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The Role of Health-Related Quality of Life Outcomes in Clinical Decision Making in Surgery for Esophageal Cancer: A Systematic Review

  • Healthcare Policy and Outcomes
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Esophagectomy for cancer offers a chance of cure but is associated with morbidity, at least a temporary reduction in health-related quality of life (HRQL), and a 5-year survival of approximately 30%. This research evaluated how and whether HRQL outcomes contribute to surgical decision making.

Methods

A systematic review identified randomized trials and longitudinal and cross-sectional studies that assessed HRQL after esophagectomy with multidimensional validated questionnaires. Articles were independently evaluated by two reviewers, and the value of HRQL in clinical decision making was categorized in three ways: (1) the assessment of the quality of HRQL methodology according to predefined criteria; (2) the influence of HRQL outcomes on treatment recommendations and/or informed consent; and (3) the HRQL after esophagectomy for cancer in methodologically robust studies.

Results

Eighteen publications were identified, of which 16 (89%) were categorized as having robust HRQL design. Of these studies, 3 concluded that HRQL influenced treatment recommendations and 11 (including the former 3) informed patient consent. The remaining five papers were well designed, but the authors did not use HRQL to influence treatment recommendations or informed consent. After esophagectomy, patients report major deterioration in most aspects of HRQL with slow recovery.

Conclusion

HRQL outcomes are relevant to surgical decision making. Methods to communicate HRQL outcomes to patients are required to inform consent and clinical practice.

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References

  1. Hulscher JB, van Sandick JW, de Boer AG, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2002; 347:1662–9.

    Article  PubMed  Google Scholar 

  2. Jamieson GG, Mathew G, Ludemann R, et al. Postoperative mortality following oesophagectomy and problems in reporting its rate. Br J Surg 2004; 91:943–7.

    Article  PubMed  CAS  Google Scholar 

  3. Portale G, Hagen JA, Peters JH, et al. Modern 5-year survival of resectable esophageal adenocarcinoma: single institution experience with 263 patients. J Am Coll Surg 2006; 202:588–96.

    Article  PubMed  Google Scholar 

  4. Altorki N, Skinner D. Should en bloc esophagectomy be the standard of care for esophageal carcinoma? Ann Surg 2001; 234:581–7.

    Article  PubMed  CAS  Google Scholar 

  5. Medical Research Council Oesophageal Cancer Working Group. Surgical resection with or without preoperative chemothearpy in oesophageal cancer. Lancet 2002; 359:1727–33.

    Article  Google Scholar 

  6. US Food and Drug Administration. Guidance for industry. Patient-reported outcome measures: use in medical product development for labeling claims. Rockville, MD: US Food and Drug Administration; 2006. p. 1–32.

    Google Scholar 

  7. Stahl M, Stuschke M, Lehmann N, et al. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 2005; 23:2310–7.

    Article  PubMed  Google Scholar 

  8. Urba SG, Orringer MB, Turrisi A, et al. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 2001; 19:305–13.

    PubMed  CAS  Google Scholar 

  9. Goodwin PJ, Black JT, Bordeleau LJ, et al. Health-related quality-of-life measurement in randomized clinical trials in breast cancer—taking stock. J Natl Cancer Inst 2003; 95:263–81.

    Article  PubMed  Google Scholar 

  10. Efficace F, Bottomley A, Osoba D, et al. Beyond the development of health-related quality-of-life (HRQOL) measures: a checklist for evaluating HRQOL outcomes in cancer clinical trials—does HRQOL evaluation in prostate cancer research inform clinical decision making? J Clin Oncol 2003; 21:3502–11.

    Article  PubMed  Google Scholar 

  11. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30:473–83.

    Article  PubMed  Google Scholar 

  12. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85:365–76.

    Article  PubMed  CAS  Google Scholar 

  13. de Haes JCJM, Olschewski M, Fayers PM, et al. Measuring the quality of life of cancer patients: the Rotterdam symptom checklist (RSCL): a manual. Groningen, The Netherlands: Northern Centre for Healthcare Research, 1996

  14. Luketich JD, Velo-Rivera M, Buenaventura PO, et al. Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 2003; 238:486–94.

