title: Effective palliation and quality of life outcomes in studies of surgery for advanced, non-curative gastric cancer: a systematic review.
abstract: BACKGROUND
  Relief of symptoms should be the primary focus of palliative treatment as defined by the World Health Organization. Evaluating the effectiveness of palliative interventions should incorporate this goal and include quality of life (QOL) outcome assessments. A systematic review of the surgical gastric cancer literature was performed to summarize the effectiveness of palliative surgical interventions in addressing QOL.
  
  
  METHODS
  An electronic literature search of EMBASE, Medline, and the Cochrane Database of Controlled Trials was performed from January 1, 1985 to December 1, 2009. English language abstracts and articles were reviewed independently by two reviewers. A systematic approach to data abstraction and presentation was followed.
  
  
  RESULTS
  No articles were identified as reporting true QOL outcomes using reliable, validated QOL instruments in surgically managed, advanced gastric cancer patients. Nine articles were identified as reporting outcomes measuring effectiveness of palliation. Commonly reported pre-procedure symptoms were weight loss, abdominal pain, vomiting, obstruction, and bleeding. Time to oral intake was reported in 5 of 9 studies, ranging from a mean of 2.9 days (laparoscopic gastrojejunostomy) to 8 days (surgical bypass). Length of postoperative inpatient stay ranged from a mean of 7 days (gastrojejunostomy) to 28 days (surgical bypass). Other measures of effective palliation included measures of clinical success, hospital re-admission rates, and post-procedure analgesic intake.
  
  
  CONCLUSIONS
  A paucity of literature exists regarding the QOL of surgically managed gastric cancer patients. Prospectively designed studies using credible QOL measures are necessary to better inform the treatment decision-making process for these patients.
authors: Department of Community Health and Epidemiology, Queen's University, Kingston, Canada.
authors: Alyson L
authors: AL
authors: Mahar
authors: Natalie G
authors: NG
authors: Coburn
authors: Paul J
authors: PJ
authors: Karanicolas
authors: Raymond
authors: R
authors: Viola
authors: Lucy K
authors: LK
authors: Helyer
mesh_terms: D003657:Decision Making; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors