Post-Treatment Nutrition and Rehabilitation Support Is Associated with Reduced Psychological Distress After Early-Stage Upper Gastrointestinal Cancer Surgery: A Retrospective Cohort Study.

Background/

Objectives

Curative-intent surgery for early-stage upper gastrointestinal (GI) cancer causes substantial nutritional, functional, and psychological morbidity; whether an integrated post-treatment nutrition and rehabilitation pathway improves distress and survival is unclear.

Methods

We conducted a retrospective cohort study of 130 patients undergoing curative-intent esophagectomy or gastrectomy for early-stage esophagogastric cancer: 65 received a structured post-treatment nutrition and rehabilitation support program (Group A), and 65 received standard care (Group B). The primary outcome was psychological distress trajectory over 12 months (Distress Thermometer; secondarily HADS); overall survival was secondary. Propensity-score matching assessed covariate balance; a multivariable Cox model estimated the adjusted mortality association.

Results

Distress scores were similar at 1 month (7.2 vs. 7.4; p = 0.43) and diverged progressively (group × time interaction p < 0.001; 4.9 vs. 6.1 at 12 months; p < 0.001, Cohen's d ≈ 0.8; 95% CI for the 12-month between-group difference 0.65-1.75 points); HADS-A and HADS-D followed a concordant trajectory (8.4 vs. 10.1; 7.7 vs. 9.3; both p ≤ 0.003). Baseline covariates were reasonably balanced before matching (all standardized mean differences [SMDs] < 0.16) and met the prespecified <0.10 balance threshold for most covariates after matching. Fourteen deaths occurred (3 vs. 11); log-rank testing showed a significant survival difference (p = 0.021), consistent after matching (p = 0.037), and in the adjusted Cox model, support-program receipt was associated with lower mortality (hazard ratio 0.25, 95% CI 0.07-0.90; p = 0.034), though underpowered (14 vs. ~37 events required) and hypothesis-generating.

Conclusions

Structured post-treatment nutrition and rehabilitation support was associated with markedly lower psychological distress, the prespecified primary outcome, with the achieved sample exceeding the a priori requirement for the assumed effect size; a secondary, exploratory survival association requires prospective confirmation. These findings support prospective, multicenter evaluation of integrated psycho-oncology and nutrition-rehabilitation care pathways after upper GI cancer surgery and should not be interpreted as demonstrating a causal treatment effect.