Quality of life is an important factor in the balance sheet indicator in patients with pancreatic cancer
Multicenter prospective study

Czech version

Authors: M. Ryska ¹; L. Dušek ²; Radek Pohnán ¹; B. Bunganič ³; L. Bieberová ¹; O. Ryska ¹; M. Loveček ⁴; B. Jon ⁵; K. Ruppert ⁶; M. Krejčí ⁷; J. Jarkovský ²
Authors‘ workplace: Chirurgická klinika 2. LF UK a ÚVN Praha ¹; Institut biostatistiky a analýz MU, Brno ²; Interní klinika 1. LF UK a ÚVN Praha ³; Chirurgická klinika LF UP, Olomouc ⁴; Chirurgická klinika LF UK, Hradec Králové ⁵; Chirurgická klinika LF UK, Plzeň ⁶; Chirurgická klinika 2. LF UK v Praze ⁷
Published in: Gastroent Hepatol 2012; 66(4): 303-310
Category: Gastrointestinal Oncology: Original Article

Overview

Introduction:
The aim of this study is to present the evaluation results of a prospective multicenter study of quality of life (QoL) in the treatment of patients with ductal adenocarcinoma of the pancreas.

Patients and methods:
151 patients with morphologically proven pancreatic ductal adenocarcinoma were treated according to the staging of the tumour. To monitor QoL, we used a generic questionnaire SF-36/2 in the Czech version before treatment and 3 months thereafter. The arithmetic mean and standard deviation (SD) were used as summary statistics for the QoL scores. The results were calculated using SF-36 software, independent samples t-test, ANOVA, paired t-test and SPSS 19.0.1 (IBM Corporation, 2010). A p value < 0.05 was considered statistically significant in all the tests.

Results:
The initial total value of QoL is significantly lower in women than men (QoL: 50.3 ± 18.0 vs. 58.3 ± 20.8; p = 0.013). Reduction in QoL after 3 months was significantly lower in men. In patients older than 60, we found a significant decrease in QoL after 3 months of starting treatment compared with younger ones (QoL: 54.7 ± 21.0 vs. 47.8 ± 18.9, difference -6.9 ± 18.5; p = 0.009). We found a significant decrease in QoL during treatment for patients in stage III and IV (p = 0.003). In patients indicated for BDA (with/without GEA), QoL was significantly higher than in patients indicated for endoscopic stent placement (QoL: 54.9 ± 18.8 vs. 30.0 ± 7.1; p < 0.001). In all patients, except for the stent group, we observed after 3 months a significant reduction in QoL. Low baseline QoL in patients in whom exploration was performed was not significantly different from the value of QoL after 3 months. Bleeding, abdominal abscess, biliary or pancreatic fistula or the presence of early infection did not result in significant impairment of QoL after 3 months of treatment. CHMT was carried out in 59 patients with a higher baseline of overall QoL scores and led to an insignificant improvement in QoL.

Conclusion:
Based on prospective monitoring of quality of life using the SF 36/2, the authors reported a significant reduction in QoL in men 3 months after treatment. Three months after treatment QoL significantly reduces in patients in stage III and IV. In patients after radical resection, BDA or exploration, QoL is significantly reduced after surgery, while it is not after endoscopic stent placement. Complications in the early period after surgery do not lead to significant reductions in QoL 3 in comparison with patients without complications. Chemotherapy does not reduce QoL. The study results may significantly affect the indicator review to establish the optimal treatment for patients with pancreatic cancer within a multidisciplinary team.

Key words:
pancreatic cancer – radical resection – palliative procedures – quality of life

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Sources

1. Sharma C, Eltawil KM, Renfrew PD et al. Advances in diagnosis, treatment and palliation of pancreatic carcinoma: 1990–2010. World J Gastroenterol 2011; 17(7): 867–897.

2. Slováček L, Slováčková B, Jebavý L et al. Kvalita života nemocných – jeden z nejdůležitějších parametrů komplexního hodnocení léčby. Vojenské zdravotnické listy 2004; 73: 6–9.

3. Klinický standard pro diagnostiku a léčbu pacientů se zhoubným onemocněním pankreatu KKCCS0007. Národní sada standardů NRC, 2011, www.chirurgie.cz.

4. Ryska M. Radikalita resekčniho výkonu u nemocných s karcinomem pankreatu z pohledu prodlouženi života a jeho kvality. Rozhl Chir 2010; 89(12): 725–730.

5. Zásady cytostatické léčby maligních onkologických onemocnění. Masarykův onkologický ústav, Brno, www.mou.cz.

6. Ware JE, Snow KK, Kosinski M et al. SF-36® Health Survey Manual and Interpretation Guide. Boston, MA: New England Medical Center, The Health Institute, 1993.

7. Ware JE, Kosinski M. SF-36 Physical and Mental Health Summary Scales: A Manual for Users of Version 1, Second Edition. Lincoln, RI: QualityMetric Incorporated, 2001.

8. Ferlay J, Shin HR, Bray F et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010; 127(12): 2893–2917.

9. Geryk E, Dítě P, Trna J et al. Zátěž nádory pankreatu u české populace. Onkologie 2010; 4: 322–325.

10. Dušek L, Duda M, Ryska M et al. Surgical oncology. In: Czech cancer in numbers 2008–2009. Praha: Grada 2009.

11. Smeenk TG, Tran TC, Erdmann J et al. Survival after surgical management of pancreatic adenocarcinoma: does curative and radical surgery truly exist? Langenbecks Arch Surg 2005; 390(2): 94–103.

12. Neoptolemos JP, Stocken DD, Bassi C et al. Adjuvant chemotherapy with Fluorouracil plus Folinic Acid vs Gemcitabine following pancreatic cancer resection. A randomized controlled trial. JAMA 2010; 304(10): 1073–1081.

13. Hilbig A, Oettl H. Adjuvant therapy of pancreatic cancer. Expert Review of Anticancer Therapy 2010; 10(4): 485–491.

14. Walter J, Nier A, Rose T et al. Palliative partial pancreaticoduodenectomy impairs quality of life compared to bypass surgery in patients with advanced adenocarcinoma of the pancreatic head. Eur J Surg Oncol 2011; 37(9): 798–804.

15. Espat NJ, Brennan MF, Conlon KC. Patients with laparoscopically staged unresectable pancreatic adenocarcinoma do not require subsequent surgical biliary or gastric bypass. J Am Coll Surg 1999; 188(6): 649–655.

16. Gupta D, Lis CG, Grutsch JF. The European organization for research and treatment of cancer quality of life questionnaire: implications for prognosis in pancreatic cancer. Int J Gastrointest Cancer 2006; 37(2–3): 65–73.

17. Nieveen van Dijkum EJM, Kuhlmann KFD, Terwee CB et al. Quality of life after curative or palliative surgical treatment of pancreatic and periampullary carcinoma. Br J Surg 2005; 92(4): 471–477.

18. Schniewind B, Bestmann B, Henne--Bruns D et al. Quality of life after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head. Br J Surg 2006; 93(9): 1099–1107.

19. Fitzmaurice C, Seiler CM, Büchler MW et al. Survival, mortality and quality of life after pylorus-preserving or classical Whipple operation. A systematic review with meta-analysis. Chirurg 2010; 81(5): 454–471.

20. Schniewind B, Bestmann B, Kurdow R et al. Bypass surgery versus paliative pancreaticoduodenectomy in patiens with advanced ductal adenocarcinoma of the pancreatic head, with an emphasis on quality of life analyses. Ann Surg Oncol 2006; 13(11): 1403–1411.

21. Walter J, Nier A, Rose T et al. Palliative partial pancreaticoduodenectomy impairs quality of life compared to bypass surgery in patients with advanced adenocarcinoma of the pancreatic head. Eur J Surg Oncol 2011; 37(9): 798–804.

22. Bonnetain F, Dahan L, Maillard E et al. Time until definitive quality of life score deterioration as a means of longitudinal analysis for treatment trials in patients with metastatic pancreatic adenocarcinoma. Eur J Cancer 2010; 46(15): 2753–2762.

23. Kalová H, Petr P, Soukupová A et al. Kvalita života u chronických onemocnění ve světle novějších modelů zdraví a nemoci. Klin Farmakol Farm 2005; 19: 165–168.

24. Jenkinson C, Stewart-Brown S, Petersen S et al. Assessment of the SF-36 version 2 in the United Kingdom. J Epidemiol Community Health 1999; 53(1): 46–50.