Title: Meta-analysis shows clinically relevant and long-lasting deterioration in health-related quality of life after esophageal cancer surgery.

Running head: HRQL after esophageal cancer

M. Jacobs1, R.C. Macefield2, R.G. Elbers3, K. Sitnikova1, I.J. Korfage4, E.M.A. Smets1, I.Henselmans1, M.I. van Berge Henegouwen5, J.C.J.M. de Haes1, J.M. Blazeby2,6, M.A.G. Sprangers1

1 Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
2 School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom

3 Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center/University of Amsterdam,

Amsterdam, The Netherlands

4 Department of Public Health, University Medical Center Rotterdam, Rotterdam, The Netherlands

5 Department of Surgery, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands

6 Division of Surgery Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom

Corresponding author at:

Marc Jacobs

Dept. Medical Psychology

Academic Medical Center, University of Amsterdam

Meibergdreef 5, 1100DD Amsterdam

PO Box 22660

Netherlands

Tel: +31-20-5668508, fax: +31-20-5669104

E-mail:

The duration of change for 28 HRQL outcomes after main analysis, and after subgroup analysis for open surgery, open surgery combined, and minimally invasive surgery.
HRQL outcome / Main analysis / Open surgery / Open surgery
combined / Minimally invasive
surgeryb
Primary outcomes
Role functioning / Unclear / Unclear / >12 monthsa / Unclear
Eating / Unclear / Unclear / Unclear / Unclear
Fatigue / >12 monthsa / >12 monthsa / 12 months / Unclear
Secondary outcomes
Physical functioning / Unclear / Unclear / >12 months / Unclear
Social functioning / 9 months / 9 months / >9 monthsb / Unclear
Dysphagia / Unclear / Unclear / Unclear / Unclear
Pain (QLQ-OES18) / Unclear / Unclear / Unclear / Unclear
Coughing problems / 12 months / Unclear / 12 months / Unclear
Other outcomes
Global Quality of Life / Unclear / 12 months / 9 months / Unclear
Emotional functioning / No change / Unclear / Improvement after 6 months / Unclear
Cognitive functioning / No change / Unclear / 12 months / Unclear
Nausea & Vomiting / Unclear / Unclear / Unclear / Unclear
Pain (QLQ-C30) / >12 monthsa / >12 monthsa / 12 months / Unclear
Dyspnoea / >12 monthsa / >12 monthsa / >12 monthsa / Unclear
Appetite Loss / Unclear / Unclear / Unclear / Unclear
Constipation / Unclear / Unclear / Unclear / Unclear
Diarrhea / Unclear / >12 monthsa / >12 monthsa / Unclear
Insomnia / No change / >12 monthsa / Improvement after 6 months / Unclear
Financial Difficulties / >9 monthsb / >12 monthsa / >9 monthsb / Unclear
Reflux / >12 monthsa / Unclear / >12 monthsa / Unclear
Trouble swallowing saliva / 12 monthsa / Unclear / 12 months / Unclear
Choking when swallowing / Unclear / Unclear / Unclear / Unclear
Dry mouth / 12 months / Unclear / 12 months / Unclear
Speech problems / No change / Unclear / No change / Unclear
Taste problems / Unclear / Unclear / 6 months / Unclear
Trouble talking / Unclear / Unclear / Unclear / Unclear
Deglutition / Unclear / Unclear / Unclear / Unclear
Fact-E / Unclear / Unclear / Unclear / Unclear

a We determined that the duration of HRQL change was longer than 12 months, because the estimate at 12 months showed a deterioration

b We determined that the duration of HRQL change lasted longer than 9 months if the estimate at 12 months follow-up was not 'sufficiently' homogenous.

c We were not able to determine the duration of HRQL change, because we could only obtain estimates for 3 and 6 months follow-up

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