The SCN, as part of a multidisciplinary team, can provide supportive care and information to enable the person affected by oesophageal cancer to navigate their way through the complexities of their cancer journey. People affected by oesophageal cancer often face very difficult treatment decisions, weighing up survival against the quality of life impacts of treatments.
There is significant morbidity associated with surgery and other treatments for oesophageal cancer. Physical issues relate to food intake, fatigue, constipation and/or diarrhoea, and may impact even long-term survivors.27
Commonly reported psychological problems include depression and fears about metastases, physical suffering, and death.25 Improving quality of life and enabling return to activities after curative oesophagectomy is achievable28 and can be improved with targeted management and reduction of symptoms.29
Common quality-of-life issues associated with oesophageal cancer and its treatment regimens include:6, 14
- dysphagia and the inability to eat solid food
- guilt associated with a history of tobacco and alcohol use
- end-of-life issues due to low survival rate.
The multimodal approach varies by clinical staging of oesophageal cancer. Factors which may be considered when developing a treatment plan include:4, 19, 23, 30
- location and size of lesion
- presence or absence of locoregional lymph nodes
- presence or absence of distant metastases
- cell type
- HER 2 status (adenocarcinoma of distal oesophagus or gastro-oesophageal junction)
- performance status
- individual's goals.
In addition, co-morbidities can influence the specific detail of the treatment plan and selection of the particular chemotherapeutic agents.
Examine the factors that may influence treatment planning for oesophageal cancer and, for each factor, explain how this would be assessed.
- Where treatment options are not definitive, explain the factors that a multidisciplinary team might consider in recommending a treatment plan.
Burt’s story 2: Treatment decisions
A multidisciplinary team meeting is planned to discuss Burt's case.
- Justify the role of a multidisciplinary team meeting in Burt's case.
- List the health professionals who would participate in such a meeting.
- Explain the key contributions that each health professional would make to develop a plan for Burt's treatment and supportive care. Use a supportive care screening tool used in your practice setting when considering your response.
Plan in detail how you would support Burt in the process of making treatment decisions.
How would you respond to Burt’s question about why he is not eligible for surgery? In your response, outline the indications and contraindications of surgical therapy for oesophageal cancer
Burt is beginning to open up about his family and concerns for the future. Formulate strategies to support Burt in dealing with existential issues at this point in his cancer journey.
After reviewing the evidence and Burt's circumstances, the multidisciplinary team has recommended the following treatment plan for Burt:
M ☑ F ☐
Week 1: 4 days continuous 5FU 1000mg/m2/day / Day 5 Carboplatin AUC5 via a peripherally inserted central catheter (PICC)
5 weeks XRT
Week 5, 8 &11: 4 days continuous 5FU 1000mg/m2/day / Day 5 Carboplatin AUC5 via a PICC
AUC5 (Area Under the Concentration x Time curve)
The multidisciplinary team has recommended that Burt have the initial phase of his treatment as an inpatient, then the remainder as an outpatient.
Access the eviQ Cancer Treatments Online:
- Outline the recommended treatment regimen for Burt's Stage III squamous cell carcinoma of the oesophagus.
Burt's treatment protocol is modified from the recommended guidelines. Discuss the factors in Burt's case which may have been considered in modification of the treatment protocol.
Following the multidisciplinary team meeting, you meet with the bed manager who has questioned why Burt is to remain an inpatient during the initial phase of treatment. Evaluate whether inpatient management for Burt is justifiable.
Examine the common quality of life concerns that are likely to be associated with Burt's proposed treatment plan.
Burt’s story 3: Treatment plan
Debate the extent to which you believe Burt's preferences and goals have been considered in this case.
Design and role-play an education session on insertion and management of his PICC.
Design a care plan for managing Burt's dysphagia and odynophagia that incorporates best available evidence.
Examine the common side effects of a treatment regimen such as Burt's.
Design an education plan for Burt regarding the planned treatment regimen and its effects. Include discussion of the content and delivery approaches.
Analyse how Burt's dependence on alcohol might be taken into account in planning and delivering his care.