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Kim D, Lee SS. Fewer Feedback Opportunities and Health Perception of Gastric Cancer Survivors: Opportunities for Patient Education. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:455-463. [PMID: 38772973 DOI: 10.1007/s13187-024-02430-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 05/23/2024]
Abstract
This study aimed to estimate the impact of having fewer opportunities for patient education on health perception of gastric cancer survivors by examining quality-of-life (QoL) responses from patients who had been away for chemotherapy for a year. The full-surveillance (FullSV) group was comprised of gastric cancer survivors with stage I cancer who completed preoperative and postoperative 3-, 6-, 9-, and 12-month surveillances. The returning (RTN) group was comprised of 1-year survivors of stage II cancer who had been away for chemotherapy for a year. Surveillance periods were utilized to provide patient education about expected postoperative weight changes. The European Organisation for Research and Treatment of Cancer QoL questionnaires were used to assess QoL. The study included a total of 278 patients (243 in the FullSV group and 35 in the RTN group). The baseline QoL was not significantly different between the groups. Significant differences in postoperative QoL were revealed by some scales (global health status/QoL, physical functioning, fatigue, financial difficulties, anxiety, dry mouth, and body image), all in favor of the FullSV group. Despite no significant difference in their actual weight changes, stronger weight dissatisfaction was revealed among the RTN group. Patients with fewer educational inputs for postoperative adjustment of weight perception were the ones with stronger dissatisfaction about current weight. The health perception of cancer survivors is under the constant influence of clinician feedback during patient education. For the best cancer survivorship care, sufficient opportunities for adjustment of health perception through patient education need to be ensured.
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Affiliation(s)
- Doyeon Kim
- Department of Surgery, Kyungpook National University Hospital, Daegu, 130 Dongdeok-Ro, Jung-Gu, 41944, Republic of Korea
| | - Seung Soo Lee
- Department of Surgery, Kyungpook National University Hospital, Daegu, 130 Dongdeok-Ro, Jung-Gu, 41944, Republic of Korea.
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
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Xiong H, He Z, Wei Y, Li Q, Xiao Q, Yang L, Deng X, Wu K, Wang K, Deng X. Probiotic Compounds Enhanced Recovery after Surgery for Patients with Distal Gastric Cancer: A Prospective, Controlled Clinical Trial. Ann Surg Oncol 2024; 31:5240-5251. [PMID: 38739239 DOI: 10.1245/s10434-024-15394-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/17/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) for radical distal gastrectomy needs to be improved urgently. We investigated the effects of probiotic compounds (including Lactobacillus plantarum, L. rhamnosus, L. acidophilus, and Bifidobacterium animalis subsp.lactis) on enhance recovery after gastrectomy. METHODS The patients in this prospective study were divided into probiotic group (PG group, n = 36) and placebo group (CG group, n = 38), taking corresponding capsule according to the protocol during the perioperative period. We compared the trends in perioperative hematologic findings and the postoperative outcomes. Patients' feces were collected for bacterial 16S rRNA sequencing. Patients were followed up at 1 month postoperatively. RESULTS After the application of probiotics, the patients' postoperative inflammatory response level was reduced, and the trend of postoperative NLR decrease was significantly faster in the patients of the PG group than in the CG group (P = 0.047, partial η2 = 0.054). The trend of postoperative increase in serum albumin concentration in the patients of the PG group was significantly better than that in the CG group (P = 0.016, partial η2 = 0.078). In addition, patients in the PG group met discharge criteria earlier postoperatively and had fewer medical expenses. The quality of life of PG group was improved postoperatively. Postoperative inflammation-related markers, including the ratio of Firmicutes/Bacteroidetes, were increasing in untreated patients. In addition, the postoperative microbial diversity and abundance in the PG group remained stable. CONCLUSIONS Probiotic compounds can reduce the inflammatory response after gastrectomy and enhance the recovery of the DGC patients by maintaining the stability of the gut microbiota.
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Affiliation(s)
- Huan Xiong
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Zhipeng He
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yuan Wei
- Department of Ophthalmology, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang, Jiangxi, People's Republic of China
| | - Qiang Li
- Department of Vascular Surgery, Tengzhou Central People's Hospital, Tengzhou, Shandong, People's Republic of China
| | - Qun Xiao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hunan College of Traditional Chinese Medicine, Zhuzhou, Hunan, People's Republic of China
| | - Liang Yang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Xi Deng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Kai Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Keqiang Wang
- Department of General Surgery, Yingtan 184 Hospital, Yingtan, Jiangxi, People's Republic of China.
| | - Xiaorong Deng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People's Republic of China.
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Song Y, Chen E, Ikoma N, Mansfield PF, Bruera E, Badgwell BD. Palliative Surgery for Patients with Gastroesophageal Junction or Gastric Cancer: A Report on Clinical Observational Outcomes. Ann Surg Oncol 2024; 31:5252-5262. [PMID: 38743284 DOI: 10.1245/s10434-024-15416-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/23/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Few studies have focused on palliative surgery in patients with advanced gastroesophageal junction (GEJ) or gastric cancer. We sought to evaluate clinical observational outcomes following palliative surgery in this population. PATIENTS AND METHODS Patients with GEJ or gastric cancer who underwent palliative surgery (1/2010-11/2022) were identified. The primary outcomes were symptom improvement, ability to tolerate an oral diet, discharge to home, 30 "good days" without hospitalization, and receipt of systemic treatment. Postoperative outcomes and survival were secondarily evaluated. RESULTS Among 93 patients, the median age was 59 (IQR 47-68) years, and the median Eastern Cooperative Oncology Group Performance Status (ECOG-PS) was 1 (range 0-3). The most frequent indication for palliative surgery was primary tumor obstruction [75 (81%) patients]. The most common procedures were feeding tube placement in 60 (65%) and intestinal bypass in 15 (16%) patients. A total of 75 (81%) patients experienced symptom improvement. Of these, 19 (25%) developed recurrent and 49 (65%) developed new symptoms. ECOG-PS was significantly associated with symptom-free time. Among those who underwent a bypass, resection, or ostomy creation for malignant obstruction, 16 (80%) tolerated an oral diet. Postoperatively, 87 (94%) were discharged home, 72 (77%) had 30 good days, and 64 (69%) received systemic treatment. Postoperative complications occurred in 35 (38%) patients, and 7 (8%) died within 30 days. The median survival time was 7.7 (95% CI 6.4-10.40) months. CONCLUSIONS Patients with incurable GEJ or gastric cancer can benefit from palliative surgery. Prognosis and performance status should inform goals-of-care discussions and patient selection for surgical palliation.
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Affiliation(s)
- Yun Song
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eunise Chen
- John P. and Katherine G. McGovern Medical School at UT Health, Houston, TX, USA
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul F Mansfield
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian D Badgwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Ueno K, Nishigori T, Tokoro Y, Nakakura A, Tsunoda S, Hisamori S, Hashimoto K, Kanaya S, Hirai K, Tanaka E, Hata H, Manaka D, Sakaguchi M, Kondo M, Kan T, Itami A, Miki A, Kawamura Y, Toda K, Okabe H, Yamamoto M, Yamashita Y, Kinjo Y, Kawada H, Obama K. The efficacy of simple oral nutritional supplements versus usual care in postoperative patients with gastric cancer: study protocol for a multicenter, open-label, parallel, randomized controlled trial. Trials 2024; 25:445. [PMID: 38961505 PMCID: PMC11223300 DOI: 10.1186/s13063-024-08169-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 05/09/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Body weight loss (BWL) after gastrectomy impact on the short- and long-term outcomes. Oral nutritional supplement (ONS) has potential to prevent BWL in patients after gastrectomy. However, there is no consistent evidence supporting the beneficial effects of ONS on BWL, muscle strength and health-related quality of life (HRQoL). This study aimed to evaluate the effects of ONS formulated primarily with carbohydrate and protein on BWL, muscle strength, and HRQoL. METHODS This will be a multicenter, open-label, parallel, randomized controlled trial in patients with gastric cancer who will undergo gastrectomy. A total of 120 patients who will undergo gastrectomy will be randomly assigned to the ONS group or usual care (control) group in a 1:1 ratio. The stratification factors will be the clinical stage (I or ≥ II) and surgical procedures (total gastrectomy or other procedure). In the ONS group, the patients will receive 400 kcal (400 ml)/day of ONS from postoperative day 5 to 7, and the intervention will continue postoperatively for 8 weeks. The control group patients will be given a regular diet. The primary outcome will be the percentage of BWL (%BWL) from baseline to 8 weeks postoperatively. The secondary outcomes will be muscle strength (handgrip strength), HRQoL (EORTC QLQ-C30, QLQ-OG25, EQ-5D-5L), nutritional status (hemoglobin, lymphocyte count, albumin), and dietary intake. All analyses will be performed on an intention-to-treat basis. DISCUSSION This study will provide evidence showing whether or not ONS with simple nutritional ingredients can improve patient adherence and HRQoL by reducing BWL after gastrectomy. If supported by the study results, nutritional support with simple nutrients will be recommended to patients after gastrectomy for gastric cancer. TRIAL REGISTRATION jRCTs051230012; Japan Registry of Clinical Trails. Registered on Apr. 13, 2023.
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Affiliation(s)
- Kohei Ueno
- Department of Surgery, Kyoto University Hospital, 54 Shogoinkawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Tatsuto Nishigori
- Department of Surgery, Kyoto University Hospital, 54 Shogoinkawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Yukinari Tokoro
- Department of Surgery, Kyoto University Hospital, 54 Shogoinkawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Akiyoshi Nakakura
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shigeru Tsunoda
- Department of Surgery, Kyoto University Hospital, 54 Shogoinkawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Shigeo Hisamori
- Department of Surgery, Kyoto University Hospital, 54 Shogoinkawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | | | | | - Kenjiro Hirai
- Department of Surgery, Japanese Red Cross Otsu Hospital, Shiga, Japan
| | - Eiji Tanaka
- Department of Surgery, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Hiroaki Hata
- Department of Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Dai Manaka
- Department of Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | | | - Masato Kondo
- Department of Surgery, Kobe City Medical Center, General Hospital, Hyogo, Japan
| | - Takatsugu Kan
- Department of Surgery, Kobe City Medical Center, West Hospital, Hyogo, Japan
| | - Atsushi Itami
- Department of Surgery, Kobe City Nishi-Kobe Medical Center, Hyogo, Japan
| | - Akira Miki
- Department of Surgery, Toyooka Hospital, Hyogo, Japan
| | | | - Kosuke Toda
- Department of Surgery, Shiga General Hospital, Shiga, Japan
| | - Hiroshi Okabe
- Department of Surgery, New Tokyo Hospital, Chiba, Japan
| | | | - Yoshito Yamashita
- Department of Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yosuke Kinjo
- Department of Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Hironori Kawada
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Kazutaka Obama
- Department of Surgery, Kyoto University Hospital, 54 Shogoinkawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
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5
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Sodergren SC, Hurley-Wallace A, Vassiliou V, Alkhaffaf B, Batsaikhan B, Darlington AS, Fleitas-Kanonnikof T, Guren MG, Honda M, Kim YW, Kim S, Krishnamurthy MN, Loh SY, Turhal NS, Zhou J, Dennis K, Krishnatry R, Terashima M, Tsironis G, Yoshikawa T, Terada M. Revisiting the use of the EORTC QLQ-STO22 to assess health-related quality of life of patients with gastric cancer: incorporating updated treatment options and cross-cultural perspectives. Gastric Cancer 2024; 27:722-734. [PMID: 38668819 PMCID: PMC11193686 DOI: 10.1007/s10120-024-01492-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/10/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND The EORTC QLQ-STO22 (QLQ-STO22) is a firmly established and validated measure of health-related quality of life (HRQoL) for people with gastric cancer (GC), developed over two decades ago. Since then there have been dramatic changes in treatment options for GC. Also, East Asian patients were not involved in the development of QLQ-STO22, where GC is most prevalent and the QLQ-STO22 is widely used. A review with appropriate updating of the measure was planned. This study aims to capture HRQoL issues associated with new treatments and the perspectives of patients and health care professionals (HCPs) from different cultural backgrounds, including East Asia. METHODS A systematic literature review and open-ended interviews were preformed to identify potential new HRQoL issues relating to GC. This was followed by structured interviews where HCPs and patients reviewed the QLQ-STO22 alongside new issues regarding relevance, importance, and acceptability. RESULTS The review of 267 publications and interviews with 104 patients and 18 HCPs (48 and 9 from East Asia, respectively) generated a list of 58 new issues. Three of these relating to eating small amounts, flatulence, and neuropathy were recommended for inclusion in an updated version of the QLQ-STO22 and covered by five additional questions. CONCLUSIONS This study supports the content validity of the QLQ-STO22, suggesting its continued relevance to patients with GC, including those from East Asia. The updated version with additional questions and linguistic changes will enhance its specificity, but further testing is required.
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Affiliation(s)
- S C Sodergren
- School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK.
| | - A Hurley-Wallace
- School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - V Vassiliou
- Medical Oncology Department, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - B Alkhaffaf
- Department of Oesophago-Gastric & Bariatric Surgery, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK
| | - B Batsaikhan
- Department of Internal Medicine, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - A S Darlington
- School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - T Fleitas-Kanonnikof
- Medical Oncology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - M G Guren
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - M Honda
- General South Tohoku Hospital, Koriyama, Japan
| | - Y W Kim
- Center for Gastric Cancer, National Cancer Center, Goyang-si, Korea
| | - S Kim
- Center for Gastric Cancer, National Cancer Center, Goyang-si, Korea
| | - M N Krishnamurthy
- Department of Clinical Pharmacology, Tata Memorial Centre, Tirupati, India
| | - S Y Loh
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - N S Turhal
- Anadolu Medical Center, Çayırova, Turkey
| | - J Zhou
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - K Dennis
- Division of Radiation Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
- Department of Radiology, University of Ottawa, Ottawa, Canada
| | - R Krishnatry
- Department of Radiation Oncology, Tata Memorial Centre, Tirupati, India
| | - M Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - G Tsironis
- Medical Oncology Department, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - T Yoshikawa
- Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - M Terada
- Department of International Clinical Development/International Trials Management Section, National Cancer Center Hospital, Tokyo, Japan
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Mizusawa J, Ogawa G, Terada M, Ishiki H, Kikawa Y, Kiyota N. Statistical Analysis Methods and Reporting of Patient-Reported Outcomes in Randomized Controlled Trials for Cancer Conducted in Japan: A Systematic Review. Cureus 2024; 16:e60804. [PMID: 38910767 PMCID: PMC11190813 DOI: 10.7759/cureus.60804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/25/2024] Open
Abstract
The Setting International Standards in Analyzing Patient-Reported Outcomes and Quality of Life Endpoints Data (SISAQOL) initiative was established in 2016 to assess the quality and standardization of patient-reported outcomes (PRO) data analysis in randomized controlled trials (RCTs) on advanced breast cancer. The initiative identified deficiencies in PRO data reporting, including nonstandardized methods for handling missing data. This study evaluated the reporting of health-related quality of life (HRQOL) in Japanese cancer RCTs to provide insights into the state of PRO reporting in Japan. The study reviewed PubMed articles published from 2010 to 2018. Eligible studies included Japanese cancer RCTs with ≥50 adult patients (≥50% were Japanese) with solid tumors receiving anticancer treatments. The evaluation criteria included clarity of the HRQOL hypotheses, multiplicity testing, primary analysis methods, and reporting of clinically meaningful differences. Twenty-seven HRQOL trials were identified. Only 15% provided a clear HRQOL hypothesis, and 63% examined multiple HRQOL domains without adjusting for multiplicity. Model-based methods were the most common statistical methods for the primary HRQOL analysis. Only 22% of the trials explicitly reported clinically meaningful differences in HRQOL. Baseline assessments were reported in most trials, but only 26% reported comparisons between the treatment groups. HRQOL analysis was based on the intention-to-treat population in 19% of the trials, and 74% reported compliance at follow-up; however, 41% did not specify how missing values were handled. Although the rates of reporting clinical hypotheses and clinically meaningful differences were relatively low, the current state of HRQOL evaluation in the Japanese cancer RCT appears comparable to that of previous studies.
