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10.1245/s10434-008-0042-8
Annals of Surgical Oncology 15:2372-2379 (2008)
© 2008 Society of Surgical Oncology
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Original Article

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

R. Parameswaran, MRCS1,2, A. McNair, MRCS2,3,4, K. N. L. Avery, PhD2, R. G. Berrisford, FRCS (Th)1, S. A. Wajed, MCRir, FRCS1, M. A. G. Sprangers, PhD5 and J. M. Blazeby, MD, FRCS2,3,4

1 Department of Thoracic and Upper GI Surgery, The Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK
2 Department of Social Medicine, University of Bristol, Bristol, UK
3 Clinical Sciences at South Bristol, University of Bristol, Bristol, UK
4 Division of Surgery, Head and Neck, United Bristol Healthcare Trust, Bristol, UK
5 Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

Correspondence: Address correspondence and reprint requests to: R. Parameswaran, MRCS; E-mail: drrajeev_p{at}yahoo.com

Background: Esophagectomy for cancer offers a chance of cure but is associated with morbidity, at least a temporary reduction in health-related quality of life (HRQL), and a 5-year survival of approximately 30%. This research evaluated how and whether HRQL outcomes contribute to surgical decision making.

Methods: A systematic review identified randomized trials and longitudinal and cross-sectional studies that assessed HRQL after esophagectomy with multidimensional validated questionnaires. Articles were independently evaluated by two reviewers, and the value of HRQL in clinical decision making was categorized in three ways: (1) the assessment of the quality of HRQL methodology according to predefined criteria; (2) the influence of HRQL outcomes on treatment recommendations and/or informed consent; and (3) the HRQL after esophagectomy for cancer in methodologically robust studies.

Results: Eighteen publications were identified, of which 16 (89%) were categorized as having robust HRQL design. Of these studies, 3 concluded that HRQL influenced treatment recommendations and 11 (including the former 3) informed patient consent. The remaining five papers were well designed, but the authors did not use HRQL to influence treatment recommendations or informed consent. After esophagectomy, patients report major deterioration in most aspects of HRQL with slow recovery.

Conclusion: HRQL outcomes are relevant to surgical decision making. Methods to communicate HRQL outcomes to patients are required to inform consent and clinical practice.

Key Words: Esophagectomy • Esophageal cancer • Systematic review • Health-related quality of life • Questionnaire






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Copyright © 2008 by the Society of Surgical Oncology.