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Malmström M, Ivarsson B, Klefsgård R, Persson K, Jakobsson U, Johansson J. The effect of a nurse led telephone supportive care programme on patients' quality of life, received information and health care contacts after oesophageal cancer surgery-A six month RCT-follow-up study. Int J Nurs Stud 2016; 64:86-95. [PMID: 27701025 DOI: 10.1016/j.ijnurstu.2016.09.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/08/2016] [Accepted: 09/11/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Following oesophagectomy, a major surgical procedure, it is known that patients suffer from severely reduced quality of life and have an unmet need for postoperative support. Still, there is a lack of research testing interventions aiming to enhance the patients' life situation after this surgical procedure. AIM The aim of the study was to evaluate the effect of a nurse led telephone supportive care programme on quality of life (QOL), received information and the number of healthcare contacts compared to conventional care following oesophageal resection for cancer. METHOD The study was designed as a randomized controlled trial (RCT) aiming to test the effect of a nurse led telephone supportive care program compared to conventional care. Patient assessments were conducted at discharge, 2 weeks, 2, 4 and 6 months after discharge and comprised evaluation of QOL, received information and the number of health care contacts. Statistical testing were conducted with repeated measurements analysis of variance to test if there were differences between the groups during follow-up. RESULT The results show that the intervention group was significantly more satisfied with received information for items concerning the information they received about things to do to help yourself, written information and for the global information score. The control group scored significantly higher on the item regarding wishing to receive more information and wish to receive less information. No effect of the intervention was shown on QOL or number of health care contacts. CONCLUSION Proactive nurse-led telephone follow-up has a significant positive impact on the patients' experience of received information. This is likely to have a positive effect on their ability to cope with a life that may include remaining side effects and adverse symptoms for a long time after surgery.
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Affiliation(s)
- Marlene Malmström
- Skåne University Hospital, Lund, Sweden; Department of Surgery, Skåne University Hospital, Lund, Sweden; Lund University, Sweden.
| | - Bodil Ivarsson
- Skåne University Hospital, Lund, Sweden; Lund University, Sweden; Department of Cardio-Thoracic Surgery, Skåne University Hospital, Lund, Sweden
| | | | - Kerstin Persson
- Skåne University Hospital, Lund, Sweden; Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Ulf Jakobsson
- Lund University, Sweden; Center for Primary Health Care Research, Faculty of Medicine, Lund University, Sweden
| | - Jan Johansson
- Skåne University Hospital, Lund, Sweden; Department of Surgery, Skåne University Hospital, Lund, Sweden; Lund University, Sweden
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Yoshino S, Nishikawa K, Morita S, Takahashi T, Sakata K, Nagao J, Nemoto H, Murakami N, Matsuda T, Hasegawa H, Shimizu R, Yoshikawa T, Osanai H, Imano M, Naitoh H, Tanaka A, Tajiri T, Gochi A, Suzuki M, Sakamoto J, Saji S, Oka M. Randomised phase III study of S-1 alone versus S-1 plus lentinan for unresectable or recurrent gastric cancer (JFMC36-0701). Eur J Cancer 2016; 65:164-71. [PMID: 27501505 DOI: 10.1016/j.ejca.2016.06.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/17/2016] [Accepted: 06/16/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Lentinan (LNT) is a purified β-1, 3-glucan that augments immune responses. The present study was conducted to assess the efficacy of LNT in combination with S-1 as a first-line treatment for unresectable or recurrent gastric cancer. PATIENTS AND METHODS Eligible patients were randomly assigned to receive S-1 alone or S-1 plus LNT. The primary end-point was overall survival (OS). Secondary end-points were time-to-treatment failure (TTF), overall response rate (ORR), safety, quality of life (QOL), and biomarker. The percentages of LNT-binding monocytes in peripheral blood prior to treatment were analysed for the biomarker assessment. RESULTS One hundred and fifty-four and 155 patients were randomly assigned to receive S-1 alone or S-1 plus LNT, respectively. The median OS was 13.8 and 9.9 months (P = 0.208), the median TTF was 4.3 and 2.6 months (P < 0.001), the ORR was 22.3% and 18.7% for the S-1 and S-1 plus LNT groups, respectively. The incidences of haematologic and non-haematologic adverse events were similar, and no significant changes in QOL scores were observed during the treatment in both groups. In a subpopulation of patients with LNT-binding monocytes ≥2%, patients who received more than two cycles of chemotherapy showed a longer survival time in the S-1 plus LNT group. CONCLUSIONS OS did not improve and TTF was significantly worse in the S-1 plus LNT group as compared with the S-1-only group. This study showed no efficacy of LNT when combined with S-1 treatment in patients with unresectable or recurrent gastric cancer. CLINICAL TRIAL REGISTRATION ID NUMBER UMIN 000000574.
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Affiliation(s)
- Shigefumi Yoshino
- Department of Digestive Surgery and Surgical Oncology, Yamaguchi University Graduate School of Medicine, Ube, Japan.
| | | | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koichiro Sakata
- Department of Digestive Surgery, Shimonoseki Medical Center, Shimonoseki, Japan
| | - Jiro Nagao
- Department of Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Hiroshi Nemoto
- Department of Gastroenterological and General Surgery, School of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Nozomu Murakami
- Department of Palliative Care and Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Takeru Matsuda
- Department of Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | | | - Ryoichi Shimizu
- Department of Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Takaki Yoshikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Hiroyuki Osanai
- Department of Surgery, Sapporo Geka Kinen Hospital, Sapporo, Japan
| | - Motohiro Imano
- Department of Surgery, Kinki University Faculty of Medicine, Osakasayama, Japan
| | - Hiroshi Naitoh
- Department of Surgery, Japan Community Health Care Organization Gunma Chuo Hospital, Maebashi, Japan
| | | | | | - Akira Gochi
- Digestive Tract Surgery, Okayama University Hospital, Okayama, Japan
| | - Michinari Suzuki
- Department of Surgery, Shunan City Shinnanyo Hospital, Shunan, Japan
| | - Junichi Sakamoto
- Japanese Foundation for Multidisciplinary Treatment of Cancer, Tokyo, Japan
| | - Shigetoyo Saji
- Japanese Foundation for Multidisciplinary Treatment of Cancer, Tokyo, Japan
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103
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Djerf P, Brundin M, Bajk M, Smedh U. Validation of the paracetamol absorption test for measuring gastric tube emptying in esophagectomized patients versus gold standard scintigraphy. Scand J Gastroenterol 2016; 50:1339-47. [PMID: 26067746 DOI: 10.3109/00365521.2015.1041151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Scintigraphy is the gold standard for objective measurement of delayed gastric tube emptying after esophagectomy. The aim of this pilot study is to validate, by reference to scintigraphy, the paracetamol absorption test for measuring gastric tube emptying in esophagectomized patients. MATERIAL AND METHODS The paracetamol absorption test and scintigraphy were performed simultaneously in 13 patients who had undergone an esophagectomy with gastric tube reconstruction. Emptying was calculated for both methods and compared. Post-esophagectomy symptoms and quality of life (QoL) were assessed by European Organization on Research and Treatment of Cancer questionnaires. RESULTS Mean time to 50% emptying was 17 min measured with the paracetamol absorption test and 23 min with scintigraphy. For time to 25% emptying, Bland-Altman calculation gave a bias of 1.6 min and 95% limits of agreement (LoA) of -6.3 to 9.5 min. For time to 50% emptying, there was one outlier resulting in a bias of -6.33 min and 95% LoA of -36.4 to 23.8 min. For time to 75% emptying, bias was -11.6 min and 95% LoA of -38.5 to 15.4 min. Post-esophagectomy symptoms were similar to those reported previously, and QoL was comparable to the general Swedish population. CONCLUSIONS There was reasonably close correlation between the paracetamol absorption test and scintigraphy for time to 25% and 50% emptying, except for one outlier. For time to 75% emptying the methods were in less accordance. The results indicate that the paracetamol absorption test may be a useful screening tool for identifying delayed gastric tube emptying in this patient group.
