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

  title={The Role of Health-Related Quality of Life Outcomes in Clinical Decision Making in Surgery for Esophageal Cancer: A Systematic Review},
  author={Rajeev Parameswaran and Angus G K McNair and Kerry N.L. Avery and Richard G. Berrisford and S. A. Wajed and Mirjam A. G. Sprangers and Jane M. Blazeby},
  journal={Annals of Surgical Oncology},
BackgroundEsophagectomy 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.MethodsA systematic review identified randomized trials and longitudinal and cross-sectional studies that assessed HRQL after esophagectomy with multidimensional validated questionnaires. Articles… 

Systematic review reveals limitations of studies evaluating health-related quality of life after potentially curative treatment for esophageal cancer

Current evidence is restricted in its ability to inform practice on HRQL after potentially curative treatment for esophageal cancer and three high-quality studies were identified—two RCTs and one case-series—capable of providing robust results.

Predictors of postoperative quality of life after esophagectomy for cancer.

Knowledge of risk factors for poor postoperative HRQL may be relevant for clinical decision making and more research is needed to see whether these factors are further predictive of poor HRQL in long-term survivors.

Systematic review: quality of life after treatment for upper gastrointestinal cancer

This review identified few well-designed studies that also included a robust assessment of HRQL, and high-quality trials with reliable HRQL methods are required for outcomes to inform health policy and clinical decision-making.

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

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.

Long-term Health-related Quality of Life Following Esophagectomy: A Nonrandomized Comparison of Thoracoscopically Assisted and Open Surgery

This large comprehensive nonrandomized analysis of longitudinal HRQL shows that TTIL is associated with more pain and constipation than TAMK.

Quality of Life After Surgical Treatment of Early Barrett’s Cancer: A Prospective Comparison of the Ivor-Lewis Resection Versus the Modified Merendino Resection

It is suggested that MER procedure is not superior to subtotal esophagectomy with regard to HRQL, and a significant restriction concerning global health and emotional and social functioning in this group 1 year after surgery is found.

The Influence of Surgical Factors on Persisting Symptoms 3 Years after Esophageal Cancer Surgery: A Population-Based Study in Sweden

Surgical approach and type of anastomosis do not seem to influence the risk of general and esophageal-specific cancer symptoms 3 years after surgery for esophagal cancer.

Assessing the relationships between health-related quality of life and postoperative length of hospital stay after oesophagectomy for cancer of the oesophagus and the gastro-oesophageal junction.

  • P. NafteuxJoke Durnez P. D. De Leyn
  • Medicine
    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
  • 2013
The data suggest that early discharge correlates with improved postoperative HRQL outcomes and a clear decrease of the HRQL is seen at 3 months after the surgery, particularly in the LOS >10 days group.

Quality of life assessment in esophagectomy patients.

Evaluation of health-related quality of life in esophageal cancer patients undergoing curative intent therapy, the relationship between postoperative HRQOL and survival as well the potential utility of pre-treatment HRZOL as a prognostic tool, and patient-reported pre- treatment HRQol assessment appear to predict survival better than clinician-derived performance status assessment period.

Education level and health-related quality of life after oesophageal cancer surgery: a nationwide cohort study

Investigating whether low education level was associated with patients’ health-related quality of life (HRQOL) after oesophageal cancer resection found no such association, and low education was in general associated with worse functioning and more symptoms in certain HRQOL domains for women.



Health-related quality of life measurement in randomized clinical trials in surgical oncology.

In surgical trials in oncology, HRQL informed clinical decision making and it is recommended that HRQL be included in relevant surgical trials and that information be used to inform clinicians and patients about the impact of surgery on short- and long-term HRQL.

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?

  • F. EfficaceA. Bottomley A. Zurlo
  • Medicine, Psychology
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • 2003
It was found that HRQOL is a valuable source of information in RCTs of treatment in metastatic prostate cancer and a minimum set of criteria for assessing the reported outcomes in cancer clinical trials is necessary to make informed decisions in clinical practice.

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.

Comparing the longitudinal quality of life (QoL) between chemoradiation with or without surgery in patients with locally advanced squamous resectable esophageal cancer included in a randomized multicenter phase III trial showed no difference between treatments, although a significantly greater decrease in the Spitzer Index was observed in the postoperative period.

The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.

The reliability and validity of the EORTC QLQ-C30 questionnaire were highly consistent across the three language-cultural groups studied: patients from English-speaking countries, Northern Europe, and Southern Europe.

Changes in quality of life after esophageal resections for carcinoma.

Most of the aspects of quality of life deteriorated after the radical surgery for esophageal carcinoma and regained the preoperative level before the end of the first postoperative year.

Minimally invasive esophagectomy: short- and long-term outcomes.

There were no clear benefits shown in this group of patients with respect to postoperative recovery or short- to medium-term QoL, and there was a decrease in the measured QOL both in general and specifically for the esophageal patients, taking 18-24 months to return to baseline.

Feasibility of quality of life assessment in patients with upper gastrointestinal tract cancer

Patients' with advanced stage cancer of the upper gastrointestinal tract receiving palliative treatment require dedicated staff to ensure good compliance with longitudinal QOL data collection, and it is essential to budget for this in clinical trails.

Quality of life and symptoms after surgery for gastroesophageal cancer: a pilot study.

  • N. SpectorF. HicksJ. Pickleman
  • Medicine
    Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates
  • 2002
There were significant differences between the two procedures related to QOL and symptom frequency in that individuals who had the total gastrectomy fared somewhat better, but patients who had esophagogastrectomy had greater symptom frequency and significantly poorer QOL.

Quality of Life Associated with Surgery for Esophageal Cancer: Differences between Collar and Intrathoracic Anastomoses

Assessing quality of life with specific and general instruments is helpful for determining the differences between surgical procedures where standard parameters such as survival have their limitations, and showed that patients with the collar anastomosis showed significantly better physical and social functioning and global health status.

Five-year survival following oesophageal cancer resection: Psychosocial functioning and quality of life

It is indicated that there is good QOL following oesophageal resection for the majority of patients which is comparable with the general population, and psychological interventions for patients with physical and emotional needs are also necessary for successful rehabilitation.