Assessment of quality of life of Assessment of quality of life of patients with gastric cancer after patients with gastric cancer after

surgery:surgery:

a systematic review 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 RibeiroFMUP/ Serviço de Bioestatística e Informática Médica

IntroductionIntroductionMeta-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

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.

IntroductionIntroduction

IntroductionIntroduction

Rate of surviving is increasing

GASTRIC CANCER IN CANCER DEATH RATE (1973-92)

http://plan1998.cancer.gov/PRGRES.htm (National Cancer Institute)

Quality of life (QoL) is then particularly important in health care. Quality of life (QoL) is then particularly important in health care. [4][4]

[4] Kaptein AA, Morita S, Sakamoto J. Quality of life in gastric cancer World J Gastroenterol 2005

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.

IntroductionIntroduction

• 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.

AimsAims

MethodsMethodsInclusion 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

MethodsMethods

Full article:

Not have access to article Not describe the patients studied Questionnaire is not validated Not refer QoL assessment

MethodsMethodsArticles searchArticles search

- Pubmed- Pubmed

MESH (Medical Subject Headings) terms:

. Quality of life

. Gastrectomy

. Stomach neoplasm

Limits of the research:

Language: EnglishHumansPublication Date: from 1950 to September 2005Only items with abstracts

Methods : Methods : Query's Query's DefinitionDefinitionPubmed

("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

MethodsMethods- Scopus- Scopus

Limits of the research:Limits of the research:

- year: until 2005; - year: until 2005; - areas: "health" e "life sciences"; - areas: "health" e "life sciences"; - document type: "review" e "article"- document type: "review" e "article"

Query´s definition:Query´s definition:

TITLE-ABS-KEY("Quality of life") AND TITLE-ABS-KEY(("stomach TITLE-ABS-KEY("Quality of life") AND TITLE-ABS-KEY(("stomach neoplasms") OR ("gastric cancer") OR ("stomach carcinoma")) neoplasms") OR ("gastric cancer") OR ("stomach carcinoma")) AND AND NOT (intestinal cancer) AND TITLE-ABS-KEY(("gastrectomy") OR NOT (intestinal cancer) AND TITLE-ABS-KEY(("gastrectomy") OR ("gastric surgery")) AND NOT (chemotherapy) AND NOT ("gastric surgery")) AND NOT (chemotherapy) AND NOT (radiotherapy)(radiotherapy)

189 articles189 articles

Articles reachedArticles reached173 + 189 = 362173 + 189 = 362

362 - 102 (common) = 260362 - 102 (common) = 260

Scopus189

Pubmed173 102

71 87

Methods : Flow Methods : Flow chartchart

76

Start

Pubmed search

Scopus search

Read titles and abstracts

NoYes

Apply exclusion

criteria

Include articles not found at Pubmed

search

260 articlesreached

Excluded by 2 revisors

78 Articles included

Article excluded

Read full article

Apply exclusion

criteria

Excluded by 2 revisors

Article included

Article excluded

NoYes

End

10

Methods - Methods - Extracted dataExtracted 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

ResultsResults• 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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101214161820

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DCDS-JSGS

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k sc

ore

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ky P

erform

. Sc.

Spitzer

Index

Body sym

ptom

sca

le

CPRS

Gas

troent.

QoL in

dex

MACL

SIP

SSIAM

Frequency of questionnaires

ResultsResults•Description of questionnaires

ResultsResults

- different characteristics of patients in each articledifferent characteristics of patients in each article

- different stages of disease

- - different techniques

- different times of measurement

- different instruments used

• Validity of the instruments used

• Possible heterogeneityPossible heterogeneity::

GGantt Chart antt Chart Task not achieved:Task not achieved:

• Extract final quantified QoLExtract final quantified QoL• AnalysisAnalysis

Due to:Due to:• Some results are only shown in graphicsSome results are only shown in graphics• A great variety of surgical technicsA great variety of surgical technics

Further Results Further Results

Expected results for 3rd apresentation:

Analysis Conclusion of Manuscript writing Website conclusion and presentation

Webpage Webpage PlanPlan

Home Page

Abstract

Introduction

Materials and Methods

Results

Discussion

References

Full Article (pdf)

Appendix

Acknowledgments

Presentations

Graphics & Tables

Tasks’ Distribution

Searches in Pubmed&Scopus

1st Presentation

2nd Presentation

3rd Presentation

Authors

Reference database

Articles Valid. Question.