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Affiliation(s)
- Pauline Djerf
- Department of Surgery, Lund University, Skåne University Hospital , Lund , Sweden
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104
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Wormald JCR, Bennett J, van Leuven M, Lewis MPN. Does the site of anastomosis for esophagectomy affect long-term quality of life? Dis Esophagus 2016; 29:93-8. [PMID: 25515370 DOI: 10.1111/dote.12301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Long-term survival after esophagectomy is improving, and hence, quality of life (QOL) of these patients has become a priority. There has been extensive debate regarding the optimal site of surgical anastomosis (cervical or intrathoracic). We aimed to evaluate the impact of anastomotic site on long-term QOL postesophagectomy. Quality of life questionnaires (European Organisation for Research and Treatment of Cancer [EORTC] C-30 and OG-25) were sent to patients surviving over 3 years following esophagectomy. The data were analyzed by site of esophagogastric anastomosis: intrathoracic or cervical. EORTC C-30 data were compared against the reference population data. Of the patients, 62 responded (82%) with a median time postsurgery of 6.1 years (range 3-12 years). Patient demographics were comparable. There was no significant difference between cervical or intrathoracic anastomosis groups for functional or symptom scores, focusing on dysphagia (cervical = 8.8 vs. intrathoracic = 17.6, P = 0.24), odynophagia (cervical = 13.4 vs. intrathoracic = 16.1, P = 0.68) and swallowing problems (cervical = 8.1 vs. intrathoracic = 13.4, P = 0.32). There was no difference in overall health score between groups (cervical = 70.5 vs. intrathoracic = 71.6, P = 0.46). Overall general health score was comparable with the reference population (esophagectomy group P = 70.9 ± 22.1 vs. reference population = 71.2 ± 22.4, P = 0.93). There is no difference in long-term QOL after esophagectomy between patients with a cervical or intrathoracic anastomosis. Scores compare favorably with EORTC reference data. Survival after esophagectomy is associated with recovery of QOL in the long term, regardless of site of anastomosis and despite worse gastrointestinal-related symptoms.
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Affiliation(s)
- J C R Wormald
- Department of Surgery, North West London Hospitals Trust, Middlesex, UK
| | - J Bennett
- Upper GI Surgery Department, Norfolk and Norwich University Hospital, Norwich, UK
| | - M van Leuven
- Upper GI Surgery Department, Norfolk and Norwich University Hospital, Norwich, UK
| | - M P N Lewis
- Upper GI Surgery Department, Norfolk and Norwich University Hospital, Norwich, UK
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Conservative management of severe caustic injuries during acute phase leads to superior long-term nutritional and quality of life (QoL) outcome. Langenbecks Arch Surg 2015; 401:81-7. [DOI: 10.1007/s00423-015-1366-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
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106
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LeGrand S, Reif S, Sullivan K, Murray K, Barlow ML, Whetten K. A Review of Recent Literature on Trauma Among Individuals Living with HIV. Curr HIV/AIDS Rep 2015; 12:397-405. [PMID: 26419376 PMCID: PMC4837695 DOI: 10.1007/s11904-015-0288-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Persons living with HIV (PLWH) report disproportionately high levels of exposure to traumatic events in childhood and adulthood. Traumatic experiences are associated with negative health and behavioral outcomes. Current research in this area seeks to further explicate the myriad health effects of trauma on PLWH and the pathways through which trauma operates. In this paper, we review articles published in English between January 2014 and June 2015 that examine traumatic experiences among PLWH, including intimate partner violence (IPV), domestic abuse, child abuse, and other forms of violence. A selection of studies examining trauma among PLWH and its associations with mental health, antiretroviral medication adherence, clinical outcomes, HIV disclosure, and sexual risk behaviors were included. Studies describing trauma coping strategies and interventions were also included. We conclude with recommendations for care of trauma-exposed PLWH and directions for future research.
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Affiliation(s)
- Sara LeGrand
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Dr., Durham, NC, 27710, USA.
- Duke Global Health Institute, Duke University, 310 Trent Dr., Durham, NC, 27710, USA.
| | - Susan Reif
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Dr., Durham, NC, 27710, USA.
| | - Kristen Sullivan
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Dr., Durham, NC, 27710, USA.
| | - Kate Murray
- FHI360, 359 Blackwell St., Suite 200, Durham, NC, 27701, USA.
| | - Morgan L Barlow
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Dr., Durham, NC, 27710, USA.
| | - Kathryn Whetten
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Dr., Durham, NC, 27710, USA.
- Duke Global Health Institute, Duke University, 310 Trent Dr., Durham, NC, 27710, USA.
- Sanford School of Public Policy, Duke University, 201 Science Dr, Durham, NC, 27708, USA.
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107
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Bowrey DJ, Baker M, Halliday V, Thomas AL, Pulikottil-Jacob R, Smith K, Morris T, Ring A. A randomised controlled trial of six weeks of home enteral nutrition versus standard care after oesophagectomy or total gastrectomy for cancer: report on a pilot and feasibility study. Trials 2015; 16:531. [PMID: 26590903 PMCID: PMC4654827 DOI: 10.1186/s13063-015-1053-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 11/12/2015] [Indexed: 12/21/2022] Open
Abstract
Background Poor nutrition in the first months after oesophago-gastric resection is a contributing factor to the reduced quality of life seen in these patients. The aim of this pilot and feasibility study was to ascertain the feasibility of conducting a multi-centre randomised controlled trial to evaluate routine home enteral nutrition in these patients. Methods Patients undergoing oesophagectomy or total gastrectomy were randomised to either six weeks of home feeding through a jejunostomy (intervention), or treatment as usual (control). Intervention comprised overnight feeding, providing 50 % of energy and protein requirements, in addition to usual oral intake. Primary outcome measures were recruitment and retention rates at six weeks and six months. Nutritional intake, nutritional parameters, quality of life and healthcare costs were also collected. Interviews were conducted with a sample of participants, to ascertain patient and carer experiences. Results Fifty-four of 112 (48 %) eligible patients participated in the study over the 20 months. Study retention at six weeks was 41/54 patients (76 %) and at six months was 36/54 (67 %). At six weeks, participants in the control group had lost on average 3.9 kg more than participants in the intervention group (95 % confidence interval [CI] 1.6 to 6.2). These differences remained evident at three months (mean difference 2.5 kg, 95 % CI −0.5 to 5.6) and at six months (mean difference 2.5 kg, 95 % CI −1.2 to 6.1). The mean values observed in the intervention group for mid arm circumference, mid arm muscle circumference, triceps skin fold thickness and right hand grip strength were greater than for the control group at all post hospital discharge time points. The economic evaluation suggested that it was feasible to collect resource use and EQ-5D data for a full cost-effectiveness analysis. Thematic analysis of 15 interviews identified three main themes related to the intervention and the trial: 1) a positive experience, 2) the reasons for taking part, and 3) uncertainty of the study process. Conclusions This study demonstrated that home enteral feeding by jejunostomy was feasible, safe and acceptable to patients and their carers. Whether home enteral feeding as ’usual practice’ is a cost-effective therapy would require confirmation in an appropriately powered, multi-centre study. Trial registration UK Clinical Research Network ID 12447 (main trial, first registered 30 May 2012); UK Clinical Research Network ID 13361 (qualitative substudy, first registered 30 May 2012); ClinicalTrials.gov NCT01870817 (first registered 28 May 2013)
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Affiliation(s)
- David J Bowrey
- Department of Surgery, University Hospitals of Leicester NHS Trust, Level 6 Balmoral Building, Leicester, UK.
| | - Melanie Baker
- Department of Surgery, University Hospitals of Leicester NHS Trust, Level 6 Balmoral Building, Leicester, UK.
| | - Vanessa Halliday
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Anne L Thomas
- Department of Cancer Studies, University of Leicester, Leicester, UK.
| | | | - Karen Smith
- Department of Health Sciences, University of Leicester, Leicester, UK.
| | - Tom Morris
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK.
| | - Arne Ring
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK. .,Current affiliation: Department of Mathematical Statistics and Actuarial Science, University of the Free State, Bloemfontein, South Africa.
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109
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Takiguchi N, Takahashi M, Ikeda M, Inagawa S, Ueda S, Nobuoka T, Ota M, Iwasaki Y, Uchida N, Kodera Y, Nakada K. Long-term quality-of-life comparison of total gastrectomy and proximal gastrectomy by postgastrectomy syndrome assessment scale (PGSAS-45): a nationwide multi-institutional study. Gastric Cancer 2015; 18:407-16. [PMID: 24801198 DOI: 10.1007/s10120-014-0377-8] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 03/30/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although proximal gastrectomy (PG) is widely accepted as a function-preserving operation for early upper-third gastric cancer, postoperative disorders, such as reflux or gastric stasis, have often been pointed out. From the perspective of postoperative disorder, the choice of total gastrectomy (TG) or PG for such cancers is still controversial. By using the newly developed Postgastrectomy Syndrome Assessment Scale (PGSAS)-45, the quality of life after TG and PG was compared. METHODS The PGSAS-45 consists of 45 items composed of the SF-8 and GSRS scales and 22 new items. The main outcomes are measured by seven subscales (SS) covering symptoms, physical and mental component summary (SF-8), meals (amount and quality), ability to work, dissatisfaction for daily life, and change in body weight. A total of 2,368 eligible questionnaires were acquired from 52 institutions. From these, 393 patients with TG and 193 patients with PG were selected and compared. RESULTS The PG was better than TG in terms of body weight loss (TG 13.8% vs. PG 10.9%; p = 0.003), necessity for additional meals (2.4 vs. 2.0; p < 0.001), diarrhea SS (2.3 vs. 2.0; p = 0.048), and dumping SS (2.3 vs. 2.0; p = 0.043). There were no differences in the other main outcome measures. CONCLUSIONS Proximal gastrectomy appears to be valuable as a function-preserving procedure for early upper-third gastric cancer.
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Affiliation(s)
- Nobuhiro Takiguchi
- Division of Gastroenterological Surgery, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-0801, Japan,
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110
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Adamson D, Blazeby J, Nelson A, Hurt C, Nixon L, Fitzgibbon J, Crosby T, Staffurth J, Evans M, Kelly NH, Cohen D, Griffiths G, Byrne A. Palliative radiotherapy in addition to self-expanding metal stent for improving dysphagia and survival in advanced oesophageal cancer (ROCS: Radiotherapy after Oesophageal Cancer Stenting): study protocol for a randomized controlled trial. Trials 2014; 15:402. [PMID: 25336193 PMCID: PMC4223756 DOI: 10.1186/1745-6215-15-402] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/01/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The single most distressing symptom for patients with advanced esophageal cancer is dysphagia. Amongst the more effective treatments for relief of dysphagia is insertion of a self-expanding metal stent (SEMS). It is possible that the addition of a palliative dose of external beam radiotherapy may prolong the relief of dysphagia and provide additional survival benefit. The ROCS trial will assess the effect of adding palliative radiotherapy after esophageal stent insertion. METHODS/DESIGN The study is a randomized multicenter phase III trial, with an internal pilot phase, comparing stent alone versus stent plus palliative radiotherapy in patients with incurable esophageal cancer. Eligible participants are those with advanced esophageal cancer who are in need of stent insertion for primary management of dysphagia. Radiotherapy will be administered as 20 Gray (Gy) in five fractions over one week or 30 Gy in 10 fractions over two weeks, within four weeks of stent insertion. The internal pilot will assess rates and methods of recruitment; pre-agreed criteria will determine progression to the main trial. In total, 496 patients will be randomized in a 1:1 ratio with follow up until death. The primary outcome is time to progression of patient-reported dysphagia. Secondary outcomes include survival, toxicity, health resource utilization, and quality of life. An embedded qualitative study will explore the feasibility of patient recruitment by examining patients' motivations for involvement and their experiences of consent and recruitment, including reasons for not consenting. It will also explore patients' experiences of each trial arm. DISCUSSION The ROCS study will be a challenging trial studying palliation in patients with a poor prognosis. The internal pilot design will optimize methods for recruitment and data collection to ensure that the main trial is completed on time. As a pragmatic trial, study strengths include collection of all follow-up data in the usual place of care, and a focus on patient-reported, rather than disease-orientated, outcomes. Exploration of patient experience and health economic analyses will be integral to the assessment of benefit for patients and the NHS. TRIAL REGISTRATION The trial was registered with Current Controlled Trials (registration number: ISRCTN12376468) on 10 July 2012.
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Affiliation(s)
- Douglas Adamson
- />Tayside Cancer Centre, Ward 32, Ninewells Hospital, Dundee, DD1 9SY UK
| | - Jane Blazeby
- />School of Social & Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Annmarie Nelson
- />Marie Curie Palliative Care Research Centre, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, 1st Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Chris Hurt
- />Wales Cancer Trials Unit, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Lisette Nixon
- />Wales Cancer Trials Unit, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Jim Fitzgibbon
- />Wales Cancer Trials Unit, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Tom Crosby
- />Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, CF14 2TL UK
| | - John Staffurth
- />Institute of Cancer and Genetics, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff, CF14 4XW UK
| | - Mim Evans
- />National Institute for Social Care and Health Research (NISCHR), Clinical Research Centre, 3rd Floor 12 Cathedral Road, Cardiff, CF11 9LJ UK
| | - Noreen Hopewell Kelly
- />Marie Curie Palliative Care Research Centre, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, 1st Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - David Cohen
- />NISCHR Welsh Health Economics Support Service, University of South Wales, Pontypridd, CF37 1DL UK
| | - Gareth Griffiths
- />University of Southampton Clinical Trials Unit, MP 131, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD UK
| | - Anthony Byrne
- />Marie Curie Palliative Care Research Centre, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, 1st Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
- />Wales Cancer Trials Unit, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
- />Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, CF14 2TL UK
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Dutton SJ, Ferry DR, Blazeby JM, Abbas H, Dahle-Smith A, Mansoor W, Thompson J, Harrison M, Chatterjee A, Falk S, Garcia-Alonso A, Fyfe DW, Hubner RA, Gamble T, Peachey L, Davoudianfar M, Pearson SR, Julier P, Jankowski J, Kerr R, Petty RD. Gefitinib for oesophageal cancer progressing after chemotherapy (COG): a phase 3, multicentre, double-blind, placebo-controlled randomised trial. Lancet Oncol 2014; 15:894-904. [PMID: 24950987 DOI: 10.1016/s1470-2045(14)70024-5] [Citation(s) in RCA: 239] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Evidence is scarce for the effectiveness of therapies for oesophageal cancer progressing after chemotherapy, and no randomised trials have been reported. We aimed to compare gefitinib with placebo in previously treated advanced oesophageal cancer. METHODS For this phase 3, parallel, randomised, placebo-controlled trial, eligible patients were adults with advanced oesophageal cancer or type I/II Siewert junctional tumours, histologically confirmed squamous-cell carcinoma or adenocarcinoma, who had progressed after chemotherapy, with WHO performance status 0-2, and with measurable or evaluable disease on CT scan. Participants were recruited from 48 UK centres and randomly assigned (1:1) to gefitinib (500 mg) or matching placebo by simple randomisation with no stratification factors. Patients, clinicians, and trial office staff were masked to treatment allocation. Treatment continued until disease progression, unacceptable toxicity, or patient choice. The primary outcome was overall survival, analysed by intention to treat. This trial is registered, number ISRCTN29580179. FINDINGS Between March 30, 2009, and Nov 18, 2011, 450 patients were randomly assigned to treatment groups (one patient withdrew consent; 224 patients allocated gefitinib and 225 allocated placebo included in analyses). Overall survival did not differ between groups (median 3·73 months, 95% CI 3·23-4·50, for gefitinib vs 3·67 months, 95% CI 2·97-4·37, for placebo; hazard ratio [HR] 0·90, 95% CI 0·74-1·09, p=0·29). Among the prespecified patient-reported outcomes (110 patients on gefitinib and 121 on placebo completed both baseline and 4 week questionnaires and were included in analyses), odynophagia was significantly better in the gefitinib group (adjusted mean difference -8·61, 95% CI -14·49 to -2·73; n=227; p=0·004), whereas the other outcomes were not significantly improved compared with placebo: global quality of life (2·69, 95% CI -2·33 to 7·72, n=231, p=0·293), dysphagia (-3·18, 95% CI -8·36 to 2·00, n=231, p=0·228), and eating (-4·11, 95% CI -9·96 to 1·75, n=229, p=0·168). Median progression-free survival was marginally longer with gefitinib than it was with placebo (1·57 months, 95% CI 1·23-1·90 in the gefitinib group vs 1·17 months, 95% CI 1·07-1·37 in the placebo group; HR 0·80, 95% CI 0·66-0·96, p=0·020). The most common toxicities were diarrhoea (36 [16%] of 224 patients on gefitinib vs six [3%] of 225 on placebo) and skin toxicity (46 [21%] vs two [1%]), both mostly grade 2. The commonest grade 3-4 toxicities were fatigue (24 [11%] vs 13 [6%] patients) and diarrhoea (13 [6%] vs two [1%]). Serious adverse events were reported in 109 (49%) of 224 patients assigned to gefitinib and 101 (45%) of 225 on placebo. 54 (24%) of patients in the gefitinib group achieved disease control at 8 weeks, as did 35 (16%) of patients on placebo (p=0·023). INTERPRETATION The use of gefitinib as a second-line treatment in oesophageal cancer in unselected patients does not improve overall survival, but has palliative benefits in a subgroup of these difficult-to-treat patients with short life expectancy. Future research should focus on identification of predictive biomarkers to identify this subgroup of benefiting patients. FUNDING Cancer Research UK.
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Affiliation(s)
- Susan J Dutton
- Oxford Clinical Trials Research Unit and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK.
| | - David R Ferry
- Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; Lilly UK, Erl Wood Manor, Windlesham, UK
| | - Jane M Blazeby
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK; School of Social and Community Medicine, University of Bristol Senate House, Bristol, UK
| | - Haider Abbas
- Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Asa Dahle-Smith
- University of Aberdeen, Institute of Medical Sciences, Aberdeen, UK
| | - Wasat Mansoor
- Christie Hospital NHS Foundation Trust, Manchester, UK
| | | | | | | | - Stephen Falk
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - David W Fyfe
- University Hospitals of Morecombe Bay, Furness General Hospital, Barrow-in-Furness, UK
| | | | - Tina Gamble
- Birmingham Heartlands Hospital, Birmingham, UK
| | - Lynnda Peachey
- Oncology Clinical Trials Office, University of Oxford, Department of Oncology, Old Road Campus Research Building, University of Oxford, Old Road Campus, Oxford, UK
| | - Mina Davoudianfar
- Oncology Clinical Trials Office, University of Oxford, Department of Oncology, Old Road Campus Research Building, University of Oxford, Old Road Campus, Oxford, UK
| | - Sarah R Pearson
- Oncology Clinical Trials Office, University of Oxford, Department of Oncology, Old Road Campus Research Building, University of Oxford, Old Road Campus, Oxford, UK
| | - Patrick Julier
- Oncology Clinical Trials Office, University of Oxford, Department of Oncology, Old Road Campus Research Building, University of Oxford, Old Road Campus, Oxford, UK
| | | | - Rachel Kerr
- Oncology Clinical Trials Office, University of Oxford, Department of Oncology, Old Road Campus Research Building, University of Oxford, Old Road Campus, Oxford, UK
| | - Russell D Petty
- University of Aberdeen, Institute of Medical Sciences, Aberdeen, UK
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112
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Blazeby JM, Strong S, Donovan JL, Wilson C, Hollingworth W, Crosby T, Nicklin J, Falk SJ, Barham CP, Hollowood AD, Streets CG, Titcomb D, Krysztopik R, Griffin SM, Brookes ST. Feasibility RCT of definitive chemoradiotherapy or chemotherapy and surgery for oesophageal squamous cell cancer. Br J Cancer 2014; 111:234-40. [PMID: 24921919 PMCID: PMC4102950 DOI: 10.1038/bjc.2014.313] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 04/25/2014] [Accepted: 05/12/2014] [Indexed: 01/26/2023] Open
Abstract
Background: The optimal treatment for localised oesophageal squamous cell carcinoma (SCC) is uncertain. We assessed the feasibility of an RCT comparing neoadjuvant treatment and surgery with definitive chemoradiotherapy. Methods: A feasibility RCT in three centres examined incident patients and reasons for ineligibility using multi-disciplinary team meeting records. Eligible patients were offered participation in the RCT with integrated qualitative research involving audio-recorded recruitment appointments and interviews with patients to inform recruitment training for staff. Results: Of 375 patients with oesophageal SCC, 42 (11.2%) were eligible. Reasons for eligibility varied between centres, with significantly differing proportions of patients excluded because of total tumour length (P=0.002). Analyses of audio-recordings and patient interviews showed that recruiters had challenges articulating the trial design in simple terms, balancing treatment arms and explaining the need for randomisation. Before analyses of the qualitative data and recruiter training no patients were randomised. Following training in one centre 5 of 16 eligible patients were randomised. Conclusions: An RCT of surgical vs non-surgical treatment for SCC of the oesophagus is not feasible in the UK alone because of the low number of incident eligible patients. A trial comparing diverse treatment approaches may be possible with investment to support the recruitment process.
