Transcript Gastric Cancer Surgery

Assessment of quality of life of
patients with gastric cancer after
surgery:
a systematic review
Ana Marques; Mylene Costa; Natália Ferreira; Paula Campelo; Paula Moreira;
Paulo Leandro; Pedro Barbosa; Pedro Mendes [Class 17 – 1st year]
Supervisors: Claúdia Dias and Mário Ribeiro MD, PhD
FMUP/ Serviço de Bioestatística e Informática Médica
Introduction
Meta-analysis, a final step in a systematic review:
“(…) statistical pooling of data across studies to generate summary estimates of
effects .” [1]
“(…) the term “effect” refers to any measure of association between exposure and
outcome” [1]
[1] Pai M, The National Medical Journal of India Vol.17 No.2,2004
Introduction
Gastric cancer as:
•A malignant cell growth in the stomach;
•Second leading cause of cancer deaths worldwide [2];
Surgery as the major way for treatment [3]:
• Distal gastrectomy without or with pylorus preservation;
• Total gastrectomy without or with pouch;
• Endoscopic mucosal resection or limited resections
• Proximal gastrectomy
[2] Plummer M, Epidemiology of gastric cancer IARC Sci Publ. 2004;(157):311-26.
[3] Roukos DH. Ann Surg Oncol. 1999 Jan-Feb;6(1):46-56. Review.
Introduction
GASTRIC CANCER IN CANCER
DEATH RATE (1973-92)
uterus
ovary
Rate of death is decreasing
stomach
Cancer localization
leucemia
pancreas
breast
colon and rectum
brain
liver
lymphoma
prostate
Lung
-60
-40
-20
0
20
40
60
Percent Change
http://plan1998.cancer.gov/PRGRES.html
(National Cancer Institute)
Quality of life (QoL) is then particularly important in health care.
[4] Kaptein AA, Morita S, Sakamoto J. Quality of life in gastric cancer World J Gastroenterol 2005
[4]
Introduction
Quality of life (QoL):
“The functional effect of an illness and its consequent therapy upon a
patient, as perceived by the patient.” [5]
“The degree to which a person enjoys the important possibilities of his
or her life.” [6]
Instruments for studying QoL:
• Questionnaires
• Interviews
• Physical examination and laboratory tests
[5]Schipper H. Spilker B Philadelphia: Lippincott-Raven, 1996
[6]Qualitty of life Research Unit, University of Toronto, www.gdrc.org/uem/qol-define.html.
Aims
• Clarify reproducibility and validity of the instruments used to
assess QoL in studies evaluating patients submitted to surgery for
gastric adenocarcinoma.
• Summarize QoL in studies using validated questionnaires.
Methods
Type of study:
• Systematic review
Target population:
• Population with gastric cancer that have been submitted to a gastrectomy;
Inclusion criteria of the articles:



Include a population with gastric cancer that have been submitted to a gastrectomy;
Include post-surgery QoL evaluation;
With abstracts.
Methods
Exclusion criteria of the articles:
Title:

Refer to radiotherapy / chemotherapy exclusively
Abstract:
•
•
•
•
If there is only one case in study
Not refer to a post-operative instrument
Not approach QoL in a global view
If patients with gastric cancer were part of a large group of patients with
various other types of cancer
Full article:




Not have access to article
Not describe the patients studied
Not refer QoL assessment
Not have retrievable data
Methods
Quality of articles:
Consider a valid article if:
- describe the patients studied;
- refer the stage of disease;
- refer the instrument used;
- questionnaire is valid.
Methods
Articles search
1. Pubmed
•
Key words

MESH (Medical Subject Headings) terms:
. Quality of life
. Gastrectomy
. Stomach neoplasm

Limits of the research:
Language: English
Humans
Publication Date: from 1950 to September 2005
Only items with abstracts
Methods : Query's Definition
Pubmed
("Quality of Life" [MeSH] OR quality of life) AND ("Stomach Neoplasms" [MeSH]
OR stomach neoplasms OR gastric cancer OR stomach carcinoma) NOT
intestinal cancer AND ("Gastrectomy" [MeSH] OR gastrectomy OR gastric
surgery) NOT chemotherapy NOT radiotherapy
173 articles found
Methods
2. Scopus
Limits of the research:
- year: until 2005;
- areas: "health" e "life sciences";
- document type: "review" e "article"
Query´s definition:
TITLE-ABS-KEY("Quality of life") AND TITLE-ABS-KEY(("stomach
neoplasms")
OR ("gastric cancer") OR ("stomach carcinoma")) AND NOT (intestinal cancer)
AND TITLE-ABS-KEY(("gastrectomy") OR ("gastric surgery")) AND NOT
(chemotherapy) AND NOT (radiotherapy)
189 articles found
Articles reached
173 + 189 = 362
362 - 102 (found in both searches) = 260
Pubmed
173
102
71
87
Scopus
189
Methods :
Flow chart
Start
Pubmed search
Scopus search
Include articles not
found at Pubmed
search
260 articles
reached
Read titles and
abstracts
Apply exclusion
criteria
Excluded by 2
revisors?
No
76 Articles
included
184 Articles
excluded
Apply exclusion
criteria
·
·
·
·
Questionnaire is not validated (45,1%)
Not refer QoL assessment (4,2%)
Not have retrievable data (7,0%)
Not have access to article (43,7%)
Yes
Excluded by 2
revisors?
End
· Patients without gastric cancer or not
·
·
·
·
Read full article
71 Article
excluded
Yes
No
5 Articles
included
·
·
gastrectomized (44,0 %)
QoL after surgery wasn't evaluated (38,0 %)
Refer to radio/chemotherapy (0,5 %)
There is only one case in study (0,5 %)
Do not use a instrument (questionnaire) (14,7
%)
Do not approach QoL in a global view (0,5 %)
Do not have abstract (1,6 %)
Methods - Extracted data
Extracted data:
- Geographical setting
- Characteristics of patients:
- stage of disease at diagnosis
- Number of patients studied
- Questionnaires
- Type of surgery
- Timing of assessment of QoL
Results - Description of questionnaires: validation
Questionnaires Frequency
20
18
16
14
12
10
8
6
4
2
0
Validated questionnaires
Non-validated questionnaires
Results - Description of questionnaires: validation
Questionnaires Validation
18%
• Validity of the instruments used
Validated
questionnaires
Non-validated
questionnaires
82%
•
We found 40 different questionnaires.
•
Only a minor part of them were validated (18%).
•
There was a great a number of single time used questionnaires (19).
•
In the 5 included articles were represented only 2 kinds of questionnaires:
EORTC QLQ-C30 and Gastrointestinal QoL Index.
Results
Description of questionnaires: main characteristics
Author
Year
Type of Surgery
Instruments
Kahlke V.
2004
Total gastrectomy
EORTC QLQ-C30
Hoksch B.
2002
Total gastrectomy with Longmire's
reconstruction without pouch
EORTC QLQ-C30 / Food
Consumption Patterns
2001
Total gastrectomy with esophagojejunostomy
and aboral pouch reconstruction and Total
gastrectomy with simple Roux-en-Y
reconstruction
Gastrointestinal QoL Index
Jentschura D.
1997
Total gastrectomy with Roux-en-Y and
Longmire's reconstruction and subtotal
gastrectomy with Billroth I and II
Gastrointestinal QoL Index
Spector NM.
2002
Total gastrectomy with Roux-en-Y
reconstruction and esophagogastrectomy
Gastrointestinal QoL Index / Life After
Gastroesophageal Surgery
Kalmar K.
Results
Summary of QoL in validated questionaires
QoL according to type of surgery and time after treatment * mean * (Preop. - preoperative values)
Total Gastrectomy
Without pouch
Distal Gastrectomy
With pouch
Without pylorus preservation
Preop.
6 months
12
months
Preop.
6 months
12
months
Preop.
6 months
12
months
Kahlke V., 2004 [20]
48
53
-
-
-
-
-
-
-
Hoksch B., 2002 [21]
66
47
49
55
52
65
-
-
-
-
-
105
-
-
-
-
-
113
-
95
-
-
-
-
-
-
-
-
96
-
-
-
-
-
-
-
EORTC QLQ-C30
(0-100)
Gastrointestinal QoL
Índex (0-144)
Jentschura D., 1997 [22]
Spector NM., 2002 [23]
Kalmar K., 2001 [24]
Conclusions
Clarify reproducibility and validity of the instruments used to assess QoL in studies
evaluating patients submitted to surgery for gastric adenocarcinoma.
1. There is a great diversity of questionnaires used to assess QoL after surgery
for gastric cancer;
2. Most studies use questionnaires that were not previously validated (82%).
3. The same questionnaire is used across different studies rarely.
Conclusions
Summarize QoL in studies using validated questionnaires.
4. A summary pooled result for QoL after surgery for gastric adenocarcinoma
was not possible to obtain.
5. Nevertheless, by observing the preoperative values, we can conjecture the
existence of a slight decreasing of QoL after surgery followed by a more or
less obvious recovery.
6. It is possible to see some benefit in the use of a pouch after total
gastrectomy.
7. Further studies would be needed in order to give a more conclusive answer
to the questions we raise, preferably using validated EORTC QLQ-C30 or
Gastrointestinal QoL Index where the collected data could be fully used in
further reviews.
Gantt Chart
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