Severe reflux, sleep disturbances, and health-related quality of life after esophageal cancer surgery

Abstract

Purpose Esophagectomy for cancer is an extensive procedure often followed by severe complications. This study investigated whether patients with severe symptoms of reflux are more likely to have sleep disturbances and reduced health-related quality of life (HRQL) after esophagectomy. Methods This Swedish nationwide prospective cohort study encompassed all patients who had undergone esophagectomy for cancer between 2013 and 2018. One year after surgery, the patients responded to three questionnaires on reflux (EORTC QLQOG25), sleep disturbances (KSQ), and HRQL (EORTC QLQ-C30). Multivariable logistic regression provided odds ratios (OR) with 95% confidence intervals (CI) for sleep disturbance/reduced HRQL between patients with and without reflux, adjusted for potential confounders. Results Among 241 esophagectomy patients, 66 (27%) reported severe reflux. Patients with reflux had an increased risk of sleep disturbances (OR 2.3, 95% CI: 1.3–4.3) compared to patients without reflux. More specifically, these patients were more likely to suffer from poor sleep quality (OR 4.9, 95% CI: 1.9–12.4). Patients with reflux and sleep disturbances reported reductions in global quality of life, role function, emotional function, social function, and more symptoms in all scales, except for dyspnea. Conclusions This study suggests that patients with severe symptoms of reflux after esophagectomy have an increased risk of sleep disturbances and poor sleep quality, which in turn are associated with reduced HRQL. Implications for Cancer Survivors Alleviating reflux after oesophageal cancer surgery is important, since this common symptom might reduce HRQL and well-being.

Reliability and validity of the cancer-related dysfunctional beliefs and attitudes about sleep scale in cancer patients

“…The data shows that in 2020, the number of newly diagnosed cancer cases in China exceeded 4.56 million, accounting for 23.7% of the global total of newly diagnosed cancer cases [ 48 ]. The prevalence of sleep disorders, including insomnia, is relatively high among cancer patients, which has a detrimental impact on their overall quality of life and cancer treatment outcomes [ 49 – 51 ]. Sleep beliefs and attitude play a crucial role in the onset, development and maintenance of insomnia problems, as well as in their treatment.…”

Reliability and validity of the cancer-related dysfunctional beliefs and attitudes about sleep scale in cancer patients

“…The data shows that in 2020, the number of newly diagnosed cancer cases in China exceeded 4.56 million, accounting for 23.7% of the global total of newly diagnosed cancer cases [42]. The prevalence of sleep disorders, including insomnia, is relatively high among cancer patients, which has a detrimental impact on their overall quality of life and cancer treatment outcomes [43][44][45]. Sleep beliefs and attitude play a crucial role in the onset, development and maintenance of insomnia problems, as well as in their treatment.…”

The association between sleep problems and general quality of life in cancer patients and in the general population

“…The validity of this scale was underlined by the correlation between this one-item scale and the Jenkins Sleep Scale of 0.73 (Hofmeister et al, 2020) in a large sample of mixed cancer patients and between 0.74 and 0.81 in colorectal cancer survivors (Legg et al, 2022). Moreover, the association between the EORTC QLQ-C30 sleep scale and the 18-item Karolinska Sleep Questionnaire was characterized by an odds ratio of 8.2 (Lagergren et al, 2021) in a study with esophageal cancer patients. Normative values of the EORTC QLQ-C30 including the sleep scale are available for several countries (Hinz et al, 2014;Nolte et al, 2019).…”