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Meta-analysis shows clinically relevant and long-lasting deterioration in health-related quality of life after esophageal cancer surgery

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Abstract

Purpose

The purpose of the study is to (1) estimate the direction, clinical relevance, and duration of health-related quality of life (HRQL) change in the first year following esophageal cancer surgery and (2) to assess the robustness of the estimates by subgroup and sensitivity analyses, and an exploration of publication bias.

Methods

A systematic literature search in MEDLINE, EMBASE, CINAHL, PsychINFO, and CENTRAL to identify randomized and non-randomized studies was performed. We compared the baseline HRQL data with 3-, 6-, 9-, or 12-month follow-ups to estimate the magnitude and duration of HRQL change. These estimates were then classified as trivial, small, medium, or large. Primary outcomes were role functioning, eating, and fatigue. Secondary outcomes were physical and social functioning, dysphagia, pain, and coughing problems. We conducted subgroup analysis for open surgery, open surgery preceded by neo-adjuvant therapy, and minimally invasive surgery. Sensitivity analyses assessed the influence of study design, transformation/imputation of the data, and HRQL questionnaire used.

Results

We included data from 15 studies to estimate the change in 28 HRQL outcomes after esophageal cancer surgery. The main analysis showed that patients’ social functioning deteriorated. Symptoms of fatigue, pain, and coughing problems increased. These changes lasted for 9–12 months, although some symptoms persisted beyond the first year after surgery. For many other HRQL outcomes, estimates were only robust after subgroup or sensitivity analyses (e.g., role and physical functioning), or remained too heterogeneous to interpret (e.g., eating and dysphagia).

Conclusions

Patients will experience a clinically relevant and long-lasting deterioration in HRQL after esophageal cancer surgery. However, for many HRQL outcomes, more and better quality evidence is needed.

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Notes

  1. A large change indicates a clear clinical relevance. A medium change indicates a clinical relevance, but to a lesser extent. A small change indicates a subtle but nevertheless clinically relevant effect. A trivial change indicates either a change of unlikely clinical relevance, or no change.

  2. QLQ-C30: global quality of life, physical functioning, role functioning, cognitive functioning, emotional functioning, social functioning, fatigue, nausea and vomiting, insomnia, constipation, pain, diarrhea, appetite loss, dyspnoea, and financial difficulties. QLQ-OES18: dysphagia, eating, reflux, swallowing saliva, choking when swallowing, speech, taste problems, and coughing problems. QLQ-OES24: deglutition, alopecia, trouble talking, emotional problems/anxiety. SF-36: role physical, role emotional, bodily pain, mental health, and vitality. FACT-E: physical well-being, functional well-being, social/family well-being, emotional well-being, oesophageal cancer subscale, fact-E total, and fact-G total. a-RSCL: psychological symptoms, physical symptoms, and activity level. MOS-SF-20: health perceptions, energy, and bodily pain.

  3. QLQ-C30: global quality of life, physical functioning, role functioning, cognitive functioning, emotional functioning, social functioning, fatigue, nausea and vomiting, insomnia, constipation, pain, diarrhea, appetite loss, dyspnoea, and financial difficulties. QLQ-OES18: dysphagia, eating, reflux, pain, swallowing saliva, choking when swallowing, speech problems, taste problems, and coughing problems. QLQ-OES24: deglutition. SF-36: role functioning and social functioning. FACT-E: fact-E. A-RSCL: global quality of life. MOS-SF-20: physical functioning, role functioning, and social functioning.

Abbreviations

HRQL:

Health-related quality of life

WHO:

World Health Organization

RCT:

Randomized controlled trial

PROM:

Patient-reported outcome measure

QLQ-C30:

European Organization of Research and Treatment of Cancer Quality of Life Questionnaire Cancer-30

QLQ-OES18:

European Organization of Research and Treatment of Cancer Quality of Life Questionnaire Esophagus-18

SD:

Standard deviation

95% CI:

95% confidence interval

MD:

Mean difference

SMD:

Standardized mean difference

QLQ-C36:

European Organization of Research and Treatment of Cancer Quality of Life Questionnaire Cancer-36

QLQ-OES24:

European Organization of Research and Treatment of Cancer Quality of Life Questionnaire Esophagus-24

95% UI:

95% uncertainty interval

MID:

Minimally important difference

SF-36:

Medical Outcomes Study Short-Form General Health Survey

MOS-SF-20:

Medical Outcomes Study Short-Form General Health Survey

a-RSCL:

Adapted Rotterdam Symptom Checklist

FACT-E:

Functional Assessment of Cancer Therapy Scale-Esophageal Cancer

PAIS:

Psychosocial adjustment to illness scale

POMS:

Profiles of mood states

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Acknowledgments

We would like to extend our gratitude to Nan van Geloven for her help in the imputation of missing data and to Miranda Langendam, Pythia T. Nieuwkerk, and Ed Hull for their insightful comments on an early draft. We would also like to extend our gratitude to Marco Scarpa, Pernilla Lagergren, Kerry Avery, Angela de Boer, Anthony Yuen Bun Teoh, and Johnny Moons for providing additional descriptive outcome data. Dr, Henselmans and Dr. Korfage both receive grants from the Dutch Cancer Society. Presented in part as a poster at the 19th Annual Conference of the International Society for Quality of Life Research, Budapest, HUN, October 24–27, 2011.

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Authors and Affiliations

  1. Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, Meibergdreef 5, 1100DD, Amsterdam, The Netherlands

    M. Jacobs, K. Sitnikova, E. M. A. Smets, I. Henselmans, J. C. J. M. de Haes & M. A. G. Sprangers

  2. School of Social and Community Medicine, University of Bristol, Bristol, UK

    R. C. Macefield & J. M. Blazeby

  3. Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    R. G. Elbers

  4. Department of Public Health, University Medical Center Rotterdam, Rotterdam, The Netherlands

    I. J. Korfage

  5. Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    M. I. van Berge Henegouwen

  6. Division of Surgery Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK

    J. M. Blazeby

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  1. M. Jacobs
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Correspondence to M. Jacobs.

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Jacobs, M., Macefield, R.C., Elbers, R.G. et al. Meta-analysis shows clinically relevant and long-lasting deterioration in health-related quality of life after esophageal cancer surgery. Qual Life Res 23, 1097–1115 (2014). https://doi.org/10.1007/s11136-013-0545-z

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