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Transcript of Assessment of Quality Of Life in patients treated with Chemo and Radiotherapy for Gastric Cancer: A...
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
MaleFemale
Cumulative risk, 0-64 years
Eucan - Database
Stomach adenocarcinoma is the most common form of gastric cancer
(95% of the cases).11
1- Crew KD, Epidemiology of upper gastrointestinal malignancies. Seminin Oncol 2004; 31: 450–464.
Background Gastric Cancer European Distribution
QoL after Chemo/Radiotherapy in Gastric Cancer
Background
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
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
Gastric Cancer Incidence
QoL after Chemo/Radiotherapy in Gastric Cancer
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
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
Aproximately 1,440,000 cases worlwide per year
BackgroundIncidence Gastric Cancer
QoL after Chemo/Radiotherapy in Gastric Cancer
Treatment for gastric cancer often
involves surgery, usually a partial
or a total gastrectomy (removal of
stomach tissue).22
Chemotherapy and radiotherapy
are standard for some stages of
stomach cancer.22
2-Ross P. 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.
BackgroundTreatments
QoL after Chemo/Radiotherapy in Gastric Cancer
Chemotherapy is the use of
chemical agents to stop cancer
cells from growing.33
Chemotherapy is considered a
systemic treatment.33
Radiotherapy uses high energy x-
rays to destroy cancer cells.44
A small dose of radiotherapy may
be very helpful to relieve pain.44
3-Janunger KG. A Systematic Overview of Chemotherapy Effects in Gastric Cancer. Acta Oncologica, Vol. 40, No. 2/3, pp. 309-326, 2001.
4-Kim GE. 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.
BackgroundChemo and Radiotherapy
QoL after Chemo/Radiotherapy in Gastric Cancer
Schipper et al. proposed:
“the functional effect of illness and its consequent therapy upon a patient, as
perceived by the patient”.55
5- Schipper H. Definitions and conceptual issues. In: Spilker B, ed. Quality of Life and pharmacoeconomics. in clinical trials, Philadephia : Lippincott- Raven, 1996: 11-24
6-WHOQoL Group (1993)
World Health Organization proposed:
“Quality of life is defined as the individual's perception of their position in life in
the context of the culture and value systems in which they live and in relation to
their goals, expectations, standards and concerns. It is a broad ranging concept
affected in a complex way by a person's physical health, psychological state,
level of independence and their relationships to salient features of their
environment”.
Some definitions
BackgroundQuality of Life
QoL after Chemo/Radiotherapy in Gastric Cancer
Schipper et al. proposed:
“the functional effect of illness and its consequent therapy upon a patient, as
perceived by the patient”.55
World Health Organization proposed:
“Quality of life is defined as the individual's perception of their position in life in
the context of the culture and value systems in which they live and in relation to
their goals, expectations, standards and concerns. It is a broad ranging concept
affected in a complex way by a person's physical health, psychological state,
level of independence and their relationships to salient features of their
environment”.
Some definitions
BackgroundQuality of Life
QoL after Chemo/Radiotherapy in Gastric Cancer
5- Schipper H. Definitions and conceptual issues. In: Spilker B, ed. Quality of Life and pharmacoeconomics. in clinical trials, Philadephia : Lippincott- Raven, 1996: 11-24
6-WHOQoL Group (1993)
Aim
__________________________________________________________________________
• Summarize the QoL of patients with gastric cancer after treatment with
chemo and radiotherapy
• Clarify the validity/validation of instruments used
• Summarize the QoL of patients with gastric cancer according to the
instrument.
__________________________________________________________________________
QoL after Chemo/Radiotherapy in Gastric Cancer
Methods
Inclusion Criteria of the article:
- Patients with gastric
cancer;
- Patients submitted to
chemo or radiotherapy;
- QoL evaluated by the
patients;
- QoL measured with an
appropriate instrument;
- More than one participant.
0102030405060708090
100
Eval
uatio
n of
QO
L
Mor
e th
anon
epa
rtic
ipan
t
Patie
nts
with
gast
ricca
ncer
Patie
nts
subm
itted
toch
emo
orra
diot
hera
py
QO
Lev
alua
ted
byth
e pa
tient
Inst
rum
ent
to m
easu
reQ
OL
Inclusion criteriaN
o. o
f inc
lude
d ar
ticle
sThese data refers to 97 articles
Type of Study: Systematic reviewType of Study: Systematic review
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.
Article Search:
Limits:
Publication Date until September 2005.
Only items with an abstract.
Humans.
MethodsQoL after Chemo/Radiotherapy in Gastric Cancer
Methods
Exclusion criteria of the article:
- Articles based on mixed diagnostic groupings (in the article these have to be approached separately);
- Articles in which QoL was measured but only symptoms were studied;
- Articles that referred to patients submitted to a surgery during or before treatment.
0
5
10
15
20
25
30
35
40
Mixed groups Only the symptoms weremeasured
Patients submitted to surgery
Exclusion criteria
No. o
f exc
lude
d ar
ticle
s
These data refers to 97 articles
QoL after Chemo/Radiotherapy in Gastric Cancer
FluxogramBeginning
Read title and abstract
Excluded by 2 reviewers ?
Exclude article
Included by 2 reviewers ?
End
Opinion of a third reviewer
no
Include article
yes
Read complete
article
Introduce data in the SPSS
Yes No
Discuss until reviewers agreement
Exclude article
Include article
MethodsQoL after Chemo/Radiotherapy in Gastric Cancer
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 and Medline
QoL after Chemo/Radiotherapy in Gastric Cancer
ResultsSearches
QoL after Chemo/Radiotherapy in Gastric Cancer
StartSearch in Pubmed
116 articles found
Apply inclusion and exclusion
criteria
11 were included
86 were excluded
19 couldn’t be used
Search for the validation
paper
All the instruments had a validation paper
End
A summary of the data extracted from the included articles A summary of the data extracted from the included articles
In the following TableIn the following Table
Is presented
ResultsIncluded Articles
QoL after Chemo/Radiotherapy in Gastric Cancer
Park SH, 2005EORTC QLQ-C30;
HADS Patients submitted to second-line chemotherapy
Patients not submitted to chemotherapy
Locally advanced or
metastic disease
QoL increases with second-line
chemotherapy
Teunissen JJ, 2004 EORTC QLQ-C30 Patients not submitted to chemotherapy
Patients treated with [177Lu-
DOTA0,Tyr3]octreotate
Metastic tumor (GEP)
QoL increases in patients treated with
[177-Lu-DOTA0,Tyr3]octreotate
Tebbutt NC 2002 EORTC QLQ-C30 Patients submitted to protracted venous infusion (PVI) 5-
fluorouracil (5-FU)
Patients submitted to PVI 5-FU plus mitomycin C
Locally advanced or
metastic disease
No differences in QoL
Bramhall SR 2002 EORTC QLQ-C30 Placebo Patients submitted to
chemotherapy
Locally advanced or
metastic disease
No differences in QoL
Ross P, 2002 EORTC QLQ-C30 Patients submitted to
mitomycin, cisplatin, and protracted venous-
infusion fluorouracil (PVI 5-FU)
Patients submitted to epirubicin, cisplatin, and
PVI 5-FU
Inoperable adenocarcino
ma
QoL increases if we use epirubicin, cisplatin,
and PVI 5-FU
Nordin K, 2001 EORTC QLQ-C30 Patients submitted to chemotherapy without best supportive care
Patients submitted to chemotherapy with best
supportive care
Advanced gastric cancer
QoL increases in chemotherapy with
best supportive care
Katarina H, 1998 EORTC QLQ-C30 Patients not submitted to chemotherapy
Patients submitted to second-line chemotherapy
Advanced gastric cancer
QoL increases with second-line
chemotherapy
