Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, Meibergdreef 5, 1100DD, Amsterdam, The Netherlands,
Qual Life Res. 2014 May;23(4):1097-115. doi: 10.1007/s11136-013-0545-z. Epub 2013 Oct 16.
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.
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.
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).
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.
本研究旨在：（1）评估食管癌手术后第一年健康相关生活质量（HRQL）变化的方向、临床相关性和持续时间；（2）通过亚组和敏感性分析评估估计值的稳健性，并探索发表偏倚。
系统检索 MEDLINE、EMBASE、CINAHL、PsychINFO 和 CENTRAL 中的文献，以确定随机和非随机研究。我们将基线 HRQL 数据与 3、6、9 或 12 个月的随访结果进行比较，以评估 HRQL 变化的幅度和持续时间。这些估计值随后被分类为微不足道、小、中或大。主要结局指标为角色功能、进食和疲劳。次要结局指标为身体和社会功能、吞咽困难、疼痛和咳嗽问题。我们进行了开放性手术、新辅助治疗前开放性手术和微创手术的亚组分析。敏感性分析评估了研究设计、数据转换/插补以及使用的 HRQL 问卷的影响。
我们纳入了 15 项研究的数据，以估计食管癌手术后 28 项 HRQL 结局的变化。主要分析表明，患者的社会功能恶化。疲劳、疼痛和咳嗽问题的症状增加。这些变化持续 9-12 个月，但一些症状在手术后的第一年仍持续存在。对于许多其他 HRQL 结局，仅在亚组或敏感性分析后（例如，角色和身体功能）估计值才稳健，或者仍存在太多异质性而无法解释（例如，进食和吞咽困难）。
食管癌手术后，患者的 HRQL 将经历临床相关且持久的恶化。然而，对于许多 HRQL 结局，需要更多和更高质量的证据。
