Quality of Life Research

, Volume 23, Issue 4, pp 1097–1115

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

  • M. Jacobs
  • R. C. Macefield
  • R. G. Elbers
  • K. Sitnikova
  • I. J. Korfage
  • E. M. A. Smets
  • I. Henselmans
  • M. I. van Berge Henegouwen
  • J. C. J. M. de Haes
  • J. M. Blazeby
  • M. A. G. Sprangers
Review

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.

Keywords

Esophageal cancer Health-related quality of life Surgery Meta-analysis Patient-reported outcomes 

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

Supplementary material

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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • M. Jacobs
    • 1
  • R. C. Macefield
    • 2
  • R. G. Elbers
    • 3
  • K. Sitnikova
    • 1
  • I. J. Korfage
    • 4
  • E. M. A. Smets
    • 1
  • I. Henselmans
    • 1
  • M. I. van Berge Henegouwen
    • 5
  • J. C. J. M. de Haes
    • 1
  • J. M. Blazeby
    • 2
    • 6
  • M. A. G. Sprangers
    • 1
  1. 1.Department of Medical Psychology, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.School of Social and Community MedicineUniversity of BristolBristolUK
  3. 3.Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  4. 4.Department of Public HealthUniversity Medical Center RotterdamRotterdamThe Netherlands
  5. 5.Department of Surgery, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  6. 6.Division of Surgery Head and NeckUniversity Hospitals Bristol NHS Foundation TrustBristolUK

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