Symptom clusters after surgery for esophageal cancer predict poor prognosis

A new study from Karolinska Institutet show 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 scientific journal Cancer.

Esophageal cancer is an aggressive cancer with a very poor prognosis, and surgery to remove the esophagus offers the only chance of a cure. Only about a quarter of patients who are diagnosed receive surgery, in the rest, the tumour is too advanced to remove. In patients who do undergo surgery, only 30 percent are still 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 and daily living. Common symptoms include eating and swallowing problems, acid reflux, pain, and fatigue.

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.

The current study includes 402 patients who underwent surgery for esophageal cancer in Sweden during the period 2001-2005. Researcher Anna Wikman, PhD, and her colleagues at Karolinska Institutet, 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.

"This is the first study of symptom clusters in surgically treated esophageal cancer patients and further research is required to confirm the findings, however the present study suggest that that post-operative symptoms should not be considered in isolation," says Dr Wikman. "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. 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."

Anna Wikman is a health psychologist and holds a postdoc position at Karolinska Institutet’s Department of Molecular Medicine and Surgery.


Anna Wikman, Asif Johar, Pernilla Lagergren
Presence of symptom clusters in surgically treated esophageal cancer patients - implications for survival
Cancer - a peer-reviewed journal of the American Cancer Society, online 25 November 2013, doi: 10.1002/cncr.28308