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Affiliation(s)
- Junki Mizusawa
- Center for Research Administration and Support, National Cancer Center, Tokyo, JPN
| | - Gakuto Ogawa
- Center for Research Administration and Support, National Cancer Center, Tokyo, JPN
| | - Mitsumi Terada
- Department of International Clinical Development, National Cancer Center Hospital, Tokyo, JPN
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, JPN
| | - Yuichiro Kikawa
- Department of Breast Surgery, Kansai Medical University, Osaka, JPN
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Cancer Center, Kobe University Hospital, Kobe, JPN
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van der Wielen N, Brenkman H, Seesing M, Daams F, Ruurda J, van der Veen A, van der Peet DL, Straatman J, van Hillegersberg R. Minimally invasive versus open gastrectomy for gastric cancer. A pooled analysis of two European randomized controlled trials. J Surg Oncol 2024; 129:911-921. [PMID: 38173355 DOI: 10.1002/jso.27578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 11/06/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Minimally invasive techniques have shown better short term and similar oncological outcomes compared to open techniques in the treatment of gastric cancer in Asian countries. It remains unknown whether these outcomes can be extrapolated to Western countries, where patients often present with advanced gastric cancer. MATERIALS AND METHODS A pooled analysis of two Western randomized controlled trials (STOMACH and LOGICA trial) comparing minimally invasive gastrectomy (MIG) and open gastrectomy (OG) in advanced gastric cancer was performed. Postoperative recovery (complications, mortality, hospital stay), oncological outcomes (lymph node yield, radical resection rate, 1-year survival), and quality of life was assessed. RESULTS Three hundred and twenty-one patients were included from both trials. Of these, 162 patients (50.5%) were allocated to MIG and 159 patients (49.5%) to OG. A significant difference was seen in blood loss in favor of MIG (150 vs. 260 mL, p < 0.001), whereas duration of surgery was in favor of OG (180 vs. 228.5 min, p = 0.005). Postoperative recovery, oncological outcomes and quality of life were similar between both groups. CONCLUSION MIG showed no difference to OG regarding postoperative recovery, oncological outcomes or quality of life, and is therefore a safe alternative to OG in patients with advanced gastric cancer.
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Affiliation(s)
- Nicole van der Wielen
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Hylke Brenkman
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten Seesing
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Freek Daams
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Jelle Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Arjen van der Veen
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Jennifer Straatman
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
- Department of Clinical Epidemiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Egbo O, Omuemu C, Okeke E, Egbo OH, Mokogwu N. Health-related quality of life in patients with dyspepsia presenting at the University of Benin Teaching Hospital, Benin City, South-South Nigeria: a cross-sectional study. Pan Afr Med J 2024; 47:107. [PMID: 38766563 PMCID: PMC11101314 DOI: 10.11604/pamj.2024.47.107.36151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 02/04/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Health-related quality of life (HRQoL) examines the impact of the symptoms of dyspepsia on the daily life of sufferers. There are a few published studies related to HRQoL of persons with dyspepsia in Africa. Methods this was a hospital-based cross-sectional study involving 324 dyspeptic patients referred for upper gastrointestinal endoscopy to the University of Benin Teaching Hospitals (UBTH) The ROME IV criteria were used to recruit patients with dyspepsia. The short form Nepean Dyspepsia Index (SF NDI) was used to assess HRQoL in all participants. Upper gastrointestinal endoscopy was performed on all 324 dyspeptic patients. Results the mean age of patients was 47.6 ± 15.6 years. Three hundred (92.6%) patients had significantly impaired HRQoL with an SF NDI mean score of 31.3 ± 9.1. Interference with daily activities and eating and drinking subdomains were more impaired than other subdomains of HRQoL (p < 0.001). There was no statistical difference between the impaired HRQoL in patients with functional dyspepsia and organic dyspepsia (p = 0.694). Among patients with organic dyspepsia, those with upper gastrointestinal cancers had significantly worse HRQoL SF NDI mean (sd) scores (39.7 ± 5.9) compared with patients with gastritis, peptic ulcer disease and GERD with (30.3 ± 9.2, 31.5 ± 9.7 and 32.9 ± 7.1 respectively) (p = 0.01). Conclusion health-related quality of life is significantly impaired in patients with dyspepsia and those with upper gastrointestinal cancers having overall worse scores. The physical, social and psychological well-being of a majority of patients with dyspepsia in South-South Nigeria is negatively affected by dyspepsia.
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Affiliation(s)
- Oziegbe Egbo
- Department of Internal Medicine, University of Benin Teaching Hospital, Edo State, Nigeria
| | - Casmir Omuemu
- Department of Internal Medicine, University of Benin Teaching Hospital, Edo State, Nigeria
| | - Edith Okeke
- Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | | | - Ndubuisi Mokogwu
- Department of Public Health and Community Medicine, University of Benin Teaching Hospital, Edo State, Nigeria
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Vallance PC, Mack L, Bouchard-Fortier A, Jost E. Quality of Life Following the Surgical Management of Gastric Cancer Using Patient-Reported Outcomes: A Systematic Review. Curr Oncol 2024; 31:872-884. [PMID: 38392059 PMCID: PMC10888285 DOI: 10.3390/curroncol31020065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction: Surgical management of gastric adenocarcinoma can have a drastic impact on a patient's quality of life (QoL). There is high variability among surgeons' preferences for the type of resection and reconstructive method. Peri-operative and cancer-specific outcomes remain equivalent between the different approaches. Therefore, postoperative quality of life can be viewed as a deciding factor for the surgical approach. The goal of this study was to interrogate patient QoL using patient-reported outcomes (PROs) following gastrectomy for gastric cancer. Methods: This systematic review was registered at Prospero and followed PRISMA guidelines. Medline, Embase, and Scopus were used to perform a literature search on 18 January 2020. A set of selection criteria and the data extraction sheet were predefined. Covidence (Melbourne, Australia) software was used; two reviewers (P.C.V. and E.J.) independently reviewed the articles, and a third resolved conflicts (A.B.F.). Results: The search yielded 1446 studies; 308 articles underwent full-text review. Ultimately, 28 studies were included for qualitative analysis, including 4630 patients. Significant heterogeneity existed between the studies. Geography was predominately East Asian (22/28 articles). While all aspects of quality of life were found to be affected by a gastrectomy, most functional or symptom-specific measures reached baseline by 6-12 months. The most significant ongoing symptoms were reflux, diarrhoea, and nausea/vomiting. Discussion: Generally, patients who undergo a gastrectomy return to baseline QoL by one year, regardless of the type of surgery or reconstruction. A subtotal distal gastrectomy is preferred when proper oncologic margins can be obtained. Additionally, no one form of reconstruction following gastrectomy is statistically preferred over another. However, for subtotal distal gastrectomy, there was a trend toward Roux-en-Y reconstruction as superior to abating reflux.
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Affiliation(s)
| | - Lloyd Mack
- Department of Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada (A.B.-F.)
- Department of Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Antoine Bouchard-Fortier
- Department of Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada (A.B.-F.)
- Department of Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Evan Jost
- Department of Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada (A.B.-F.)
- Department of Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada
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10
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Moehler M, Xiao H, Blum SI, Elimova E, Cella D, Shitara K, Ajani JA, Janjigian YY, Garrido M, Shen L, Yamaguchi K, Liu T, Schenker M, Kowalyszyn R, Bragagnoli AC, Bruges R, Montesarchio V, Pazo-Cid R, Hunter S, Davenport E, Wang J, Kondo K, Li M, Wyrwicz L. Health-Related Quality of Life With Nivolumab Plus Chemotherapy Versus Chemotherapy in Patients With Advanced Gastric/Gastroesophageal Junction Cancer or Esophageal Adenocarcinoma From CheckMate 649. J Clin Oncol 2023; 41:5388-5399. [PMID: 37713657 PMCID: PMC10713185 DOI: 10.1200/jco.23.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/27/2023] [Accepted: 07/17/2023] [Indexed: 09/17/2023] Open
Abstract
PURPOSE In CheckMate 649, first-line nivolumab plus chemotherapy prolonged overall survival versus chemotherapy in patients with advanced/metastatic non-human epidermal growth factor receptor 2 (HER2)-positive gastric/gastroesophageal junction cancer (GC/GEJC) or esophageal adenocarcinoma (EAC). We present exploratory patient-reported outcomes (PROs). METHODS In patients (N = 1,581) concurrently randomly assigned 1:1 to nivolumab plus chemotherapy or chemotherapy and in those with tumor PD-L1 expression at a combined positive score (CPS) of ≥5, health-related quality of life (HRQoL) was assessed using the EQ-5D and Functional Assessment of Cancer Therapy-Gastric (FACT-Ga), which included the FACT-General (FACT-G) and Gastric Cancer subscale (GaCS). The FACT-G GP5 item assessed treatment-related symptom burden. Longitudinal changes in HRQoL were assessed using mixed models for repeated measures in the PRO analysis population (randomly assigned patients with baseline and ≥1 postbaseline assessments). Time to symptom or definitive deterioration analyses were also conducted. RESULTS In the PRO analysis population (n = 1,360), PRO questionnaire completion rates were mostly >80% during treatment. Patient-reported symptom burden was not increased with nivolumab plus chemotherapy versus chemotherapy. Mean improved changes from baseline were greater with nivolumab plus chemotherapy versus chemotherapy for FACT-Ga total, GaCS, and EQ-5D visual analog scale in patients with a CPS of ≥5; results were similar for the overall PRO analysis population. In CPS ≥5 and all randomly assigned populations, nivolumab plus chemotherapy reduced the risk of symptom deterioration versus chemotherapy, on the basis of FACT-Ga total score and GaCS; time to definitive deterioration was longer, and the risk of definitive deterioration in HRQoL was reduced with nivolumab plus chemotherapy across EQ-5D and most FACT-Ga measures (hazard ratio [95% CI] <1). CONCLUSION Compared with chemotherapy alone, first-line nivolumab plus chemotherapy showed stable or better on-treatment HRQoL in patients with advanced/metastatic non-HER2-positive GC/GEJC/EAC and also showed decreased risk of definitive HRQoL deterioration.
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Affiliation(s)
| | | | | | - Elena Elimova
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kohei Shitara
- National Cancer Center Hospital East, Kashiwa, Japan
| | - Jaffer A. Ajani
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yelena Y. Janjigian
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Marcelo Garrido
- Clinica San Carlos de Apoquindo, Pontificia Universidad Católica, Santiago, Chile
| | - Lin Shen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | | | - Tianshu Liu
- Zhongshan Hospital Fudan University, Shanghai, China
| | - Michael Schenker
- Department of Medical Oncology, Sfantul Nectarie Oncology Center, Dolj, Romania
| | - Ruben Kowalyszyn
- Instituto Multidiciplinario de Oncología, Clinica Viedma SA, Viedma, Argentina
| | | | - Ricardo Bruges
- Internal Medicine, Clinical Oncology, Instituto Nacional de Cancerología Empresa Social del Estado, Bogotá, Colombia
| | | | | | | | | | - Jinyi Wang
- RTI Health Solutions, Research Triangle Park, NC
| | | | | | - Lucjan Wyrwicz
- Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warszawa, Poland
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11
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Chen YX, Huang QZ, Wang PC, Zhu YJ, Chen LQ, Wu CY, Wang JT, Chen JX, Ye K. Short- and long-term outcomes of Roux-en-Y and Billroth II with Braun reconstruction in total laparoscopic distal gastrectomy: a retrospective analysis. World J Surg Oncol 2023; 21:361. [PMID: 37990273 PMCID: PMC10664253 DOI: 10.1186/s12957-023-03249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The controversy surrounding Roux-en-Y (R-Y) and Billroth II with Braun (BII + B) reconstruction as an anti-bile reflux procedure after distal gastrectomy has persisted. Recent studies have demonstrated their efficacy, but the long-term outcomes and postoperative quality of life (QoL) among patients have yet to be evaluated. Therefore, we compared the short-term and long-term outcomes of the two procedures as well as QoL. METHODS The clinical data of 151 patients who underwent total laparoscopic distal gastrectomy (TLDG) at the Gastrointestinal Surgery Department of the Second Hospital of Fujian Medical University from January 2016 to December 2019 were retrospectively analyzed. Of these, 57 cases with Roux-en-Y procedure (R-Y group) and 94 cases with Billroth II with Braun procedure were included (BII + B group). Operative and postoperative conditions, early and late complications, endoscopic outcomes at year 1 and year 3 after surgery, nutritional indicators, and quality of life scores at year 3 postoperatively were compared between the two groups. RESULTS The R-Y group recorded a significantly longer operative time (194.65 ± 21.52 vs. 183.88 ± 18.02 min) and anastomotic time (36.96 ± 2.43 vs. 27.97 ± 3.74 min) compared to the BII + B group (p < 0.05). However, no other significant differences were observed in terms of perioperative variables, including blood loss (p > 0.05). Both groups showed comparable rates of early and late complications. Endoscopic findings indicated similar food residuals at years 1 and 3 post-surgery for both groups. The R-Y group had a lower occurrence of residual gastritis and bile reflux at year 1 and year 3 after surgery, with a statistically significant difference (p < 0.001). Reflux esophagitis was not significantly different between the R-Y and BII + B groups in year 1 after surgery (p = 0.820), but the R-Y group had a lower incidence than the BII + B group in year 3 after surgery (p = 0.023). Nutritional outcomes at 3 years after surgery did not differ significantly between the two groups (p > 0.05). Quality of life scores measured by the QLQ-C30 scale were not significantly different between the two groups. However, on the QLQ-STO22 scale, the reflux score was significantly lower in the R-Y group than in the BII + B group (0 [0, 0] vs. 5.56 [0, 11.11]) (p = 0.003). The rest of the scores were not significantly different (p > 0.05). CONCLUSION Both R-Y and B II + B reconstructions are equally safe and efficient for TLDG. Nevertheless, the R-Y reconstruction reduces the incidence of residual gastritis, bile reflux, and reflux esophagitis, as well as postoperative reflux symptoms, and provides a better quality of life for patients. R-Y reconstruction is superior to BII + B reconstruction for TLDG.
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Affiliation(s)
- Yan-Xin Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Qiao-Zhen Huang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Peng-Cheng Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Yue-Jia Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Li-Quan Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Chu-Ying Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Jin-Tian Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Jun-Xing Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Kai Ye
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China.
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12
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Kastelijn JB, van de Pavert YL, Besselink MG, Fockens P, Voermans RP, van Wanrooij RLJ, de Wijkerslooth TR, Curvers WL, de Hingh IHJT, Bruno MJ, Koerkamp BG, Patijn GA, Poen AC, van Hooft JE, Inderson A, Mieog JSD, Poley JW, Bijlsma A, Lips DJ, Venneman NG, Verdonk RC, van Dullemen HM, Hoogwater FJH, Frederix GWJ, Molenaar IQ, Welsing PMJ, Moons LMG, van Santvoort HC, Vleggaar FP. Endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for palliation of malignant gastric outlet obstruction (ENDURO): study protocol for a randomized controlled trial. Trials 2023; 24:608. [PMID: 37749590 PMCID: PMC10518948 DOI: 10.1186/s13063-023-07522-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/17/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Malignant gastric outlet obstruction (GOO) is a debilitating condition that frequently occurs in patients with malignancies of the distal stomach and (peri)ampullary region. The standard palliative treatment for patients with a reasonable life expectancy and adequate performance status is a laparoscopic surgical gastrojejunostomy (SGJ). Recently, endoscopic ultrasound-guided gastroenterostomy (EUS-GE) emerged as a promising alternative to the surgical approach. The present study aims to compare these treatment modalities in terms of efficacy, safety, and costs. METHODS The ENDURO-study is a multicentre, open-label, parallel-group randomized controlled trial. In total, ninety-six patients with gastric outlet obstruction caused by an irresectable or metastasized malignancy will be 1:1 randomized to either SGJ or EUS-GE. The primary endpoint is time to tolerate at least soft solids. The co-primary endpoint is the proportion of patients with persisting or recurring symptoms of gastric outlet obstruction for which a reintervention is required. Secondary endpoints are technical and clinical success, quality of life, gastroenterostomy dysfunction, reinterventions, time to reintervention, adverse events, quality of life, time to start chemotherapy, length of hospital stay, readmissions, weight, survival, and costs. DISCUSSION The ENDURO-study assesses whether EUS-GE, as compared to SGJ, results in a faster resumption of solid oral intake and is non-inferior regarding reinterventions for persistent or recurrent obstructive symptoms in patients with malignant GOO. This trial aims to guide future treatment strategies and to improve quality of life in a palliative setting. TRIAL REGISTRATION International Clinical Trials Registry Platform (ICTRP): NL9592. Registered on 07 July 2021.
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Affiliation(s)
- Janine B Kastelijn
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yorick L van de Pavert
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Paul Fockens
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Rogier P Voermans
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Roy L J van Wanrooij
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, the Netherlands
| | - Thomas R de Wijkerslooth
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Wouter L Curvers
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Gijs A Patijn
- Department of Surgery, Isala Clinics, Zwolle, the Netherlands
| | - Alexander C Poen
- Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, the Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Akin Inderson
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - J Sven D Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Alderina Bijlsma
- Department of Gastroenterology and Hepatology, Martini Hospital, Groningen, the Netherlands
| | - Daan J Lips
- Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Niels G Venneman
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Robert C Verdonk
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Hendrik M van Dullemen
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Frederik J H Hoogwater
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Geert W J Frederix
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - I Quintus Molenaar
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paco M J Welsing
- Division of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Leon M G Moons
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
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13
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Stocker G, Lorenzen S, Ettrich T, Herz AL, Longo F, Kiani A, Venerito M, Trojan J, Mahlberg R, Moosmann N, Chibaudel B, Kubicka S, Greil R, Daum S, Geissler M, Larcher-Senn J, Keller G, Lordick F, Haag GM. S-1 maintenance therapy in Caucasian patients with metastatic esophagogastric adenocarcinoma-final results of the randomized AIO MATEO phase II trial. ESMO Open 2023; 8:101572. [PMID: 37270871 PMCID: PMC10373924 DOI: 10.1016/j.esmoop.2023.101572] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 06/06/2023] Open
Abstract
PURPOSE Platinum-fluoropyrimidine combinations are standard of care for treatment of metastatic esophagogastric adenocarcinoma. The optimal duration of first-line chemotherapy is unknown, however, and maintenance strategies have not yet been established. DESIGN MATEO is an international randomized phase II trial exploring efficacy and safety of S-1 maintenance therapy in human epidermal growth factor receptor 2 (HER2)-negative advanced esophagogastric adenocarcinoma. After 3 months of first-line platinum-fluoropyrimidine-based induction therapy, patients without progression were randomized in a 2 : 1 allocation to receive S-1 monotherapy (arm A) or to continue combination chemotherapy (arm B). The primary objective was to show non-inferiority of overall survival in the S-1 maintenance group. Progression-free survival, adverse events, and quality of life were secondary endpoints. RESULTS From 2014 to 2019, 110 and 55 patients were randomized in arm A and arm B, respectively (recruitment closed prematurely). Median overall survival from randomization was 13.4 months for arm A and 11.4 months for arm B [hazard ratio 0.97 (80% confidence interval 0.76-1.23), P = 0.86]. Median progression-free survival from randomization was 4.3 and 6.1 months for arm A versus arm B, respectively [hazard ratio 1.10 (80% confidence interval 0.86-1.39), P = 0.62]. Patients in arm A had numerically fewer treatment-related adverse events (84.9% versus 93.9%) and significantly less peripheral sensory polyneuropathy ≥grade 2 (9.4% versus 36.7%). CONCLUSIONS S-1 maintenance following platinum-based induction therapy leads to non-inferior survival outcomes compared with the continuation of platinum-based combination. Toxicity patterns favor a fluoropyrimidine maintenance strategy. These data challenge the continued use of platinum combination chemotherapy after response to 3 months induction therapy in patients with advanced human epidermal growth factor receptor 2-negative esophagogastric adenocarcinoma.
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Affiliation(s)
- G Stocker
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases) and University Cancer Center Leipzig, University of Leipzig Medical Center, Leipzig, Germany
| | - S Lorenzen
- Clinic and Policlinic for Internal Medicine III, Technical University of Munich, School of Medicine, Munich, Germany
| | - T Ettrich
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - A-L Herz
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - F Longo
- Ramon y Cajal University Hospital, IRYCIS, CIBERONC, Madrid, Spain
| | - A Kiani
- Department of Medicine IV, Klinikum Bayreuth GmbH, Bayreuth, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - M Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - J Trojan
- Medical Clinic 1, Goethe University Hospital, Frankfurt am Main, Germany
| | - R Mahlberg
- Department of Internal Medicine I, Klinikum Mutterhaus der Borromaerinnen, Trier, Germany
| | - N Moosmann
- Department of Hematology and Oncology, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - B Chibaudel
- Department of Medical Oncology, Franco-British Hospital, Fondation Cognacq-Jay, Levallois-Perret, France
| | - S Kubicka
- Cancer Center Reutlingen, Reutlingen, Germany
| | - R Greil
- IIIrd Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria
| | - S Daum
- Department of Gastroenterology, Campus B. Franklin, Charité - Universitätsmedizin, Berlin, Germany
| | | | - J Larcher-Senn
- Assign Data Management and Biostatistics GmbH, Innsbruck, Austria
| | - G Keller
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - F Lordick
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases) and University Cancer Center Leipzig, University of Leipzig Medical Center, Leipzig, Germany
| | - G M Haag
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Applied Tumor-Immunity, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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14
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Yang K, Zhang W, Chen Z, Chen X, Liu K, Zhao L, Hu J. Comparison of long-term quality of life between Billroth-I and Roux-en-Y anastomosis after distal gastrectomy for gastric cancer: a randomized controlled trial. Chin Med J (Engl) 2023; 136:1074-1081. [PMID: 37014767 PMCID: PMC10228481 DOI: 10.1097/cm9.0000000000002602] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The results of studies comparing Billroth-I (B-I) with Roux-en-Y (R-Y) reconstruction on the quality of life (QoL) are still inconsistent. The aim of this trial was to compare the long-term QoL of B-I with R-Y anastomosis after curative distal gastrectomy for gastric cancer. METHODS A total of 140 patients undergoing curative distal gastrectomy with D2 lymphadenectomy in West China Hospital, Sichuan University from May 2011 to May 2014 were randomly assigned to the B-I group ( N = 70) and R-Y group ( N = 70). The follow-up time points were 1, 3, 6, 9, 12, 24, 36, 48, and 60 months after the operation. The final follow-up time was May 2019. The clinicopathological features, operative safety, postoperative recovery, long-term survival as well as QoL were compared, among which QoL score was the primary outcome. An intention-to-treat analysis was applied. RESULTS The baseline characteristics were comparable between the two groups. There were no statistically significant differences in terms of postoperative morbidity and mortality rates, and postoperative recovery between the two groups. Less estimated blood loss and shorter surgical duration were found in the B-I group. There were no statistically significant differences in 5-year overall survival (79% [55/70] of the B-I group vs. 80% [56/70] of the R-Y group, P = 0.966) and recurrence-free survival rates (79% [55/70] of the B-I group vs. 78% [55/70] of the R-Y group, P = 0.979) between the two groups. The scores of the global health status of the R-Y group were higher than those of the B-I group with statistically significant differences (postoperative 1 year: 85.4 ± 13.1 vs . 88.8 ± 16.1, P = 0.033; postoperative 3 year: 87.3 ± 15.2 vs . 92.8 ± 11.3, P = 0.028; postoperative 5 year: 90.9 ± 13.7 vs . 96.4 ± 5.6, P = 0.010), and the reflux (postoperative 3 year: 8.8 ± 12.9 vs . 2.8 ± 5.3, P = 0.001; postoperative 5 year: 5.1 ± 9.8 vs . 1.8 ± 4.7, P = 0.033) and epigastric pain (postoperative 1 year: 11.8 ± 12.7 vs. 6.1 ± 8.8, P = 0.008; postoperative 3 year: 9.4 ± 10.6 vs. 4.6 ± 7.9, P = 0.006; postoperative 5 year: 6.0 ± 8.9 vs . 2.7 ± 4.6, P = 0.022) were milder in the R-Y group than those of the B-I group at the postoperative 1, 3, and 5-year time points. CONCLUSIONS Compared with B-I group, R-Y reconstruction was associated with better long-term QoL by reducing reflux and epigastric pain, without changing survival outcomes. TRIAL REGISTRATION ChiCTR.org.cn, ChiCTR-TRC-10001434.
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Affiliation(s)
- Kun Yang
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Weihan Zhang
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zehua Chen
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiaolong Chen
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Kai Liu
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Linyong Zhao
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jiankun Hu
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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15
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Zhang S, Liu R, Zhang M, Hu J, Xiang S, Jiang Z, Wang D. The Predictive Value of a New Inflammatory-Nutritional Score for Quality of Life after Laparoscopic Distal Gastrectomy for Gastric Cancer. Nutr Cancer 2023; 75:1165-1176. [PMID: 36892498 DOI: 10.1080/01635581.2023.2181732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
We explored the predictive value of various inflammatory-nutritional indicators for postoperative quality of life (QoL) in gastric cancer (GC) patients undergoing laparoscopic distal gastrectomy (LDG) and developed a novel inflammatory-nutritional score (INS). In this study, 156 GC patients who underwent LDG were included. We used multiple linear regression to analyze the correlation between postoperative QoL and inflammatory-nutritional indicators. Least absolute shrinkage and selection operator (LASSO) regression analysis was performed to construct INS. Hemoglobin was positively correlated with physical functioning (β =8.5; p = 0.003) and cognitive functioning (β = 3.5; p = 0.038) 3 mo, after surgery. Prognostic nutritional index (PNI) was positively associated with global health status (β =5.8; p = 0.043). Albumin-alkaline phosphatase ratio (AAPR) was negatively correlated with emotional functioning 12 mo, after surgery (β = -5.7; p = 0.024). Neutrophil-lymphocyte ratio (NLR), Lymphocyte- monocyte ratio (LMR), AAPR, hemoglobin and PNI were selected using LASSO regression analysis to construct INS. The C-index values of the model in the training group and the validation group were 0.806 (95% CI, 0.719-0.893) and 0.758 (95% CI: 0.591-0.925), respectively. INS had particular predictive value for postoperative QoL in patients undergoing LDG and provided a reference for risk stratification and clinical practice.
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Affiliation(s)
- Simeng Zhang
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
| | - Ruiqing Liu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Maoshen Zhang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - JiLin Hu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shuai Xiang
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
| | - Zinian Jiang
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
| | - Dongsheng Wang
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China.,Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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16
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Kang SH, Yoo M, Hwang D, Lee E, Lee S, Park YS, Ahn SH, Suh YS, Kim HH. Postoperative pain and quality of life after single-incision distal gastrectomy versus multiport laparoscopic distal gastrectomy for early gastric cancer - a randomized controlled trial. Surg Endosc 2023; 37:2095-2103. [PMID: 36307602 PMCID: PMC9616415 DOI: 10.1007/s00464-022-09709-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although it has been more than ten years since its first introduction, single-incision distal gastrectomy (SIDG) still lacks solid evidence and there are also no reports on patient quality of life (QOL). This study evaluates the postoperative outcomes and patient QOL of SIDG compared to multiport laparoscopic distal gastrectomy (MLDG). METHODS This study was designed as a prospective phase II randomized controlled study. Patients diagnosed with early gastric cancer in the distal 2/3rd of the stomach were randomized to either multiport or single-port group. Primary endpoint was pain using the visual analogue scale on postoperative day (POD) 1. Other outcomes include operative data, complications, and patient QOL using the EORTC C30 and STO22 modules. RESULTS A total of 43 patients in the SIDG group and 40 patients in the MLDG group were enrolled from September 2017 to February 2020. Mean operation time was 154.3 ± 53.3 min in the MLDG group and 148.9 ± 50.1 min in the SIDG group (p = 0.631). There was no difference in POD1 pain scores between the two groups (MLDG = 4.0 ± 1.3, SIDG = 4.3 ± 1.3, p = 0.372). Mean hospital stay was 5.5 (range 4-12) days in the MLDG group and 5 (range 4-17) days in the SIDG group (p = 0.993). There was no statistical significance in postoperative QOL scores. CONCLUSION Unlike previous reports, there was no difference in POD1 pain scores between SIDG and MLDG. Nevertheless, SIDG did not increase short-term morbidity compared to MLDG and had similar outcomes in QOL.
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Affiliation(s)
- So Hyun Kang
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 13620, Gyenggi-Do, Korea
| | - Mira Yoo
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 13620, Gyenggi-Do, Korea
| | - Duyeong Hwang
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 13620, Gyenggi-Do, Korea
| | - Eunju Lee
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 13620, Gyenggi-Do, Korea
| | - Sangjun Lee
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 13620, Gyenggi-Do, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 13620, Gyenggi-Do, Korea.
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 13620, Gyenggi-Do, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 13620, Gyenggi-Do, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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17
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The impact of the 30-day postoperative complications on the quality of life following gastrectomy for gastric carcinoma: A prospective study. Eur J Surg Oncol 2023; 49:983-989. [PMID: 36682945 DOI: 10.1016/j.ejso.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/02/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The effect of postoperative complications on long-term quality of life (QoL) is controversial in abdominal surgery. This study aimed to investigate the impact of 30-day postoperative complications on long-term QoL after gastrectomy. METHOD This is a longitudinal cohort study that enrolled 908 patients undergoing gastrectomy for gastric cancer between 2016 and 2017. QoL was assessed using the European Organization for Research and Treatment of Cancer (EORTC) generic cancer (QLQ C-30) and gastric module (STO-22) preoperatively and at 1, 6, 12, and 24 months postoperatively. Patients were divided into the morbidity (30-day postoperative complications) and no-morbidity groups, and the postoperative QoL change was compared using a linear mixed model. RESULTS The mean age was 62.5 ± 12.0 years. Subtotal and total gastrectomy was performed in 763 (84.0%) and 145 (16.0%) patients, respectively. There were 189 (20.8%) patients developing postoperative complications. The morbidity group showed worse scores in several functions and symptoms of QoL at the baseline. However, the two groups showed no significant difference in postoperative changes in most functions and symptoms of the QLQ C-30 and STO-22 (Pgroup × time > 0.05). The recovery of global health (Pgroup × time < 0.001) and anxiety (Pgroup × time = 0.008) was slightly better in the morbidity group. The subgroup analysis of patients developing major abdominal complications showed similar results. CONCLUSION The morbidity group showed worse QoL in several functions and symptoms at the baseline. However, postoperative complications had little influence on QoL change following gastrectomy for gastric cancer.
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Zub V, Manzhalii E. ASSESSMENT OF QUALITY OF LIFE IN PATIENTS WITH GASTRIC CANCER IN UKRAINE. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:956-963. [PMID: 37326076 DOI: 10.36740/wlek202305111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim: To identify the main problems in the quality of life of patients with gastric cancer to optimize health care for them. PATIENTS AND METHODS Materials and methods: The sociological study was performed by surveying 404 patients with gastric cancer usage questionnaires EORTC QLQ-C30 and QLQ-STO22. Calculations were performed according to the EORTC QLQ-C30 Scoring Manual and QLQ-STO22. The analysis of three main indicators was performed: functional scale, symptom scale and quality of life scale. RESULTS Results: The quality of life of gastric cancer patients amounted to 51.80±11.35 on a 100-point scale. According to the QLQ-C30 functional scale, the psy¬cho-emotional sphere (59.62±12.91), social functioning (66.42±13.48) are the most impressive in patients. According to the results obtained in the QLQ-C30 symptoms scale, gastric cancer patients were most concerned about financial difficulties (57.18±12.45) and fatigue with a score of 50.12±10.86 on a 100-point scale. According to the QLQ-STO22 symptom scale in the study of patients, anxiety (59.07±12.46) and hair loss (56.97±11.78) amounted to the highest scores. CONCLUSION Conclusions: Given the low quality of life of gastric cancer patients, they need psychological support, which is aimed at adapting to the manifestations of the disease and should be a mandatory component in the development of models or strategies for providing medical care to cancer patients. Standardized psychological care should be organized at all stages of diagnosis, treatment and rehabilitation in all institutions that provide treatment to gastric cancer pa¬tients. It is also important to develop and implement a comprehensive program to support gastric cancer patients in interaction with society, family and work.
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Affiliation(s)
- Valeriy Zub
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE
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19
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Kim I, Lim JY, Kim JK, Lee JH, Sohn TS, Park S, Kang SH, Lee JY, Hwang JH. Effectiveness of a personalized digital exercise and nutrition-based rehab program for patients with gastric cancer after surgery: Study protocol for a randomized controlled trial. Digit Health 2023; 9:20552076231187602. [PMID: 37485329 PMCID: PMC10357057 DOI: 10.1177/20552076231187602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023] Open
Abstract
Background Patients with gastric cancer often encounter impaired quality of life and reduced tolerability to adjuvant treatments after surgery. Weight preservation is crucial for the overall prognosis of these patients, and exercise and supplemental nutrition play the main role. This study is the first randomized clinical trial to apply personalized, treatment stage-adjusted digital intervention with wearable devices in gastric cancer rehabilitation intervention for 12 months, commencing immediately after surgery. Methods This is a prospective, multicenter, two-armed, randomized controlled trial and aims to recruit 324 patients from two hospitals. Patients will be randomly allocated to two groups for 1 year of rehabilitation, starting immediately after the operation: a personalized digital therapeutic (intervention) group and a conventional education-based rehabilitation (control) group. The primary objective is to clarify the effect of mobile applications and wearable smart bands in reducing weight loss in patients with gastric cancer. The secondary outcomes are quality of life measured by the EORTC-QLQ-C30 and STO22; nutritional status by mini nutrition assessment; physical fitness level measured by grip strength test, 30-s chair stand test and 2-min walk test; physical activity measured by IPAQ-SF; pain intensity; skeletal muscle mass; and fat mass. These measurements will be performed on enrollment and at 1, 3, 6, and 12 months thereafter. Conclusions Digital therapeutic programs include exercise and nutritional interventions modified by age, body mass index, surgery type and postoperative days. Thus, expert intervention is pivotal for precise and safe calibration of this program. Trial registration Clinicaltrials.gov identifier: NCT04907591 (registration date: June 11, 2020; https://clinicaltrials.gov/ct2/show/NCT04907591).
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Affiliation(s)
- Inah Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Young Lim
- Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | | | - Jun Ho Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sungsoo Park
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Kim HJ, Yoon HM, Ryu KW, Kim YW, Kim SY, Oh JM, Wie GA, Ko H, Lee J, Kim Y, Cho H, Eom BW. An early interactive human coaching via a mobile application to improve quality of life in patients who underwent gastrectomy for gastric cancer: Design and protocol of a randomized controlled trial. PLoS One 2022; 17:e0278370. [PMID: 36490244 PMCID: PMC9733875 DOI: 10.1371/journal.pone.0278370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/04/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND After gastrectomy, patients may experience the postgastrectomy syndrome and face difficulties adapting to everyday diet. Recently, human health coaching via a mobile application (app) has been used for obese patients or patients with chronic diseases, with significant improvements in clinical outcomes. The aim of this study is to evaluate and compare the effects of human health coaching via a mobile app and conventional face-to-face counseling in patients who underwent gastrectomy for gastric cancers. METHODS This study is a single-institution, prospective randomized controlled trial comparing the mobile health and face-to-face counselling groups. After randomization, participants assigned to the mobile health coaching group will receive health coaching via a mobile app for 3 months after discharge, and the assigned coaches will provide personalized advice based on the self-recorded health data. Participants in the face-to-face group will have 1- and 3-months postoperative dietary consultations with a clinical dietitian. The primary endpoint is the food restriction score on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-STO22, and secondary endpoints included all other quality of life scale scores and nutritional parameters. The calculated sample size is 180, and the outcomes will be measured until 1-year post-surgery. SIGNIFICANCE This study will show the efficacy of human health coaching via a mobile app on dietary adaptation in patients who underwent gastrectomy. A relational approach based on personal data and timely intervention using a mobile platform could reduce patients' trial and error and improve quality of life. TRIAL REGISTRATION ClinicalTrials.gov, NCT04394585, Registered 19 May, 2020 -Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT040394585.
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Affiliation(s)
- Hak Jin Kim
- Department of Cardiology, Center for Clinical Specialty, National Cancer Center, Goyang, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang, Republic of Korea
| | - So Young Kim
- Department of Clinical Nutrition, National Cancer Center, Goyang, Republic of Korea
| | - Jin Myoung Oh
- Department of Clinical Nutrition, National Cancer Center, Goyang, Republic of Korea
| | - Gyung Ah Wie
- Department of Clinical Nutrition, National Cancer Center, Goyang, Republic of Korea
| | - Hyunyoung Ko
- Research and Development Team, Noom Inc, Seoul, Republic of Korea
| | - Jungeun Lee
- Research and Development Team, Noom Inc, Seoul, Republic of Korea
| | - Youngin Kim
- Research and Development Team, Noom Inc, Seoul, Republic of Korea
| | - Hyunsoon Cho
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang, Republic of Korea
- * E-mail:
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21
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Rowsell A, Sodergren SC, Vassiliou V, Darlington AS, Guren MG, Alkhaffaf B, Moorbey C, Dennis K, Terada M. Systematic review of health-related quality of life (HRQoL) issues associated with gastric cancer: capturing cross-cultural differences. Gastric Cancer 2022; 25:665-677. [PMID: 35689705 PMCID: PMC9225973 DOI: 10.1007/s10120-022-01309-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/16/2022] [Indexed: 02/07/2023]
Abstract
The treatment landscape for gastric cancer (GC) is constantly evolving with therapies affecting all aspects of health-related quality of life (HRQoL) which need careful monitoring. While there are HRQoL measures designed specifically to capture issues relevant to patients with GC, these might be outdated and only relevant to patients in westernised cultures. This review identifies the patient-reported measures used to assess HRQoL of patients with GC and compares the HRQoL measures used across cultures including East Asia, where GC is more prevalent. We conducted a systematic review of publications between January 2001 and January 2021. A total of 267 papers were identified; the majority (66%) of studies involved patients from East Asian countries. Out of the 24 HRQoL questionnaires captured, the European Organisation for Research and Treatment of Cancer Core Cancer measure (QLQ-C30) was the most widely used (60% of all studies and 62% of those involving patients from East Asian countries), followed by its gastric cancer-specific module (QLQ-STO22, 34% of all studies and 41% from East Asia). Eight questionnaires were developed within East Asian countries and, of the 20 studies including bespoke questions, 16 were from East Asia. There were six qualitative studies. HRQoL issues captured include diarrhoea, constipation, reflux, abdominal pain and abdominal fulness or bloating, difficulty swallowing, restricted eating, and weight loss. Psychosocial issues related to these problems were also assessed. Issues relating to the compatibility of some of the westernised measures within East Asian cultures were highlighted.
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Affiliation(s)
- Alison Rowsell
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Samantha C Sodergren
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
| | | | - Anne-Sophie Darlington
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Marianne G Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bilal Alkhaffaf
- Department of Oesophago-Gastric & Bariatric Surgery, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Chantelle Moorbey
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Kristopher Dennis
- Division of Radiation Oncology, The Ottawa Hospital Cancer Centre, Ottawa, K1H 8L6, Canada
- Department of Radiology, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Mitsumi Terada
- Asian Partnerships Office, Department of International Clinical Development/International Trials Management Section, Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan
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22
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Ko CS, Gong CS, Kim BS, Kim SO, Kim HS. A comparative study of laparoscopic near-total and total gastrectomy for patient nutritional status and quality of life using a propensity score matching analysis. Surg Endosc 2022; 36:5610-5617. [PMID: 35612639 DOI: 10.1007/s00464-021-08959-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies of LNTG had small sample sizes and short follow-up periods and did not evaluate quality of life after LNTG. We aimed to compare surgical, oncological, nutritional outcomes, and quality of life of patients after laparoscopic near-total and total gastrectomy (LNTG and LTG, respectively). METHODS We retrospectively collected and analyzed data of 167 and 294 patients who underwent LNTG and LTG, respectively, for treatment of upper or middle third gastric cancer between January 2008 and December 2018. After propensity score matching, the surgical, oncological, and nutritional outcomes of 324 patients were analyzed. Moreover, we measured quality of life after surgery using a postgastrectomy syndrome scale. RESULTS The operation time and the length of hospital stay was significantly shorter in the LNTG group than in the LTG group. In addition, patients with anastomotic complications were fewer in the LNTG group. No significant difference was found in the 5-year overall survival rate between the two groups. However, patients in the LNTG group had a significantly smaller body weight loss after 3 months postoperatively. Furthermore, patients in the LNTG group had significantly healthier albumin and cholesterol than those in the LTG group. The mean scores on the postgastrectomy symptom scale at 3, 6, and 12 months postoperatively were higher in the LNTG group than in the LTG group. CONCLUSION LNTG is a surgically safe and oncologically favorable method compared with LTG. Furthermore, patients who underwent LNTG had improved nutritional status and quality of life than those who underwent LTG.
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Affiliation(s)
- Chang Seok Ko
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Chung Sik Gong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Byung Sik Kim
- Department of Surgery, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, 712, Dongil-ro, Uijeongbu-si, Gyeonggi-do, 11759, Republic of Korea
| | - Seon Ok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Sung Kim
- Department of Surgery, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, 712, Dongil-ro, Uijeongbu-si, Gyeonggi-do, 11759, Republic of Korea.
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Factors affecting the quality of life of gastric cancer survivors. Support Care Cancer 2022; 30:3215-3224. [PMID: 34973098 PMCID: PMC8857153 DOI: 10.1007/s00520-021-06683-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/03/2021] [Indexed: 12/30/2022]
Abstract
Background The number of gastric cancer survivors has been increasing, and such survivors experience various changes in their lives post-recovery. Adapting to these changes requires appropriate interventions that can improve their quality of life (QoL). This study was conducted to investigate the factors affecting the QoL of gastric cancer survivors and provide basic data for effective intervention. Methods Data were collected between September 8 and September 29, 2017, from the Gastric Cancer Center at a tertiary hospital. Questionnaire surveys were conducted using the EORTC QLQ-C30/STO22, Self-Efficacy-Scale, Multidimensional Scale of Perceived Social Support, and Quality of Life-Cancer Survivors Questionnaire on gastric cancer survivors who were followed up for 3 years after gastrectomy. Data were analyzed using descriptive statistics, t test, ANOVA, Pearson’s correlation coefficient, and multiple regression analysis. Results A total of 136 gastric cancer survivors completed the questionnaire survey. There were significant positive correlations of QoL with self-efficacy, functional status, and social support (r = .35, p < .001; r = .53, p < .001; r = .26, p < .001, respectively). There were significant negative correlations of QoL with general symptoms (r = − .39, p < .001) and gastric cancer-specific symptoms (r = − .51, p < .001). The regression model explained 48.3% of the QoL, and the affecting factors were gastric cancer-specific symptoms (β = − .397, p < .001), religious belief (β = .299, p < .001), functional status (β = .251, p = .003), and self-efficacy (β = .191, p = .004). Conclusion This study confirmed that gastric cancer-specific symptoms, spiritual well-being, self-efficacy, and functional status affect the QoL of gastric cancer survivors. Hence, these factors should be considered in the interventions to improve the QoL of gastric cancer survivors.
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Hanna L, Nguo K, Furness K, Porter J, Huggins CE. Association between skeletal muscle mass and quality of life in adults with cancer: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2022; 13:839-857. [PMID: 35156342 PMCID: PMC8977976 DOI: 10.1002/jcsm.12928] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 11/11/2021] [Accepted: 01/10/2022] [Indexed: 01/06/2023] Open
Abstract
Low skeletal muscle mass is known to be associated with poor morbidity and mortality outcomes in cancer, but evidence of its impact on health-related quality of life (HRQOL) is less established. This systematic review and meta-analysis was performed to investigate the relationship between skeletal muscle mass and HRQOL in adults with cancer. Five databases (Ovid MEDLINE, Embase via Ovid, CINAHL plus, Scopus, and PsycInfo) were systematically searched from 1 January 2007 until 2 September 2020. Studies reporting on the association between measures of skeletal muscle (mass and/or radiodensity) derived from analysis of computed tomography imaging, and a validated measure of HRQOL in adults with cancer, were considered for inclusion. Studies classifying skeletal muscle mass as a categorical variable (low or normal) were combined in a meta-analysis to investigate cross-sectional association with HRQOL. Studies reporting skeletal muscle as a continuous variable were qualitatively synthesized. A total of 14 studies involving 2776 participants were eligible for inclusion. Skeletal muscle mass classified as low or normal was used to dichotomize participants in 10 studies (n = 1375). Five different cut points were used for classification across the 10 studies, with low muscle mass attributed to 58% of participants. Low muscle mass was associated with poorer global HRQOL scores [n = 985 from seven studies, standardized mean difference -0.27, 95% confidence interval (CI) -0.40 to -0.14, P < 0.0001], and poorer physical functioning domain HRQOL scores (n = 507 from five studies, standardized mean difference -0.40, 95% CI -0.74 to -0.05, P = 0.02), but not social, role, emotional, or cognitive functioning domain scores (all P > 0.05). Five studies examined the cross-sectional relationship between HRQOL and skeletal muscle mass as a continuous variable and found little evidence of an association unless non-linear analysis was used. Two studies investigated the relationship between longitudinal changes in both skeletal muscle and HRQOL, reporting that an association exists across several HRQOL domains. Low muscle mass may be associated with lower global and physical functioning HRQOL scores in adults with cancer. The interpretation of this relationship is limited by the varied classification of low muscle mass between studies. There is a need for prospective, longitudinal studies examining the interplay between skeletal muscle mass and HRQOL over time, and data should be made accessible to enable reanalysis according to different cut points. Further research is needed to elucidate the causal pathways between these outcomes.
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Affiliation(s)
- Lauren Hanna
- Department of Nutrition, Dietetics and FoodMonash UniversityClaytonVICAustralia
- Department of Nutrition and Dietetics, Monash Medical CentreMonash HealthClaytonVICAustralia
| | - Kay Nguo
- Department of Nutrition, Dietetics and FoodMonash UniversityClaytonVICAustralia
| | - Kate Furness
- Department of Nutrition and Dietetics, Monash Medical CentreMonash HealthClaytonVICAustralia
- Department of Physiotherapy, School of Primary and Allied Health CareMonash UniversityFrankstonVICAustralia
| | - Judi Porter
- Department of Nutrition, Dietetics and FoodMonash UniversityClaytonVICAustralia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesDeakin UniversityGeelongVICAustralia
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van Amelsfoort RM, Walraven I, Kieffer J, Jansen EPM, Cats A, van Grieken NCT, Meershoek-Klein Kranenbarg E, Putter H, van Sandick JW, Sikorska K, van de Velde CJH, Aaronson NK, Verheij M. Quality of Life Is Associated With Survival in Patients With Gastric Cancer: Results From the Randomized CRITICS Trial. J Natl Compr Canc Netw 2022; 20:261-267. [PMID: 35276669 DOI: 10.6004/jnccn.2021.7057] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The evaluation of health-related quality of life (HRQoL) in clinical trials has become increasingly important because it addresses the impact of treatment from the patient's perspective. The primary aim of this study was to investigate the effect of postoperative chemotherapy and chemoradiotherapy (CRT) after neoadjuvant chemotherapy and surgery with extended (D2) lymphadenectomy on HRQoL in the CRITICS trial. Second, we investigated the potential prognostic value of pretreatment HRQoL on event-free survival (EFS) and overall survival (OS). PATIENTS AND METHODS Patients in the CRITICS trial were asked to complete HRQoL questionnaires (EORTC Quality-of-Life Questionnaire-Core 30 and Quality-of-Life Questionnaire gastric cancer-specific module) at baseline, after preoperative chemotherapy, after surgery, after postoperative chemotherapy or CRT, and at 12 months follow-up. Patients with at least 1 evaluable questionnaire (645 of 788 randomized patients) were included in the HRQoL analyses. The predefined endpoints included dysphagia, pain, physical functioning, fatigue, and Quality-of-Life Questionnaire-Core 30 summary score. Linear mixed modeling was used to assess differences over time and at each time point. Associations of baseline HRQoL with EFS and OS were investigated using multivariate Cox proportional hazards analyses. RESULTS At completion of postoperative chemo(radio)therapy, the chemotherapy group had significantly better physical functioning (P=.02; Cohen's effect size = 0.42) and less dysphagia (P=.01; Cohen's effect size = 0.38) compared with the CRT group. At baseline, worse social functioning (hazard ratio [HR], 2.20; 95% CI, 1.36-3.55; P=.001), nausea (HR, 1.89; 95% CI, 1.39-2.56; P<.001), worse WHO performance status (HR, 1.55; 95% CI, 1.13-2.13; P=.007), and histologic subtype (diffuse vs intestinal: HR, 1.94; 95% CI, 1.42-2.67; P<.001; mixed vs intestinal: HR, 2.35; 95% CI, 1.35-4.12; P=.003) were significantly associated with worse EFS and OS. CONCLUSIONS In the CRITICS trial, the chemotherapy group had significantly better physical functioning and less dysphagia after postoperative treatment. HRQoL scales at baseline were significantly associated with EFS and OS.
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Affiliation(s)
| | - Iris Walraven
- 1Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam.,2Department for Health Evidence, Radboud University Medical Center, Nijmegen
| | | | - Edwin P M Jansen
- 1Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam
| | - Annemieke Cats
- 4Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam
| | | | | | - Hein Putter
- 6Department of Surgical Oncology, Leiden University Medical Center, Leiden
| | | | - Karolina Sikorska
- 8Department of Biostatistics, Netherlands Cancer Institute, Amsterdam; and
| | | | - Neil K Aaronson
- 2Department for Health Evidence, Radboud University Medical Center, Nijmegen
| | - Marcel Verheij
- 1Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam.,9Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
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26
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Kawabata R, Fujitani K, Sakamaki K, Ando M, Ito Y, Tanizawa Y, Yamada T, Hirao M, Yamada M, Hihara J, Ryoji, Fukushima, Choda Y, Kodera Y, Teshima S, Shinohara H, Kondo M, Yoshida K. Survival analysis of a prospective multicenter observational study on surgical palliation among patients with malignant bowel obstruction caused by peritoneal dissemination of gastric cancer. Gastric Cancer 2022; 25:422-429. [PMID: 34550490 DOI: 10.1007/s10120-021-01251-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Our previous report showed that surgical palliation maintained quality of life (QOL), improved solid food intake, and had an acceptable surgical safety among patients with malignant bowel obstruction (MBO) caused by advanced gastric cancer. This study performed a survival analysis stratified by the patients' QOL to elucidate its impact on survival. METHODS Patients who underwent resection or bypass of the small intestine/colon or ileostomy/colostomy for bowel obstruction caused by peritoneal dissemination of gastric cancer were included. Validated instruments (EuroQoL-5 Dimensions) were used to assess QOL at baseline and 2 weeks, 1 month, and 3 months following surgical palliation. Postoperative improvement in oral intake was also evaluated using the Gastric Outlet Obstruction Scoring System (GOOSS). Univariate and multivariate survival analyses were performed using baseline characteristics and changes in QOL and GOOSS scores 2 weeks after surgery to determine prognostic factors. RESULTS We enrolled 60 patients with a median survival time of 6.64 (95% CI 4.76-10.28) months. Patients who received postoperative chemotherapy and had lower baseline C-reactive protein (CRP) levels, higher baseline albumin levels, better baseline EuroQoL-5 Dimensions (EQ-5D) scores, and improved oral intake after palliative surgery exhibited significantly better survival. Multivariate analysis identified postoperative chemotherapy, lower baseline CRP levels, and improved oral intake as independent prognostic factors. CONCLUSIONS The current study revealed that baseline QOL and postoperative QOL changes did not affect survival. Moreover, improved oral intake, lower baseline CRP levels, and postoperative chemotherapy were significant prognostic factors in patients who underwent palliative surgery for advanced gastric cancer with MBO.
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Affiliation(s)
- Ryohei Kawabata
- Department of Surgery, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Kita-ku, Sakai-city, , Osaka, 5918025, Japan. .,Department of Surgery, Sakai City Medical Center, Sakai, Japan.
| | - Kazumasa Fujitani
- Department of Gastroenterological Surgery, Osaka Prefectural General Medical Center, Osaka, Japan
| | - Kentaro Sakamaki
- Center for Data Science, Yokohama City University, Yokohama, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Yuichi Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Takanobu Yamada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Makoto Yamada
- Department of Surgery, Gifu Municipal Hospital, Gifu, Japan
| | - Jun Hihara
- Department of Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan
| | | | - Fukushima
- Department of Surgery, Teikyo University School of Medicine, Itabashi City, Japan
| | - Yasuhiro Choda
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shin Teshima
- Department of Surgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Hisashi Shinohara
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masato Kondo
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Japan
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Tsuji T, Isobe T, Seto Y, Tanaka C, Kojima K, Motoori M, Ikeda M, Nitta T, Oshio A, Nakada K. Effects of creating a jejunal pouch on postoperative quality of life after total gastrectomy: A cross-sectional study. Ann Gastroenterol Surg 2022; 6:63-74. [PMID: 35106416 PMCID: PMC8786703 DOI: 10.1002/ags3.12497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 07/29/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022] Open
Abstract
AIM Total gastrectomy results in the complete loss of gastric function and the development of severe postgastrectomy syndrome. During the jejunal pouch procedure following total gastrectomies, a substitute stomach is created to alleviate the effects of postgastrectomy syndrome. However, the procedure's effectiveness remains controversial. This study aimed to explore the effect of jejunal pouch creation after total gastrectomy on postoperative quality of life. METHODS A nationwide multi-institutional cross-sectional study, the Postgastrectomy Syndrome Assessment study NEXT, used the Postgastrectomy Syndrome Assessment Scale-45 questionnaire to explore the optimal gastrectomy procedure for cancer located in the upper third of the stomach or around the esophagogastric junction. The questionnaire consists of 45 items consolidated into 19 main outcome measures relating to postgastrectomy symptoms, amount of food ingested, quality of ingestion, ability for working, level of satisfaction for daily life, and the physical and mental component summary of the 8-Item Short Form Health Survey. Eligible completed questionnaires were retrieved from 1909 patients. Of these, the data were analyzed for 1020 patients who underwent total gastrectomy and 93 patients who underwent jejunal pouch creation after total gastrectomy. RESULTS Postoperative quality of life was compared between patients with and without pouches. The analysis revealed that patients with pouches, particularly oral pouches, experienced substantially improved postoperative quality of life than those without, even after adjusting for several clinical factors using multiple regression analyses. CONCLUSION The results suggest that total gastrectomy with jejunal pouch creation, particularly oral pouches, may significantly improve postoperative quality of life.
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Affiliation(s)
- Toshikatsu Tsuji
- Department of Gastroenterological SurgeryIshikawa Prefectural Central HospitalIshikawaJapan
| | - Taro Isobe
- Department of SurgeryKurume University School of MedicineKurumeJapan
| | - Yasuyuki Seto
- Department of Gastrointestinal SurgeryGraduate School of MedicineUniversity of TokyoTokyoJapan
| | - Chie Tanaka
- Department of Gastroenterological SurgeryNagoya University Graduate School of MedicineNagoyaJapan
| | - Kazuyuki Kojima
- First Department of SurgeryDokkyo Medical University HospitalTochigiJapan
| | | | | | - Toshikatsu Nitta
- Division of SurgeryGastroenterological CenterMedico Shunjyu Shiroyama HospitalOsakaJapan
| | - Atsushi Oshio
- Faculty of Letters, Arts and SciencesWasedaTokyoJapan
| | - Koji Nakada
- Department of Laboratory MedicineThe Jikei University School of MedicineTokyoJapan
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28
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Nunobe S, Takahashi M, Kinami S, Fujita J, Suzuki T, Suzuki A, Tanahashi T, Kawaguchi Y, Oshio A, Nakada K. Evaluation of postgastrectomy symptoms and daily lives of small remnant distal gastrectomy for upper‐third gastric cancer using a large‐scale questionnaire survey. Ann Gastroenterol Surg 2021; 6:355-365. [PMID: 35634182 PMCID: PMC9130885 DOI: 10.1002/ags3.12536] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/17/2021] [Accepted: 12/02/2021] [Indexed: 11/18/2022] Open
Abstract
Aim Total gastrectomy (TG) is often performed for proximal gastric cancer. Small remnant distal gastrectomy (SRDG) can also be used in cases where surgical margins can be secured. The impact of preserving proximal small remnant stomach on postoperative quality of life (QOL) has not been fully elucidated. In the present study, we compared postgastrectomy symptoms and daily lives between patients undergoing SRDG and those undergoing TG for proximal gastric cancer using the developed Postgastrectomy Syndrome Assessment Scale (PGSAS)‐45. Methods Of the 1909 patients enrolled in the PGSAS NEXT study, univariate analysis of 19 main outcomes measures (MOMs) of PGSAS‐45 was performed in patients undergoing TG (n = 1020) or SRDG (n = 54). Multiple regression analysis was performed with several clinical factors as explanatory variables. Results There was no difference in age and sex between TG and SRDG groups. In SRDG group, postoperative period was shorter, the rates of laparoscopic approach and preservation of the celiac branch of the vagus nerve were higher, and the rates of clinical stage III/IV disease, ≥D2 dissection, and combined resection with other organs were lower than in the TG group significantly (P < .05). SRDG was associated with significantly lower symptoms and better daily lives than TG in 12 and 13 of 19 MOMs in PGSAS‐45 by univariate and multiple regression analyses, respectively (P < .05). Several other clinical factors were also associated with certain MOMs. Conclusion The PGSAS‐45 revealed that SRDG was associated with better postgastrectomy symptoms and daily lives than TG.
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Affiliation(s)
- Souya Nunobe
- Department of Gastroenterological surgery Cancer Institute Ariake Hospital Koto‐ku Japan
| | - Masazumi Takahashi
- Division of Gastroenterological Surgery Yokohama Municipal Cirizen's Hospital Kanagawa Japan
| | - Shinichi Kinami
- Department of Surgical Oncology Kanazawa Medical University Kahoku‐gun Japan
| | - Junya Fujita
- Department of surgery Yao Municipal Hospital Osaka Japan
| | - Takahisa Suzuki
- Department of Surgery National Hospital Organization Kure Medical CenterChu‐goku Cancer Center Hiroshima Japan
| | - Akihiro Suzuki
- Department of Gastrointestinal Surgery St. Luke's International Hospital Chuo‐ku Japan
| | | | - Yoshihiko Kawaguchi
- First Department of Surgery Faculty of Medicine University of Yamanashi Chuo Japan
| | - Atsushi Oshio
- Faculty of Letters, Arts and Sciences Waseda University Shinjuku‐ku Japan
| | - Koji Nakada
- Department of Laboratory Medicine The Jikei University School of Medicine Tokyo Japan
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29
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Van Cutsem E, Amonkar M, Fuchs CS, Alsina M, Özgüroğlu M, Bang YJ, Chung HC, Muro K, Goekkurt E, Benson AB, Sun W, Wainberg ZA, Norquist JM, Chen X, Shih CS, Shitara K. Health-related quality of life in advanced gastric/gastroesophageal junction cancer with second-line pembrolizumab in KEYNOTE-061. Gastric Cancer 2021; 24:1330-1340. [PMID: 34363528 PMCID: PMC8502140 DOI: 10.1007/s10120-021-01200-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND In the primary analysis population (i.e., PD-L1 combined positive score [CPS] ≥ 1) of the phase 3 KEYNOTE-061 study (NCT02370498), pembrolizumab did not significantly prolong overall survival or progression-free survival. Pembrolizumab had a favorable safety profile in the all-patient population. We present results of prespecified health-related quality of life (HRQoL) analyses. METHODS HRQoL was measured using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30), EORTC QLQ gastric cancer questionnaire (QLQ-STO22), and EuroQol 5-dimension, 3-level questionnaire (EQ-5D-3L). Data were analyzed from patients who received ≥ 1 dose of study treatment and who completed ≥ 1 HRQoL assessment. Key analyses included baseline to week 12 least-squares mean (LSM) change in global health status (GHS)/QoL, functional/symptom subscales, and time to deterioration (TTD; ≥ 10-point decrease from baseline) for specific subscales. RESULTS The HRQoL population included 371 patients (pembrolizumab, n = 188; paclitaxel, n = 183). Compliance and completion rates for all 3 questionnaires were similar in both groups at baseline and week 12. There was no difference in LSM change between groups (- 3.54; 95% CI - 8.92 to 1.84) in GHS/QoL at week 12. LSM change from baseline to week 12 for most QLQ-C30, QLQ-STO22, and EQ-5D-3L subscales indicated some worsening of QoL in both groups. TTD for GHS/QoL, nausea/vomiting, and appetite loss subscales in QLQ-C30 and the pain subscales in QLQ-STO22 were similar between treatment groups. CONCLUSIONS In this population with advanced gastric and GEJ cancer receiving second-line treatment, HRQoL was similar in patients receiving pembrolizumab and those receiving paclitaxel. CLINICAL TRIAL REGISTRY AND NUMBER ClinicalTrials.gov, NCT02370498.
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Affiliation(s)
- Eric Van Cutsem
- Department of Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, 49 Herestraat, Leuven, Belgium.
| | - Mayur Amonkar
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Charles S Fuchs
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Maria Alsina
- Department of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, University Autònoma de Barcelona, Barcelona, Spain
| | - Mustafa Özgüroğlu
- Department of Internal Medicine, Medical Oncology, and Clinical Trial Unit, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Yung-Jue Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun Cheol Chung
- Department of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Eray Goekkurt
- North-German Trial Center for Innovative Oncology, Hematology Oncology Practice Eppendorf, University Cancer Center Hamburg, Hamburg, Germany
| | - Al B Benson
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Weijing Sun
- Department of Internal Medicine and Medical Oncology, University of Kansas, Westwood, KS, USA
| | - Zev A Wainberg
- Department of Medicine and Hematology and Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Josephine M Norquist
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Xinqun Chen
- Department of Medical Oncology, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Chie-Schin Shih
- Department of Medical Oncology, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Kohei Shitara
- Department of Gastrointestinal Oncology, National Cancer Center Hospital, Chiba, Japan
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30
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Ito Y, Fujitani K, Sakamaki K, Ando M, Kawabata R, Tanizawa Y, Yoshikawa T, Yamada T, Hirao M, Yamada M, Hihara J, Fukushima R, Choda Y, Kodera Y, Teshima S, Shinohara H, Kondo M. QOL assessment after palliative surgery for malignant bowel obstruction caused by peritoneal dissemination of gastric cancer: a prospective multicenter observational study. Gastric Cancer 2021; 24:1131-1139. [PMID: 33791885 DOI: 10.1007/s10120-021-01179-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with peritoneal dissemination of gastric cancer have poor oral intake caused by malignant bowel obstruction (MBO). Palliative surgery has often been undertaken to improve quality of life (QOL), but few prospective studies on palliative surgery in this patient population have been published. PATIENTS AND METHODS We prospectively investigated the significance of palliative surgery using patient-reported QOL measures. Patients underwent palliative surgery by small intestine/colon resection or small intestine/colon bypass or ileostomy/colostomy for MBO. The primary endpoint was change in QOL assessed at baseline, 14 days, 1 month, and 3 months following palliative surgery using the Euro QoL Five Dimensions (EQ-5D™) questionnaire and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire gastric cancer module (QLQ-STO22). Secondary endpoints were postoperative improvement in oral intake and surgical complications. RESULTS Between April 2013 and March 2018, 63 patients were enrolled from 14 institutions. The mean EQ-5D™ utility index baseline score of 0.6 remained consistent. Gastric-specific symptoms mostly showed statistically significant improvement from baseline. Forty-two patients (67%) were able to eat solid food 2 weeks after palliative surgery and 36 patients (57%) tolerated it for 3 months. The rate of overall morbidity of ≥ grade III according to the Clavien-Dindo classification was 16% (10 patients) and the 30-day postoperative mortality rate was 3.2% (2 patients). CONCLUSIONS In patients with MBO caused by peritoneal dissemination of gastric cancer, palliative surgery did not improve QOL while improving solid food intake, with an acceptable postoperative morbidity and mortality rate.
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Affiliation(s)
- Yuichi Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
| | - Kazumasa Fujitani
- Department of Surgery, Osaka Prefectural General Medical Center, Osaka, Japan
| | - Kentaro Sakamaki
- Center for Data Science, Yokohama City University, Yokohama, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | | | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takaki Yoshikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Takanobu Yamada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Makoto Yamada
- Department of Surgery, Gifu Municipal Hospital, Gifu, Japan
| | - Jun Hihara
- Department of Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Ryoji Fukushima
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Choda
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shin Teshima
- Department of Surgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Hisashi Shinohara
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masato Kondo
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
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van der Wielen N, Daams F, Rosati R, Parise P, Weitz J, Reissfelder C, Diez Del Val I, Loureiro C, Parada-González P, Pintos-Martínez E, Vallejo FM, Achirica CM, Sánchez-Pernaute A, Campos AR, Bonavina L, Asti ELG, Poza AA, Gilsanz C, Nilsson M, Lindblad M, Gisbertz SS, van Berge Henegouwen MI, Romario UF, De Pascale S, Akhtar K, Bonjer HJ, Cuesta MA, van der Peet DL, Straatman J. Health related quality of life following open versus minimally invasive total gastrectomy for cancer: Results from a randomized clinical trial. Eur J Surg Oncol 2021; 48:553-560. [PMID: 34503850 DOI: 10.1016/j.ejso.2021.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/19/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Minimally invasive techniques show improved short-term and comparable long-term outcomes compared to open techniques in the treatment of gastric cancer and improved survival has been seen with the implementation of multimodality treatment. Therefore, focus of research has shifted towards optimizing treatment regimens and improving quality of life. MATERIALS AND METHODS A randomized trial was performed in thirteen hospitals in Europe. Patients were randomized between open total gastrectomy (OTG) or minimally invasive total gastrectomy (MITG) after neoadjuvant chemotherapy. This study investigated patient reported outcome measures (PROMs) on health-related quality of life (HRQoL) following OTG or MITG, using the Euro-Qol-5D (EQ-5D) and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires, modules C30 and STO22. Due to multiple testing a p-value < 0.001 was deemed statistically significant. RESULTS Between January 2015 and June 2018, 96 patients were included in this trial. Forty-nine patients were randomized to OTG and 47 to MITG. A response compliance of 80% was achieved for all PROMs. The EQ5D overall health score one year after surgery was 85 (60-90) in the open group and 68 (50-83.8) in the minimally invasive group (P = 0.049). The median EORTC-QLQ-C30 overall health score one year postoperatively was 83,3 (66,7-83,3) in the open group and 58,3 (35,4-66,7) in the minimally invasive group (P = 0.002). This was not statistically significant. CONCLUSION No differences were observed between open total gastrectomy and minimally invasive total gastrectomy regarding HRQoL data, collected using the EQ-5D, EORTC QLQ-C30 and EORTC-QLQ-STO22 questionnaires.
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Affiliation(s)
- Nicole van der Wielen
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands.
| | - Freek Daams
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands
| | | | - Paolo Parise
- Department of Surgery, San Raffaele Hospital, Milan, Italy
| | - Jürgen Weitz
- Department of of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | | | - Carlos Loureiro
- Department of Surgery, Hospital Universitario de Basurto, Bilbao, Spain
| | | | - Elena Pintos-Martínez
- Department of Surgery, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | | | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato University Hospital, Milan, Italy
| | - Emanuele L G Asti
- Department of Surgery, IRCCS Policlinico San Donato University Hospital, Milan, Italy
| | | | - Carlos Gilsanz
- Department of Surgery, Hospital Del Sureste, Madrid, Spain
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Lindblad
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | | | - Khurshid Akhtar
- Department of Surgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - H Jaap Bonjer
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands
| | - Miguel A Cuesta
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands
| | - Jennifer Straatman
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Pinheiro RN, Mucci S, Zanatto RM, Picanço Junior OM, Oliveira AF, Lopes Filho GDJ. Health-related quality of life after gastric cancer treatment in Brazil: Narrative review and reflections. World J Clin Cases 2021; 9:4123-4132. [PMID: 34141775 PMCID: PMC8173417 DOI: 10.12998/wjcc.v9.i17.4123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/18/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
In Brazil, gastric cancer is the third most common type of cancer among men and fifth among women, with an estimated 13360 new cases among men and 7870 among women each year during the 2020-2022 period. This study presents reflections and attempts to add knowledge to the theme of quality of life (QoL) in patients with gastric adenocarcinoma and describes some of its characteristics in three regions of Brazil, with an evaluation of the disease’s impacts in various dimensions of life, as reported by the patients themselves. We performed a narrative review of the literature and a data analysis of studies on QoL in Brazilian patients treated for gastric adenocarcinoma from three different cities in three geographic regions: Brasília (the midwest), Jaú (the southeast), and Macapá (the north).
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Affiliation(s)
- Rodrigo Nascimento Pinheiro
- Surgical Oncology Service, Surgical Oncology Residency and Academic League of Oncology, Federal District Base Hospital, Brasília 70330-150, Distrito Federal, Brazil
| | - Samantha Mucci
- Department of Psychiatry, Federal University of São Paulo, Paulista School of Medicine (UNIFESP-EPM), São Paulo 04024-002, São Paulo, Brazil
| | - Renato Morato Zanatto
- Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú 17210-070, São Paulo, Brazil
| | | | | | - Gaspar de Jesus Lopes Filho
- Postgraduate Program in Interdisciplinary Surgical Science, Federal University of São Paulo, Paulista School of Medicine (UNIFESP-EPM), São Paulo 04024-002, São Paulo, Brazil
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Eom BW, Park JY, Park KB, Yoon HM, Kwon OK, Ryu KW, Kim YW. Comparison of nutrition and quality of life of esophagogastrostomy and the double-tract reconstruction after laparoscopic proximal gastrectomy. Medicine (Baltimore) 2021; 100:e25453. [PMID: 33847651 PMCID: PMC8052067 DOI: 10.1097/md.0000000000025453] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 03/18/2021] [Indexed: 01/04/2023] Open
Abstract
This study aims to compare the nutritional outcomes and quality of life between patients who underwent esophagogastrostomy (EG) and those who underwent the double-tract reconstruction (DTR) after laparoscopic proximal gastrectomy for early gastric cancer.We retrospectively reviewed the prospectively established database of 45 patients who underwent EG with anti-reflux procedure and 58 patients who underwent the DTR after laparoscopic proximal gastrectomy between December 2013 and June 2017. Then, we compared the baseline characteristics, clinical outcomes, postoperative nutritional parameters, and quality of life (QOL) using European Organization for Research and Treatment of Cancer (EORTC) QLQ STO-22 between the EG and DTR groups.In the postoperative 1-year endoscopic findings, the incidence of esophageal reflux was higher in the EG group (17.8% vs 3.4%, P = .041) and there was no significant difference in anastomotic stricture. Nutritional status was evaluated via body mass index, serum albumin, protein, hemoglobin, and ferritin; we found no significant differences. The incidences of iron deficiency anemia and vitamin B12 deficiency also showed no significant difference between the 2 groups. With regards to the quality of life, the difference values between preoperative and postoperative 1-year were evaluated; there was no significant difference between the EG with anti-reflux procedure and DTR groups.EG had higher incidence of esophageal reflux and similar nutritional outcomes and QOL compared with the double-tract reconstruction after laparoscopic proximal gastrectomy. Additional large-scale research is needed to evaluate the long-term functional outcomes of EG and the double-tract reconstruction.
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Affiliation(s)
- Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang
| | - Ji Yeon Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu
| | - Ki Bum Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, Goyang
| | - Oh Kyoung Kwon
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
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Schütte K, Schulz C, Middelberg-Bisping K. Impact of gastric cancer treatment on quality of life of patients. Best Pract Res Clin Gastroenterol 2021; 50-51:101727. [PMID: 33975681 DOI: 10.1016/j.bpg.2021.101727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 01/31/2023]
Abstract
Treatment of gastric cancer is stage specific and ranges from endoscopic resections in early gastric cancer to gastrectomy and multimodal treatment in locally advanced tumour situations. Palliative systemic treatment has the potential to prolong survival in advanced tumour stages. However, tumour-directed therapies and their side-effects potentially worsen the general condition of a patient. Treatment discussions and decisions, especially when trading-off the options with the patient, have widened their focus from 'technical' terms like overall survival, disease-free survival and progression-free survival to patient reported outcomes (PROs) including quality of life (QoL). The assessment of PROs has evolved as important endpoint in clinical studies. A precise definition of QoL seems impossible. Its multiple dimensions can be evaluated by various validated questionnaires like the QLQ-C30 and FACT-G focusing on different priorities. Special additional tools have been developed and validated to assess QoL in gastric cancer patients (QLQ-STO22, FACT-Ga). We herein give an overview on the options to evaluate QoL in patients with gastric cancer and on published data on the impact of tumour-targeted therapy on QoL in these patients.
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Affiliation(s)
- Kerstin Schütte
- Department of Internal Medicine and Gastroenterology, Niels-Stensen-Klinken Marienhospital Osnabrück, Germany.
| | - Christian Schulz
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | - Kristina Middelberg-Bisping
- Department of Internal Medicine and Gastroenterology, Niels-Stensen-Klinken Marienhospital Osnabrück, Germany
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Taste alteration after gastrectomy in patients with gastric cancer. Surg Today 2021; 51:777-784. [PMID: 33387026 DOI: 10.1007/s00595-020-02194-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/05/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate the relationship between changes in taste due to surgical procedures and other clinical factors, we performed a detailed investigation of taste alteration in patients who underwent gastrectomy. METHODS Questionnaires on taste alteration were distributed to patients who visited our outpatient clinic from July 2018 to January 2019 for the postoperative evaluation of gastric cancer. Associations of clinical characteristics with changes in sensitivity to the four major taste types (sweet, sour, salty, and bitter) were examined. RESULTS Of the 243 eligible patients, 42 (17.3%) experienced taste alteration after gastrectomy; taste sensitivity decreased in 21 (8.6%) patients and increased in 31 (12.7%) patients. The frequency of a decreased sensitivity to sweet was significantly higher in patients who underwent total gastrectomy than in those who underwent distal gastrectomy (18.8% vs. 3.3%, P = 0.001). Patients who underwent total gastrectomy were significantly more likely than those who received distal gastrectomy to experience increased sensitivity to sour (12.5% vs. 2.2%, respectively; P = 0.004) and bitter (15.6% vs. 3.8%, respectively; P = 0.007) tastes. A multivariate analysis revealed that total gastrectomy was an independent risk factor for total taste alteration. CONCLUSIONS Patients who underwent total gastrectomy showed a high likelihood of both loss and gain of taste sensitivity.
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Terashima M, Fujitani K, Ando M, Sakamaki K, Kawabata R, Ito Y, Yoshikawa T, Kondo M, Kodera Y, Kaji M, Oka Y, Imamura H, Kawada J, Takagane A, Shimada H, Tanizawa Y, Yamanaka T, Morita S, Ninomiya M, Yoshida K. Survival analysis of a prospective multicenter observational study on surgical palliation among patients receiving treatment for malignant gastric outlet obstruction caused by incurable advanced gastric cancer. Gastric Cancer 2021; 24:224-231. [PMID: 32789710 DOI: 10.1007/s10120-020-01114-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND We had previously reported that surgical palliation could maintain quality of life (QOL) while improving solid food intake among patients with malignant gastric outlet obstruction (GOO) caused by advanced gastric cancer. The present study aimed to perform a survival analysis according to the patients' QOL to elucidate its impact on survival. METHODS Patients with GOO who underwent either palliative gastrectomy or gastrojejunostomy were included in this study. A validated QOL instrument (EQ-5D) was used to assess QOL at baseline and 2 weeks, 1 month, and 3 months following surgical palliation. Postoperative improvement in oral intake was also evaluated using the GOO scoring system (GOOSS). Thereafter, univariate and multivariate survival analyses were performed to determine independent prognostic factors. RESULTS The median survival time of the 104 patients included herein was 11.30 months. Patients who received postoperative chemotherapy, PS 0/1, baseline EQ-5D ≥ 0.75, improved or stable EQ-5D, and improved oral intake expressed as GOOSS = 3 had significantly better survival. Multivariate analysis identified postoperative chemotherapy, a better baseline PS, a better baseline EQ5D, improved or stable EQ5D scores, and improved oral intake 3 months after surgical palliation as independent prognostic factors. CONCLUSION Apart from preoperative PS and postoperative chemotherapy, the present study identified better baseline QOL, improvement in postoperative QOL, and improvement in oral intake as prognostic factors among patients who underwent palliative surgery for advanced gastric cancer with GOO.
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Affiliation(s)
- Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan.
| | | | - Masahiko Ando
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kentaro Sakamaki
- Center for Data Science, Yokohama City University, Yokohama, Japan
| | | | - Yuichi Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan
| | - Takaki Yoshikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Masato Kondo
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Yoshio Oka
- Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
| | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Junji Kawada
- Department of Surgery, Kaizuka City Hospital, Kaizuka, Japan
| | - Akinori Takagane
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Hideaki Shimada
- Department of Gastrointestinal Surgery, Toho University School of Medicine, Ota-Ku, Tokyo, Japan
| | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Kazuhiro Yoshida
- Department of Surgical Oncology, School of Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
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Han DS, Ahn J, Ahn HS. Are the elderly patient's changes in the health-related quality of life one year after gastrectomy for stomach cancer different from those in young patients? Ann Surg Treat Res 2020; 100:8-17. [PMID: 33457392 PMCID: PMC7791192 DOI: 10.4174/astr.2021.100.1.8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose Gastrectomy for elderly patients can significantly deteriorate the health-related quality of life (HRQoL). There was no report comparing HRQoL of elderly patients with young patients after gastrectomy for gastric cancer. This study assessed the differences in the changes of HRQoL at one year after gastrectomy according to age. Methods From May 2014 to Feb 2016, we prospectively enrolled patients undergoing gastrectomy for gastric cancer. They completed the European Organization for Research and Treatment of Cancer and gastric questionnaires preoperatively and at postoperative 1, 3, 6, 9, and 12 months. Results We included 57 elderly patients (≥70 years old) and 74 younger patients. The elderly had similar demographic, surgical, and pathological characteristics with young patients except that elderly had more comorbidity, laparoscopic gastrectomies, and lesser postoperative chemotherapy. One month after gastrectomy, the score of global health status/quality of life, physical, role, and social functioning were significantly impaired in elderly patients. Among them, physical and role functioning were more impaired than those of young patients. The scores of physical functioning, role functioning, cognitive functioning, and social functioning were not fully recovered till 1 year after surgery. There was a significant age group difference in the changes in physical function over the 1-year follow-up. Conclusion Elderly patients' global health status/quality of life and social functioning significantly decreased at postoperative 1 month and recovered by 6 months after gastrectomy. There was a significant age-specific difference in physical functioning throughout the 1-year follow-up. Surgeons need to pay more attention to recovery of the elderly patients' HRQoL after gastrectomy.
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Affiliation(s)
- Dong-Seok Han
- Department of Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington DC, USA
| | - Hye Seong Ahn
- Department of Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
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Watanabe J, Watanabe J, Kotani K. Early vs. Delayed Feeding after Endoscopic Submucosal Dissection for Gastric Cancer: A Systematic Review and Meta-Analysis. MEDICINA-LITHUANIA 2020; 56:medicina56120653. [PMID: 33261059 PMCID: PMC7760827 DOI: 10.3390/medicina56120653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 12/09/2022]
Abstract
Background: Endoscopic submucosal dissection (ESD) for gastric cancer is increasingly performed worldwide due to its efficacy and safety. This study aimed to assess the evidence of the impact of early vs. delayed feeding after ESD on quality of care, which remains to be fully determined. Methods: Electronic databases (PubMed, the Cochrane Central Register of Controlled Trials, EMBASE) and the trial registries (the World Health Organization International Clinical Trials Platform Search Portal and ClinicalTrials.gov) were searched for studies performed prior to September 2020. Study selection, data abstraction, and quality assessment were independently performed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Self-rated satisfaction and hospital stay were chiefly analyzed. Results: Two randomized controlled trials (239 patients) were included. The early and delayed post-ESD feeding groups had similar rates of post-ESD bleeding (risk ratio 1.90, 95% CI 0.42 to 8.63; I2 = 0%). Early post-ESD feeding resulted in increased patients’ satisfaction in comparison to delayed post-ESD feeding (standard mean difference (MD) 0.54, 95% CI 0.27 to 0.81; I2 = 0%) and reduced the length of hospital stay (MD −0.83, 95% CI −1.01 to −0.65; I2 = 0%). Conclusion: Early post-ESD feeding was associated with increased patients’ satisfaction and reduced hospital stay in comparison to delayed feeding, while the rate of complications did not differ to a statistically significant extent. As we must acknowledge the limited number of reviewed studies, various trials regarding the quality of care are further needed to determine the benefits of early feeding after ESD.
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Affiliation(s)
- Jun Watanabe
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke-City 329-0498, Tochigi, Japan;
- Department of Surgery, Iwami Hospital, Iwami-Town, Tottori 681-0003, Japan;
| | - Joji Watanabe
- Department of Surgery, Iwami Hospital, Iwami-Town, Tottori 681-0003, Japan;
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke-City 329-0498, Tochigi, Japan;
- Correspondence: ; Fax: +81-285-44-0628
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Hu Y, Vos EL, Baser RE, Schattner MA, Nishimura M, Coit DG, Strong VE. Longitudinal Analysis of Quality-of-Life Recovery After Gastrectomy for Cancer. Ann Surg Oncol 2020; 28:48-56. [PMID: 33125569 DOI: 10.1245/s10434-020-09274-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/03/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this study was to identify factors associated with quality-of-life recovery after gastrectomy. METHODS Patients anticipated to undergo gastric cancer resection were invited to complete the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and STO22 surveys in the preoperative setting and at 0-1.5 months (early), > 1.5-6 months (intermediate), and > 6-18 months (late) following resection. Quality-of-life recovery was measured as paired differences between pre- and postoperative results. Multivariable linear regression identified factors associated with preoperative quality of life and degree of change following resection. RESULTS Across 393 participants, response rates at the intermediate and late postoperative time points were 58% (n = 228) and 71% (n = 277), respectively. Relative to baseline, median global health scale decreased in the early (- 15.1 pts, p < 0.001) and intermediate (- 3.6 pts, p = 0.02) time points, but recovered by the late time point (+ 1.2 pts, p = 0.411). Relative to distal/subtotal gastrectomy, proximal/total gastrectomy was associated with worse recovery in both the early and late time points. Surgical complications were associated with worse early recovery. Patients who presented with locally advanced tumors (T3-T4) had lower preoperative quality-of-life scores, and more readily recovered to baseline after surgery. A minimally invasive approach was not associated with postoperative recovery. CONCLUSIONS Most patients recover to baseline within 1 year following major gastrectomy, and recovery is easier with more limited resections. Patients with locally advanced tumors tend to have poorer baseline quality of life, which may improve following resection.
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Affiliation(s)
- Yinin Hu
- Division of General and Oncologic Surgery, Department of Surgery, University of Maryland Baltimore, Baltimore, MD, USA
| | - Elvira L Vos
- Division of Surgical Oncology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Raymond E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Mark A Schattner
- Department of Gastroenterology, Hepatology, and Nutrition, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Makoto Nishimura
- Department of Gastroenterology, Hepatology, and Nutrition, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Daniel G Coit
- Division of Surgical Oncology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Vivian E Strong
- Division of Surgical Oncology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Huang C, Yu F, Zhao G, Xia X. Postoperative quality of life after laparoscopy-assisted pylorus-preserving gastrectomy compared with laparoscopy-assisted distal gastrectomy for early gastric cancer. J Gastroenterol Hepatol 2020; 35:1712-1719. [PMID: 31945189 DOI: 10.1111/jgh.14985] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/12/2020] [Accepted: 01/14/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM This study aimed to investigate the postoperative quality of life (QOL) between laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) and laparoscopy-assisted distal gastrectomy with Billroth I anastomosis (LADGBI) in patients with middle-third early gastric cancers (EGC). METHODS From January 2015 to August 2017, a total 91 patients with EGC underwent LAPPG or LADGBI procedure with complete QLQ-C30 and QLQ-STO22 in Ren Ji Hospital. Not only do surgical and oncological safety as well as clinicopathologic characteristics analyze, but also chronological changes of QOL and nutritional status were compared for the evaluation of functional advantages. RESULTS There was no significant difference in clinicopathologic characteristics and perioperative recovery between LAPPG and LADGBI. During postoperative 2-year follow up, LAPPG showed significant advantages over LADGBI in emotional functioning, insomnia, appetite loss, reflux, and taste problem and presented larger area in global and functional scales and less area in symptom scales, which means that LAPPG tended to present better improvement and less symptoms than LADGBI for QOL 2 years after surgery. Furthermore, LAPPG could bring about significant improvement in total protein and hemoglobin compared to LADGBI at postoperative 2 years. CONCLUSION LAPPG obtains QOL as well as total protein and hemoglobin superiority and could be recommended to patients with EGC whose tumor located in the middle third of the stomach.
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Affiliation(s)
- Chen Huang
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | | | - Gang Zhao
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiang Xia
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Kristensen MB, Wessel I, Ustrup KS, Dieperink KB, Zwisler AD, Beck AM. Nutrition screening and assessment tools for patients with cancer and survivors of cancer: a systematic review protocol. BMJ Open 2020; 10:e037844. [PMID: 33004394 PMCID: PMC7534678 DOI: 10.1136/bmjopen-2020-037844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Nutritional challenges are common consequences of cancer, and they do not only occur in the hospital setting. They are also frequent after completion of treatment, and nutritional interventions in community-based post-treatment rehabilitation services are important. The first step towards initiating any nutritional intervention is to identify the individual in need hereof, but evidence is limited on the applicability of different nutrition screening and assessment tools in the post-treatment rehabilitation services. The aim is to systematically review and identify nutrition screening and assessment tools appropriate for use in patients with cancer and survivors of cancer in hospital or community-based healthcare settings. METHODS AND ANALYSIS In this systematic review, the electronic databases PubMed, CINAHL Complete and Embase were searched systematically using comprehensive search strategies. Primary searches were carried out in August 2018 with updated searches performed in November 2019. Clinicaltrials.gov and PROSPERO International Prospective Register of Systematic Reviews will be searched for additional relevant studies. Studies will be included if they validate a nutrition screening or assessment tool in adult patients with cancer or survivors of cancer. No restriction on publication date will be applied, and full-text articles in English, Danish, Norwegian and Swedish are eligible for inclusion. Two reviewers will independently conduct screening of search results, study selection, data extraction and quality assessment. Data will be synthesised narratively. ETHICS AND DISSEMINATION No ethical approval is required. Results will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and published in an international peer-reviewed journal. Furthermore, results will be presented in relevant research and clinical fora to facilitate transfer of results to clinical practice in benefit of patients. PROSPERO REGISTRATION NUMBER CRD42018096678.
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Affiliation(s)
- Marianne Boll Kristensen
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Nyborg, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Kim Skov Ustrup
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| | - Karin B Dieperink
- Research Unit of Oncology, Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Nyborg, Denmark
| | - Anne Marie Beck
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
- Dietetics and Clinical Nutrition Research Unit, Herlev and Gentofte Hospital, Herlev, Denmark
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Hu Y, Zaydfudim VM. Quality of Life After Curative Resection for Gastric Cancer: Survey Metrics and Implications of Surgical Technique. J Surg Res 2020; 251:168-179. [PMID: 32151826 DOI: 10.1016/j.jss.2020.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/07/2020] [Accepted: 02/01/2020] [Indexed: 02/07/2023]
Abstract
Gastric cancer is one of the most common cancers worldwide, and radical gastrectomy is an integral component of curative therapy. With improvements in perioperative morbidity and mortality, attention has turned to short- and long-term post-gastrectomy quality of life (QoL). This article reviews the common psychometric surveys and preference-based measures used among patients following gastrectomy. It also provides an overview of studies that address associations between surgical decision-making and postoperative health-related QoL. Further attention is focused on reported associations between technical aspects of the operation, such as extent of gastric resection, minimally-invasive approach, pouch-based conduits, enteric reconstruction, and postoperative QoL. While there are several randomized studies that include QoL outcomes, much remains to be explored. The relationship between symptom profiles and preference-based measures of health state utility is an area in need of further research.
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Affiliation(s)
- Yinin Hu
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Victor M Zaydfudim
- Division of Surgical Oncology, University of Virginia, Charlottesville, Virginia; Department of Surgery, Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia.
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Tabernero J, Alsina M, Shitara K, Doi T, Dvorkin M, Mansoor W, Arkenau HT, Prokharau A, Ghidini M, Faustino C, Gorbunova V, Zhavrid E, Nishikawa K, Ando T, Yalçın Ş, Van Cutsem E, Sabater J, Skanji D, Leger C, Amellal N, Ilson DH. Health-related quality of life associated with trifluridine/tipiracil in heavily pretreated metastatic gastric cancer: results from TAGS. Gastric Cancer 2020; 23:689-698. [PMID: 32128634 PMCID: PMC7305098 DOI: 10.1007/s10120-020-01053-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In TAGS, an international, double-blind, phase 3 trial, trifluridine/tipiracil significantly improved overall survival and progression-free survival compared with placebo in heavily pretreated metastatic gastric cancer patients. This paper reports pre-specified quality of life (QoL) outcomes for TAGS. METHODS Patients were randomized 2:1 to trifluridine/tipiracil (35 mg/m2 twice daily on days 1-5 and 8-12 of each 28-day cycle) plus best supportive care (BSC) or placebo plus BSC. QoL was evaluated at baseline and at each treatment cycle, using the EORTC QLQ-C30 and EORTC QLQ-STO22 questionnaires; results were considered valid for analysis only if ≥ 10% of patients completed the questionnaires. Key QoL outcomes were mean changes from baseline and time to deterioration in QoL. A post hoc analysis assessed the association between QoL and time to deterioration of Eastern Cooperative Oncology Group performance score (ECOG PS) to ≥ 2. RESULTS Of 507 randomized patients, 496 had baseline QoL data available. The analysis cut-off was 6 cycles for trifluridine/tipiracil and 3 cycles for placebo. In both treatment groups, there were no clinically significant deteriorations in the mean QLQ-C30 Global Health Status (GHS) score, or in most subscale scores. In a sensitivity analysis including death and disease progression as events, there was a trend towards trifluridine/tipiracil reducing the risk of deterioration of QoL scores compared with placebo. Deterioration in the GHS score was associated with deterioration in ECOG PS. CONCLUSION QoL was maintained in TAGS, and there was a trend towards trifluridine/tipiracil reducing the risk of QoL deterioration compared with placebo. Trial registration ClinicalTrials.gov number: NCT02500043.
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Affiliation(s)
- Josep Tabernero
- grid.411083.f0000 0001 0675 8654Vall d’Hebron University Hospital and Institute of Oncology (VHIO), UVic-UCC, IOB-Quiron, Barcelona, Spain
| | - Maria Alsina
- grid.411083.f0000 0001 0675 8654Vall d’Hebron University Hospital and Institute of Oncology (VHIO), UVic-UCC, IOB-Quiron, Barcelona, Spain
| | - Kohei Shitara
- grid.497282.2National Cancer Center Hospital East, Chiba, Japan
| | - Toshihiko Doi
- grid.497282.2National Cancer Center Hospital East, Chiba, Japan
| | | | - Wasat Mansoor
- grid.412917.80000 0004 0430 9259The Christie NHS Foundation Trust, Manchester, UK
| | | | | | | | - Catia Faustino
- grid.418711.a0000 0004 0631 0608Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Vera Gorbunova
- grid.466904.9N.N. Blokhin Russian Cancer Research Center, Moscow, Russia
| | - Edvard Zhavrid
- Alexandrov National Cancer Centre of Belarus, Minsk, Belarus
| | | | - Takayuki Ando
- grid.267346.20000 0001 2171 836XUniversity of Toyama, Toyama, Japan
| | - Şuayib Yalçın
- grid.14442.370000 0001 2342 7339Hacettepe University, Ankara, Turkey
| | - Eric Van Cutsem
- grid.410569.f0000 0004 0626 3338University Hospitals and KU Leuven, Leuven, Belgium
| | - Javier Sabater
- grid.418301.f0000 0001 2163 3905Market Access Department, Servier, Suresnes, France
| | - Donia Skanji
- grid.418301.f0000 0001 2163 3905Institut de Recherches Internationales Servier, Suresnes, France
| | - Catherine Leger
- grid.418301.f0000 0001 2163 3905Institut de Recherches Internationales Servier, Suresnes, France
| | - Nadia Amellal
- grid.418301.f0000 0001 2163 3905Institut de Recherches Internationales Servier, Suresnes, France
| | - David H. Ilson
- grid.51462.340000 0001 2171 9952Memorial Sloan Kettering Cancer Center, New York, NY USA
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Pinheiro RN, Mucci S, Zanatto RM, Picanço Junior OM, Bottino AAG, Fontoura RP, Lopes Filho GDJ. Quality of life as a fundamental outcome after curative intent gastrectomy for adenocarcinoma: lessons learned from patients. J Gastrointest Oncol 2019; 10:989-998. [PMID: 31602337 DOI: 10.21037/jgo.2019.06.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Gastric cancer has an important epidemiologic impact, and the main curative therapeutic modality for gastric cancer is surgical resection. However, even curative intent therapy can have negative effects on the quality of life (QoL) of these patients, which is undesirable; thus, it is difficult to balance the standardized treatment reported in the literature and treatment response to achieve full patient satisfaction. The purpose of our study was to evaluate the QoL and identify the association of scores on the Functional Assessment of Cancer Therapy-Gastric (FACT-Ga) and Short Form 36 Health Survey version 2 (SF36v2) questionnaires with sociodemographic, clinical and anatomopathological aspects of gastric adenocarcinoma patients undergoing curative surgery. Methods This was a cross-sectional study involving 104 patients from three regions of Brazil. Inferential analyses were used to compare (multiple regression and Mann-Whitney or Kruskal-Wallis tests) the relationships between these scores and variables (Spearman's coefficient). Results In the multiple regression analysis, we found correlations between Helicobacter pylori status and physical well-being (PWB) (P=0.026), between gender and emotional well-being (EWB) (P=0.008), between Lauren's histology and physical functioning (P=0.009), as well as the Short Form 36 Health Survey version 2 (SF-36v2) role-physical (P=0.027), between the tumor site and EWB (P=0.038), between the SF-36v2 mental health and N (the lower the staging, the better the score, P=0.006) and between the SF-36v2 mental health and lymph nodes removed (P=0.029). According to the Mann-Whitney or Kruskal-Wallis test, women had worse FACT-Ga total (P=0.049), PWB (P=0.005), EWB (P=0.007), gastric cancer subscale (GaCS, P=0.011), trial outcome index (TOI, P=0.030) and mental health scores than men (P=0.011). Patients with distal tumors had better scores (FACT-Ga, P=0.018; GaCS, P=0.014; TOI, P=0.020) than patients with proximal tumors. Patients with tumors located in the cardia had better physical functioning than those with proximal tumors (P=0.042). Patients who underwent partial gastrectomy had better FACT-Ga total scores (P=0.011), PWB (P=0.033), GaCS scores (P=0.006) and TOI scores (P=0.008) than those who underwent total gastrectomy. Patients who did not receive adjuvant therapy had worse bodily pain as reported on the SF-36v2 than those who received therapy (P=0.048). According to Spearman's coefficient, a higher lymph node stage corresponded to worse FACT-Ga total (s=-0.200, P=0.034), GaCS (s=-0.206, P=0.037), TOI (s=-0.216; P=0.028) and vitality (s=-0.215, P=0.029) scores. A longer time after treatment corresponded to a better SF-36v2 role-physical domain score (s=0.223; P=0.023). Conclusions The type of treatment instituted, postoperative time and sociodemographic and anatomopathological factors influence the QoL.
