Transcript Gastric cancer AND

Assessment of Quality Of Life in patients
treated with Chemo and Radiotherapy
for Gastric Cancer: A Systematic Review
Authors: Turma 14
Supervisors: Mário Dinis Ribeiro
Cláudia Camila Dias
Professor Doutor Altamiro da Costa Pereira
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FMUP/SBIM
Gastric Cancer in the World
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850 000 deaths worlwide each year cause due to gastric cancer
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8
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Men
Women
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Eucan - Database
World, age-standardized rates (per 100.000 persons.year)
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Gastric Cancer in Europe
Cumulative risk, 0-64 years
Female
Male
Eucan - Database
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Introduction
QoL after Chemo/Radiotherapy in Gastric Cancer
 Stomach adenocarcinoma is
the most common form of
gastric cancer (95% of the
cases).1
 Stomach cancer is a
multifactorial disease:diet,
hereditary factors,
Helicobacter pylori infection
are possible causes.2-3
 Tobacco smoking has also
been clearly accepted as
increasing the risk of stomach
cancer.4
1- Crew KD, Neugut AI. Epidemiology of upper gastrointestinal malignancies. Seminin Oncol 2004; 31: 450–464.
2- World Cancer Research Fund (WCRF) Panel. Diet, nutrition and the prevention of cancer: a global perspective. Washington, DC, USA: World Cancer Research Fund; 1997.
3- IARC Monograph on the Evaluation of Carcinogenic Risks to Humans, Vol. 61. Schistosomes, Liver Flukes and helicobacter pylori. Lyon, France: International Agency for Research on Cancer;
1994.
4- IARC Monographs on the Evaluation of Carcinogenic Risk to Humans. Vol. 83: Tobacco Smoke and Involuntary Smoking. Lyon, France: International Agency for Research on Cancer; 2004.
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Introduction
 Treatment
cancer
for
often
QoL after Chemo/Radiotherapy in Gastric Cancer
gastric
involves
surgery, usually a partial
or
a
total
(removal
gastrectomy
of
stomach
 Chemotherapy
and
tissue).5
radiotherapy are standard
for
some
stages
of
stomach cancer.5
5-Ross P, Nicolson M, Cunningham D, Valle J, et al. Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) with
epirubicin, cisplatin and PVI 5-FU in advanced esophagogastric cancer. Journal of Clinical Oncology, Vol. 20, Issue 8 (April), 2002.
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Introduction
QoL after Chemo/Radiotherapy in Gastric Cancer
 Chemotherapy is the use
of chemical agents to stop
cancer
cells
from
growing.6
 Chemotherapy is
considered a systemic
treatment.6
6-Janunger KG, Hafström L, Nygren P, Glimelius B for teha SBU-group. A Systematic Overview of Chemotherapy Effects in Gastric Cancer. Acta Oncologica, Vol. 40, No.
2/3, pp. 309-326, 2001.
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Introduction
QoL after Chemo/Radiotherapy in Gastric Cancer
 Radiotherapy uses high
energy x-rays to destroy
cancer cells.7
 A small dose of
radiotherapy may be very
helpful to relieve pain.7
7-Kim GE, Shin HS, MD, et al. The role of radiation treatment in management of extrahepatic biliary tract metastasis from gastric carcinoma. Int. J. Radiation Oncology Biol.
Phys., Vol. 28, No. 3, pp.711-717, 1994.
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Introduction
 These multiple treatments
have different
consequences in Quality of
Life (QoL) in
patients.8
QoL after Chemo/Radiotherapy in Gastric Cancer
 QoL cannot be yet
universally defined8,
however there are many
attempts to do so.
 Schipper et al. proposed:
“the functional effect of illness and its consequent therapy
upon a patient, as perceived by the patient”.9
8-Spilker B, ed. Quality of Life and pharmacoeconomics in clinical trials. Philadelphia:Lippincott-Raven, 1996.
9- Schipper H, Clinch J, Olweny LM. Definitions and conceptual issues. In: Spilker B, ed. Quality of Life and pharmacoeconomics
in clinical trials, Philadephia : Lippincott- Raven, 1996: 11-24
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Aim
QoL after Chemo/Radiotherapy in Gastric Cancer
____________________________________________
• To review which instruments were used to measure
the QoL in patients with gastric cancer submitted to
chemo and radiotherapy.
• To summarize QoL measures across studies.
____________________________________________
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Methods
QoL after Chemo/Radiotherapy in Gastric Cancer
 The Query used was:
◊ ″Gastric cancer AND (Quality of Life OR
Psychology) AND (Radiotherapy OR
Chemotherapy)”
 Literature searches were conducted
in Medline.
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Limits
QoL after Chemo/Radiotherapy in Gastric Cancer
 Publication Date until September 2005.
 Only items with an abstract.
 Humans.
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Methods
QoL after Chemo/Radiotherapy in Gastric Cancer
 Inclusion Criteria
one
had
gastric cancer;
- Patients
submitted
to
chemo or radiotherapy;
- QoL measured with an
Instrument to
measure
QOL?
who
QOL
evaluated by
the patient?
- Patients
Submitted to
chemo or
radiotherapy?
patients;
90
80
70
60
50
40
30
20
10
0
Gastric
cancer?
- QoL evaluated by the
No. of articles
participant;
More than one
participant?
than
Was QOL
evaluated?
