Cultural adaptation and psychometric evaluation of the Swedish version of the Reproductive Concerns After Cancer (RCAC) scale

BACKGROUND: Reproductive concerns are common among young cancer survivors and include worries related to different aspects of fertility and parenthood. The Reproductive Concerns After Cancer (RCAC) scale is an 18-item scale with six dimensions, developed to capture a variety of such concerns. The aim of the present study was to describe the cultural adaptation of the RCAC scale into Swedish and evaluate its psychometric properties among young women who have undergone treatment for cancer. METHODS: The RCAC was forward translated from English into Swedish and assessed for cultural adaptation based on a two-panel approach followed by cognitive interviews with the target group. For the psychometric evaluation, a Swedish cohort of 181 female young adult breast cancer survivors completed a survey including the RCAC scale approximately 1.5 years post-diagnosis. Psychometric properties were examined by analyses of construct validity (confirmatory factor analysis and convergent validity), data quality (score distribution, floor and ceiling effects), reliability and known-groups validity. RESULTS: The confirmatory factor analysis yielded an acceptable fit (RMSEA 0.08, SRMR 0.09, CFI 0.92). Convergent validity was demonstrated by a negative correlation of moderate size (- 0.36) between the RCAC total score and the emotional function scale of the EORTC QLQ-C30. Reliability measured with Revelle Ω total was satisfactory (0.73-0.92) for five of the dimensions, and poor for the dimension Becoming pregnant (Revelle Ω total = 0.60); Cronbach's alpha showed a similar pattern. Known-groups validity was indicated by significant RCAC mean score differences (MD), reflecting more concerns among women with a certain (MD 4.56 [95% CI 3.13 to 5.99]) or uncertain (MD 3.41 [95% CI 1.68 to 5.14]) child wish compared to those with no wish for (additional) children. CONCLUSION: The translation and cultural adaptation of the Swedish RCAC has resulted in a scale demonstrating construct and known-groups validity, and satisfactory reliability for five of six dimensions. The dimension Becoming pregnant showed non-optimal internal consistency and should undergo further evaluation. The Swedish RCAC is recommended to be used in research settings for measurement of concerns related to fertility and parenthood in young women with cancer

Oesophageal cancer surgery : nutritional determinants of survivorship [Elektronisk resurs]

Oesophagectomy, the surgery offered as a curative treatment for cancer of the oesophagus is highly invasive with a radical change in anatomy and carries a risk for significant morbidity and mortality. The recovery is lengthy, burdened by deterioration in health-related quality of life (HRQOL). Eating difficulties and symptoms affecting patients’ nutritional status, termed nutrition impact symptoms (NIS) are commonly reported in the survivorship even up to 10 years after surgery. Clinically noticeable weight loss is a problem right from diagnosis but also persists after surgery as a troublesome trait of the survivorship. Hence, this thesis aimed to clarify how nutritional problems after surgery for oesophageal cancer influence HRQOL and survival, and to assess the role of dietitian support in improving nutritional status and thereby contribute to the clinical decision-making process. Studies I-IV included in this thesis are prospective cohort studies in design based on two large cohorts comprising of patients who underwent surgery for oesophageal cancer in Sweden. Studies I and II were based on a prospective cohort including patients operated between 2001 and 2005 and followed up for HRQOL and nutritional outcomes until 2015. Studies III and IV were based on a cohort of patients who underwent surgery from 2013 and 2016 and followed up for one and half years after surgery. Clinical variables obtained from medical charts of patients included in both the cohorts provided the possibility to adjust for potential confounders. In Study I, the interactive influence of eating difficulties and weight loss on HRQOL up to 10 years after oesophagectomy were assessed. Severe eating difficulties irrespective of the degree of weight loss were associated with clinically and significantly worse HRQOL in almost all aspects up to 10 years after surgery. Study II examined the combined effect of NIS and weight loss on specific HRQOL aspects at six months after surgery and five-year overall survival, stratified by preoperative body mass index (BMI). Patients with severe NIS, regardless of preoperative BMI status and extent of postoperative weight loss, exhibited worse HRQOL. Patients with a higher preoperative BMI and postoperative weight loss, showed worse survival when they experienced severe NIS after surgery. Study III investigated the impact of symptoms of early and late dumping syndrome at one year after surgery for oesophageal cancer on specific HRQOL aspects. Clinically and statistically relevant differences in several HRQOL aspects were seen in both early and late dumping when compared with no dumping, with late dumping showing worse effects. Study IV evaluated if preoperative dietitian support in addition to postoperative support and a high level of patient reported satisfaction of the support are associated with an improved nutritional status. No differences in nutritional status existed with respect to whether dietitian support was initiated preoperatively or postoperatively and with regards to the level of satisfaction of the support as reported by patients. In conclusion, symptoms that affect eating and in turn nutrition, experienced after surgery for oesophageal cancer are important determinants of HRQOL. In those who are overweight or obese before surgery the presence of severe nutritional problems after surgery adversely impacted survival. Patients with symptoms of dumping syndrome, especially late dumping have poorer HRQOL and need attention. Preoperative dietitian support and high level of patient satisfaction of the support did not determine the nutritional status but are integral components of nutritional status

