Nurse-led Follow-up and Palliative Care of Esophageal Cancer Patients

Approximately 400,000 patients are annually diagnosed world-wide with esophageal cancer, which makes this malignancy the eight most common cancer (1). The incidence of esophageal cancer has risen remarkably over the past two decades in the Western world, because of a marked increase in the incidence of adenocarcinoma (2, 3). In the Netherlands, on average 1100 new patients are diagnosed annually with esophageal cancer. The prognosis of esophageal cancer is poor with a 5-year survival of 10-15% (4, 5). If a patient is able to undergo surgery and the tumor is considered resectable without evidence of distant metastases, a surgical resection is the primary treatment for esophageal cancer. Despite recent advances in the curative treatment of esophageal cancer (6), more than 50% of patients with esophageal cancer have an inoperable disease at presentation. For these patients, only palliative treatment is possible. The goal of such treatment is to relief dysphagia, the case of much distress to these patients. Self-expanding metal stents are commonly used for the palliation of esophageal obstruction because of inoperable cancer. One of the drawbacks of the presently used stents is the high percentage of recurrent dysphagia due to stent migration and tissue in-/overgrowth. New stent designs have been developed that should overcome this unwanted sequel of stent placement. In addition, to overcome the problem of stent migration, large diameter stents have been introduced. The extra pressure on the esophageal wall exerted by large diameter stents, however, may cause more complications. Stents are eff ective for the palliation of esophageal cancer, particularly if the tumor is located in the mid or distal esophagus. Strictures of the proximal esophagus are more diffi cult to palliate. The use of stents in the proximal esophagus is, in particular, hampered by the risk of complications, the risk of compression on the trachea or patients intolerance. Surgery for esophageal cancer is often accompanied by signifi cant morbidity and aff ects patients quality of life.