Glimelius B, 1997 EORTC QLQ-C30 Best supportive careChemotherapy and best
suportive care
Locally advanced or
metastic disease
QoL increases in chemotherapy with
best supportive care
Bamias A, 1996 EORTC QLQ-C30 Patients submitted to a treatment with epirubicin
and cisplatin
Patients submitted to a venous infusion of 5-
fluorouracil
Locally advanced or
metastic disease
QoL increases in both groups
Scieszka M, 1998 FACT Patients submitted to chemotherapy
Patients submitted to palliative care
Advanced gastric cancer
No differences in QoL
Findlay M, 1994 Rotterdam
Symptom Checklist Patients submitted to a
treatment with epurubicin and cisplatin in
combination with infusion 5-fluorouracil
Patients not submitted to this treatment
Locally advanced or
metastic disease
No differences in QoL
Control groupPatients stage
ResultsFist author and Publication date of the
articleInstrument Validation paper of
the instruments
Group in study
Park SH, 2005EORTC QLQ-C30;
HADS Patients submitted to second-line chemotherapy
Patients not submitted to chemotherapy
Locally advanced or
metastic disease
QoL increases with second-line
chemotherapy
Teunissen JJ, 2004 EORTC QLQ-C30 Patients not submitted to chemotherapy
Patients treated with [177Lu-
DOTA0,Tyr3]octreotate
Metastic tumor (GEP)
QoL increases in patients treated with
[177-Lu-DOTA0,Tyr3]octreotate
Tebbutt NC 2002 EORTC QLQ-C30 Patients submitted to protracted venous infusion (PVI) 5-
fluorouracil (5-FU)
Patients submitted to PVI 5-FU plus mitomycin C
Locally advanced or
metastic disease
No differences in QoL
Bramhall SR 2002 EORTC QLQ-C30 Placebo Patients submitted to
chemotherapy
Locally advanced or
metastic disease
No differences in QoL
Ross P, 2002 EORTC QLQ-C30 Patients submitted to
mitomycin, cisplatin, and protracted venous-
infusion fluorouracil (PVI 5-FU)
Patients submitted to epirubicin, cisplatin, and
PVI 5-FU
Inoperable adenocarcino
ma
QoL increases if we use epirubicin, cisplatin,
and PVI 5-FU
Nordin K, 2001 EORTC QLQ-C30 Patients submitted to chemotherapy without best supportive care
Patients submitted to chemotherapy with best
supportive care
Advanced gastric cancer
QoL increases in chemotherapy with
best supportive care
Katarina H, 1998 EORTC QLQ-C30 Patients not submitted to chemotherapy
Patients submitted to second-line chemotherapy
Advanced gastric cancer
QoL increases with second-line
chemotherapy
Glimelius B, 1997 EORTC QLQ-C30 Best supportive careChemotherapy and best
suportive care
Locally advanced or
metastic disease
QoL increases in chemotherapy with
best supportive care
Bamias A, 1996 EORTC QLQ-C30 Patients submitted to a treatment with epirubicin
and cisplatin
Patients submitted to a venous infusion of 5-
fluorouracil
Locally advanced or
metastic disease
QoL increases in both groups
Scieszka M, 1998 FACT Patients submitted to chemotherapy
Patients submitted to palliative care
Advanced gastric cancer
No differences in QoL
Findlay M, 1994 Rotterdam
Symptom Checklist Patients submitted to a
treatment with epurubicin and cisplatin in
combination with infusion 5-fluorouracil
Patients not submitted to this treatment
Locally advanced or
metastic disease
No differences in QoL
Control groupPatients stage
ResultsFist author and Publication date of the
articleInstrument Validation paper of
the instruments
Group in study
Park SH, 2005EORTC QLQ-C30;
HADS Patients submitted to second-line chemotherapy
Patients not submitted to chemotherapy
Locally advanced or
metastic disease
QoL increases with second-line
chemotherapy
