title: Meta-analysis shows clinically relevant and long-lasting deterioration in health-related quality of life after esophageal cancer surgery.
abstract: OBJECTIVE
  The purpose of the study is to (1) estimate the direction, clinical relevance, and duration of health-related quality-of-life (HRQL) change in the first year following esophageal cancer surgery and (2) to assess the robustness of the estimates by subgroup and sensitivity analyses, and an exploration of publication bias.
  
  
  METHODS
  A systematic literature search in MEDLINE, EMBASE, CINAHL, PsychINFO, and CENTRAL to identify randomized and non-randomized studies was performed. We compared the baseline HRQL data with 3-, 6-, 9-, or 12-month follow-ups to estimate the magnitude and duration of HRQL change. These estimates were then classified as trivial, small, medium, or large. Primary outcomes were role functioning, eating, and fatigue. Secondary outcomes were physical and social functioning, dysphagia, pain, and coughing problems. We conducted subgroup analysis for open surgery, open surgery preceded by neoadjuvant therapy, and minimally invasive surgery. Sensitivity analyses assessed the influence of study design, transformation/imputation of the data, and HRQL questionnaire used.
  
  
  RESULTS
  We included the data from 15 studies to estimate the change in 28 HRQL outcomes after esophageal cancer surgery. The main analysis showed that patients' social functioning deteriorated. Symptoms of fatigue, pain, and coughing problems increased. These changes lasted for 9-12 months, although some symptoms persisted beyond the first year after surgery. For many other HRQL outcomes, estimates were only robust after subgroup or sensitivity analyses (e.g., role and physical functioning), or remained too heterogeneous to interpret (e.g., eating and dysphagia).
  
  
  CONCLUSIONS
  Patients will experience a clinically relevant and long-lasting deterioration in HRQL after esophageal cancer surgery. However, for many HRQL outcomes, more and better quality evidence is needed.
authors.affiliation: Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Meibergdreef 5, PO Box 22660, 1100 DD, Amsterdam, The Netherlands, m.jacobs@amc.uva.nl.
authors.forename: M
authors.initials: M
authors.lastname: Jacobs
authors.forename: R C
authors.initials: RC
authors.lastname: Macefield
authors.forename: R G
authors.initials: RG
authors.lastname: Elbers
authors.forename: K
authors.initials: K
authors.lastname: Sitnikova
authors.forename: I J
authors.initials: IJ
authors.lastname: Korfage
authors.forename: E M A
authors.initials: EM
authors.lastname: Smets
authors.forename: I
authors.initials: I
authors.lastname: Henselmans
authors.forename: M I
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.forename: J C J M
authors.initials: JC
authors.lastname: de Haes
authors.forename: J M
authors.initials: JM
authors.lastname: Blazeby
authors.forename: M A G
authors.initials: MA
authors.lastname: Sprangers
mesh_terms: D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000523:psychology* / Q000601:surgery*; D016629:Esophagectomy; D005221:Fatigue / Q000209:etiology / Q000523:psychology; D006304:Health Status; D006801:Humans; D063868:Patient Outcome Assessment; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D013997:Time Factors