Abstracts
1997 Digestive Disease Week

Quality of life analysis after pancreatic cancer treatments.

ER Kokoska, TP Wade, DR Stapleton, FE Johnson. St. Louis (MO) University and Scott US Air Force Base Medical Centers.

Although resection for pancreatic cancer is occasionally curative, its major value lies in restoring a more normal life and activity to patients with malignant jaundice. However, no multi-institutional study has assessed QoL after the application of available treatments for pancreatic cancer. We reviewed 822 patients (pts) with pancreatic cancer treated from 1989-1995 in Department of Defense (DoD) hospitals and listed in their central computer tumor registry. Local tumor registrars contacted patients at least yearly and compiled a QoL index using a self-reported Karnofsky's Performance Status (KPS) [20=hospitalized, 40=special care, 60-occasional care, 80=some limitations, 100=normal]. KPS values were obtained for patients alive in March of 1995 or 1996. Survival and KPS scores were then compared by stage and treatment using ANOVA (F test, *p<0.05 vs pts not undergoing treatment).

                       Stage I-II               Stage III
                 resected     unresected    resected      unresected
 Number pts         82           162           59             119
 Survival (mos)   22.2±2.1*    8.5± 0.8    15.8 ± 2.0*      6.6± 0.7
 KPS             86.4 ± 4*     59 ± 6        77 ± 6         82 ± 3
 unresected patients only:
               chemo&XRT     no adjuvant    chemo&XRT      no adjuvant
 Number pts         23           102            13             88
 Survival (mos)   11.5±1.6     8.2 ± 1.1    13.4 ± 2.8*     5.7 ± 0.8
 KPS               70 ± 12*     43 ± 9        83 ± 4         81 ± 5

Resection significantly increased QoL and survival for Stage I-II cancer. However, resection significantly improved neither QoL indices nor mean survival when compared to combined chemo- and radiation therapy in node+ (Stage III) disease. Projected 5-year survival rate after resection was 28% in Stages I-II, but less than 10% for Stage III. Both QoL measures and mean survival support pancreatic resection for localized cancers, but not when lymph nodes are involved.