Teunissen JJ, 2004 EORTC QLQ-C30 Patients not submitted to chemotherapy
Patients treated with [177Lu-
DOTA0,Tyr3]octreotate
Metastic tumor (GEP)
QoL increases in patients treated with
[177-Lu-DOTA0,Tyr3]octreotate
Tebbutt NC 2002 EORTC QLQ-C30 Patients submitted to protracted venous infusion (PVI) 5-
fluorouracil (5-FU)
Patients submitted to PVI 5-FU plus mitomycin C
Locally advanced or
metastic disease
No differences in QoL
Bramhall SR 2002 EORTC QLQ-C30 Placebo Patients submitted to
chemotherapy
Locally advanced or
metastic disease
No differences in QoL
Ross P, 2002 EORTC QLQ-C30 Patients submitted to
mitomycin, cisplatin, and protracted venous-
infusion fluorouracil (PVI 5-FU)
Patients submitted to epirubicin, cisplatin, and
PVI 5-FU
Inoperable adenocarcino
ma
QoL increases if we use epirubicin, cisplatin,
and PVI 5-FU
Nordin K, 2001 EORTC QLQ-C30 Patients submitted to chemotherapy without best supportive care
Patients submitted to chemotherapy with best
supportive care
Advanced gastric cancer
QoL increases in chemotherapy with
best supportive care
Katarina H, 1998 EORTC QLQ-C30 Patients not submitted to chemotherapy
Patients submitted to second-line chemotherapy
Advanced gastric cancer
QoL increases with second-line
chemotherapy
Glimelius B, 1997 EORTC QLQ-C30 Best supportive careChemotherapy and best
suportive care
Locally advanced or
metastic disease
QoL increases in chemotherapy with
best supportive care
Bamias A, 1996 EORTC QLQ-C30 Patients submitted to a treatment with epirubicin
and cisplatin
Patients submitted to a venous infusion of 5-
fluorouracil
Locally advanced or
metastic disease
QoL increases in both groups
Scieszka M, 1998 FACT Patients submitted to chemotherapy
Patients submitted to palliative care
Advanced gastric cancer
No differences in QoL
Findlay M, 1994 Rotterdam
Symptom Checklist Patients submitted to a
treatment with epurubicin and cisplatin in
combination with infusion 5-fluorouracil
Patients not submitted to this treatment
Locally advanced or
metastic disease
No differences in QoL
Control groupPatients stage
ResultsFist author and Publication date of the
articleInstrument Validation paper of
the instruments
Group in study
Discussion
Lack of information
due to:
Many articles in japanese
Most of the papers focus on surgery
Because
Surgery is the only potencially curative treatment
in gastric cancer.88
Japan is a country with a high
incidence of gastric cancer.77
Understandable
once
7-IARC Scientific Publications. In: Whelan SL, Parkin DM, Masuyer E, eds. Trends in Cancer Incidence and Mortality. Lyon: WHO Publications, 1993;102.
8-Wilke Hj, Van Cutsem E. Current treatments and future perspectives in colorectal and gastric cancer . Ann Oncol, 2003;14: 49-55.
Search Limitations Related with
QoL after Chemo/Radiotherapy in Gastric Cancer
Discussion
Chemo and radiotherapy are considered:
Adjuvant therapies (before or after surgery)88
Palliative treatments77
8-Current treatments and future perspectives in colorectal and gastric cancer .
TreatmentLimitations Related with
QoL after Chemo/Radiotherapy in Gastric Cancer
Discussion
Just a few could be included
Some of the causes:
Studies just evaluated differences on survival
time according to treatment
Only the physical parameters were considered
Limitations Related withPapers
QoL after Chemo/Radiotherapy in Gastric Cancer
Discussion
Just a few could be included
Some of the causes:
Studies just evaluated differences on survival
time according to treatment
Only the physical parameters were considered
QoL is still a minor concern!
