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

1. Assessment of quality of life of patients with gastric cancer after surgery: 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 Ribeiro FMUP/ Serviço de Bioestatística e Informática Médica

2. Introduction • Meta-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

3. Introduction • 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.

4. Introduction GASTRIC CANCER IN CANCER DEATH RATE (1973-92) • Rate of surviving is increasing http://plan1998.cancer.gov/PRGRES.htm (National Cancer Institute) Quality of life (QoL) is then particularly important in health care. [4] [4] Kaptein AA, Morita S, Sakamoto J. Quality of life in gastric cancer World J Gastroenterol 2005

5. Introduction • 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.

6. Aims • 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.

7. Methods • Inclusion 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

8. Methods Full article: • Not have access to article • Not describe the patients studied • Questionnaire is not validated • Not refer QoL assessment

9. Methods Articles search - Pubmed MESH (Medical Subject Headings)terms: . Quality of life . Gastrectomy . Stomach neoplasm Limits of the research: Language: English Humans Publication Date: from 1950 to September 2005 Only items with abstracts

10. Methods : Query's Definition • Pubmed • ("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

11. Methods - Scopus Limits of the research: - year: until 2005; - areas: "health" e "life sciences"; - document type: "review" e "article" Query´s definition: TITLE-ABS-KEY("Quality of life") AND TITLE-ABS-KEY(("stomach neoplasms") OR ("gastric cancer") OR ("stomach carcinoma")) AND NOT (intestinal cancer) AND TITLE-ABS-KEY(("gastrectomy") OR ("gastric surgery")) AND NOT (chemotherapy) AND NOT (radiotherapy) 189 articles

12. Articles reached 173 + 189 = 362 362 - 102 (common) = 260 102 87 71

13. 10 Methods : Flow chart 76

14. Methods - Extracted 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

15. Results • 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

16. Results • Description of questionnaires

17. Results • Validity of the instruments used • Possible heterogeneity: • -different characteristics of patients in each article • - different stages of disease • - different techniques • - different times of measurement • - different instruments used

18. Gantt Chart • Task not achieved: • Extract final quantified QoL • Analysis • Due to: • Some results are only shown in graphics • A great variety of surgical technics

19. Further Results Expected results for 3rd apresentation: • Analysis • Conclusion of Manuscript writing • Website conclusion and presentation

20. Webpage Plan