Challenges in Nutritional Management for Patients With Esophageal Cancer

A recent systematic review and meta-synthesis of literature explored issues regarding nutritional management in esophageal cancer from the perspective of patients. The findings of this analysis were reported in the journal Supportive Care in Cancer.

“Challenges associated with nutritional management were primarily related to eating difficulties, symptoms, and dietary changes, resulting in negative emotions, exacerbated by inappropriate social support and inadequate nutritional management,” explained the researchers conducting the analysis in their report.

The analysis was a systematic review and meta-synthesis of qualitative studies written in either Chinese or English. Studies were identified through PubMed, Web of Science, Cochrane Library, CINAHL, Embase, CNKI, WanFang, VIP, and SinoMed databases. A total of 19 articles, with publication dates between 2002 and 2022, were included in the analysis. A total of 309 patients were included across these articles overall, of whom 256 had esophageal cancer.

The researchers identified 3 major themes in this study regarding nutritional management: dietary experiences, emotional experiences, and social support. 

• For dietary experiences, subthemes included perception of symptoms and dietary behaviors. 
• For emotional experiences, positive and negative emotions were subthemes. 
• Regarding social support, subthemes involved inappropriate social support and inadequate nutritional management. 

Most patients appeared to have undergone significant changes in perception of diet upon starting treatment and rehabilitation. These changes were in the setting of various gastrointestinal symptoms, ranging from difficulties with swallowing to nausea and vomiting, and others. Additionally, patients expressed concern regarding changes in body shape and body image. 

Dietary behaviors included shifts in eating awareness, inadequate involvement in decision making regarding diet, and variety of changes in dietary habits. Anxiety and worries, doubt and compromise, loneliness and helplessness, and avoidance and embarrassment were negative emotional experiences patients faced. In later stages of treatment, a more optimistic outlook was expressed by some patients.

Inappropriate social support appeared to include overprotectiveness, such as by family members, and limited peer support, with most patients not encountering others who had similar experiences. Inadequate nutritional support and guidance was also reported by patients, including insufficient patient information and incomplete nutritional management systems at medical institutions. 

“Medical institutions should expedite the development of comprehensive nutritional management systems, establish professional multidisciplinary teams, create favorable nutritional environments, and maximize the effectiveness of nutritional therapy for EC [esophageal cancer] patients to promote early recovery,” the researchers concluded. 

Reference

Wang X, Liu X, Gu Z, Li X, Shu Y. Experiences and requirements in nutritional management of patients with esophageal cancer: a systematic review and qualitative meta‑synthesis. Support Care Cancer. 2023;31(12):633. doi:10.1007/s00520-023-08100-y