ABSTRACT
BACKGROUND: Esophageal and gastric cancers are a significant public health problem worldwide, with most patients presenting with advanced-stage disease and, consequently, poor prognosis. Systemic oncological treatments (SOT) have been widely used over more conservative approaches, such as supportive care. Nevertheless, its effectiveness in this scenario is not sufficiently clear. This paper provides an overview of systematic reviews that assessed the effectiveness of SOT compared with the best supportive care (BSC) or placebo in patients with advanced esophageal or gastric cancers in an end-of-life context. METHODS: We searched MEDLINE, EMBASE, The Cochrane Library, Epistemonikos, and PROSPERO for eligible systematic reviews (SRs) published from 2008 onwards. The primary outcomes were overall survival (OS), progression-free survival (PFS), functional status, and toxicity. Two authors assessed eligibility and extracted data independently. We evaluated the methodological quality of included SRs using the AMSTAR-2 tool and the overlap of primary studies (corrected covered area, CCA). Also, we performed a de novo meta-analysis with data reported for each primary study when it was possible. We assessed the certainty of evidence using the GRADE approach. RESULTS: We identified 16 SRs (19 included trials) for inclusion within this overview. Most reviews had a critically low methodological quality, and there was a very high overlap of primary studies. It is uncertain whether SOT improves OS and PFS over more conservative approaches due to the very low certainty of evidence. CONCLUSIONS: The evidence is very uncertain about the effectiveness of SOT for advanced esophageal or gastric cancers. High-quality SRs and further randomized clinical trials that include a thorough assessment of patient-centered outcomes are needed. TRIAL REGISTRATION: Open Science Framework, https://doi.org/10.17605/OSF.IO/7CHX6 .
Subject(s)
Esophageal Neoplasms/mortality , Immunotherapy/methods , Stomach Neoplasms/mortality , Humans , Survival Analysis , Systematic Reviews as Topic , Treatment OutcomeSubject(s)
Atrial Fibrillation/therapy , Cardiovascular Agents/therapeutic use , Renal Dialysis , Adrenergic beta-Antagonists/therapeutic use , Aged , Amiodarone/adverse effects , Amiodarone/therapeutic use , Atrial Fibrillation/drug therapy , Atrial Fibrillation/etiology , Bisoprolol/therapeutic use , Bradycardia/etiology , Calcium Channel Blockers/therapeutic use , Combined Modality Therapy , Digoxin/adverse effects , Digoxin/therapeutic use , Diltiazem/therapeutic use , Female , Humans , Hypothyroidism/chemically induced , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Myocardial Infarction/complications , Pacemaker, ArtificialABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Atrial Fibrillation/drug therapy , Renal Insufficiency, Chronic/complications , Renal Dialysis , Digoxin/administration & dosage , Pacemaker, ArtificialABSTRACT
No disponible