Transcript Gastric Cancer Surgery

Assessment of quality of life of
patients with gastric cancer after
surgery:
a systematic review
Ana Rita Marques; Natália Ferreira; Mylene Costa; Paula Joana Moreira; Paula Campelo;
Paulo Leandro; Pedro Barbosa; Pedro Mendes [Class 17 – 1st year]
Supervisors: Claúdia Camila e Mário Ribeiro
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, McCulloch M, Gordan JD, Pai N, Enanoria W, Kennedy G, Tharyan P, Colford,Jr JM. Systematic reviews
and meta-analyses: An illustrated, step-by-step guide The National Medical Journal of India Vol.17 No.2,2004
Introduction
Gastric cancer as:
•A malignant cell growth;
•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, Franceschi S, Munoz N Epidemiology of gastric cancer IARC Sci Publ. 2004;(157):311-26.
[3] Roukos DH. Related Articles, Links Current advances and changes in treatment strategy may improve survival and quality of life in
patients with potentially curable gastric cancer. Ann Surg Oncol. 1999 Jan-Feb;6(1):46-56. Review.
Introduction
GASTRIC CANCER IN CANCER
DEATH RATE (1973-92)
Rate of surviving is increasing
http://plan1998.cancer.gov/PRGRES.htm
(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, Clinch J, Olweny LM. Definitions and conceptual issues. Spilker B Philadelphia:
Lippincott-Raven, 1996
[6]Qualitty of life Research Unit, University of Toronto, www.gdrc.org/uem/qol-define.html.
Aims
• Assess and summarize QoL in patients submitted to surgery for gastric cancer.
Study QoL in a generic view:
functional limitations;
emotional state;
gastrointestinal symptoms;
social maladjustment;
physical performance and dependence
(…)
• Clarifying validity and validation of the instruments used.
Methods
Inclusion criteria:
•Include a population with gastric cancer that have been submitted to a gastrectomy;
•Include post-surgery QoL evaluation.
•With abstracts.
Exclusion criteria:
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 generic view
•If patients with gastric cancer were part of a large group of patients with various other types
of cancer
Methods
Full article:




Not have access to article
Not describe the patients studied
Questionnaire is not validated
Not refer QoL assessment
Methods
Articles search
- Pubmed
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
Methods
- 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
Articles reached
173 + 189 = 362
362 - 102 (common) = 260
Pubmed
173
Scopus
189
102
71
87
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
Yes
Excluded by 2
revisors
No
Article
excluded
78 Articles
76
included
Read full
article
Apply
exclusion
criteria
Article
excluded
Yes
Excluded by 2
revisors
End
No
Article
included
10
Methods - Extracted data

Extracted data:
- Authors
- Title
- Magazine
- Institution
- Characteristics of patients
- Number of patients studied
- Other important data
- Questionnaires
- Types of surgery
- Assessement of QoL
- Stage of disease
Results
• Included articles (after reading titles and abstracts – exclusion criteria)
 Included at previous analysis
n = 57 (pubmed) + 19 (scopus)= 76 art.
• Quality of articles:
Consider a valid article if:
- describe the patients studied;
- refer the stage of disease;
- refer the instrument used;
- questionnaire is valid;
 10 articles respect these parameters
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12
10
8
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Results
•Description of questionnaires
Frequency of questionnaires
Results
•
Validity of the instruments used
• Possible heterogeneity:
- different characteristics of patients in each article
- different stages of disease
- different techniques
- different times of measurement
- different instruments used
Gantt Chart

Task not achieved:
• Extract final quantified QoL
• Analysis

Due to:
• Some results are only shown in graphics
• A great variety of surgical technics
Further Results
Expected results for 3rd apresentation:
 Analysis
 Conclusion of Manuscript writing
 Website conclusion and presentation
Home Page
Abstract
Introduction
Webpage
Plan
Materials and Methods
Results
Discussion
References
Full Article (pdf)
Appendix
Presentations
1st Presentation
2nd Presentation
3rd Presentation
Graphics & Tables
Tasks’ Distribution
Searches in Pubmed&Scopus
Reference database
Articles Valid. Question.
Acknowledgments
Authors