Effectiveness of Nurse-Led Multimodal Rehabilitation for Patients Undergoing Postoperative Radiotherapy of Esophageal Cancer: A Randomized Controlled Trial

Purpose/Objective(s)

About 40% of patients develop serious complications after esophageal cancer surgery, which affects the quality of life. Symptoms such as fatigue and appetite loss caused by radiotherapy can also negatively impact the quality of life. However, rehabilitation exercises have been proven to significantly improve the quality of life. This study aimed to compare the effects of nurse-led multimodal rehabilitation versus conventional rehabilitation on physical recovery during adjuvant radiotherapy for postoperative esophageal cancer.

Materials/Methods

This randomized controlled trial recruited 70 patients who were randomized into the control group (CG, N = 35) and the intervention group (IG, N = 35). The CG received conventional care, and the IG received nurse-led multimodal rehabilitation. The patient’s quality of life, dyspnea index, fatigue, sleep quality, nutrition, anxiety, and depression were recorded before the start of radiotherapy (T0), after completion of radiotherapy (T1), and 6 months (T2) and 12 months (T3) after completion of radiotherapy. Data were analyzed following intention-to-treat principles. Linear mixed models were used to assess the effects of multimodal rehabilitation over time.

Results

The IG significantly increased the global health scores compared to the CG at T1 (difference = 26.19; 95% CI = 17.14 to 35.24; P < 0.001), with differences remaining significant at T2 (difference = 21.43; 95% CI = 8.02 to 34.84; P = 0.002) and T3 (difference = 23.34; 95% CI = 7.31 to 39.36; P = 0.005). Compared with the CG, the weight of the IG was significantly higher at T1 (difference = 3.33; 95% CI = 0.89 to 5.77; P = 0.008), and the difference was still significant at T2 (difference = 3.13; 95% CI = 0.26 to 6.00; P = 0.033) and T3 (difference = 3.91; 95% CI = 0.64 to 7.19; P = 0.020). The fatigue score of the IG decreased significantly at T1(difference = -65.74; 95% CI = -90.74 to -40.75; P < 0.001), and the difference remained statistically significant at T2 (difference = -64.86; 95% CI = -96.98 to -32.74; P < 0.001) and T3 (difference = -48.80; 95% CI = -82.61 to -14.99; P = 0.005). The anxiety and depression status of the IG improved significantly at T1 (difference = -3.00; 95% CI = -4.99 to -1.01; P = 0.004) and (difference = -2.43; 95% CI = -4.48 to -0.38; P = 0.021), and the difference remained significant at T2 (difference = -3.63; 95% CI = -6.84 to -0.42; P = 0.027) and (difference = -3.66; 95% CI = -6.80 to -0.51; P = 0.023).

Conclusion

Nurse-led multimodal rehabilitation significantly improved the quality of life, sleep quality, nutrition, fatigue, anxiety, and depression status in patients undergoing postoperative radiotherapy for esophageal cancer.