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Pre-Diagnosis Impairment in Activities of Daily Living Predicts Worse Overall Survival in Pancreatic Adenocarcinoma
Clancy J. Clark*1, Pradeep Yarra3, Nora Fitzgerald2, Rishi Pawa3
1General Surgery, Wake Forest Baptist Health, Winston Salem, NC; 2Public Health Sciences, Wake Forest Baptist Health, Winston Salem, NC; 3Gastroenterology, Wake Forest Baptist Health, Winston Salem, NC
Background: Pancreatic ductal adenocarcinoma (PDAC) is a cancer of the elderly with a 5-year overall survival (OS) of only 6.7 %. Poor functional status, such as the inability to perform activities of daily living (ADLs), typically limits treatment options due to the high morbidity associated with current therapies. While impairment in ADLs is frequently attributed to the burden of the cancer, we have limited understanding of how the impairment in ADLs prior to diagnosis impacts cancer survivorship. The aim of the current study is to evaluate the effect of pre-diagnosis ADLs on OS for patients with PDAC.
Methods: The 1998-2011 Surveillance, Epidemiology and End Results-Health Outcomes Survey linked database (SEER-MHOS) was queried for patients with histologically confirmed PDAC who reported their ability to perform ADLs within 24 months prior to diagnosis. Patients with any impairment in ADLs were compared with patients who reported no ADL impairment. Overall survival was evaluated using Kaplan-Meier and Cox proportional hazard regression.
Results: 377 patients (median age 77, 53.6% male) with PDAC were identified with 41% (n=155) reporting impairment in ADLs. Median time of reporting ADLs was 11.4 (IQR 12.5) months prior to PDAC diagnosis. The majority of patients presented with metastatic disease (50.7%, n=188) and only 15% (n=60) underwent pancreatic resection. No long-term survivors were identified in the study cohort. Median OS was 4.5 months (IQR 7.5). OS for patients with any impairment in ADLs prior to diagnosis was significantly worse than patients reporting no ADL impairment, 3.4 months vs. 5.5 months, respectively (log-rank p=0.012). After adjusting for patient age, stage at diagnosis, and resection, any impairment in ADLs within the 24 months prior to diagnosis was an independent predictor of OS for pancreatic cancer patients (HR 1.3, 95% CI 1.1-1.6, p=0.013).
Conclusions: Impairment in ADLs is common among patients with PDAC and is associated with significantly worsen overall survival. Adjunctive interventions focused on addressing ADL impairments may broaden treatment options and thus improve clinical outcomes.
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