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Upper Gastrointestinal (lips to ileocecal valve, including esophagus and stomach)

E454: Patient Perceived Impact of Quality-of-Life Following Gastrectomy for Gastric Cancer

Introduction: Patient reported outcomes can guide clinical decision-making and set expectations for postoperative recovery. This study evaluated quality of life (QoL) outcomes and patient perceived significance of change in physical (PF) and mental functioning (MF) following gastrectomy for gastric cancer.

Methods: Patients diagnosed with gastric cancer between 2020-2023 prospectively completed SF-12 and EORTC QLQ-STO22 surveys pre and post (0-3, 3-12, and/or >12 months) gastrectomy. Mean (M) SF-12 PF and MF were compared to population norms with one sample t-tests. Patient perceived change in postoperative PFs and MFs relative to baseline were measured by absolute minimal important difference effect size (mild ES 0.2-0.5; moderate ES ≥0.5). Stratified analysis was performed for procedure type (subtotal (SG) vs. total gastrectomy (TG)). Relationships between STO22 symptom scales (pain, fatigue, and eating difficulty) and PF and MF were measured with Pearson’s correlation (r).

Results:

49 patients were recruited and 20 were excluded due to metastatic disease diagnosed on staging or no surveys completed. Among 29 patients, median age was 74 [61-78] years, 13 were female, and 18 had subtotal gastrectomy. Compared to population norms (M=43.65), PF was worse at baseline (M=37.62, p< 0.001), 0-3 (M=32.07, p< 0.001), and 6-12 months (M=37.01, p=0.02) after gastrectomy but improved after 12 months (M=40.75, p=0.36). Similarly, MF (M=52.10) was worse at baseline (M=44.15, p< 0.001), 0-3 (M=40.03, p< 0.001), and 6-12 months (M=43.09, p=0.02) post gastrectomy but improved after 12 months (M=48.18, p=0.07). Moderate patient perceived decline in PF was reported 0-3 months after gastrectomy (ES=0.74) and improved mildly after 12 months (ES=0.42). Patient perceived MF declined at 0-3 months (ES=0.38) but improved mildly after 12 months (ES=0.37). Stratified analysis showed that SG patients perceived mild improvement in PF at 6-12 months (ES=0.22) while moderate decline (ES=0.69) continued in TG patients. At 0-3 months, lower PF was significantly correlated with eating difficulties (r= -0.64, p=0.004). At 6-12 months and >12 months, worse MF correlated with greater fatigue (r=-0.75, p=0.008) and pain (r=-0.89, p=0.008), respectively.

Conclusions:

Decline was observed in PF and MF early after gastrectomy, particularly in TG patients, but recovered to population baseline after one year. Early postoperative eating difficulties and longer-term fatigue and pain symptoms correlated with reduced functioning.

Learning Objectives:

  • Upon completion, participants will be able to demonstrate appreciation of quality of life measures as a tool in facilitating patient expectations in postoperative recovery after gastrectomy for gastric cancer.
  • Upon completion, participants will be able to describe the longitudinal changes in physical and mental functioning relative to baseline after gastrectomy for gastric cancer.
  • Upon completion, participants will be able to list early and long-term symptoms after gastrectomy for gastric cancer that correlate with changes in physical and mental functioning.