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Affiliation(s)
- J M Blazeby
- 1] Centre of Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK [2] Division of Surgery, Head & Neck, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8HW, UK
| | - S Strong
- 1] Centre of Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK [2] Division of Surgery, Head & Neck, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8HW, UK
| | - J L Donovan
- Centre of Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - C Wilson
- Centre of Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - W Hollingworth
- Centre of Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - T Crosby
- Velindre NHS Trust, Unit 2 Charnwood Court, Cardiff CF14 2TL, UK
| | - J Nicklin
- Division of Surgery, Head & Neck, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8HW, UK
| | - S J Falk
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol BS8 2PS, UK
| | - C P Barham
- Division of Surgery, Head & Neck, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8HW, UK
| | - A D Hollowood
- Division of Surgery, Head & Neck, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8HW, UK
| | - C G Streets
- Division of Surgery, Head & Neck, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8HW, UK
| | - D Titcomb
- Division of Surgery, Head & Neck, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8HW, UK
| | - R Krysztopik
- 1] Division of Surgery, Head & Neck, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8HW, UK [2] Royal United Hospital Bath, Bath, BA1 3NG, UK
| | - S M Griffin
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
| | - S T Brookes
- Centre of Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
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113
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Pullmer R, Linden W, Rnic K, Vodermaier A. Measuring symptoms in gastrointestinal cancer: a systematic review of assessment instruments. Support Care Cancer 2014; 22:2941-55. [PMID: 24865875 DOI: 10.1007/s00520-014-2250-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 04/09/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE It is critical for gastrointestinal cancer researchers and clinicians to have access to comprehensive, sensitive and simple-to-use symptom measures that allow them to understand and quantify the subjective patient experience. Development and validation of such scales requires training in psychometrics and occasionally uses technical jargon that can be difficult to penetrate. This review evaluates existing measures of gastrointestinal cancer symptoms, provides tool descriptions, and uses predefined, objective quality criteria to rate psychometric quality and facilitate tool choices for researchers and clinicians. METHODS MEDLINE, EMBASE, CINAHL, and PsycINFO databases were systematically reviewed for scales assessing gastrointestinal cancer and gastrointestinal cancer site-specific symptoms. Evaluation criteria were the following: breadth of domain coverage (content validity), high internal consistency (α ≥ .80), sensitivity to change, and extent of validation. RESULTS In n = 36 validation studies, 26 gastrointestinal cancer symptom measures were identified. Of these, n = 13 tools met criteria for recommendation, and six in particular showed strong psychometric properties. The Functional Assessment of Cancer Therapy-Colorectal (FACT-C), European Organization for Research and Treatment of Cancer (EORTC) gastric cancer module (QLQ-STO22), FACT-Hepatobiliary (FACT-Hep), and EORTC oesophagus, oesophago-gastric junction and stomach module (QLQ OG-25) were identified as the most comprehensive and best validated scales for each of the major gastrointestinal cancer sites. The FACT-Colorectal Symptom Index (FCSI-9) and the National Comprehensive Cancer Network (NCCN) FACT-Hepatobiliary Symptom Index (FHSI-18) were specifically validated in patients with advanced colorectal and liver cancer and also demonstrated superior psychometric properties. CONCLUSIONS Several comprehensive, well-validated scales exist to adequately assess gastrointestinal cancer site-specific symptoms. Specifically, gastrointestinal cancer submodules of the FACT quality of life questionnaire represent adequate tool choices in most instances and overall, were better validated than the respective EORTC tools. Further improvement of existing, highly rated measures is recommended.
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Affiliation(s)
- Rachelle Pullmer
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada,
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114
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Bowrey DJ, Baker M, Halliday V, Thomas AL, Pulikottil-Jacob R, Smith K. Six weeks of home enteral nutrition versus standard care after esophagectomy or total gastrectomy for cancer: study protocol for a randomized controlled trial. Trials 2014; 15:187. [PMID: 24885032 PMCID: PMC4039309 DOI: 10.1186/1745-6215-15-187] [Citation(s) in RCA: 12] [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: 01/07/2014] [Accepted: 05/09/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Each year approximately 3000 patients in the United Kingdom undergo surgery for esophagogastric cancer. Jejunostomy feeding tubes, placed at the time of surgery for early postoperative nutrition, have been shown to have a positive impact on clinical outcomes in the short term. Whether feeding out of hospital is of benefit is unknown. Local experience has identified that between 15 and 20% of patients required 'rescue' jejunostomy feeding for nutritional problems and weight loss while at home. This weight loss and poor nutrition may contribute to the detrimental effect on the overall quality of life (QoL) reported in these patients. METHODS/DESIGN This randomized pilot and feasibility study will provide preliminary information on the routine use of jejunostomy feeding after hospital discharge in terms of clinical benefits and QoL. Sixty participants undergoing esophagectomy or total gastrectomy will be randomized to receive either a planned program of six weeks of home jejunostomy feeding after discharge from hospital (intervention) or treatment-as-usual (control). The intention of this study is to inform a multi-centre randomized controlled trial. The primary outcome measures will be recruitment and retention rates at six weeks and six months. Secondary outcome measures will include disease specific and general QoL measures, nutritional parameters, total and oral nutritional intake, hospital readmission rates, and estimates of healthcare costs. Up to 20 participants will also be enrolled in a qualitative sub-study that will explore participants' and carers' experiences of home tube feeding.The results will be disseminated by presentation at surgical, gastroenterological and dietetic meetings and publication in appropriate peer review journals. A patient-friendly lay summary will be made available on the University of Leicester and the University Hospitals of Leicester NHS Trust websites. The study has full ethical and institutional approval and started recruitment in July 2012. TRIAL REGISTRATION UKClinical Research Network ID #12447 (Main study); UKCRN ID#13361 (Qualitative sub study); ClinicalTrials.gov #NCT01870817 (First registered 28 May 2013).
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Affiliation(s)
- David J Bowrey
- Department of Surgery, University Hospitals of Leicester NHS Trust, Level 6 Balmoral Building, Leicester Royal Infirmary, Leicester LE1 5WW, UK
| | - Melanie Baker
- Department of Surgery, University Hospitals of Leicester NHS Trust, Level 6 Balmoral Building, Leicester Royal Infirmary, Leicester LE1 5WW, UK
| | - Vanessa Halliday
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield S1 4DA, UK
| | - Anne L Thomas
- Department of Oncology, Clinical Sciences Building, University of Leicester, Leicester LE1 5WW, UK
| | - Ruth Pulikottil-Jacob
- Department of Health Economics, Room A101, University of Warwick, Warwick CV4 7AL, UK
| | - Karen Smith
- Department of Health Sciences, University of Leicester, 22-28 Princess Rd West, Leicester LE1 6TP, UK
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115
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Hesari AE, Lari MA, Shandiz FH. Psychometric analysis of a Persian version of the European Organization for Research and Treatment of Cancer OG25 Quality of Life Questionnaire in oesophagogastric cancer patients. Asian Pac J Cancer Prev 2014; 15:2739-45. [PMID: 24761894 DOI: 10.7314/apjcp.2014.15.6.2739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQL) is a fundamental outcome in oncology patients and quality of life (QOL) assessment requires clinically relevant questionnaires. The purpose of this study was translation and definition of measurement properties and the clinical validity of Quality of Life Questionnaire (QLQ) -OG25 module in Persian patients with oesophagus, oesophagogastric junction (OGJ) or gastric cancers. MATERIALS AND METHODS The translation procedure followed European Organization for Research and Treatment of Cancer (EORTC) guidelines. Both EORTC QLQ-OG25 and a core questionnaire (EORTC QLQ-C30) were administered to patients with oesophagus (150), OG junction (93) and gastric (32) cancer undergoing multi-modal treatments. Convergent and discriminant validity, Cronbach's alpha coefficient and known-groups comparisons were used to examine reliability and validity. RESULTS In all, 275 patients (mean age 62 years) completed both questionnaires. Compliance rate was high and the questionnaire module was well accepted. We found good reliability for multi-item subscales of QLQ-OG25 (Cronbach's alpha coefficients 0.76-0.89). About 73% had TNM staging and scales distinguished between clinically distinct groups of patients. However, patients in palliative group experienced compromised functional status and worse treatment-associated symptoms than those in the potentially curative group. Test-retest scores were consistent. Multi-trait scaling analysis demonstrated good convergent and discriminant validity. CONCLUSIONS Overall, the Persian version of QLQ-OG25 demonstrated psychometric and clinical validity that supports its application as a supplement to the original tool (EORTC QLQ-C30) when assessing HRQL in patients with upper-gastrointestinal (GI) cancer both in curative and palliative phases.
