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A Prospective Study of Patient Reported Outcomes in Pancreatic and Peri-ampullary Malignancy

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Abstract

Background

The purpose of the present study was to describe the impact of treatment of pancreatic and peri-ampullary malignancy on patient reported outcomes (PRO). However, limited data are available describing the impact of curative or palliative therapy on pancreatic/peri-ampullary malignancy and quality of life.

Methods

Patients selected for pancreaticoduodenectomy (PD) completed the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire pre-surgery and 6 weeks, 3, 6, 12, 18, and 24 months postoperatively. Patients selected for palliative treatments completed the same questionnaire before treatment and monthly thereafter. Mean scores and 95 % confidence intervals (CI) were calculated for functional scales. Symptom scales and single items were categorized as either minimal or severe, and they were reported as proportions of patients experiencing severe symptoms with 95 % CI.

Results

A total of 100 patients (53 planned PD, 47 palliative) were enrolled. Of the 53 patients planned for surgery, 12 had tumors that were unresectable and 41 underwent pancreatoduodenectomy (PD). Seven patients were excluded because of benign histology or concurrent malignancy. Baseline questionnaire compliance was 70 %. For those undergoing PD, there were 53 complications, 7 deaths at 1 year, and 14 deaths at 2 years. Post-surgery most functions and symptoms deteriorated. Recovery in global health and most symptoms occurred by 3 months, and functional scales recovered by 6 months. Recovery of PRO was maintained in the survivors at 2 years. Palliative patients had poorer function and more symptoms at baseline; however, poor follow-up questionnaire compliance prevented further analysis of this group.

Conclusions

Pancreaticoduodenectomy has a short-term negative impact on PRO that recovers within 6 months and is maintained at 2 years in survivors. Further work evaluating palliative and curative treatment in larger patient groups with disease-specific questionnaires is necessary.

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Acknowledgments

This work was funded in part by a personal MRC Clinician Scientist Award (J.M.B.), by the MRC Hub for Trials Methodology Research (ConDuCT) (R.M and J.M.B.), and by the (UK) National Institute of Health Research (J.R. and N.S.B.). The authors are grateful to Joanna Nicklin for collecting the PRO data used in this study and to the members of the Upper Gastrointestinal Multidisciplinary Team at University Hospitals Bristol NHS Foundation Trust.

Conflict of interest

None declared.

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Authors and Affiliations

  1. Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK

    J. R. E. Rees, R. C. Macefield, N. S. Blencowe & J. M. Blazeby

  2. University Hospitals Bristol NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU, UK

    J. R. E. Rees, N. S. Blencowe, M. D. Finch-Jones & J. M. Blazeby

  3. Academic Department of Surgery, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Birmingham, B15 2TH, UK

    D. Alderson

Authors
  1. J. R. E. Rees
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  2. R. C. Macefield
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  3. N. S. Blencowe
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  4. D. Alderson
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  5. M. D. Finch-Jones
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  6. J. M. Blazeby
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Corresponding author

Correspondence to J. R. E. Rees.

Additional information

J. R. E. Rees and R. C. Macefield contributed equally to this study.

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Rees, J.R.E., Macefield, R.C., Blencowe, N.S. et al. A Prospective Study of Patient Reported Outcomes in Pancreatic and Peri-ampullary Malignancy. World J Surg 37, 2443–2453 (2013). https://doi.org/10.1007/s00268-013-2104-8

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  • DOI: https://doi.org/10.1007/s00268-013-2104-8

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