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Health Related Quality of Life Is Not Adversely Affected by Operation in Patients with Unresectable Pancreatic Adenocarcinoma
Thomas J. Howard, Ron M. Brooks, James A. Madura, Kathy A. McGreevy, Seth A. Moore, Jian Yu, Faouzi Azzouz, Thomas F. Imperiale, John M. DeWitt, Indiana University School of Medicine, Indianapolis, IN
Introduction: Health related quality of life (HRQOL) measurements quantify the impact of both the disease and its treatment on the physical, psychological, and social aspects of a patient. Pancreatic cancer is a malignancy in which quality of life is paramount due to its rapid progression and debilitating course. Surgery with complete resection improves overall survival, however many patients are found to be unresectable at the time of operation. For patients who undergo surgical treatment, the procedures can be both physically and psychologically disruptive. The impact of operation, both successful (complete resection) and palliative (incomplete resection) and their relationship to HRQOL in this disease is unknown. This study prospectively measured the HRQOL over time in a mixed cohort of 80 patients with pancreatic cancer, some of whom had surgery and others who did not.
Methods: Of 120 patients enrolled in an IRB sanctioned CT-EUS imaging study, 80 patients had pancreatic cancer: 27 (34%) patients were managed nonoperatively, 28 (35%) had operation but were found to be unresectable and underwent palliative bypasses, and 25 (31%) had operation and were resected. SF-12 questionnaires and symptom index were obtained at 1, 3, 6, 12, 18, 24, and 36 months from the time of diagnosis. Linear mixed effects (LME) models were used to test the impact of treatment groups and total number of symptoms at all waves for the SF-12. Kaplan-Meier estimator was used to estimate the survivor function. Results: HRQL, both the physical component summary (pcs) and mental component summary (mcs) subscales declined significantly (p < 0.0001) 1 month post-diagnosis in all three treatment groups. These values rebounded to baseline by three months (overall mean scores ranged from 39 to 52) and remained in this range without significant differences among groups during follow-up. Changes in the symptom index (total number of symptoms) paralleled these findings. Mean survival time in resected patients (21 months) was significantly longer (p<0.0001) than that of unresectable (12.5 months) or nonoperative (9.6 months) patients. Conclusions: HRQL in patients with pancreatic cancer is not adversely affected by surgery, whether or not the tumor is resected. When technically feasible, surgical resection resulted in significantly longer survival times. These data support surgical management for all potentially resectable patients with pancreatic cancer.
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