Relationship Between Quality of Life and Survival in Patients With Pancreatic and Periampullary Cancer: A Multicenter Cohort Analysis

Abstract

Background: A relationship between quality of life (QoL) and survival has been shown for several types of cancer, mostly in clinical trials with highly selected patient groups. The relationship between QoL and survival for patients with pancreatic or periampullary cancer is unclear. Methods: This study analyzed QoL data from a prospective multicenter patient-reported outcome registry in patients with pancreatic or periampullary carcinoma registered in the nationwide Netherlands Cancer Registry (2015–2018). Baseline and delta QoL, between baseline and 3-month follow-up, were assessed with the Happiness, EORTC Quality of Life Questionnaire-Core 30 (QLQ-C30), and QLQ-PAN26 questionnaires. The relationship between QoL and survival was assessed using Cox regression models, and additional prognostic value of separate items was assessed using Nagelkerke R2 (explained variance). Results: For the baseline and delta analyses, 233 and 148 patients were available, respectively. Most were diagnosed with pancreatic adenocarcinoma (n=194; 83.3%) and had stage III disease (n=77; 33.0%), with a median overall survival of 13.6 months. Multivariate analysis using baseline scores indicated several scales to be of prognostic value for the total cohort (ie, happiness today, role functioning, diarrhea, pancreatic pain, and body image; hazard ratios all P<.05) and for patients without resection (ie, overall satisfaction with life, physical and cognitive functioning, QLQ-C30 summary score, fatigue, pain, constipation, diarrhea, and body image; hazard ratios all P<.05). Except for diarrhea, all QoL items accounted for >5% of the additional explained variance and were of added prognostic value. Multivariate analysis using delta QoL revealed that only constipation was of prognostic value for the total cohort, whereas no association with survival was found for subgroups with or without resection. Conclusions: In a multicenter cohort of patients with pancreatic or periampullary carcinoma, QoL scores predicted survival regardless of patient, tumor, and treatment characteristics. QoL scores may thus be used for shared decision-making regarding disease management and treatment choice.

Prognostic value of patient-reported quality of life for survival in oesophagogastric cancer: analysis from the population-based POCOP study

“…Its specific relation to tumour size could not be investigated in our study population due to a lack of data on the precise size of the tumour, and possible mechanical obstruction. Interestingly, body image was also prognostic for OS, which is in line with recent results in pancreatic cancer patients [24]. It is hypothesized that body image is associated with nutritional status, and that involuntary weight loss resulting in cachexia may induce a negative perception of one's body [25].…”

“…Nagelkerke's R 2 was used to assess the outcome variance explained by clinical, sociodemographic, and HRQoL variables. An increase of 5% in explained variance by HRQoL variables alongside clinical variables was considered clinically relevant [24]. All analysis were stratified per patient group, i.e., potentially curable versus advanced disease, and performed in Stata 16.1 (StataCorp, College Station, TX).…”

Cancer outcomes research—a European challenge: measures of the cancer burden

“…Hence, we must foster more patient‐centered research that incorporates all stakeholders' perspective [ 33 ]. Quality of life and patient‐reported outcomes have also been reported to predict survival in different types of cancer, although the mechanisms still need to be identified [ 34 , 35 , 36 , 37 ]. The World Health Organization defines quality of life as an individual's perception of their position in life in the context of the culture and value systems in which they live, and also in relation to their goals, expectations, standards, and concerns.…”

Psychosocial Distress and Quality of Life in Patients after Radical Cystectomy – One Year Follow-Up in 842 German Patients

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