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Quality-of-Life in Pancreatic Cancer: Analysis of Stage and Treatment
Stefano Crippa*, Ismael DomíNguez, J. Ruben Rodriguez, Oswaldo a. Razo, Sarah P. Thayer, Andrew L. Warshaw, Carlos Fernandezdelcastillo
Department of Surgery, Massachusetts General Hospital, Boston, MA


Objective: Considering the limited treatment options in pancreatic cancer, health-related quality of life (QOL) could play an important role in the decision-making work-up. The gain in survival and palliation of symptoms should be balanced against social and functional impairment. In pancreatic cancer, most of QOL studies have been performed in resected patients.The aim of this work was to compare QOL in patients with different stages of pancreatic adenocarcinoma who underwent surgical and/or medical interventions. We also evaluated differing treatments, readmissions, need for endoscopic palliation and survival as secondary endpoints.
Methods: A prospective single-center study comprising 94 patients (48 female, 46 male, mean age of 66 years, range: 42-89) with pathologically proven ductal adenocarcinoma of the pancreas was performed over a 2-year period. Patients were evaluated with the Functional Assessment of Cancer Therapy-Hepatobiliary (Fact-Hep) questionnaire at diagnosis, 3 and 6 months.
Results: At diagnosis, 31 patients (32.9%) had localized disease (Group 1); 34 (36.1%) were locally advanced (Group 2); and 29 (30.8%) had metastatic disease (Group 3). There were no differences regarding age or gender between groups. Psychiatric comorbidity (depression/anxiety) was present in 16% of patients before cancer diagnosis. No significant difference in QOL was found between the three groups as a whole. Within group 1 QOL was better among those who underwent resection without adjuvant chemo/chemoradiation than in those treated (p=0.019). Additionally, higher QOL scores were found in the resected group when compared to patients who did not undergo resection (p=0.04). No QOL differences were found regarding age, gender, and CA19-9 levels.In Groups 2 and 3, endoscopic palliation of biliary obstruction was needed in 21 patients. Thirteen patients required one biliary stent, and eight required two or more. There were no differences in QOL between these two groups.Twenty-eight patients underwent resection with an average length of stay of 7.4 days. The number of admissions was similar in the resected vs non resected patients (median 1.5 vs. 1) but hospitalization was greater in the surgical group (median 12 vs 7; p=0.001).After a mean follow up of 8.3 months (range: 1-21), 64.5% of Group 1 patients, 23.5% of Group 2, and 7% of Group 3 were alive (p=0.0001).
Conclusions: Unexpectedly, pancreatic cancer stage had no overall significant impact on QOL. QOL was better in patients who underwent resection, but chemoradiation diminished QOL, a fact that needs to be balanced against its survival and palliation benefits.


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