types of patients. In addition, patients with certain symptom clusters have an increased risk of dying from their disease. The findings are published in the November 25, 2013 online edition of Cancer, a peer-reviewed journal published by the American Cancer Society (ACS).[1]

Esophageal cancer is an aggressive cancer with a very poor prognosis. The American Cancer Society Estimates 17,900 new cases and 15,2010 deaths from esophageal cancer in the United States in 2013. [2] While esophageal cancer is a treatable disease, it is rarely curable. The primary treatment modalities include surgery alone or chemotherapy with radiation therapy. Combined modality therapy (i.e., chemotherapy plus surgery, or chemotherapy and radiation therapy plus surgery) is under clinical evaluation.


These findings suggest that post-operative symptoms should not be seen in isolation but as clusters of symptoms.


The available data show that only about a quarter of patients who are diagnosed receive surgery ? in most other patients the tumor is too advanced to remove or the patient is not fit for such extensive surgery. Furthermore, only 30% of patients who do undergo surgery are alive five years after the surgery. The surgery is very extensive, and patients experience severe post-operative symptoms and limitations that affect their quality of life (QoL) and daily living. Common symptoms include eating and swallowing problems, reflux, pain, and fatigue.

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Symptom Clusters
Research of symptoms in other cancers suggests that symptoms experienced by patients may present in specific groupings or clusters, and that these clusters may have an important impact on patient outcomes.

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In the current study of 402 patients who underwent surgery for esophageal cancer, Anna Wikman, PhD, of the Karolinska Institutet in Stockholm, Sweden, and her colleagues found that symptoms reported by patients six months after surgery clustered together in three groups: one symptom cluster included symptoms related to fatigue and pain, another cluster included symptoms related to reflux and cough, and a third cluster included symptoms related to eating difficulties. The patients who experienced the reflux/cough symptom cluster and the eating difficulties cluster were more likely to die within five years than patients who did not experience these symptom clusters.

Not to be considered in isolation
“As this is the first study of symptom clusters in surgically treated esophageal cancer patients, further work is needed to confirm the existence of these symptom clusters in this patient population. However, the present findings do suggest that post-operative symptoms should not be considered in isolation but that clusters of symptoms must be considered,” Wikman said. “It seems that patients who experience clustering of certain symptoms also have an increased mortality risk over and above the effect of other known prognostic factors. 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.”

For more information:
[1] Wikman A, Johar A, Lagergren P. Presence of symptom clusters in surgically treated patients with esophageal cancer: Implications for survival. Cancer. 2013 Nov 25. DOI: 10.1002/cncr.28308 [Article]
[2] American Cancer Society.: Cancer Facts and Figures 2013. Atlanta, Ga: American Cancer Society, 2013.[Article]

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