Patient-Reported Quality of Life Before and After Chemoradiation for Intact Pancreas Cancer: A Prospective Registry Study |
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| Authors: | William G Breen Krishan R Jethwa Nathan Y Yu Grant M Spears William S Harmsen Robert C Miller Jonathan B Ashman William G Rule Terence T Sio Michelle A Neben-Wittich Michael G Haddock Amit Mahipal Mark J Truty Christopher L Hallemeier Kenneth W Merrell |
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| Institution: | 1. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota;2. Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut;3. Department of Radiation Oncology, Mayo Clinic, Phoenix/Scottsdale, Arizona;4. Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota;5. Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland;6. Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota;7. Department of Surgery, Mayo Clinic, Rochester, Minnesota;1. Department of Radiation Oncology, City of Hope Medical Center, Duarte, California;2. Department of Radiation Oncology, University of California San Diego, San Diego, California;3. Department of Radiation Oncology, Arizona Oncology, Tucson, Arizona;4. Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania;1. Department of Oncology, University of Torino, Torino, Italy;2. Medical Physics Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy;1. Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany;2. Institute of Pathology, University Medical Center Mainz, Mainz, Germany;3. Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany;4. Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany;5. Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany;1. Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Canada;2. Department of Oncology, Cross Cancer Institute, Edmonton, Canada;3. Department of Oncology, University of Calgary, Calgary, Alberta, Canada;1. Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;2. School of Information and Library Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;3. Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina |
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| Abstract: | PurposeOur purpose was to determine the effect of chemoradiotherapy (CRT) on patient-reported quality of life (QOL) for patients with intact pancreas cancer.Methods and MaterialsWe reviewed a prospective QOL registry for patients with intact, clinically localized pancreatic ductal adenocarcinoma treated with CRT between June 2015 and November 2018. QOL was assessed pre-CRT (immediately before CRT, after neoadjuvant chemotherapy) and at the completion of CRT with the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) and its component parts: FACT-General (FACT-G) and hepatobiliary cancer subscore (HCS). A minimally important difference from pre-CRT was defined as ≥ 6, 5, and 8 points for FACT-G, HCS, and FACT-Hep, respectively.ResultsOf 157 patients who underwent CRT, 100 completed both pre- and post-CRT surveys and were included in the primary analysis. Median age at diagnosis was 65 years (range, 23-90). National Comprehensive Cancer Network resectability status was resectable (3%), borderline resectable (40%), or locally advanced (57%). Folinic acid, 5-fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) (75%) or gemcitabine and nab-paclitaxel (42%) were given for a median of 6 cycles (range, 0-42) before CRT. Radiation therapy techniques included 3-dimensional conformal (22%), intensity modulated photon (55%), and intensity modulated proton (23%) radiation therapy to a median dose of 50 Gy (range, 36-62.5). Concurrent chemotherapy was most commonly capecitabine (82%). Sixty-three patients (63%) had surgery after CRT. The mean decline in FACT-G, HCS subscale, and FACT-Hep from pre- to post-CRT was 3.5 (standard deviation SD], 13.7), 1.7 (SD 7.8), and 5.2 (SD 19.4), respectively. Each of these changes were statistically significant, but did not meet the minimally important difference threshold. Pancreatic head tumor location was associated with decline in FACT-Hep. Nausea was the toxicity with the greatest increase from pre- to post-CRT by both physician-assessment and patient-reported QOL.ConclusionsFor patients with intact pancreatic adenocarcinoma, modern CRT is well tolerated with minimal decline in QOL during treatment. |
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