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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

The role of health-related quality of life outcomes in clinical decision making in surgery for esophageal cancer: a systematic review

R Parameswaran, A McNair, KN Avery, RG Berrisford, SA Wajed, MA Sprangers, and JM Blazeby.

Review published: 2008.

Link to full article: [Journal publisher]

CRD summary

The review aimed to examine how and whether health-related quality of life outcomes contributed to surgical decision making for oesophageal cancer. The authors concluded that most studies were well performed and health-related quality of life outcomes were relevant to surgical decision making. The authors’ conclusions were based on the evidence and appear appropriate.

Authors' objectives

To examine how and whether health-related quality of life outcomes contribute to surgical decision making for oesophageal cancer.

Searching

MEDLINE, EMBASE, CINAHL and PsycINFO were searched from inception to December 2006. Search terms were reported.

Study selection

Studies that assessed health-related quality of life to evaluate oesophageal surgery for cancer were eligible for inclusion. Studies with a non-validated measure were excluded. Studies with a sample size of fewer than 50 participants were excluded. Review articles were excluded.

Randomised controlled trials (RCTs), longitudinal studies and cross-sectional studies of health-related quality of life measurement for oesophageal surgery were included. Instruments utilised included Rotterdam Symptom Checklist (RSCL), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ), Functional Assessment of Cancer Therapy (FACT) and Medical Outcome Study Short Form (MOS-SF). The included studies were published between 1992 and 2006.

The authors did not state how many reviewers performed study selection.

Assessment of study quality

Two reviewers independently assessed whether health-related quality of life was assessed robustly using a criteria defined by Efficace et al. Seven quality criteria were assessed: a priori hypothesis; rationale for instrument choice; coverage and adequacy of measurement domains; techniques of instrument administration and compliance; timing of assessments; baseline assessment; and reason for missing data. An eighth criterion of whether results were presented with a discussion of clinical significance was considered. Methods were judged as robust if five of the eight criteria were were fulfilled for RCTs and longitudinal studies and four of seven criteria were fulfilled for cross-sectional studies.

Data extraction

Data were extracted on whether health-related quality of life influenced treatment recommendation and/or influenced informed consent with oesophageal surgery.

The authors did not state how many reviewers were involved in data extraction.

Methods of synthesis

A narrative synthesis was presented. Studies were grouped according to study type.

Results of the review

Eighteen studies (n=2,843 patients) were included in the review: two RCTs, nine longitudinal studies and seven cross-sectional studies. Study sample size ranged from 53 to 458 participants. Length of follow-up in robust studies ranged from six to 60 months. Sixteen studies were deemed to have a robust design and were included in the narrative synthesis (n=2,555 patients).

Three of the 16 robust studies indicated that health-related quality of life outcomes influenced treatment recommendations. Eleven studies, which included the former three studies, inferred that health-related quality of life measures influenced informed consent. The other five studies did not demonstrate that health-related quality of life outcomes influenced treatment recommendations or informed consent.

In 10 robust studies, patients reported a global deterioration in most aspects of health-related quality of life after oesophagectomy that took approximately nine to 12 months to recover to baseline values.

Authors' conclusions

Most studies of health-related quality of life after oesophageal surgery were well performed. Health-related quality of life outcomes were relevant to surgical decision making.

CRD commentary

Inclusion criteria for the review were broadly defined. Several relevant databases were searched. The authors did not state whether language restrictions were imposed, which made potential for language bias unclear. Publication bias was not assessed and no attempts were made to locate unpublished studies, so publication bias could not be ruled out. Two reviewers undertook validity assessment, which minimised risks of reviewer error and bias; it was unclear whether such methods were used for study selection and data extraction. No formal quality assessment of specific study designs was undertaken. The included studies generally assessed health-related quality of life in a robust manner, although the sample size of some studies was small. The studies were narratively synthesised, which appeared appropriate given the type of study design.

The authors’ conclusions were based on the evidence and appear appropriate.

Implications of the review for practice and research

Practice: The authors stated that clinicians should consider informing patients of the expected impact of surgery on health-related quality of life as an integral part of informed consent.

Research: The authors stated that there was a need to develop methods to communicate health-related quality of life information to patients alongside clinical data to ensure that consent was fully informed and to provide patients with information relevant to their recovery and outcome.

Funding

Not stated.

Bibliographic details

Parameswaran R, McNair A, Avery KN, Berrisford RG, Wajed SA, Sprangers MA, Blazeby JM. The role of health-related quality of life outcomes in clinical decision making in surgery for esophageal cancer: a systematic review. Annals of Surgical Oncology 2008; 15(9): 2372-2379. [PubMed: 18626719]

Indexing Status

Subject indexing assigned by NLM

MeSH

Cross-Sectional Studies; Decision Making; Endpoint Determination; Esophageal Neoplasms /surgery; Esophagectomy; Health Status; Humans; Longitudinal Studies; Quality of Life; Questionnaires; Randomized Controlled Trials as Topic

AccessionNumber

12009100455

Database entry date

06/04/2011

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 18626719

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