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Annals of Surgical Oncology

, Volume 15, Issue 1, pp 125–133 | Cite as

Survival and Health Outcomes After Cytoreductive Surgery With Intraperitoneal Hyperthermic Chemotherapy for Disseminated Peritoneal Cancer of Appendiceal Origin

  • Richard P. McQuellon
  • Gregory B. Russell
  • Perry Shen
  • John H. StewartIV
  • Weston Saunders
  • Edward A. Levine
Healthcare Policy and Outcomes

Abstract

Background

Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis of appendiceal origin can alleviate symptoms and prolong survival. This aggressive therapy may impair patient quality of life (QOL). The purpose of this study was to monitor health outcomes before and after treatment.

Methods

Patients underwent cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal cancer. Patients completed questionnaires consisting of demographic information and the Functional Assessment of Cancer Therapy, the SF-36 Medical Outcomes Study survey, the Center for Epidemiologic Studies—Depression Scale, and the ECOG Performance Status Rating before (T1) and after surgery at 3 (T2), 6 (T3), 12 (T4), and 24 (T5) months. Time trends were assessed with the mixed model (SAS PROC MIXED) to allow use of all the observed data as well as to account for missing data.

Results

Fifty-eight patients (50% female) with a mean age 52.4 years (SD 12.6; range, 28–80) were assessed before surgery. Overall survival at 1 year was 78.7%. Emotional well-being improved over the study period, while physical well-being and physical functioning declined at T2 and then improved to near baseline levels at T3 and T4. Percentage of patients with depressive symptoms was as follows: T1 = 24%, T2 = 30%, T3 = 24%, and T4 = 33%. QOL scores improved over time.

Conclusions

Although complications can affect short-term recovery, survival in appendix cancer patients with peritoneal cancer is good and for some can be achieved without major decrements in QOL at 1 year. Depressive symptoms and some physical limitations remain in surviving patients.

Keywords

Health outcomes Intraperitoneal hyperthermic chemotherapy 

Notes

ACKNOWLEDGMENTS

We acknowledge the assistance of Lisa Pruitt, RN, Joyce Fenstermaker, RN, Sheila Lee, and Mary Cromer, and we acknowledge the courage and thoughtfulness of the patients and family members who participated in this study.

