Research output: Contribution to journal › Article › Academic › peer-review
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 et al.
In: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus, Vol. 36, No. 1, 31.12.2022.Research output: Contribution to journal › Article › Academic › peer-review
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TY - JOUR
T1 - Identifying a core symptom set triggering radiological and endoscopic investigations for suspected recurrent esophago-gastric cancer
T2 - a modified Delphi consensus process
AU - Chidambaram, Swathikan
AU - Patel, Nikhil M.
AU - Sounderajah, Viknesh
AU - Alfieri, Rita
AU - Bonavina, Luigi
AU - Cheong, Edward
AU - Cockbain, Andy
AU - D'Journo, Xavier Benoit
AU - Ferri, Lorenzo
AU - Griffiths, Ewen A.
AU - Grimminger, Peter
AU - Gronnier, Caroline
AU - Gutschow, Christian
AU - Hedberg, Jakob
AU - Kauppila, Joonas H.
AU - Lagarde, Sjoerd
AU - Low, Donald
AU - Nafteux, Philippe
AU - Nieuwenhuijzen, Grard
AU - Nilsson, Magnus
AU - Rosati, Riccardo
AU - Schroeder, Wolfgang
AU - Smithers, B. Mark
AU - van Berge Henegouwen, Mark I.
AU - van Hillegesberg, Richard
AU - Watson, David I.
AU - Vohra, Ravinder
AU - Maynard, Nick
AU - Markar, Sheraz R.
N1 - Publisher Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus.
PY - 2022/12/31
Y1 - 2022/12/31
N2 - 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.
AB - 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.
KW - endoscopic
KW - esophageal cancer
KW - gastric cancer
KW - surveillance
KW - symptom
UR - http://www.scopus.com/inward/record.url?scp=85145954867&partnerID=8YFLogxK
U2 - 10.1093/dote/doac038
DO - 10.1093/dote/doac038
M3 - Article
C2 - 35858213
VL - 36
JO - Diseases of the esophagus
JF - Diseases of the esophagus
SN - 1120-8694
IS - 1
ER -
ID: 30840200