- More
Inclusion criteria
appropriate instrument.
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Methods
QoL after Chemo/Radiotherapy in Gastric Cancer
 Exclusion criteria
- Articles in which QoL
was measure but only
symptoms
were
studied;
- Articles that referred to
patients submitted to a
surgery
during
or
before treatment.
40
35
No. of articles
- Articles based on mixed
diagnostic
groupings
(in the article these
have to be approached
separately);
30
25
20
15
10
5
0
Mixed groups?
Were only the symptoms
measured?
Surgery?
Exclusion criteria
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Methods
QoL after Chemo/Radiotherapy in Gastric Cancer
 Validation Papers
o A second search was conducted, to discover if the
instruments used in the included articles were
valid. To find the validation papers we search the
questionnaire title through Google.
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Fluxogram
QoL after Chemo/Radiotherapy in Gastric Cancer
Start
Read title and
abstract
Excluded by 2
reviewers
Yes
Exclude
article
No
Included by 2
reviewers
Yes
no
Yes
Include
article
Opinion of a
third reviewer
Read
complete
article
Yes
Excluded by 2
reviewers
Discuss until
reviewers
agreement
No
Include Article
Exclude
article
Yes
Included by 2
reviewers
Include
article
no
Opinion of a
third reviewer
No
Yes
Introduce data in
the SPSS
Discuss until
reviewers
agreement
Include Article
No
Exclude
Article
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End
Results
QoL after Chemo/Radiotherapy in Gastric Cancer
 116 articles were found;
 Due to the application of the inclusion and exclusion
criteria, 10 were included and 76 were excluded;
 Some of the articles found couldn’t be read and so we
don’t have information referred to them;
 Only 1 of the included articles didn’t have a validated
paper of the instrument.
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Results
QoL after Chemo/Radiotherapy in Gastric Cancer
Article
Questionnaire
A multicentre, randomised phase III trial comparing protracted venous infusion (PVI) 5-fluorouracil
(5-FU) with PVI 5-FU plus mitomycin C in patients with inoperable oesophago-gastric cancer
EORTC) QLQ-C30
Marimastat as maintenance therapy for patients with advanced gastric cancer: a randomised trial.
EORTC) QLQ-C30
Evaluation of Clinical Benifit of Chemotherapy in Patients with upper Gastrointestinal Cancer
Randomized comparison between chemotherapy plus best supportive care with best supportive
care in advanced gastric cancer.
CBR
EORTC) QLQ-C30
A phase II study in advanced gastro-esophageal cancer using epirubicin and cisplatin in
combination with continuous infusion 5-fluorouracil (ECF).
Rotterdam Symptom
Checklist
Epirubicin, cisplatin, and protracted venous infusion of 5-fluorouracil for esophagogastric
adenocarcinoma: response, toxicity, quality of life, and survival.
EORTC) QLQ-C30
Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion
fluorouracil (PVI 5-FU) With epirubicin, cisplatin, and PVI 5-FU in advanced esophagogastric
cancer.
EORTC) QLQ-C31
Alternative methods of interpreting quality of life data in advanced gastrointestinal cancer patients.
EORTC) QLQ-C32
Quality of life in patients with gastroenteropancreatic tumors treated with [177LuDOTA0,Tyr3]octreotate.
EORTC) QLQ-C30
Multivariate prognostic factor analysis in locally advanced and metastatic esophago-gastric
cancer--pooled analysis from three multicenter, randomized, controlled trials using individual
patient data.
EORTC) QLQ-C30
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Results
QoL after Chemo/Radiotherapy in Gastric Cancer
Validation Paper
of the instrument
Publication
Date
Name of first
Author
A multicentre, randomised phase III trial comparing protracted venous infusion
(PVI) 5-fluorouracil (5-FU) with PVI 5-FU plus mitomycin C in patients
with inoperable oesophago-gastric cancer
2002
Tebbutt NC
√
Marimastat as maintenance therapy for patients with advanced gastric cancer:
a randomised trial.
2002
Bramhall SR
√
Evaluation of Clinical Benifit of Chemotherapy in Patients with upper
Gastrointestinal Cancer
1998
Katarina H
Randomized comparison between chemotherapy plus best supportive care
with best supportive care in advanced gastric cancer.
1997
Glimelius B
√
A phase II study in advanced gastro-esophageal cancer using epirubicin and
cisplatin in combination with continuous infusion 5-fluorouracil (ECF).
1994
Findlay M
√
Epirubicin, cisplatin, and protracted venous infusion of 5-fluorouracil for
esophagogastric adenocarcinoma: response, toxicity, quality of life,
and survival.
1996
Bamias A
√
Prospective randomized trial comparing mitomycin, cisplatin, and protracted
venous-infusion fluorouracil (PVI 5-FU) With epirubicin, cisplatin, and
PVI 5-FU in advanced esophagogastric cancer.
2002
Ross P
√
Alternative methods of interpreting quality of life data in advanced
gastrointestinal cancer patients.
2001
Nordin K
√
Quality of life in patients with gastroenteropancreatic tumors treated with
[177Lu-DOTA0,Tyr3]octreotate.
2004
Teunissen JJ
√
Multivariate prognostic factor analysis in locally advanced and metastatic
esophago-gastric cancer--pooled analysis from three multicenter,
randomized, controlled trials using individual patient data.
2004
Chau I
√
Article
Present
Absent
√
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