Gastric Cancer in the World

1. Authors: Turma 14Supervisors: Mário Dinis RibeiroCláudia Camila Dias Professor Doutor Altamiro da Costa PereiraFMUP/SBIM Assessment of Quality Of Life in patients treated with Chemo and Radiotherapy for Gastric Cancer: A Systematic Review

2. Gastric Cancer in the World 35 31 30 25 20 16 14 15 13 10 10 9 10 8 8 8 8 6 4 4 4 5 4 3 3 3 2 1 1 1 0 0 0 0 0 0 NHL Skin CCR Liver Stomach Lung Ovary Uterus Breast Thyroid Prostate Pancreas Leukemia Oesophagus Men Women 850 000 deaths worlwide each year cause due to gastric cancer Eucan - Database World, age-standardized rates (per 100.000 persons.year) FMUP/SBIM

3. Gastric Cancer in Europe Cumulative risk, 0-64 years Male Female Eucan - Database FMUP/SBIM

4. Introduction QoL after Chemo/Radiotherapy in Gastric Cancer • Stomach adenocarcinoma is the most common form of gastric cancer (95% of the cases).1 • Stomach cancer is a multifactorial disease:diet, hereditary factors, Helicobacter pylori infection are possible causes.2-3 • Tobacco smoking has also been clearly accepted as increasing the risk of stomach cancer.4 1- Crew KD, Neugut AI. Epidemiology of upper gastrointestinal malignancies. Seminin Oncol 2004; 31: 450–464. 2- World Cancer Research Fund (WCRF) Panel. Diet, nutrition and the prevention of cancer: a global perspective. Washington, DC, USA: World Cancer Research Fund; 1997. 3- IARC Monograph on the Evaluation of Carcinogenic Risks to Humans, Vol. 61. Schistosomes, Liver Flukes and helicobacter pylori. Lyon, France: International Agency for Research on Cancer; 1994. 4- IARC Monographs on the Evaluation of Carcinogenic Risk to Humans. Vol. 83: Tobacco Smoke and Involuntary Smoking. Lyon, France: International Agency for Research on Cancer; 2004.

5. Introduction QoL after Chemo/Radiotherapy in Gastric Cancer • Treatment for gastric cancer often involves surgery, usually a partial or a total gastrectomy (removal of stomach tissue).5 • Chemotherapy and radiotherapy are standard for some stages of stomach cancer.5 5-Ross P, Nicolson M, Cunningham D, Valle J, et al. Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) with epirubicin, cisplatin and PVI 5-FU in advanced esophagogastric cancer. Journal of Clinical Oncology, Vol. 20, Issue 8 (April), 2002.

6. Introduction QoL after Chemo/Radiotherapy in Gastric Cancer • Chemotherapy is the use of chemical agents to stop cancer cells from growing.6 • Chemotherapy is considered a systemic treatment.6 6-Janunger KG, Hafström L, Nygren P, Glimelius B for teha SBU-group. A Systematic Overview of Chemotherapy Effects in Gastric Cancer. Acta Oncologica, Vol. 40, No. 2/3, pp. 309-326, 2001.

7. Introduction QoL after Chemo/Radiotherapy in Gastric Cancer • Radiotherapy uses high energy x-rays to destroy cancer cells.7 • A small dose of radiotherapy may be very helpful to relieve pain.7 7-Kim GE, Shin HS, MD, et al. The role of radiation treatment in management of extrahepatic biliary tract metastasis from gastric carcinoma. Int. J. Radiation Oncology Biol. Phys., Vol. 28, No. 3, pp.711-717, 1994.

8. Introduction QoL after Chemo/Radiotherapy in Gastric Cancer • These multiple treatments have different consequences in Quality of Life (QoL) in patients.8 • QoL cannot be yet universally defined8, however there are many attempts to do so. • Schipper et al. proposed: “the functional effect of illness and its consequent therapy upon a patient, as perceived by the patient”.9 8-Spilker B, ed. Quality of Life and pharmacoeconomics in clinical trials. Philadelphia:Lippincott-Raven, 1996. 9- Schipper H, Clinch J, Olweny LM. Definitions and conceptual issues. In: Spilker B, ed. Quality of Life and pharmacoeconomics in clinical trials, Philadephia : Lippincott- Raven, 1996: 11-24

9. Aim QoL after Chemo/Radiotherapy in Gastric Cancer ____________________________________________ • To review which instruments were used to measure the QoL in patients with gastric cancer submitted to chemo and radiotherapy. • To summarize QoL measures across studies. ____________________________________________ FMUP/SBIM

10. Methods QoL after Chemo/Radiotherapy in Gastric Cancer • The Query used was: ◊ ″Gastric cancer AND (Quality of Life OR Psychology) AND (Radiotherapy OR Chemotherapy)” Literature searches were conducted in Medline. FMUP/SBIM

11. Limits QoL after Chemo/Radiotherapy in Gastric Cancer Publication Date until September 2005. Only items with an abstract. Humans. FMUP/SBIM

12. Methods QoL after Chemo/Radiotherapy in Gastric Cancer • Inclusion Criteria • More than one participant; • QoL evaluated by the patients; • Patients who had gastric cancer; • Patients submitted to chemo or radiotherapy; • QoL measured with an appropriate instrument. FMUP/SBIM

13. Methods QoL after Chemo/Radiotherapy in Gastric Cancer • Exclusion criteria • Articles based on mixed diagnostic groupings (in the article these have to be approached separately); • Articles in which QoL was measure but only symptoms were studied; • Articles that referred to patients submitted to a surgery during or before treatment. FMUP/SBIM

14. Methods QoL after Chemo/Radiotherapy in Gastric Cancer • Validation Papers • A second search was conducted, to discover if the instruments used in the included articles were valid. To find the validation papers we search the questionnaire title through Google. FMUP/SBIM

15. Fluxogram QoL after Chemo/Radiotherapy in Gastric Cancer

16. Results QoL after Chemo/Radiotherapy in Gastric Cancer • 116 articles were found; • Due to the application of the inclusion and exclusion criteria, 10 were included and 76 were excluded; • Some of the articles found couldn’t be read and so we don’t have information referred to them; • Only 1 of the included articles didn’t have a validated paper of the instrument. FMUP/SBIM

17. Results QoL after Chemo/Radiotherapy in Gastric Cancer

18. Results QoL after Chemo/Radiotherapy in Gastric Cancer FMUP/SBIM