Identifying a core symptom set triggering radiological and endoscopic investigations for suspected recurrent esophago-gastric cancer: a modified Delphi consensus process.
Chidambaram, Swathikan Patel, Nikhil M Sounderajah, Viknesh Alfieri, Rita Bonavina, Luigi Cheong, Edward Cockbain, Andy D'Journo, Xavier Benoit Ferri, Lorenzo Griffiths, Ewen A
Chidambaram, Swathikan
Patel, Nikhil M
Sounderajah, Viknesh
Alfieri, Rita
Bonavina, Luigi
Cheong, Edward
Cockbain, Andy
D'Journo, Xavier Benoit
Ferri, Lorenzo
Griffiths, Ewen A
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2022-12-31
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Abstract
Background: There is currently a lack of evidence-based guidelines regarding surveillance for recurrence after esophageal and gastric (OG) cancer surgical resection, and which symptoms should prompt endoscopic or radiological investigations for recurrence. The aim of this study was to develop a core symptom set using a modified Delphi consensus process that should guide clinicians to carry out investigations to look for suspected recurrent OG cancer in previously asymptomatic patients.
Methods: A web-based survey of 42 questions was sent to surgeons performing OG cancer resections at high volume centers. The first section evaluated the structure of follow-up and the second, determinants of follow-up. Two rounds of a modified Delphi consensus process and a further consensus workshop were used to determine symptoms warranting further investigations. Symptoms with a 75% consensus agreement as suggestive of recurrent cancer were included in the core symptom set.
Results: 27 surgeons completed the questionnaires. A total of 70.3% of centers reported standardized surveillance protocols, whereas 3.7% of surgeons did not undertake any surveillance in asymptomatic patients after OG cancer resection. In asymptomatic patients, 40.1% and 25.9% of centers performed routine imaging and endoscopy, respectively. The core set that reached consensus, consisted of eight symptoms that warranted further investigations included; dysphagia to solid food, dysphagia to liquids, vomiting, abdominal pain, chest pain, regurgitation of foods, unexpected weight loss and progressive hoarseness of voice.
Conclusion: There is global variation in monitoring patients after OG cancer resection. Eight symptoms were identified by the consensus process as important in prompting radiological or endoscopic investigation for suspected recurrent malignancy. Further randomized controlled trials are necessary to link surveillance strategies to survival outcomes and evaluate prognostic value.
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Chidambaram S, Patel NM, Sounderajah V, Alfieri R, Bonavina L, Cheong E, Cockbain A, D'Journo XB, Ferri L, Griffiths EA, Grimminger P, Gronnier C, Gutschow C, Hedberg J, Kauppila JH, Lagarde S, Low D, Nafteux P, Nieuwenhuijzen G, Nilsson M, Rosati R, Schroeder W, Smithers BM, van Berge Henegouwen MI, van Hillegesberg R, Watson DI, Vohra R, Maynard N, Markar SR. Identifying a core symptom set triggering radiological and endoscopic investigations for suspected recurrent esophago-gastric cancer: a modified Delphi consensus process. Dis Esophagus. 2022 Dec 31;36(1):doac038. doi: 10.1093/dote/doac038
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Article