Systematic Review and Meta-Analysis of Patient Experiences of Oesophageal Cancer Survivorship After Oesophagectomy.
Despite improving survival rates, the complexity of post-operative survivorship for oesophageal cancer patients remains poorly understood. This mixed-methods review explores quantitative health-related quality-of-life (HRQoL) outcomes and qualitative survivor experiences to provide a comprehensive, person-centred perspective.
A convergent synthesis framework was employed to examine patient perspectives on survivorship following oesophageal cancer resection. A systematic search of the literature was undertaken across four databases to identify studies reporting EORTC QLQ-C30 and QLQ-OES18 outcomes and qualitative research exploring post-operative experiences. Quantitative studies underwent random-effects meta-analysis to examine HRQoL trajectories from baseline to 5 years post-operatively. Qualitative studies underwent thematic synthesis following Thomas and Harden's established three-stage framework.
Fifty-seven studies were included, consisting of 40 quantitative and 17 qualitative studies. HRQoL followed a triphasic pattern with a marked deterioration at 6 months, partial recovery by 12-36 months, followed by a plateau with persistent symptoms at 5 years. Reflux, eating restriction and fatigue were the most prevalent symptoms following oesophagectomy. Thematic synthesis identified five domains of oesophageal cancer survivorship; digestive disruption, physical impairment, psychosocial impact, navigating healthcare and support systems, and striving for normalcy. Qualitative accounts revealed challenges under-represented in quantitative measures, including an altered relationship with food, fear of recurrence, as well as identity loss.
Post-oesophagectomy survivorship is a sustained process of adaptation, not a return to baseline health. Current oncology-centred care models overlook chronic, multidimensional needs of patients. Integrated survivorship pathways combining nutritional support, rehabilitation, and psychosocial support are essential to restore agency and improve long-term wellbeing.
A convergent synthesis framework was employed to examine patient perspectives on survivorship following oesophageal cancer resection. A systematic search of the literature was undertaken across four databases to identify studies reporting EORTC QLQ-C30 and QLQ-OES18 outcomes and qualitative research exploring post-operative experiences. Quantitative studies underwent random-effects meta-analysis to examine HRQoL trajectories from baseline to 5 years post-operatively. Qualitative studies underwent thematic synthesis following Thomas and Harden's established three-stage framework.
Fifty-seven studies were included, consisting of 40 quantitative and 17 qualitative studies. HRQoL followed a triphasic pattern with a marked deterioration at 6 months, partial recovery by 12-36 months, followed by a plateau with persistent symptoms at 5 years. Reflux, eating restriction and fatigue were the most prevalent symptoms following oesophagectomy. Thematic synthesis identified five domains of oesophageal cancer survivorship; digestive disruption, physical impairment, psychosocial impact, navigating healthcare and support systems, and striving for normalcy. Qualitative accounts revealed challenges under-represented in quantitative measures, including an altered relationship with food, fear of recurrence, as well as identity loss.
Post-oesophagectomy survivorship is a sustained process of adaptation, not a return to baseline health. Current oncology-centred care models overlook chronic, multidimensional needs of patients. Integrated survivorship pathways combining nutritional support, rehabilitation, and psychosocial support are essential to restore agency and improve long-term wellbeing.
Authors
Sivakumar Sivakumar, Dao Dao, Alnimri Alnimri, Liu Liu, Chen Chen, Laidsaar-Powell Laidsaar-Powell, Hii Hii, Duong Duong
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