Development of an Esophageal Cancer-specific Nutrition Impact Symptom Scale for Individualized Postoperative...

This study aimed to develop and preliminarily validate the Nutrition Impact Symptom-Esophageal Cancer scale (NIS-EC) and evaluate its clinical use for individualized postoperative nutritional nursing. This two-stage study included scale development/preliminary psychometric evaluation, followed by clinical application. In stage I, items were generated from a literature review, the Theory of Unpleasant Symptoms, two rounds of Delphi consultation, and pilot testing. Thirty clinically stable patients with esophageal cancer completed the NIS-EC for item analysis, reliability testing, validity assessment, and 14 ± 2 day retesting. In stage II, an unblinded single-arm phase II supportive-care study with a non-concurrent historical-control comparison was conducted among 107 patients after radical surgery for esophageal cancer. Fifty-seven patients received NIS-EC-guided individualized nutritional nursing, whereas 50 historical controls received routine postoperative nutritional nursing. Outcomes were assessed at baseline and 4 weeks. The final NIS-EC contained 22 items in three domains: digestive tract symptoms, malaise-related symptoms, and psychological-emotional symptoms. The scale showed good internal consistency, with a Cronbach's alpha of 0.921, split-half reliability of 0.904, and test-retest reliability of 0.913. Content and structural validity were acceptable, and the total score correlated with PG-SGA score (r = 0.784, P < 0.001). At week 4, the intervention group had lower NIS-EC scores, greater improvements in BMI, albumin, prealbumin, and hemoglobin, higher attainment of protein intake targets, fewer postoperative complications, and a shorter postoperative hospital stay than historical controls (P < 0.05). In conclusion, the NIS-EC provides preliminary, reliable, and valid symptom profiling in esophageal cancer. NIS-EC-guided nutritional nursing may support postoperative symptom control and nutritional recovery, but multicenter randomized controlled trials are required to validate these findings.