Correlation of Clinical Stage and Performance Status With Quality of Life in Patients Seen in a Pancreas Multidisciplinary Clinic

Abstract

Introduction The objectives of this study were to evaluate quality of life (QoL) in patients presenting to the Johns Hopkins Pancreas Multidisciplinary Clinic (PMDC), and to examine associations between disease status, performance status, and QoL in order to identify patient subgroups that are most at risk for reduced QoL. Patients and Methods Data from 77 patients were evaluated. At initial presentation, disease and performance status were assessed, as well as QoL, which was obtained with the European Organisation for Research and Treatment of Cancer QLQ-PAN26 questionnaire. Statistical analyses examined associations between QoL, disease status, and performance status. Results Digestive symptoms (P < .003) significantly differed by pancreatic disease status (resectable, resected, locally advanced, and metastatic). Patients with a worse performance status, defined as Eastern Cooperative Oncology Group ≥ 1, were more likely to report symptomatic pancreatic pain (P = .001), digestive symptoms (P = .017), cachexia (P = .004), and ascites (P < .001) compared with patients with a performance status of 0. The majority (92%) of patients reported a significant fear of future health problems, regardless of disease status or performance status. Conclusion Although several measures of QoL have been observed in all patients, certain measures appear to correlate specifically with worse disease status. Therefore, routine assessment of QoL is suggested in order to guide treatment decisions. Further investigation on optimizing the use of QoL measures and patient-reported outcomes to better tailor management is warranted.

Impact of Palliative Care in Evaluating and Relieving Symptoms in Patients with Advanced Cancer. The DEMETRA Study

“…The prevalence of symptoms at baseline differed according to the site of the primary tumor, as also reported elsewhere [22,23]. The association between speci c tumor sites and cancer symptoms is clear, even at advanced stages of the disease when widespread metastasis can dilute this speci city.…”

The Relationship between Distressing Symptoms and Performance Status among Cancer Patients Receiving Palliative Care

“…Congruent with our results, other researchers found a significant negative relationship between symptom burden and functional status of advanced cancer patients [27][28][29][30][31] . In a recent study from Egypt that included patients with metastatic cancer, the total average ESAS score differed significantly according to the Eastern Cooperative Oncology Group (ECOG) performance scale from 34 in patients with an ECOG score of 1 to 70 in patients with an ECOG score…”

“…Similarly, in a study from Japan that included 292 cancer patients, the total ESAS-r score was significantly higher among patients with an ECOG score of 2-4 than those with a score of 0-1 (p<0.0001) 28 . In another study that included pancreatic cancer patients; pain, digestive symptoms, cachexia and ascites were significantly more likely to be reported by patients with an ECOG score of ≥1 29 . In lung cancer patients, moderate/severe fatigue is associated with significantly poorer PS 30 .…”

The Relation between the Severity of Pain and Common Symptoms in Patients with Metastatic Cancer

“…This is in accordance with a Japanese study where ESAS-r was significantly higher in patients with an ECOG performance status of 2-4 than in those with a performance status of 0 and 1 29 . Similarly, in the study done by Shalini et al, patients with lower performance status measured by both ECOG and Karnofsky performance scales had worse QoL scores in symptomatic pancreatic pain 30 . This can be explained by the fact that patients at the end of life are very sick and have high symptom burden which may contribute to the decline in performance status and QoL scores.…”