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Affiliation(s)
- Ali Esmaeili Hesari
- Department of Epidemiology and Biostatistics, School of Public Health, , Iran University of Medical Sciences, Tehran, Iran E-mail :
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Psychometric characteristics of health-related quality-of-life questionnaires in oropharyngeal dysphagia. Dysphagia 2014; 29:183-98. [PMID: 24590284 DOI: 10.1007/s00455-013-9511-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 12/14/2013] [Indexed: 10/25/2022]
Abstract
Dysphagia can have severe consequences for the patient's health, influencing health-related quality of life (HRQoL). Sound psychometric properties of HRQoL questionnaires are a precondition for assessing the impact of dysphagia, the focus of this study, resulting in recommendations for the appropriate use of these questionnaires in both clinical practice and research contexts. We performed a systematic review starting with a search for and retrieval of all full-text articles on the development of HRQoL questionnaires related to oropharyngeal dysphagia and/or their psychometric validation from the electronic databases PubMed and Embase published up to June 2011. Psychometric properties were judged according to quality criteria proposed for health status questionnaires. Eight questionnaires were included in this study. Four are aimed solely at HRQoL in oropharyngeal dysphagia: the deglutition handicap index (DHI), dysphagia handicap index (DHI'), M.D. Anderson Dysphagia Inventory (MDADI), and SWAL-QOL, while the EDGQ, EORTC QLQ-STO 22, EORTC QLQ-OG 25 and EORTC QLQ-H&N35 focus on other primary diseases resulting in dysphagia. The psychometric properties of the DHI, DHI', MDADI, and SWAL-QOL were evaluated. For appropriate applicability of HRQoL questionnaires, strong scores on the psychometric criteria face validity, criterion validity, and interpretability are prerequisites. The SWAL-QOL has the strongest ratings for these criteria, while the DHI' is the most easy to apply given its 25 items and the use of a uniform scoring format. For optimal use of HRQoL questionnaires in diverse settings, it is necessary to combine psychometric and utility approaches.
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117
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Martin RCG, Cannon RM, Brown RE, Ellis SF, Williams S, Scoggins CR, Abbas AE. Evaluation of quality of life following placement of self-expanding plastic stents as a bridge to surgery in patients receiving neoadjuvant therapy for esophageal cancer. Oncologist 2014; 19:259-65. [PMID: 24567281 DOI: 10.1634/theoncologist.2013-0344] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To determine whether self-expanding plastic stent (SEPS) placement significantly improves quality of life and maintains optimal nutrition while allowing full-dose neoadjuvant therapy (NAT) in patients with esophageal cancer. PATIENTS AND METHODS A prospective, dual-institution, single-arm, phase II (http://ClinicalTrials.gov: NCT00727376) evaluation of esophageal cancer patients undergoing NAT prior to resection. All patients had a self-expanding polymer stent placed prior to NAT. The European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OG25, Functional Assessment of Cancer Therapy-Anorexia, and Functional Assessment of Cancer Therapy-General surveys were administered prior to stenting, within 1 week post-stent placement, and at the completion of neoadjuvant therapy. RESULTS Fifty-two patients were enrolled; 3 (5.8%) had stent migrations requiring replacement. There were no instances of esophageal erosion or perforation. All patients received some form of neoadjuvant therapy. Thirty-six (69%) received chemoradiation; 34 (93%) of these patients received the planned dose of chemotherapy, and 27 (75%) received the full planned dose of radiotherapy. There were 16 (31%) patients receiving chemotherapy alone; 12 (74%) of patients in the chemotherapy-alone group completed the planned dose of therapy. CONCLUSION Placement of SEPS appears to provide significant improvement in quality of life related to dysphagia and eating restriction in patients with esophageal cancer undergoing neoadjuvant therapy. Consideration of SEPS instead of percutaneous feeding tube should be initiated as a first line in dysphagia palliation and NAT nutritional support.
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Affiliation(s)
- Robert C G Martin
- University of Louisville, Department of Surgery, Division of Surgical Oncology, Louisville, Kentucky, USA; Department of Surgery, Ochsner Medical Center, Ochsner Health Systems, New Orleans, Louisiana, USA
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Macefield RC, Jacobs M, Korfage IJ, Nicklin J, Whistance RN, Brookes ST, Sprangers MAG, Blazeby JM. Developing core outcomes sets: methods for identifying and including patient-reported outcomes (PROs). Trials 2014; 15:49. [PMID: 24495582 PMCID: PMC3916696 DOI: 10.1186/1745-6215-15-49] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 01/17/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Synthesis of patient-reported outcome (PRO) data is hindered by the range of available PRO measures (PROMs) composed of multiple scales and single items with differing terminology and content. The use of core outcome sets, an agreed minimum set of outcomes to be measured and reported in all trials of a specific condition, may improve this issue but methods to select core PRO domains from the many available PROMs are lacking. This study examines existing PROMs and describes methods to identify health domains to inform the development of a core outcome set, illustrated with an example. METHODS Systematic literature searches identified validated PROMs from studies evaluating radical treatment for oesophageal cancer. PROM scale/single item names were recorded verbatim and the frequency of similar names/scales documented. PROM contents (scale components/single items) were examined for conceptual meaning by an expert clinician and methodologist and categorised into health domains. A patient advocate independently checked this categorisation. RESULTS Searches identified 21 generic and disease-specific PROMs containing 116 scales and 32 single items with 94 different verbatim names. Identical names for scales were repeatedly used (for example, 'physical function' in six different measures) and others were similar (overlapping face validity) although component items were not always comparable. Based on methodological, clinical and patient expertise, 606 individual items were categorised into 32 health domains. CONCLUSION This study outlines a methodology for identifying candidate PRO domains from existing PROMs to inform a core outcome set to use in clinical trials.
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Affiliation(s)
- Rhiannon C Macefield
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Marc Jacobs
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Meibergdreef 5, Amsterdam NL 1105 AZ, Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, P.O. Box 2040, Rotterdam NL 3000 CA, Netherlands
| | - Joanna Nicklin
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Level 3, Dolphin House, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK
| | - Robert N Whistance
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Sara T Brookes
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Mirjam AG Sprangers
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Meibergdreef 5, Amsterdam NL 1105 AZ, Netherlands
| | - Jane M Blazeby
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Level 3, Dolphin House, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK
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McNair AGK, Blazeby JM. Health-related quality-of-life assessment in GI cancer randomized trials: improving the impact on clinical practice. Expert Rev Pharmacoecon Outcomes Res 2014; 9:559-67. [DOI: 10.1586/erp.09.68] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
Adenocarcinoma of the stomach is often diagnosed in the late stages of the disease. Surgical resection of all gross and microscopic disease is essential for curative treatment. Complete resection is often not achievable when patients present with advanced stage IV cancer. In the absence of symptoms, chemotherapy without resection has been the standard of care in most major centers. With improvements in response to chemotherapy and less invasive surgical approaches, patients with metastatic gastric cancer have had better survival outcomes than in the past. The challenge today when treating these patients is in defining who will benefit from more aggressive interventions. Reviewing the literature for guidance is difficult because the goals of treatment are often not clearly defined. Finding the proper balance of aggressiveness needed to extend survival while preserving and maximizing quality of life is a decision that clinicians have to make with increasing frequency. This review will attempt to provide a framework to aid in determining what role, if any, gastrectomy has in the management of patients with stage IV gastric cancer.
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Affiliation(s)
- Martin S Karpeh
- Department of Surgery, Beth Israel Medical Center, Continuum Cancer Centers of New York, New York, N.Y., USA.
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Main influencing factors and health-related quality of life issues in patients with oesophago-gastric cancer - as measured by EORTC tools. Contemp Oncol (Pozn) 2013; 17:311-6. [PMID: 24596521 PMCID: PMC3934069 DOI: 10.5114/wo.2013.35280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 01/18/2013] [Accepted: 02/08/2013] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY To assess influencing factors and main health-related quality of life (HRQoL) issues in patients with cancers of the oesophago-gastric region using the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire Core 30 (QLQ-C30) and its oesophago-gastric module (QLQ-OG25). MATERIAL AND METHODS Patients were qualified for this study based on the histological confirmation of oesophageal, oesophago-gastric or gastric cancers. Each patient filled out the Polish version of the EORTC QLQ-C30, the QLQ-OG25 module and a personal questionnaire. Patients were divided into groups based on gender, age, treatment intention, tumour localization, working status and level of education. RESULTS Our study included 112 patients - 39 women (35%) and 73 men (mean age ± SD; 60.2 ±10.9). Thirty-five patients (31.3%) completed the questionnaires twice. Eighty-four (75%) patients had gastric cancer (GC), twenty-six (23.2%) oesophageal cancer (OC) and two (1.8%) cancer of the oesophago-gastric junction (OGJC). Eighty (71.4%) patients underwent surgical treatment prior to either chemo-, radio- or chemoradiotherapy. The Global Health Status scale of the QLQ-C30 inversely correlated with all the other QLQ-C30 and QLQ-OG25 symptom scales (r = -0.26 to -0.61; p < 0.05). CONCLUSIONS The main HRQoL problems of Polish OC, OGJC and GC patients are fatigue, insomnia, anxiety, and appetite and weight loss. Older age, receiving palliative treatment, having gastric cancer, being on retirement and having lower education are factors associated with higher symptom scores (worse symptoms) and thus poorer HRQoL.
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122
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Amdal CD, Jacobsen AB, Sandstad B, Warloe T, Bjordal K. Palliative brachytherapy with or without primary stent placement in patients with oesophageal cancer, a randomised phase III trial. Radiother Oncol 2013; 107:428-33. [PMID: 23647761 DOI: 10.1016/j.radonc.2013.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 04/03/2013] [Accepted: 04/05/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate whether a combination of self-expanding metal stent (SEMS) and brachytherapy provided more rapid and prolonged effect on dysphagia without increased pain compared to brachytherapy alone in patients with incurable oesophageal cancer. METHODS 41 Patients were randomised to SEMS followed by brachytherapy, 8 Gy×3 (n=21) or brachytherapy alone, 8 Gy×3 (n=20). Change in dysphagia and pain three and seven weeks after randomisation (FU1 and FU2) was assessed by patient-reported outcome. Dysphagia, other symptoms and health-related quality of life were assessed every four weeks thereafter. The study was closed before the estimated patient-number was reached due to slow recruitment. RESULTS Patients receiving SEMS followed by brachytherapy had significantly improved dysphagia at FU1 compared to patients receiving brachytherapy alone (n=35). Difference in pain was not observed. At FU2, patients in both arms (n=21) had less dysphagia. Four patients in the combined treatment arm experienced manageable complications, no complications occurred after brachytherapy alone. CONCLUSION For the relief of dysphagia, SEMS followed by brachytherapy is preferable and safe for patients in need of immediate alleviation, while brachytherapy with or without preceding SEMS provides relief within a few weeks after treatment.
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Tomaszewski KA, Püsküllüoğlu M, Biesiada K, Bochenek J, Nieckula J, Krzemieniecki K. Validation of the Polish Version of the EORTC QLQ-C30 and the QLQ-OG25 for the Assessment of Health-Related Quality of Life in Patients with Esophagi-Gastric Cancer. J Psychosoc Oncol 2013; 31:191-203. [DOI: 10.1080/07347332.2012.761323] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Chmielowska K, Tomaszewski KA, Pogrzebielski A, Brandberg Y, Romanowska-Dixon B. Translation and validation of the Polish version of the EORTC QLQ-OPT30 module for the assessment of health-related quality of life in patients with uveal melanoma. Eur J Cancer Care (Engl) 2012; 22:88-96. [PMID: 22966840 DOI: 10.1111/ecc.12001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The purpose of this study was to translate into Polish and validate the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Ophthalmic Module (QLQ-OPT30). The QLQ-OPT30 was translated and pilot-tested according to EORTC guidelines. Patients were qualified based on the histological or ophthalmoscopic and ultrasonographic diagnosis of uveal melanoma. Each patient filled out the Polish version of the EORTC Quality of Life Questionnaire (EORTC QLQ-C30), the QLQ-OPT30 module and a personal questionnaire. Patients were divided into three groups according to treatment type, melanoma localisation and possible negative outcomes of the disease or treatment. Reliability and validity test were performed and patients' comments were analysed. Our study included 94 patients--50 women (53.2%) and 44 men (46.8%) in the mean age of 58.4 (±13) years. Treatment type and melanoma location did not influence the health-related quality of life. The QLQ-OPT30, apart from two scales, showed positive internal consistency (Cronbach's alpha coefficients range: 0.70-0.88). We found the Polish version of the EORTC QLQ-OPT30 module a useful tool for measuring health-related quality of life in uveal melanoma patients. Although its discriminative validity is somewhat limited it still can be recommended for clinical use in the Polish population.
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Affiliation(s)
- K Chmielowska
- Department of Ophthalmology and Ocular Oncology, Jagiellonian University Medical College, Krakow, Poland.
