Assessment of post-operative
quality of life in gastric cancer:
a systematic review
Ana Rita Marques; Natália Ferreira; Mylene Costa; Paula Joana Moreira;
Paula Campelo; Paulo Leandro; Pedro Barbosa; Pedro Mendes
Supervisors: Camila Dias and Mário Dinis Ribeiro
FMUP/ Serviço de Bioestatística e Informática Médica
1st year, Class 17
Assessment of post-operative quality of life in gastric cancer
Introduction
Meta-analysis, a final step in a systematic review:
“(…) statistical pooling of data across studies to generate summary estimates of
effects .(…) the term “effect” refers to any measure of association between exposure
and outcome” [1]
“Meta-analysis is a statistical procedure that integrates the results of several
independent studies considered to be “combinable”.”
Huke MF, 1988
[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
Supervisors: Camila Dias and Mário Dinis Ribeiro
1st year, Class 17
Assessment of post-operative quality of life in gastric cancer
Introduction
Gastric cancer as:
GASTRIC CANCER IN CANCER
DEATH RATE (1973-92)
• A malignant cell growth;
• Second leading cause of cancer deaths worldwide;
Surgery as the major way for treatment:
• Subtotal gastrectomy;
• Total gastrectomy;
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.
Kaptein AA, Morita S, Sakamoto J. Quality of life in gastric cancer World J Gastroenterol 2005
http://massgeneral.org/cancer/about/providers/surgical/gastric.asp
Supervisors: Camila Dias and Mário Dinis Ribeiro
1st year, Class 17
Assessment of post-operative quality of life in gastric cancer
Introduction
Quality of life (QoL):
“The functional effect of an illness and its consequent therapy upon a
patient, as perceived by the patient.” [2]
“The degree to which a person enjoys the important possibilities of his
or her life.” [3]
Instruments for studying QoL:
• Questionnaires
• Interviews
[2]Schipper H, Clinch J, Olweny LM. Definitions and conceptual issues. Spilker B Philadelphia:
Lippincott-Raven, 1996
[3]Qualitty of life Research Unit, University of Toronto, www.gdrc.org/uem/qol-define.html.
Supervisors: Camila Dias and Mário Dinis Ribeiro
1st year, Class 17
Assessment of post-operative quality of life in gastric cancer
Objectives
• Assess and summarize QoL in patients submitted to surgery for gastric cancer
• Clarifying validity of the instruments used
Supervisors: Camila Dias and Mário Dinis Ribeiro
1st year, Class 17
Assessment of post-operative quality of life in gastric cancer
Methods
Inclusion criteria:
Include a population with gastric cancer that have been submitted to a gastrectomy
Include post-surgery QoL evaluation
MESH (Medical Subject Headings) terms:
• Quality of life
• Gastrectomy
• Stomach neoplasm
Limits of the research
•Language: English, French, Spanish and Italian
•Humans
•Publication Date: from 1950 to September 2005
•Only items with abstracts
Supervisors: Camila Dias and Mário Dinis Ribeiro
1st year, Class 17
Assessment of post-operative quality of life in gastric cancer
Methods
Exclusion criteria:
Title:
Refer to radiotherapy / chemotherapy
Not refer specifically to gastric cancer
Abstract:
Not have abstracts
Not refer to QoL
If there is only one case in study
Not refer to a post-operative instrument (questionnaire)
Not approach QoL in a generic view
If patients have more than one type of cancer besides gastric cancer
All text:
If we could not have access to the manuscript
Supervisors: Camila Dias and Mário Dinis Ribeiro
1st year, Class 17
Assessment of post-operative quality of life in gastric cancer
Methods : Query's Definition
Quality of life [MESH] AND (stomach neoplasm [MESH] OR Gastric cancer OR stomach
carcinoma) NOT intestinal cancer AND (gastrectomy [MESH] OR gastric surgery) NOT
chemotherapy (175)
With limits:
 English and humans and within the defined publication date and with abstracts – 109
articles
 Italian and humans and within the defined publication date and with abstracts – 4 articles
(Surgical treatment OR gastrectomy OR surgery) AND (gastric carcinoma OR gastric cancer OR
stomach neoplasm OR stomach cancer) AND quality of life [MESH] AND questionnaires(42)
With limits:
 Humans and within the defined publication date – 42 articles
 English and humans and within the defined publication date – 32 articles
Gastric cancer [MESH] AND surgery [MESH] AND quality of life [MESH] AND carcinoma [MESH] AND
neoplasm [MESH] (51)
With limits:
 English and humans – 33 articles
 English and humans and within the defined publication date – 33 articles
Supervisors: Camila Dias and Mário Dinis Ribeiro
1st year, Class 17
Assessment of post-operative quality of life in gastric cancer
Methods : Flow chart
START
Articles
search
(PubMed)
Apply
inclusion
criteria
Read titles
of included
articles
Apply
exclusion
criteria
Article
not
excluded
Excluded by
2 revisors
no
yes
Article
excluded
Without agreement
Read
abstract of
articles
END
Ask opinion of
a 3rd revisor
no
yes
Excluded by
3rd revisor
Articles
included in
the study
no
Apply
exclusion
criteria
Article
not
excluded
no
Excluded by
2 revisors
yes
no
Without agreement
Excluded by
3rd revisor
Ask opinion
of a 3rd
revisor
Without
agreement
Excluded by
2 revisors
Apply
exclusion
criteria
yes
yes
Article
excluded
Supervisors: Camila Dias and Mário Dinis Ribeiro
Read full
articles
Ask opinion of
a 3rd revisor
no
Excluded by
3rd revisor
1st year, Class 17
Assessment of post-operative quality of life in gastric cancer
Expected results
• 61 included articles
•QoL after gastric cancer surgery lower than QoL of the general population
•Different values of QoL between patients submitted to total gastrectomy and
sub-total gastrectomy
Possible heterogeneity
View Gantt Map
Supervisors: Camila Dias and Mário Dinis Ribeiro
1st year, Class 17