    PubMed  Google Scholar 

  15. O’Hanlon DM, Harkin M, Karat D, et al. Quality-of-life assessment in patients undergoing treatment for oesophageal carcinoma. Br J Surg 1995; 82:1682–5.

    Article  PubMed  CAS  Google Scholar 

  16. Zieren HU, Jacobi CA, Zieren J, et al. Quality of life following resection of oesophageal carcinoma. Br J Surg 1996; 83:1772–5.

    Article  PubMed  CAS  Google Scholar 

  17. Blazeby JM, Farndon JR, Donovan J, et al. A prospective longitudinal study examining the quality of life of patients with esophageal carcinoma. Cancer 2000; 88:1781–7.

    Article  PubMed  CAS  Google Scholar 

  18. Brooks JA, Kesler KA, Johnson CS, et al. Prospective analysis of quality of life after surgical resection for esophageal cancer: preliminary results. J Surg Oncol 2002; 81:185–94.

    Article  PubMed  Google Scholar 

  19. de Boer AG, van Lanschot JJ, van Sandick JW, et al. Quality of life after transhiatal compared with extended transthoracic resection for adenocarcinoma of the esophagus. J Clin Oncol 2004; 22:4202–8.

    Article  PubMed  Google Scholar 

  20. Blazeby JM, Sanford E, Falk SJ, et al. Health-related quality of life during neoadjuvant treatment and surgery for localized esophageal carcinoma. Cancer 2005; 103:1791–9.

    Article  PubMed  Google Scholar 

  21. Bonnetain F, Bouche O, Michel P, et al. A comparative longitudinal quality of life study using the Spitzer quality of life index in a randomized multicenter phase III trial (FFCD 9102): chemoradiation followed by surgery compared with chemoradiation alone in locally advanced squamous resectable thoracic esophageal cancer. Ann Oncol 2006; 17:827–34.

    Article  PubMed  CAS  Google Scholar 

  22. Cense HA, Hulscher JB, de Boer AG, et al. Effects of prolonged intensive care unit stay on quality of life and long-term survival after transthoracic esophageal resection. Crit Care Med 2006; 34:354–62.

    Article  PubMed  CAS  Google Scholar 

  23. Reynolds JV, McLaughlin R, Moore J, et al. Prospective evaluation of quality of life in patients with localized oesophageal cancer treated by multimodality therapy or surgery alone. Br J Surg 2006; 93:1084–90.

    Article  PubMed  CAS  Google Scholar 

  24. van Knippenberg FC, Out JJ, Tilanus HW, et al. Quality of Life in patients with resected oesophageal cancer. Soc Sci Med 1992; 35:139–45.

    Article  PubMed  Google Scholar 

  25. McLarty AJ, Deschamps C, Trastek VF, et al. Esophageal resection for cancer of the esophagus: long-term function and quality of life. Ann Thorac Surg 1997; 63:1568–72.

    Article  PubMed  CAS  Google Scholar 

  26. Hallas CN, Patel N, Oo A, et al. Five-year survival following oesophageal cancer resection: psychosocial functioning and quality of life. Psychol Health Med 2001; 6:84–94.

    Article  Google Scholar 

  27. Headrick JR, Nichols FC III, Miller DL, et al. High-grade esophageal dysplasia: long-term survival and quality of life after esophagectomy. Ann Thorac Surg 2002; 73:1697–702.

    Article  PubMed  Google Scholar 

  28. Schmidt CE, Bestmann B, Kuchler T, et al. Quality of life associated with surgery for esophageal cancer: differences between collar and intrathoracic anastomoses. World J Surg 2004; 28:355–60.

    Article  PubMed  Google Scholar 

  29. Viklund P, Lindblad M, Lagergren J. Influence of surgery-related factors on quality of life after esophageal or cardia cancer resection. World J Surg 2005; 29:841–8.

    Article  PubMed  Google Scholar 

  30. Viklund P, Wengstrom Y, Rouvelas I, et al. Quality of life and persisting symptoms after oesophageal cancer surgery. Eur J Cancer 2006; 42:1407–14.

    Article  PubMed  Google Scholar 

  31. Cense HA, Visser MR, van Sandick JW, et al. Quality of life after colon interposition by necessity for esophageal cancer replacement. J Surg Oncol 2004; 88:32–8.

    Article  PubMed  Google Scholar 

  32. Leibman S, Smithers BM, Gotley DC, et al. Minimally invasive esophagectomy: short- and long-term outcomes. Surg Endosc 2006; 20:428–33.

    Article  PubMed  CAS  Google Scholar 

  33. de Boer AG, Genovesi PI, Sprangers MA, et al. Quality of life in long-term survivors after curative transhiatal oesophagectomy for oesophageal carcinoma. Br J Surg 2000; 87:1716–21.

    Article  PubMed  Google Scholar 

  34. Spector NM, Hicks FD, Pickleman J. Quality of life and symptoms after surgery for gastroesophageal cancer: a pilot study. Gastroenterol Nurs 2002; 25:120–5.

    Article  PubMed  Google Scholar 

  35. Blazeby JM, Nicklin J, Brookes ST, et al. Feasibility of quality of life assessment in patients with upper gastrointestinal tract cancer. Br J Cancer 2003; 89:497–501.

    Article  PubMed  CAS  Google Scholar 

  36. Blazeby JM, Avery K, Sprangers M, et al. Health-related quality of life measurement in randomized clinical trials in surgical oncology. J Clin Oncol 2006; 24:3178–86.

    Article  PubMed  Google Scholar 

  37. Lagergren P, Avery KN, Hughes R, et al. Health-related quality of life among patients cured by surgery for esophageal cancer. Cancer 2007; 110:686–93.

    Article  PubMed  Google Scholar 

  38. Medical Defence Union. Consent to Treatment. London: MDU, 2004

  39. Gore DM. Ethical, professional, and legal obligations in clinical practice: a series of discussion topics for postgraduate medical education. Introduction and topic 1: informed consent. Postgrad Med J 2001; 77:238–9.

    Article  PubMed  CAS  Google Scholar 

  40. General Medical Council online. Seeking patients’ consent: the ethical considerations. November 1998. Available at: www.gmc-uk.org/guidance/ethical-guidance/contents.asp. Accessed June 25, 2008

  41. Osoba D, Rodrigues G, Myles J, et al. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 1998; 16:139–44.

    PubMed  CAS  Google Scholar 

  42. King MT. The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30. Qual Life Res 1996; 5:555–67.

    Article  PubMed  CAS  Google Scholar 

  43. Gradauskas P, Rubikas R, Saferis V. Changes in quality of life after esophageal resections for carcinoma. Medicina (Kaunas) 2006; 42:187–94.

    Google Scholar 

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Authors and Affiliations

  1. Department of Thoracic and Upper GI Surgery, The Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK

    R. Parameswaran MRCS, R. G. Berrisford FRCS (Th) & S. A. Wajed MCRir, FRCS

  2. Department of Social Medicine, University of Bristol, Bristol, UK

    R. Parameswaran MRCS, A. McNair MRCS, K. N. L. Avery PhD & J. M. Blazeby MD, FRCS

  3. Clinical Sciences at South Bristol, University of Bristol, Bristol, UK

    A. McNair MRCS & J. M. Blazeby MD, FRCS

  4. Division of Surgery, Head and Neck, United Bristol Healthcare Trust, Bristol, UK

    A. McNair MRCS & J. M. Blazeby MD, FRCS

  5. Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

    M. A. G. Sprangers PhD

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  1. R. Parameswaran MRCS
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  2. A. McNair MRCS
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  3. K. N. L. Avery PhD
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  7. J. M. Blazeby MD, FRCS
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Correspondence to R. Parameswaran MRCS.

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Parameswaran, R., McNair, A., Avery, K.N.L. et al. The Role of Health-Related Quality of Life Outcomes in Clinical Decision Making in Surgery for Esophageal Cancer: A Systematic Review. Ann Surg Oncol 15, 2372–2379 (2008). https://doi.org/10.1245/s10434-008-0042-8

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  • DOI: https://doi.org/10.1245/s10434-008-0042-8

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