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Aims In addition to amnesia, executive deficits are prominent in Korsakoff's syndrome (KS), yet poorly studied. This study investigates the degree of executive dysfunction in patients with KS for the three main executive subcomponents shifting, updating and inhibition using novel, theory-driven paradigms. Short summary Compared to healthy controls, patients with KS show impairments on the executive subcomponents shifting and updating, but not on inhibition. Methods Executive functions were measured with six carefully designed tasks in 36 abstinent patients with KS (mean age 62.3; 28% woman) and compared with 30 healthy non-alcoholic controls (mean age 61.8; 40% woman). ANOVAs were conducted to examine group differences and effect sizes were calculated. Results Compared to healthy controls, patients with KS were impaired on the executive subcomponents shifting and updating. No statistically significant group difference was found on the factor inhibition. Conclusions Executive dysfunction in long-abstinent patients with alcoholic KS shows a profile in which shifting and updating ability are affected most. It also highlights that executive dysfunction is an important feature of KS and requires more attention in scientific and clinical practice, as these deficits may also affect daily functioning. [ABSTRACT FROM AUTHOR]

Between January 2004 and February 2006, 109 patients after intentionally curative surgery for oesophageal or gastric cardia cancer were randomised to standard follow-up of surgeons at the outpatient clinic (standard follow-up; n=55) or by regular home visits of a specialist nurse (nurse-led follow-up; n=54). Longitudinal data on generic (EuroQuol-5D, European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30) and disease-specific quality of life (EORTC QLQ-OES18), patient satisfaction and costs were collected at baseline and at 6 weeks and 4, 7 and 13 months afterwards. We found largely similar quality-of-life scores in the two follow-up groups over time. At 4 and 7 months, slightly more improvement on the EQ-VAS was noted in the nurse-led compared with the standard follow-up group (P=0.13 and 0.12, respectively). Small differences were also found in patient satisfaction between the two groups (P=0.14), with spouses being more satisfied with nurse-led follow-up (P=0.03). No differences were found in most medical outcomes. However, body weight of patients of the standard follow-up group deteriorated slightly (P=0.04), whereas body weight of patients of the nurse-led follow-up group remained stable. Medical costs were lower in the nurse-led follow-up group (\[euro]2600 vs \[euro]3800), however, due to the large variation between patients, this was not statistically significant (P=0.11). A cost effectiveness acceptability curve showed that the probability of being cost effective for costs per one point gain in general quality-of-life exceeded 90 and 75% after 4 and 13 months of follow-up, respectively. Nurse-led follow-up at home does not adversely affect quality of life or satisfaction of patients compared with standard follow-up by clinicians at the outpatient clinic. This type of care is very likely to be more cost effective than physician-led follow-up.British Journal of Cancer (2009) 100, 70–76. doi:10.1038/sj.bjc.6604811 www.bjcancer.com Published online 9 December 2008 [ABSTRACT FROM AUTHOR]

We investigated which problems patients experience after resection for oesophageal cancer and what care they expect, in order to devise a better-tailored follow-up policy. Thirty patients, all within 1 year after surgery, filled in a one-time questionnaire on experienced physical, psychological and social problems and on expected care for these problems. Additionally, a semi-structured interview was performed. Frequencies of experienced problems and expected care over time were analysed. The majority of patients experienced physical problems such as 'early satiety' (97%) and 'fatigue' (84%) after oesophagectomy. In addition, patients often felt depressed (64%), were afraid of metastases (80%) and death (47%). Over time, the frequency of problems such as 'fatigue' (P = 0.035) and 'being dependent' (P = 0.012) decreased. Patients particularly expected professional care for physical issues related to their disease, whereas they often managed psychosocial problems in their own social network. Patients indicated that nurses' involvement during follow-up might improve their possibility to satisfactorily deal with problems. Patients frequently experience physical problems after oesophagectomy, and professional care is expected for these issues. Psychosocial problems are also present, but care is less commonly expected. Nurses' involvement during follow-up could be a way to optimize patients' management after oesophageal cancer surgery. [ABSTRACT FROM AUTHOR]

The incidence of esophageal cancer has increased markedly during the past 3 decades, especially due to an increase of the incidence of adenocarcinoma. The prognosis for patients with esophageal cancer is poor, with a 5-year survival rate of 10-25%. The important risk factors for esophageal squamous cell carcinoma are smoking and alcohol intake. Esophageal adenocarcinomas are related to gastro-esophageal reflux disease. The diagnostic procedures are not only focused on obtaining diagnoses, but also on determining how advanced the tumor is. If a patient is fit enough to undergo surgery and no evidence is found that the tumor has spread to adjacent organs or that there are distant metastases, a surgical resection is the primary treatment. In case surgical resection is not an option, palliative treatment is generally needed to reduce the complaints of dysphagia. The improvement or maintenance of the quality of life and symptom-control are important goals of both curative and palliative treatment of esophageal cancer.

Background: Presently, no evidence-based guidelines for the follow-up of patients after surgery for gastrointestinal cancer are available. As a consequence, follow-up strategies may differ between hospitals depending on preference of physicians. We investigated which follow-up procedures are currently employed after surgery for gastrointestinal cancer in the Netherlands., Method: A questionnaire was sent to all surgical departments in the Netherlands. The questionnaire focused on frequency of follow-up visits and diagnostic procedures after surgical treatment for oesophageal, gastric, pancreatic and colorectal cancer and psychosocial issues during follow-up., Results: The response rate was 90% (83/92). In the majority of hospitals, surgeons treated patients with colorectal (100%) and gastric (96%) cancer in their own centre, whereas patients with pancreatic (64%) and oesophageal (61%) cancer were more often referred to a tertiary centre. For all patients treated for gastrointestinal cancer, three to four follow-up visits were made in the first year, followed by at least two annual visits thereafter. After colorectal surgery, blood tests (78%), colonoscopy (75%) and abdominal ultrasound (57%) were frequently performed. In other gastrointestinal malignancies, procedures were in most cases only performed if symptoms occurred. In almost three-quarters of patients, psychosocial problems were observed, which were dealt with by surgeons in two-thirds of patients. The majority of patients treated for gastrointestinal cancer were pre- and postoperatively discussed in a multidisciplinary setting. Oncologists, gastroenterologists and dieticians were the most frequently consulted specialists after surgery for gastrointestinal cancer., Conclusion: Patients frequently visit the outpatient clinic after surgery for gastrointestinal cancer in the Netherlands. Whereas follow-up after colorectal cancer surgery focuses on finding recurrent disease and metachronous lesions in the colorectum, this is less clear after oesophageal, gastric and pancreatic cancer surgery. Further studies are needed to establish what is the most effective follow-up protocol after different types of gastrointestinal cancer surgery.

More than 50% of patients with oesophageal carcinoma will undergo palliative treatment because of distant metastases or local tumour ingrowth into surrounding organs. The majority of these patients have symptoms ofdysphagia. If metastases from oesophageal carcinoma are present, the most commonly used treatment modalities for dysphagia in The Netherlands are placement of a self-expanding stent or intraluminal radiotherapy (brachytherapy). If the life expectancy of patients is longer than 3 months, brachytherapy is sometimes combined with external radiotherapy. If patients with metastases are in a good condition, chemotherapy may be considered. If there is local tumour ingrowth but no metastases, chemotherapy in combination with radiation therapy (chemoradiation) is an option. These treatments should preferably make up part of well-designed studies. Quality of life is an important endpoint to consider in the palliative treatment of patients with oesophageal cancer. Well-established standardized and validated questionnaires are available for this purpose.