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Abstract
OBJECTIVE This review summarizes reporting of complications of esophageal cancer surgery. BACKGROUND Accurate assessment of morbidity and mortality after surgery for cancer is essential to compare centers, allow data synthesis, and inform clinical decision-making. A lack of defined standards may distort clinically relevant treatment effects. METHODS Systematic literature searches identified articles published between 2005 and 2009 reporting morbidity and mortality after esophagectomy for cancer. Data were analyzed for frequency of complication reporting and to check whether outcomes were defined and classified for severity and whether a validated system for grading complications was used. Information about reporting outcomes adjusting for baseline risk factors was collated, and a descriptive summary of the results of included outcomes was undertaken. RESULTS Of 3458 abstracts, 224 full papers were reviewed and 122 were included (17 randomized trials and 105 observational studies), reporting outcomes of 57,299 esophagectomies. No single complication was reported in all papers, and 60 (60.6%) did not define any of the measured complications. Anastomotic leak was the most commonly reported morbidity, assessed in 80 (80.1%) articles, defined in 28 (28.3%), but 22 different descriptions were used. Five papers (5.1%) categorized morbidity with a validated grading system. One hundred fifteen papers reported postoperative mortality rates, 25 defining the term using 10 different definitions. In-hospital mortality was the most commonly used term for postoperative death, with 6 different interpretations of this phrase. Eighteen papers adjusted outcomes for baseline risk factors and 60 presented baseline measures of comorbidity. CONCLUSIONS Outcome reporting after esophageal cancer surgery is heterogeneous and inconsistent, and it lacks methodological rigor. A consensus approach to reporting clinical outcomes should be considered, and at the minimum it is recommended that a "core outcome set" is defined and used in all studies reporting outcomes of esophageal cancer surgery. This will allow meaningful cross study comparisons and analyses to evaluate surgery.
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van der Schaaf M, Derogar M, Lagergren P. Reference values of oesophago-gastric symptoms (EORTC QLQ-OG25) in a population-based setting. Eur J Cancer 2012; 48:1602-7. [DOI: 10.1016/j.ejca.2011.10.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 07/14/2011] [Accepted: 10/24/2011] [Indexed: 01/26/2023]
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Dorcaratto D, Grande L, Ramón JM, Pera M. [Quality of life of patients with cancer of the oesophagus and stomach]. Cir Esp 2011; 89:635-44. [PMID: 21907976 DOI: 10.1016/j.ciresp.2011.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 06/27/2011] [Indexed: 12/17/2022]
Abstract
The study of the health related quality of life in patients with digestive tract cancer, and particularly in those with tumours of the oesophagus and stomach, provides useful information for selecting the most suitable therapeutic option. It may also be used to predict the impact of the disease and its possible treatments on the physical, emotional and social condition of the patient. Various sensitive and reliable tools have been developed over the past decades that are capable of measuring the quality of life of patients; the use of questionnaires has made it easier to exchange information between the patient and the doctor. The pre- and post-operative variations in the quality of life in patients with oesophageal-gastric cancer are of prognostic value on the outcome of the disease. For all these reasons, the health related quality of life is currently considered, along with disease free survival and absence of recurrences, one of the most important parameters in order to assess the impact on the patients of a particular oncological treatment. The aim of this article is to review the role of the health related quality of life assessment, as well as the various tools which are available to measure it in patients with oesophageal-gastric cancer.
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Affiliation(s)
- Dimitri Dorcaratto
- Sección de Cirugía Gastrointestinal, Servicio de Cirugía General y Digestiva, Hospital Universitario del Mar, Institut de Recerca IMIM-Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Nakamura M, Hosoya Y, Umeshita K, Yano M, Doki Y, Miyashiro I, Dannoue H, Mori M, Kishi K, Lefor AT. Postoperative quality of life: development and validation of the "Dysfunction After Upper Gastrointestinal Surgery" scoring system. J Am Coll Surg 2011; 213:508-14. [PMID: 21862356 DOI: 10.1016/j.jamcollsurg.2011.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 07/11/2011] [Accepted: 07/11/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although postoperative quality of life is an important outcomes measure, few tools exist to evaluate patients specifically after upper gastrointestinal surgery. The previously developed Dysfunction After Upper Gastrointestinal Surgery (DAUGS)32 scoring system has been further refined to include just 20 items. This study was undertaken to validate the refined evaluation tool. STUDY DESIGN The study was performed as a survey, administered to patients after upper gastrointestinal resection at 3 separate institutions. RESULTS The DAUGS20 score after gastrectomy (n = 662) was 27.8 and that after esophagectomy (n = 221) was 36.1, showing a significant difference (p < 0.05). The score after distal gastrectomy (n = 282) was 25.4 and that after total gastrectomy (n = 149) was 32.0, showing a significant (p < 0.05) difference. The α coefficient of all items on the DAUGS20 system was 0.904 and Cronbach's α coefficients of the subscales were 0.612 to 0.856, demonstrating high reliability of this evaluation tool. In addition, 7 factors were extracted from the 20 items using definitive factor analysis, to verify validity. CONCLUSIONS Patient quality of life should be evaluated as an outcomes measure after surgical resection for cancer, just as overall survival is analyzed. The DAUGS20 score is reliable, has validity in the evaluation of postoperative patients, and is a valuable tool to assess patient quality of life after upper gastrointestinal surgery for cancer.
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Affiliation(s)
- Misuzu Nakamura
- Department of Nursing, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Oñate-Ocaña LF, Velázquez-Monroy N, Vázquez L, Espinosa-Mireles-de-Villafranca P, Núñez-Rosas E, Ovando-Lezama M, Vilar-Compte D, García-Hubard G, Carrillo JF, Blazeby JM, Aiello-Crocifoglio V. Clinical validation of the EORTC QLQ-OG25 questionnaire for the evaluation of health-related quality of life in Mexican patients with esophagogastric cancers. Psychooncology 2011; 21:745-53. [DOI: 10.1002/pon.1974] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 03/12/2011] [Indexed: 11/12/2022]
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Garland SN, Pelletier G, Lawe A, Biagioni BJ, Easaw J, Eliasziw M, Cella D, Bathe OF. Prospective evaluation of the reliability, validity, and minimally important difference of the functional assessment of cancer therapy-gastric (FACT-Ga) quality-of-life instrument. Cancer 2010; 117:1302-12. [DOI: 10.1002/cncr.25556] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 06/22/2010] [Accepted: 06/29/2010] [Indexed: 12/12/2022]
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Chie WC, Tsai CJ, Chiang C, Lee YC. Quality of life of patients with oesophageal cancer in Taiwan: validation and application of the Taiwan Chinese (Mandarin) version of the EORTC QLQ-OES18: a brief communication. Qual Life Res 2010; 19:1127-31. [PMID: 20495876 DOI: 10.1007/s11136-010-9675-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2010] [Indexed: 01/04/2023]
Abstract
PURPOSE The aim of this study was to examine the reliability and validity, and the application of the Taiwan Chinese Version of the EORTC QLQ-OES18. METHODS The authors translated the questionnaire according to the guideline of the EORTC. Ninety-five patients with oesophageal cancer in National Taiwan University Hospital were interviewed using the questionnaire and the EORTC QLQ-C30 between October 2002 and September 2007. Answer distribution and psychometric properties of the EORTC QLQ-OES18 were examined. RESULTS The mean age of the patients was 60 years (SD 12 years). Most of the patients were in advanced stages of disease, with two-thirds off-treatment. The Cronbach's alpha coefficients were satisfactory (0.77-0.82) or near-satisfactory (pain: 0.67). The item-to-own and item-to-other scale correlations showed satisfactory results. Patients who were on-treatment versus off-treatment had significantly poorer quality of life scores in dysphagia, dry mouth, and taste, and a borderline poorer score in cough. Opposite situations were seen in the scales of reflux and choking. CONCLUSIONS The EORTC QLQ-OES18 is a valid instrument to assess quality of life issues in patients with oesophageal cancer in Taiwan.
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Affiliation(s)
- Wei-Chu Chie
- Department of Public Health, Graduate Institute of Preventive Medicine, College of Public Health, National Taiwan University, Room 520, 17 Xuzhou Road, Taipei, 10055 Taiwan, ROC.
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