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Affiliation(s)
- Rodrigo Nascimento Pinheiro
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Federal District Surgical Oncology Unity, Base Hospital Institute, Brasília, Brazil.,Academic League of Oncology, Base Hospital Institute, Brasília, Brazil
| | - Samantha Mucci
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Psychiatry Department, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Renato Morato Zanatto
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Amaral Carvalho Cancer Hospital, Jaú, São Paulo, Brazil
| | - Olavo Magalhães Picanço Junior
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,High Complexity Unity in Oncology, Alberto Lima Hospital, Federal University of Amapá, Macapá, Brazil
| | | | | | - Gaspar de Jesus Lopes Filho
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
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45
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Park KB, Yu B, Park JY, Kwon OK, Yu W. Impact of body mass index on quality of life after distal gastrectomy for gastric cancer. Ann Surg Treat Res 2019; 96:250-258. [PMID: 31073515 PMCID: PMC6483929 DOI: 10.4174/astr.2019.96.5.250] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/03/2018] [Accepted: 12/21/2018] [Indexed: 12/14/2022] Open
Abstract
Purpose Few studies have evaluated changes in quality of life (QoL) in relation to changes in body mass index (BMI) after gastrectomy. This study aimed to evaluate the impact of postoperative changes in BMI on QoL after distal gastrectomy in gastric cancer patients. Methods QoL data from the European Organization for the Research and Treatment of Cancer (EORTC) gathered via the QLQ-C30 and QLQ-STO22 questionnaires were obtained from 1,036 patients preoperatively and at 1 year postoperatively. The patients were divided into 2 groups: group 1 - decreased postoperative BMI and group 2 - unchanged or increased postoperative BMI. Results There were 577 patients in group 1 and 459 in group 2. According to global health status and functional scales, emotional functioning (P = 0.035) was significantly worse in group 1 than in group 2 at 1 year postoperatively. Furthermore, there were significant decreases in QoL symptom scale scores, including fatigue (P = 0.016), nausea and vomiting (P = 0.002), and appetite loss (P = 0.001) scores, in group 1 compared with group 2. Regarding QLQ-STO22, reflux symptoms (P = 0.020), anxiety (P = 0.003), and body image (P = 0.003) were significantly worse in group 1 than in group 2 at 1 year after surgery. Conclusion BMI changes after distal gastrectomy influence QoL. Focus on controlling gastrointestinal symptoms and providing psychological support is essential in patients with decreased BMI after surgery. Patients should be offered follow-up care to assist them in maintaining BMI, for example, through dietary-behavior modifications and via intensive nutritional support, to prevent QoL deterioration after distal gastrectomy.
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Affiliation(s)
- Ki Bum Park
- Gastric Cancer Center, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Byunghyuk Yu
- Gastric Cancer Center, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Ji Yeon Park
- Gastric Cancer Center, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Oh Kyoung Kwon
- Gastric Cancer Center, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Wansik Yu
- Gastric Cancer Center, Kyungpook National University Chilgok Hospital, Daegu, Korea
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Tey J, Zheng H, Soon YY, Leong CN, Koh WY, Lim K, So JBY, Shabbir A, Tham IWK, Lu J. Palliative radiotherapy in symptomatic locally advanced gastric cancer: A phase II trial. Cancer Med 2019; 8:1447-1458. [PMID: 30790469 PMCID: PMC6488108 DOI: 10.1002/cam4.2021] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 01/28/2023] Open
Abstract
To evaluate the response and quality of life of palliative gastric radiotherapy in patients with symptomatic locally advanced gastric cancer. Patients with bleeding, pain or obstruction and were treated with palliative gastric radiotherapy to a dose of 36 Gy in 12 daily fractions. The primary outcomes were symptom response rates. Secondary outcomes included overall survival, adverse events and proportion of patients with ≥10‐point absolute improvement in the fatigue, nausea/vomiting and pain subscales in the EORTC Qualify of Life Questionnaire C30 (EORTC QLQ‐C30) and dysphagia/pain subscales in the gastric specific module (STO22) at the end of RT and 1 month after the completion of radiotherapy. Fifty patients were accrued. Median survival duration was 85 days. 40/50 patients (80%) with bleeding, 2/2 (100%) patients with obstruction and 1/1 (100%) patient with pain responded to radiotherapy. Improvements fatigue, nausea/vomiting and pain subscales of the EORTC QLQ‐C30 was seen in 50%, 28% and 44% of patients at the end of RT and in 63%, 31% and 50% of patients 1 month after RT. Improvements in dysphagia/pain subscales of the STO22 was seen in 42% and 28% of patients at then end of RT and 44% and 19% of patients 1 month after RT. Two patients (5%) had grade 3 anorexia and gastritis. Palliative gastric radiotherapy was effective, well tolerated and resulted in improvement in fatigue, dysphagia and pain at the end of radiotherapy and 1 month after the completion of radiotherapy in a significant proportion of patients.
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Affiliation(s)
- Jeremy Tey
- Department of Radiation Oncology, National University Hospital, National Cancer Institute of Singapore, Singapore, Singapore
| | - Huili Zheng
- National Registry of Diseases, Singapore, Singapore
| | - Yu Y Soon
- Department of Radiation Oncology, National University Hospital, National Cancer Institute of Singapore, Singapore, Singapore
| | - Cheng N Leong
- Department of Radiation Oncology, National University Hospital, National Cancer Institute of Singapore, Singapore, Singapore
| | - Wee Y Koh
- Department of Radiation Oncology, National University Hospital, National Cancer Institute of Singapore, Singapore, Singapore
| | - Keith Lim
- Department of Radiation Oncology, National University Hospital, National Cancer Institute of Singapore, Singapore, Singapore
| | - Jimmy B Y So
- Department of Surgery, National University Hospital, Singapore, Singapore
| | - Asim Shabbir
- Department of Surgery, National University Hospital, Singapore, Singapore
| | - Ivan W K Tham
- Department of Radiation Oncology, National University Hospital, National Cancer Institute of Singapore, Singapore, Singapore
| | - Jiade Lu
- Shanghai Heavy ion and Proton Centre, Shanghai, China
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Chau I, Fuchs CS, Ohtsu A, Barzi A, Liepa AM, Cui ZL, Hsu Y, Al-Batran SE. Association of quality of life with disease characteristics and treatment outcomes in patients with advanced gastric cancer: Exploratory analysis of RAINBOW and REGARD phase III trials. Eur J Cancer 2019; 107:115-123. [PMID: 30557792 DOI: 10.1016/j.ejca.2018.11.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/08/2018] [Accepted: 11/11/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Inadequate understanding of interpretation of quality of life (QoL) instruments leads to unsatisfactory data reporting and clinical decision-making, including in gastric cancer care. MATERIALS AND METHODS Pooled QoL data from two phase III studies of ramucirumab with or without paclitaxel in previously treated patients with gastric or gastroesophageal junction cancer were used to explore associations with clinical attributes, including tumour response, disease measurability and performance status (PS). The European Organisation for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire (QLQ)-C30 was used in both studies. Changes in QLQ-C30 scores from baseline to week 6 as a predictor of clinical outcomes and impacts of changes in clinical status on QoL were estimated by multivariate logistic regression and analyses of variance, respectively. RESULTS Baseline QoL data were available for 989 patients. Fatigue, pain and appetite loss were prominent baseline symptoms. Disease progression resulted in worse QoL in all functional scales (p < 0.0001 to p = 0.0306), global QoL (p = 0.0011) and symptom scales (fatigue, p < 0.0001; nausea/vomiting, p = 0.0007; pain, p = 0.0052; appetite loss, p = 0.0061). Similar trends were seen with deterioration of PS on QoL. A 15- to 20-point change in global QoL and functional scale scores predicted change in tumour status as did change in fatigue, pain and appetite loss scores. Smaller QoL changes (5-15 points) predicted PS change. Results were similar in patients regardless of baseline disease measurability. CONCLUSIONS Our study underscores the importance of disease control for maintaining or improving QoL. These data could improve future trial design and routine clinical care for patients receiving therapy for previously treated gastric cancer. NCT00917384, NCT01170663.
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Affiliation(s)
- Ian Chau
- Department of Medicine, Royal Marsden Hospital, Downs Rd., Sutton, Surrey, SM2 5PT, United Kingdom.
| | - Charles S Fuchs
- Yale Cancer Center, 333 Cedar St., New Haven, CT, 06510, United States.
| | - Atsushi Ohtsu
- Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Afsaneh Barzi
- Division of Oncology, Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, United States.
| | - Astra M Liepa
- Eli Lilly and Company, 893 S. Delaware St., Indianapolis, IN, 46225, United States.
| | - Zhanglin Lin Cui
- Eli Lilly and Company, 893 S. Delaware St., Indianapolis, IN, 46225, United States.
| | - Yanzhi Hsu
- Eli Lilly and Company, 893 S. Delaware St., Indianapolis, IN, 46225, United States.
| | - Salah-Eddin Al-Batran
- Institute of Clinical Cancer Research (IKF), University Cancer Center, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
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Li Z, Shan F, Ying X, Xue K, Ji J. Laparoscopic versus open gastrectomy for elderly local advanced gastric cancer patients: study protocol of a phase II randomized controlled trial. BMC Cancer 2018; 18:1118. [PMID: 30445943 PMCID: PMC6240197 DOI: 10.1186/s12885-018-5041-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/05/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Gastric cancer is one of the most common malignant tumors worldwide. With the rapid aging of global population, the number of elderly patients with local advanced gastric cancer is increasing. Surgery is the essential treatment for local advanced gastric cancer. However, elderly patients are at high risk of postoperative complications due to reduced functional reserve and increased comorbidities. Laparoscopic gastrectomy may be a promising surgery approach for elderly patients but its benefits remain controversial. We therefore proposed this randomized trial to evaluate the safety and efficacy of laparoscopic versus open gastrectomy for local advanced gastric cancer in patients aged 70 and above. METHODS The current study has a randomized, parallel controlled, single-center, open-label, superiority design with two arms. A sample of 180 local advanced gastric cancer patients aged 70 and above will be recruited in Peking University Cancer Hospital and Institute. Participants will be randomized to either receive open or laparoscopic gastrectomy. The primary outcome is surgical safety, including complication rate, reoperation rate, readmission rate, and mortality rate within 30 days after surgery. The secondary endpoints include postoperative rehabilitation status, one-year postoperative life quality, three-year overall and disease-free survival. Assessments will take place at baseline (before random assignment), at 30 days, one-year, and three-year after the surgery. The study has been approved by an ethical review board. DISCUSSION We hypothesized that laparoscopic gastrectomy is superior to open gastrectomy in terms of perioperative safety for local advanced gastric cancer patients aged 70 and above. If this hypothesis is statistically proved, the rational introduction of minimally invasive surgery technique in traditional gastrectomy can help improve the surgical safety for elderly patients, reduce patient financial burden, shorten hospital stay, and improve hospital beds turnover rate. Our research data will also provide high quality clinical evidence and data support for the conduction of multicenter phase III clinical trials. TRIAL REGISTRATION The study has been prospectively registered in ClinicalTrial.gov ( NCT03564834 ).
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Affiliation(s)
- Ziyu Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Fei Shan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Xiangji Ying
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Kan Xue
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Jiafu Ji
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142 China
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49
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Park JY, Park KB, Kwon OK, Yu W. Comparison of laparoscopic proximal gastrectomy with double-tract reconstruction and laparoscopic total gastrectomy in terms of nutritional status or quality of life in early gastric cancer patients. Eur J Surg Oncol 2018; 44:1963-1970. [PMID: 30197164 DOI: 10.1016/j.ejso.2018.08.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 07/19/2018] [Accepted: 08/17/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the surgical outcomes of laparoscopic proximal gastrectomy (LPG) reconstructed by the double-tract method in comparison to those of laparoscopic total gastrectomy (LTG). METHODS A retrospective review of the prospectively established database identified early gastric cancer patients who underwent LPG (n = 34) or LTG (n = 46) between January 2011 and December 2015. Baseline characteristics and surgical outcomes including postoperative complications, changes in body composition, nutritional status, and quality of life (QOL) after surgery were compared between the LPG and LTG patients. RESULTS Operating time was significantly longer in the LTG group (240.7 ± 43.9 vs. 211.7 ± 32.8 min, p = 0.007). The incidence of grade II or more complications and the hospital stay were comparable between the groups. There was no significant difference between the groups in terms of body composition using a bioelectrical impedance method in 1 year postoperatively. Nutritional status assessed by serum hemoglobin, iron, vitamin B12, albumin, total protein, and total cholesterol levels and postoperative changes in quality of life up to 2 years after surgery were also similar between the groups. Vitamin B12 supplementation was required in 75.4% of the patients in the LTG group and 46.5% in the LPG group within 2 years after surgery (p = 0.005). CONCLUSION LPG with double-tract reconstruction appears superior in preventing vitamin B12 deficiency compared to LTG, particularly after 1 year after the surgery, although it offered little benefit in terms of postoperative body composition changes and QOL.
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Affiliation(s)
- Ji Yeon Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Ki Bum Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Oh Kyoung Kwon
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea.
| | - Wansik Yu
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
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Fujitani K, Ando M, Sakamaki K, Terashima M, Kawabata R, Ito Y, Yoshikawa T, Kondo M, Kodera Y, Yoshida K. Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer. BJS Open 2017; 1:165-174. [PMID: 29951619 PMCID: PMC5989952 DOI: 10.1002/bjs5.26] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/14/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Quality of life (QoL) is a key component in decision-making for surgical palliation, but QoL data in association with surgical palliation in advanced gastric cancer are scarce. The aim of this multicentre observational study was to examine the impact of surgical palliation on QoL in advanced gastric cancer. METHODS The study included patients with gastric outlet obstruction caused by incurable advanced primary gastric cancer who had no oral intake or liquid intake only. Patients underwent palliative distal/total gastrectomy or bypass surgery at the physician's discretion. The primary endpoint was change in QoL assessed at baseline, 14 days, 1 month and 3 months following surgical palliation by means of the EuroQoL Five Dimensions (EQ-5D™) questionnaire and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire gastric cancer module (QLQ-STO22). Secondary endpoints were postoperative improvement in oral intake and surgical complications. RESULTS Some 104 patients (23 distal gastrectomy, 9 total gastrectomy, 70 gastrojejunostomy, 2 exploratory laparotomy) were enrolled from 35 institutions. The mean EQ-5D™ utility index scores remained consistent, with a baseline score of 0·74 and the change from baseline within ± 0·05. Gastric-specific symptoms showed statistically significant improvement from baseline. The majority of patients were able to eat solid food 2 weeks after surgery and tolerated it thereafter. The rate of overall morbidity of grade III or more according to the Clavien-Dindo classification was 9·6 per cent (10 patients) and the 30-day postoperative mortality rate was 1·9 per cent (2 patients). CONCLUSION In patients with gastric outlet obstruction caused by advanced gastric cancer, surgical palliation maintained QoL while improving solid food intake, with acceptable morbidity for at least the first 3 months after surgery. Registration number 000023494 (UMIN Clinical Trials Registry).
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Affiliation(s)
- K. Fujitani
- Department of SurgeryOsaka Prefectural General Medical CentreOsakaJapan
| | - M. Ando
- Centre for Advanced Medicine and Clinical ResearchNagoya University HospitalNagoyaJapan
| | - K. Sakamaki
- Department of BiostatisticsYokohama City University Graduate School of MedicineYokohamaJapan
| | - M. Terashima
- Division of Gastric SurgeryShizuoka Cancer CentreNagaizumiJapan
| | - R. Kawabata
- Department of SurgeryOsaka Rosai HospitalSakaiJapan
| | - Y. Ito
- Department of Gastroenterological SurgeryAichi Cancer CentreNagoyaJapan
| | - T. Yoshikawa
- Department of Gastrointestinal SurgeryKanagawa Cancer CentreYokohamaJapan
| | - M. Kondo
- Department of SurgeryKobe City Medical Centre General HospitalKobeJapan
| | - Y. Kodera
- Department of Gastroenterological SurgeryNagoya University Graduate School of MedicineNagoyaJapan
| | - K. Yoshida
- Department of Surgical OncologyGifu University Graduate School of MedicineGifuJapan
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