Gastroenterologie
a hepatologie

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

Miroslav Ryska¹, Ladislav Dušek ^{Orcid.org  2,3}, Radek Pohnán ^{Orcid.org  4}, Bohuš Bunganič ^{Orcid.org  5}, Lucie Bieberová ^{Orcid.org  4}, Ondřej Ryska ^{Orcid.org  6}, Martin Loveček ^{Orcid.org  7}, Bohumil Jon ^{Orcid.org  8}, Karel Ruppert ^{Orcid.org  9}, M. Krejčí ^{Orcid.org  10}, Jiří Jarkovský ^{Orcid.org  11,12}

+ Affiliation
¹ Chirurgická klinika 2. LF UK a ÚVN – VFN v Praze
² Ústav zdravotnických informací a statistiky ČR, Praha
³ Institut biostatistiky a analýz LF MU, Brno
⁴ Chirurgická klinika 2. LF UK a ÚVN Praha
⁵ Interní klinika 1. LF UK a ÚVN – VFN v Praze
⁶ Chirurgické oddělení, NH Hospital a.s., Nemocnice Hořovice
⁷ Chirurgická klinika LF UP a FN Olomouc
⁸ Chirurgická klinika LF UK, Hradec Králové
⁹ Chirurgická klinika LF UK, Plzeň
¹⁰ Chirurgická klinika 2. LF UK v Praze
¹¹ Institut biostatistiky a analýz, LF MU, Brno
¹² Ústav zdravotnických informací a statistiky České republiky, Praha

Summary

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 olderthan 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.

Keywords

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