1
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
FMUP/SBIM
2
Gastric Cancer in the World
31
14
109 8
4 4 3
1 0 0 0 0
108
68
4
0
3 3 21 1
13
8
4
16
0
5
10
15
20
25
30
35
Lung
Stom
ach
Live
rCCR
Oesop
hagu
s
Pros
tate
Panc
reas
Leuk
emia
NHLSk
in
Thyr
oid
Breas
t
Uteru
s
Ovary
Men Women
FMUP/SBIM
850 000 deaths worlwide each year cause due to 850 000 deaths worlwide each year cause due to
gastric cancergastric cancer
World, age-standardized rates (per 100.000 persons.year)
Eucan - Database
3
Gastric Cancer in Europe
MaleFemale
FMUP/SBIM
Cumulative risk, 0-64 years
Eucan - Database
4
Introduction
Stomach adenocarcinoma is
the most common form of
gastric cancer (95% of the
cases).11
Stomach cancer is a
multifactorial disease:diet,
hereditary factors,
Helicobacter pylori infection
are possible causes.2-32-3
Tobacco smoking has also Tobacco smoking has also
been clearly accepted as been clearly accepted as
increasing the risk of stomach increasing the risk of stomach
cancer.cancer.44
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.
QoL after Chemo/Radiotherapy in Gastric Cancer
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Introduction
Treatment for gastric
cancer often involves
surgery, usually a partial
or a total gastrectomy
(removal of stomach
tissue).55
Chemotherapy and
radiotherapy are standard
for some stages of
stomach cancer.55
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.
QoL after Chemo/Radiotherapy in Gastric Cancer
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Introduction
Chemotherapy is the use
of chemical agents to stop
cancer cells from growing.66
Chemotherapy is considered a systemic treatment.66
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.
QoL after Chemo/Radiotherapy in Gastric Cancer
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Introduction
Radiotherapy uses high
energy x-rays to destroy
cancer cells.77
A small dose of
radiotherapy may be very
helpful to relieve pain.77
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.
QoL after Chemo/Radiotherapy in Gastric Cancer
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Introduction
These multiple treatments
have different
consequences in Quality of
Life (QoL) in patients.8
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
QoL after Chemo/Radiotherapy in Gastric Cancer
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
FMUP/SBIM
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
The Query used was:
◊ ″Gastric cancer AND (Quality of Life OR
Psychology) AND (Radiotherapy OR
Chemotherapy)”
FMUP/SBIM
QoL after Chemo/Radiotherapy in Gastric Cancer
Literature searches were
conducted
in Medline.
11
Limits
FMUP/SBIM
QoL after Chemo/Radiotherapy in Gastric Cancer
Publication Date until September 2005.
Only items with an abstract.
Humans.
12
Methods
Inclusion Criteria
- More than one
participant;
- QoL evaluated by the
patients;
- Patients who had gastric
cancer;
- Patients submitted to
chemo or radiotherapy;
- QoL measured with an
appropriate instrument.
FMUP/SBIM
0102030405060708090
Was
QO
Lev
aluat
ed?
Mor
e th
an o
nepa
rticip
ant?
Gas
tric
canc
er?
Subm
itted
toch
emo
orra
dioth
erap
y?
QO
Lev
aluat
ed b
yth
e pa
tient
?
Inst
rum
ent t
om
easu
reQ
OL?
Inclusion criteriaNo
. of a
rticl
es
QoL after Chemo/Radiotherapy in Gastric Cancer
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Methods
Exclusion criteria
- Articles based on mixed diagnostic groupings (in the article these have to be approached separately);
- Articles in which QoL was measure but only symptoms were studied;
- Articles that referred to patients submitted to a surgery during or before treatment.
FMUP/SBIM
QoL after Chemo/Radiotherapy in Gastric Cancer
0
5
10
15
20
25
30
35
40
Mixed groups? Were only the symptomsmeasured?
Surgery?
Exclusion criteria
No. o
f arti
cles
14
Methods
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.
QoL after Chemo/Radiotherapy in Gastric Cancer
FMUP/SBIM
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Fluxogram QoL after Chemo/Radiotherapy in Gastric Cancer
Start
Read title and abstract
Excluded by 2 reviewers
Exclude article
Included by 2 reviewers
End
Opinion of a third reviewer
no
Include article
Read complete
article
Introduce data in the SPSS
YesNo
Discuss until reviewers agreement
Excluded by 2 reviewers
Exclude article
Yes No
Included by 2 reviewers
Include article
Yes
Include Article
Exclude Article
NoOpinion of a
third reviewer
no
Discuss until reviewers agreement
Include Article No
Yes
Yes
Yes
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Results
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.
QoL after Chemo/Radiotherapy in Gastric Cancer
FMUP/SBIM
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Results
Article QuestionnaireA 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 CBR
Randomized comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer. 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-C30Prospective 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 [177Lu-DOTA0,Tyr3]octreotate. EORTC) QLQ-C30Multivariate 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
QoL after Chemo/Radiotherapy in Gastric Cancer
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Results
Article PublicationDate
Name of firstAuthor
Validation Paperof the instrument
Present Absent
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 √
QoL after Chemo/Radiotherapy in Gastric
Cancer
FMUP/SBIM