Predicting the risk of weight loss after esophageal cancer surgery

Background Malnutrition after esophageal cancer surgery is associated with reduced health-related qualify of life. Therefore, a prediction model identifying patients at risk for severe weight loss after surgery was developed. Methods Data from a Swedish population-based cohort study, including 616 patients undergoing esophageal cancer surgery in 2001–2005, was used. Candidate predictors included risk factors available before and immediately after surgery. Severe weight loss was defined as ≥ 15% loss of body weight between the time of surgery and 6 months postoperatively. The prediction model was developed using multivariable models. The accuracy of the model was measured by the area under the receiver operating characteristics curve (AUC) with bootstrap validation. The model was externally validated in a hospital-based cohort of 91 surgically treated esophageal cancer patients in the United Kingdom in 2011–2016. Each predictor in the final model was assigned a corresponding risk score. The sum of risk scores was equivalent to an estimated probability for severe weight loss. Results Among the 351 patients with 6 months follow-up data, 125 (36%) suffered from severe postoperative weight loss. The final prediction model included body mass index at diagnosis, preoperative weight loss, and neoadjuvant therapy. The AUC for the model was 0.78 (95% CI 0.74–0.83). In the validation cohort, the AUC was 0.76. A clinical risk assessment guide was derived from the prediction model. Conclusions This prediction model can preoperatively identify individuals with high risk of severe weight loss after esophageal cancer surgery. Intensive nutritional interventions for these patients are recommended. Nutritional problems are common in esophageal cancer patients, with a significant proportion of patients already suffering from severe weight loss at diagnosis.1, 2, 3 Malnutrition after extensive gastrointestinal surgery has been associated with poor postoperative recovery, reduced survival rate, and deterioration in health-related quality of life (HRQOL).4, 5, 6, 7 The underlying cause of such malnutrition is complex and multifactorial. The primary symptom of esophageal cancer is progressive dysphagia, caused by an obstructing tumor.3,8 This may lead to the increased basal metabolism not being met due to insufficient caloric intake, which results in weight loss. The weight loss also can be related to the cancer treatment. Chemoradiotherapy, which often is included in the esophageal cancer treatment, can contribute to catabolic muscle loss.9,10 During esophagostomy, a large part of the stomach is reconstructed into a tube, which replaces the removed esophagus and upper stomach.11 This may lead to the normal capacity of the stomach being lost. The altered anatomy with the missing reservoir function is usually accompanied by physiological issues with pancreatic insufficiency and/or gastric dumping syndrome and often presents as eating difficulties.12 There also is a psychological aspect of the problem, where the diagnosis and treatment can result in depressive symptoms, which may in turn further reduce appetite.5 To prevent or reduce such involuntary weight loss, a method for identifying patients at risk at an early postoperative stage would be beneficial for tailored follow-up planning. The at-risk patients could then be further screened to plan individually for nutritional support in those with poor nutritional status.13,14 The purpose of this study was to develop and externally validate a prediction model identifying patients at risk for severe weight loss after esophageal cancer surgery, by using objective parameters measured preoperatively or immediately after surgery

Nutrition impact symptoms are prognostic of quality of life and mortality after surgery for oesophageal cancer

We aimed to clarify the influence of nutritional problems after surgery for oesophageal cancer on functional health related quality of life (HRQOL) and survival. A prospective nationwide cohort of oesophageal cancer patients operated 2001⁻2005 in Sweden with 6 months postoperative follow up was used. Nutritional problems were categorized as low/moderate/severe/very severe based on weight loss and nutrition impact symptoms. An ANCOVA model calculated mean score differences (MD) with 95% confidence intervals (CI) of global quality of life (QOL), social and physical function scores, stratified by preoperative body mass index (BMI) <25 and ≥25. A Cox proportional hazards model produced hazard ratios (HR) with 95% CI for overall 5-year survival. Of 358 patients, 196 (55%) had preoperative BMI ≥25. Very severe and severe nutritional problems were associated with worse HRQOL in both BMI groups. E.g. MD's for global QOL among 'very severe' group was -29 (95% CI -39⁻-19) and -20 (95% CI -29⁻-11) for <25 and ≥25 BMI, respectively, compared to the 'low' group. Overall 5-year survival among 'very severe' and BMI ≥ 25 was worse; HR 4.6 (95% CI 1.4⁻15.6). Intense nutritional problems negatively impact postoperative HRQOL and combined with preoperative BMI ≥ 25 are associated with poorer 5-year overall survival representing a group needing greater clinical attention