Limitations Related withPapers
QoL after Chemo/Radiotherapy in Gastric Cancer
Discussion
Therefore:
It was impossible to achieve a meta analysis with the obtained data
Evaluation of QoL is qualitative, although a
scale exists in every instrument
Meta analysisQoL after Chemo/Radiotherapy in Gastric Cancer
Discussion
Therefore:
It was impossible to achieve a meta analysis with the obtained data
More research is needed
Evaluation of QoL is qualitative, although a
scale exists in every instrument
Meta analysisQoL after Chemo/Radiotherapy in Gastric Cancer
Discussion
Questionnaire Number of Items Areas Measured
FACT-Ga 28physical, functional, social, and
emotional
EORTC QLQ-C30 30physical, functional, social, and
emotional
RSCL 30 psychological and physical
HADS 14 psychological
Questionnaires usedQoL after Chemo/Radiotherapy in Gastric Cancer
Discussion
Items removed from the applied Items removed from the applied questionnairesquestionnaires
Do you have any trouble taking a long
walk?
you limited in pursing your hobbies or
other leisure time activities?
I am satisfied with my sex life I am able to enjoy life
Lack of sexual interest
Maybe this isn’t the best approach...
Items of the questionnaires for Items of the questionnaires for patients under palliationpatients under palliation
Approximately how many hours per day (8
a.m. to 8 p.m.) have you been lying down? How much help have you needed with
dressing and hygiene?
How much pain have you had last week?
How many days during the past week have
you spent in a hospital/nursing home?
Some differencesQuestionnaires
QoL after Chemo/Radiotherapy in Gastric Cancer
Discussion
Questionnaire Number of Items Areas Measured
AQEL 36physical, psychological,
social, existential
EORTC QLQ-C15-PAL 15Functional, choice of
treatment, psychological
PQLI 28functional, symptom, choice
of treatment scale, psychological
McGill 16
physical symptoms, psychological symptoms,
outlook on life, and meaningful existence
FLIC 22
physical well-being and ability, emotional state,
sociability, family situation and nausea
Questionnaires proposedQoL after Chemo/Radiotherapy in Gastric Cancer
Discussion
When chemo and radiotherapy are used as
treatment
The instrument to measure QoL should not be the same used with
the other treatments
The most appropriate option is a The most appropriate option is a
Questionnaire to Patients under PalliationQuestionnaire to Patients under Palliation
A Systematic Review about these instruments can be
consulted to better understand their characteristics
Final RemarksQoL after Chemo/Radiotherapy in Gastric Cancer
Discussion
When chemo and radiotherapy are used as
treatment
The instrument to measure QoL should not be the same used with
the other treatments
The most appropriate option is a The most appropriate option is a
Questionnaire to Patients under PalliationQuestionnaire to Patients under Palliation
““Instruments for assessing quality of life in palliative care settings.” Instruments for assessing quality of life in palliative care settings.”
Massaro T, McMillan SC; Int J Palliat Nurs.; 2000 Oct; 6(9):429-33Massaro T, McMillan SC; Int J Palliat Nurs.; 2000 Oct; 6(9):429-33
Final RemarksQoL after Chemo/Radiotherapy in Gastric Cancer
Web SiteQoL after Chemo/Radiotherapy in Gastric Cancer
Trabalho anual - FMUP- Faculdade de Medicina da Universidade do Porto
Acknowledgments
We acknowledge the help of:We acknowledge the help of:
Cláudia Camila Dias
Mário Dinis Ribeiro
We are also very grateful to:We are also very grateful to:
Professor Doutor Altamiro da Costa Pereira
All the authors that have promptly fournished the articles
necessary for the succes of our work
QoL after Chemo/Radiotherapy in Gastric Cancer
Not forgetting:Not forgetting: