Quality of life in gastric cancer

Table 1 Summary of the 26 studies on QOL in gastric cancer.

First author, yr	Country	Diagnosis	Objective(s)	N patients, age in yr, ♂; ♀	QOL measure(s)	Result(s) regarding QOL	Domains	Type(s) of questionnaires	Remarks
Adachi, 1999[15]	Japan	Early gastric cancer	Evaluate QOL after laparoscopic assisted vs conventional gastrectomy	76-64±10 (mean) ♂44; ♀32	Mailed questionnaire, 24 items (cf. Korenaga 1992[28]) ‘QOL’, dumping syndrome	Laparascopic-assisted gastrectomy patients: QOL ↑	PHY: eating PSY: fatigue, pain SOC: –	Gastric-Spec-H, C-Gen	No Bonferroni correction for multiple testing, no social dimension in QOL, non- randomized design
Anderson, 1995[16]	Scotland	Adenocarcinoma of the stomach	Examine relief of symptoms after surgical treatment	57-67 (median); 48-88 (range) ♂35; ♀22	Symptom list scored via interviews	After surgery: symptoms ↓	PHY: dysphagia, dyspepsia PSY: pain SOC: –	Gastric-Spec-H	-
Buhl, 1990[17]	Germany	Gastric cancer	Evaluate QOL after subtotal vs total gastrectomy ♂-♀: n.r.	89-61±13(mean) disease-specific	Troidl questionnaire: between groups and socio-personal dimensions; psychological problems (Horowitz scale; Zerrsen scale)	No significant differences between groups	PHY: eating PSY: intrusion, avoidance, fatigue, pain, depression SOC: –	Disease specific, H	Of the six measures, only QOL; no correlation between objective and subjective measures; no social dimension
Davies,1998[18]	UK	Gastric carcinoma	Evaluate QOL after subtotal vs total gastrectomy	47 69 (median) 33-84 (range) ♂27; ♀20	ADL, HAD, RSCL, Troidl	QOL ↑ in subtotal gastrectomy	Full blown QOL: PHY, PSY, SOC	Cancer generic,gastric cancer specific,H	Non-randomized design
Eguchi,2003[19]	Japan	Gastric cancer	Examine effects of docetaxel+5FU on survival and QOL	5 64 (mean) 57-70 (range) ♂4 ; ♀1	EORTC-QOL-C30	QOL ↑ PSY, SOC	Full blown QOL: PHY,	Cancer generic	QOL is secondary endpoint
Fuchs, 1995[20]	Germany	Gastric cancer	QOL as one of the outcome measures in two surgical procedures (JIP vs RYP)	120 58 (mean)♂78; ♀42	Spitzer and Visick questionnaires:both patient scored	No differencesbetween procedures	PHY: functional status PSY: activities SOC: support	Cancer generic	Interesting:Spitzer and Visick were patient scored; randomized design
Hoffman, 1998[21]	Sweden	Gastric cancer	Assess relevance of Clinical Benefit Response (CBR) criteria for effectiveness of chemotherapy	61 63 (median) 40-75 (range)♂-♀: n.r.	EORTC-QOL-C30, QLQ-C13 items, symptoms → translated into CBR	Patients’ views, doctors’ views and CBR: similar results	Full blown QOL: PHY, PSY, SOC	Cancer generic,gastric cancer specific, H	CBR reflects combination of objective and subjective changes; retrospective design
Hoksch, 2002[22]	Germany	Gastric cancer	Assess QOL after gastrectomy, with different types of reconstruction (IPP, IPP7, IPP15)	41-59 (mean) 25-74 (range)♂20; ♀21	EORTC-QLQ-C30, food consumption	No major differences,except for ‘global health status’ (IPP15↑)	Full blown QOL: PHY, PSY, SOC	Cancer generic,gastric cancer specific, H	Prospective randomized trial; QOL was target of trial
Horváth, 2001[23]	Hungary	Total gastrectomy	Assess QOL (aboral pouch, R-and-Y)	46 60 (median) 26-80 (range) ♂24; ♀22	GIQLI	In aboral pouch: QOL ↑	Full blown QOL: PHY, PSY, SOC	Disease specific for gastrointestinal disorders in general	Randomized controlled study
Ishihara, 1999[24]	Japan	Stomach cancer	Evaluate QOL and ADL≥2 yr after total gastrectomy	51 67 (mean) 39-82 (range)♂32; ♀19	QLI, dumping symptoms	QOL ↓	PHY: physical strength PSY: fatigue, anxiety SOC: –	Cancer generic,H; gastric cancer specific, H	Validity?
Jentschura, 1997[25]	Germany	Gastric carcinoma	Effects of subtotal vs total gastrectomy on QOL	195 61 (mean)♂122; ♀73	GIQLI	Subtotal gastrectomy better QOL	Full blown QOL: PHY, PSY, SOC	Questionnaire designed for assessing gastrointestinal symptoms	Non-randomized design
Kalmár,2001[26]	Hungary	Adenocarcinomaof the stomach	Aboral pouch vs total gastrectomy re QOL	40 -60±-9♂19;♀21	GIQLI	Pouch better QOL	Full blown QOL: PHY, PSY, SOC	See Jentschura 1997[25]	Randomized trial; see also Horváth et al[23], 2001
Kono, 2003[27]	Japan	Early gastric cancer	R -en- Y vs pouch re QOL	47 -66±11 ♂32;♀15	GSRS and symptoms	Pouch better QOL (at 3 mo; not at 12 or 48 mo)	PHY: reflux PSY: pain SOC: –	Disease specific for gastrointestinal disorders in general	Randomized controlled study; author modified GSRS; no social dimension
Korenaga, 1992[28]	Japan	Gastric cancer	Retrospective QOL assessment after gastrectomy	150 ≤59:89 ≥60:61♂97; ♀53	QOL: symptoms via interview (cf. Adachi et al[15], 1999 )	Food tolerance ↓ Appetite ↓	PHY: eating PSY: appetite SOC: – See Adachi et al[15],1999	Gastric cancer specific, H	QOL?
de Liaňo,2003[29]	Spain	Gastric cancer	Assess QOL after curative resection	54 67 (mean) 41-89 (range) ♂36; ♀18	EORTC-QLQ-C30, and disease-specific questions	QOL-social ↓	Full blown QOL: PHY, PSY, SOC	Cancer generic and disease specific	No correlation between tumor stage and QOL
Liedman,2001[30]	Sweden	Gastric cancer	To examine relations between clinical nutritional parameters and QOL after gastrectomy	32 66 (mean) 41-82 (range)♂21; ♀11	BSS, CPRS, GSRS (gastric symptoms), MACL, SIP, SSIAM	Strong correlations between change in body composition and QOL	Full blown QOL: PHY, PSY, SOC	Generic and gastric symptoms specific	-
Miyoshi, 2001[31]	Japan	Gastric cancer	Compare long- term results regarding symptoms and nutritional status in patients with/without pouch	34 -63±12♂22; ♀12	GSRS and symptoms	Pouch: QOL ↑	PHY: pain, reflux PSY: eating SOC: –	Gastric symptoms questionnaire	QOL?
Nakano, 1999[32]	Japan	Unresectable gastric cancer and postoperative gastric cancer	Effects of Lentinan on survival and QOL	45 -64 (mean) 45-75 (range)♂34;♀11	Homemade QOL questionnaire	Lentinan: QOL↑	Full blown QOL: PHY, PSY, SOC	Disease specific questionnaire (14 items)	Validity of QOL scale?
Shiraishi, 2002[33]	Japan	Gastrectomy	Compare QOL among three surgical techniques	51 -63±11♂37;♀14	Adachi 1999[15] questionnaire: 24 items on symptoms	Gastric tube reconstruction: best QOL; no other differences in QOL between techniques	Full blown QOL: PHY, PSY, SOC	Gastric cancer specific, H	Validity? See Adachi 1999[15]
Svedlund, 1999[34] (see also Svedlund, 1997[35])	Sweden	Subtotal vs total gastrectomy	Examine impact of gastrectomy procedures on QOL	64 67 (mean)♂39;♀25	BSS, CPRS, EDS, GSRS, MACL, SIP, SSIAM	Physical QOL categories negatively impaired	Full blown QOL: PHY, PSY, SOC	Disease generic; gastric symptoms specific; gastric cancer specific symptoms	One of the few follow-up studies in this area; prospective randomized trial; psychiatric focus
Svedlund,1996[36]	Sweden	Gastrectomy	QOL before gastrectomy	103 72 (mean)♂60; ♀43	BSS, MACL, SIP	Patients vs healthy controls: QOL ↓; 25% report functional limitations	Full blown QOL: PHY, PSY, SOC	Generic and symptom specific	Comparison of gastric cancer patients with other patient groups
Thybusch-Bernhardt, 1999[37]	Germany	Total gastrectomy and D2 lymphadenectomy	Effects on QOL following surgical procedures	62 63 (mean) 32-80 (range) ♂40;♀22	EORTC-QOL-C30 and gastric cancer module	No major differences in QOL between procedures	Full blown QOL: PHY, PSY, SOC	Cancer generic; gastric cancer specific, H	Non-randomized design
Troidl,1987[38]	Germany	Gastric cancer	Esophago-jejunostomy vs Hunt-Lawrence-Rodino pouch on QOL	38 -69 (median) 41-75 (range)♂23; ♀15	Troidl questionnaire: 11 items, “disease specific” and “socio-personal”	HLR: QOL ↑	PHY: daily activities PSY: fatigue SOC: –	Disease specific symptoms, H	Randomized trial, no social dimension; validity?
Vickery, 2001[39]	France,Germany,Spain,UK	Gastric cancer	Develop disease- specific QOL questionnaire	115 66 (mean) 35-97 (range) ♂75;♀40	22-item EORTC-QLQ-STO22	5 scales, 4 items	Full blown QOL: PHY, PSY, SOC	Disease specific QOL questionnaire	First formal disease-specific QOL instrument for gastric cancer
Yamaoka, 1998[40]	Japan	Gastrectomy	Examine effects of personality on HRQOL	207 -57 (mean) 32-83 (range) ♂140;♀67	EPQ, HRQOL-20	Relationships between personality and QOL	Full blown QOL: PHY, PSY, SOC	Disease generic scale, H; generic questionnaire	Interesting theoretical extension: examine personality factors
Zieren,1998[41]	Germany	Gastric carcinoma	Compare Spitzer with EORTC-QOL-C36, after resection	71 59 (mean) 27-77 (range) ♂47; ♀24	EORTC-QLQ-C36	Physical functioning most limited	Full blown QOL: PHY, PSY, SOC	Cancer generic questionnaire	-

ADL, activities of daily living; BSS, body symptom scale; C, cancer; C-Gen, cancer generic; CBR, clinical benefit response; CPRS, comprehensive psychopathological rating scale; EDS, eating dysfunction scale; EORTC-QLQ-C36, EORTC, QLQ, cancer 36 items; EORTC-QLQ-STO22, EORTC, QLQ, stomach cancer 22 items; EORTC-QOL-C30, European Organization for Research and Treatment of Cancer, QOL, cancer 30 items; EPQ, Eysenck Personality Questionnaire; Gastric-Spec-H, gastric cancer specific, home made; Gen, generic; GIQLI, gastrointestinal quality of life index; GSRS, gastrointestinal symptom rating scale; H, home made; HAD, hospital anxiety depression; HRQOL-20, health related quality of life, 20 items; IPP, Longmire’s reconstruction without a pouch; JIP, jejunal interposition with pouch; MACL, mood adjective check list; PHY, physical; PSY, psychological; QLI, quality of living index; QLQ-C13, Quality of Life Questionnaire, cancer 13 items; QOL, quality of life; RSCL, Rotterdam Symptom Check List; RYP, Roux-en-Y reconstruction; SIP, sickness impact profile; SOC, social; Spec, specific; SSIAM, structured and scaled interview to assess maladjustments.