Objectives:
Oesophago-gastric cancer surgery is associated with significant short-term deficits in physical function which can result in difficulties in returning to physical activity post-operatively and impair quality of life in survivorship. The aim of this study was to investigate patients’ perspectives of their physical recovery in the first six months post upper gastro-intestinal surgery. Specific objectives were to examine patients perspectives in relation to: i) their ability to return to physical activity, ii) barriers to returning to physical activity and activities of daily living, and iii) patient-reported rehabilitative needs in the first six months post-oesophagectomy/gastrectomy.
Methods:
Semi-structured interviews were held at St James’s Hospital, Dublin with participants who were 4 weeks to 6 months post oesophagectomy/gastrectomy. Interviews lasted approximately 14 minutes and included questions pertaining to physical recovery following oesophagectomy or gastrectomy. Interviews were audio-taped, transcribed verbatim, and analyzed by thematic analysis.
Results:
Seventeen participants (mean age 62.78 (7.27) years, mean time post-surgery 5.5(1.04) months) were recruited. Participants’ perspectives on recovery were coded into five main themes: i) impact of the recovery process on return to physical activity, ii) barriers to, and facilitators of, returning to physical activity post-operatively, iii) challenges of returning to pre-operative societal role functions, iv) importance of personal and professional support during recovery, and v) recommendations for health services on measures which may enhance the return to physical activity following oesophago-gastric cancer surgery.
Participants reported feeling satisfied with their overall recovery, but identified that issues such as ongoing dietary symptoms, continuing treatments (chemotherapy), other comorbidities, and post-operative complications impeded return to physical activity. Participant reported physical and psychosocial barriers to returning to pre-operative levels of physical activity included pain, breathlessness, muscle weakness, fatigue, fear, and anxiety. Participants also identified strategies which facilitate physical activity participation, such as a gradual return to activities and the incorporation of rest periods into their daily routine. Participants reported difficulties in returning to societal roles held before surgery, such as; familial responsibilities, professional roles, and leisure pursuits. The support of family, friends, colleagues and health care professionals in physical recovery was acknowledged as essential for a positive recovery. Participants recommended that the following resources may aid postoperative recovery: i) enhanced physiotherapy input including; pain and scar management, thoracic and upper-limb range of motion exercise, and aerobic and resistance exercise prescription, ii) improved psycho-social support, and iii) individual goal setting from health care professionals with regard to return to physical activity.
Conclusion:
This study indicates that in the first few months following oesophago-gastric surgery, patients experience difficulties which can impair their ability to re-engage in physical activity. Many of the physical difficulties described (e.g. pain, sensation loss, fatigue, reduced fitness, and muscle atrophy) are amenable to physiotherapeutic intervention. Since these physical difficulties can profoundly and negatively impact psychosocial wellbeing, the potential positive impact of physiotherapeutic intervention during this early recovery period should not be underestimated. There has been little research to date on rehabilitative interventions following oesophago-gastric cancer surgery; this study emphasizes the need for multidisciplinary rehabilitative interventions which aim to improve the physical and mental health of patients in the first six months of recovery from oesophago-gastric cancer surgery.
Ethical Approval:
Ethical approval was obtained from the SJH/AMNCH Research Ethics Committee (REC Reference: 2016-11 Chairman’s Action (9)).
