Heterogeneous trajectories of nutritional support needs in patient–caregiver dyads following radical esophagectomy: a latent class growth analysis

Introduction Patients with esophageal cancer are at high risk of malnutrition, with family caregivers playing an indispensable role in nutritional management. However, the dynamic and heterogeneous changes of nutritional support needs of patients after radical esophagectomy, viewed from the perspectives of both patients and their caregivers, remain poorly understood. This may potentially hinder the development of timely and tailored interventions. Therefore, this study aimed to investigate the longitudinal trajectories of nutritional support needs within patient–caregiver dyads and identify distinct patterns of change over time, and explore associated influencing factors. Methods This prospective longitudinal study recruited 159 patient–caregiver dyads from a tertiary hospital in Shanghai, China, between August 2024 and January 2025. Data were collected at four time points: pre-discharge (T1), 2 weeks (T2) post-discharge, 1 month (T3) post-discharge, and 3 months (T4) post-discharge. The Questionnaire of Nutritional Needs in Patients after Esophagectomy (QNN-E) was used to assess dyadic nutritional support needs. Trajectory homogeneity and heterogeneity were analyzed using latent growth curve modeling and latent class growth analysis. Baseline factors, including General Self-Efficacy Scale (GSES), quality of life (QLQ-OES18), Hospital Anxiety and Depression Scale (HADS), Activities of Daily Living (ADL), and Patient-Generated Subjective Global Assessment (PG-SGA), were examined as predictors of trajectory membership. Results The nutritional support needs of patient–caregiver dyads declined over time. Significant heterogeneity was observed in therapeutic diet preparation, symptom surveillance and complication management. For therapeutic diet preparation, two distinct trajectories emerged in the patients ( Consistently Stable Needs 16.4% and Delayed Needs Escalation 83.6%), influenced by enteral access type and nutritional status. The trajectories of the family caregivers ( High-need Declining 47.2% and High-need Sustenance 52.8%) were associated with educational level and relationship to the patient. In symptom surveillance and complication management, the trajectories of the patients were influenced by basic activities of daily living, while the trajectories of the caregivers were linked to the presence of other caregivers. Conclusion The findings revealed significant heterogeneity in the postoperative nutritional support needs of patient-caregiver dyads, influenced by distinct factors. As primary providers of postoperative home-based nutritional care, caregivers’ needs provide valuable insights for a more comprehensive understanding of postoperative nutritional care requirements. Continuity of nutritional care for patients with esophageal cancer should be grounded in dynamic and holistic assessments of their support needs, enabling personalized interventions at critical time points to improve postoperative recovery outcomes and care effectiveness.