REFERENCES

  1. 1.
    Yan TD, Black D, Savady R, Sugarbaker PH. A systematic review on the efficacy of cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei. Ann Surg Oncol 2007;14:484–92PubMedCrossRefGoogle Scholar
  2. 2.
    Stewart JH 4th, Shen P, Levine EA. Intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: current status and future directions. Ann Surg Oncol 2005;12:765–77CrossRefGoogle Scholar
  3. 3.
    Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 2003;21:3737–43PubMedCrossRefGoogle Scholar
  4. 4.
    Schmidt U, Dahlke MH, Klempnauer J, Schlitt HJ, Piso P. Perioperative morbidity and quality of life in long-term survivors following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 2005;31:53–8PubMedCrossRefGoogle Scholar
  5. 5.
    McQuellon RP, Loggie BW, Fleming RA, Russell GB, Lehman AB, Rambo TD. Quality of life after intraperitoneal hyperthermic chemotherapy (IPHC) for peritoneal carcinomatosis. Eur J Surg Oncol 2001;27:65–73PubMedCrossRefGoogle Scholar
  6. 6.
    Alexander R, Mavroukakis S, Libutti S, et al. Impact of tumor resection (Rxn) and intraperitoneal (IP) chemotherapy (CHRx) on health related quality of life (HRQL) in patients (Pts) with peritoneal surface malignancies (PSM). Proc Soc Surg Oncol 2005;S109Google Scholar
  7. 7.
    Tuttle TM, Zhang Y, Greeno E, Knutsen A. Toxicity and quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol 2006;13:1627–32PubMedCrossRefGoogle Scholar
  8. 8.
    McQuellon RP, Danhauer SC, Russell GB, Shen P, Fenstermaker J, Stewart JH, Levine EA. Monitoring health outcomes following cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis. Ann Surg Oncol 2007;14:1105–13 PubMedCrossRefGoogle Scholar
  9. 9.
    McQuellon RP, Loggie BW, Lehman AB, et al. Long-term survivorship and quality of life after cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis. Ann Surg Oncol 2003;10:155–62PubMedCrossRefGoogle Scholar
  10. 10.
    Eton D, Fairclough D, Cella D, Yount S, Bonomi P, Johnson D. Early change in patient-reported health during lung cancer chemotherapy predicts clinical outcomes beyond those predicted by baseline report: results from Eastern Cooperative Oncology Group Study 5592. J Clin Oncol 2003;21:1536–43PubMedCrossRefGoogle Scholar
  11. 11.
    McQuellon R, Thaler H, Cella D, Moore D. Quality of Life (QOL) outcomes from a randomized trial of cisplatin versus cisplatin plus paclitaxel in advanced cervical cancer: a gynecologic oncology group study. Gynecol Oncol 2006;101:296–304PubMedCrossRefGoogle Scholar
  12. 12.
    Brady MJ, Cella DF, Mo F, et al. Reliability and validity of the Functional Assessment of Cancer Therapy—Breast quality-of-life instrument. J Clin Oncol 1997;15:974–86PubMedGoogle Scholar
  13. 13.
    Cella DF, Tulsky DS, Gray G, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 1993;11:570–9PubMedGoogle Scholar
  14. 14.
    Ware JE Jr, Snow KK, Kosinski M, Gandek B. SF-36 health survey. In: Manual and Interpretation Guide. Boston: Nimrod Press, 1993Google Scholar
  15. 15.
    McHorney CA, Ware JE Jr, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 1993;31:247–63PubMedCrossRefGoogle Scholar
  16. 16.
    Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measure 1977;1:385–401CrossRefGoogle Scholar
  17. 17.
    Katz MR, Kopek N, Waldron J, Devins GM, Tomlinson G. Screening for depression in head and neck cancer. Psychooncology 2004;13:269–80PubMedCrossRefGoogle Scholar
  18. 18.
    Husaini B, Neff J, Harrington J, Hughes M, Stone R. Depression in rural communities: validating the CES-D Scale. J Community Psychol 1980;8:20–37CrossRefGoogle Scholar
  19. 19.
    Zubrod CG, Schneiderman M, Frei E, et al. Appraisal of methods for the study of chemotherapy of cancer in man: comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide. J Chronic Dis 1960;11:7–33CrossRefGoogle Scholar
  20. 20.
    Sloan JA, Frost MH, Berzon R, et al. Clinical Significance Consensus Meeting Group. The clinical significance of quality of life assessments in oncology: a summary for clinicians. Support Care Cancer 2006;14:988–98PubMedCrossRefGoogle Scholar
  21. 21.
    Cella D, Eton DT, Fairclough DL, et al. What is clinically meaningful change (CMC) on the Functional Assessment of Cancer Therapy—Lung (FACT-L) questionnaire? An analysis of data from ECOG 5592. J Clin Epidemiol 2002;55:286–95CrossRefGoogle Scholar
  22. 22.
    Sloan J, Cella D, Frost M, Guyatt G, Sprangers M, Symonds T, and the Clinical Significance Consensus. Assessing clinical significance in measuring oncology patient quality of life: introduction to the symposium, content overview, and definition of terms. Mayo Clin Proc 2002;77:367–70PubMedCrossRefGoogle Scholar
  23. 23.
    Yost K, Eton D, Cella D, Ayanian J, Zaslavsky A, West D. Minimal important differences on the Functional Assessment of Cancer Therapy—Colorectal. Qual Life Res 2002;11:629Google Scholar
  24. 24.
    Cella D, Bullinger M, Scott C, Barofsky I, and the Clinical Significance Consensus Meeting Group. Group versus individual approaches to understanding the clinical significance of differences or changes in quality of life. Clin Ther 2002;24(B):6CrossRefGoogle Scholar
  25. 25.
    Piso P, Bektas H, Werner U, et al. Improved prognosis following peritonectomy procedures and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from appendiceal carcinoma. Eur J Surg Oncol 2001;27:286–90PubMedCrossRefGoogle Scholar
  26. 26.
    Witkamp AG, de Bree E, Kaag MM, van Slooten GW, van Coevorden F, Zoetmulder FA. Extensive surgical cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei. Br J Surg 2001;88:458–63PubMedCrossRefGoogle Scholar
  27. 27.
    Gough DB, Donohue JH, Schutt AJ, et al. Pseudomyxoma peritonei. Long-term patient survival with an aggressive regional approach. Ann Surg 1994;219:112–9PubMedCrossRefGoogle Scholar
  28. 28.
    Sugarbaker PH, Chang D. Results of treatment of 385 patients with peritoneal surface spread of appendiceal malignancy. Ann Surg Oncol 1999;6:727–31PubMedCrossRefGoogle Scholar
  29. 29.
    Deraco M, Baratti D, Inglese MG, et al. Peritonectomy and intraperitoneal hyperthermic perfusion (IPHP): a strategy that has confirmed its efficacy in patients with pseudomyxoma peritonei. Ann Surg Oncol 2004;11:393–8PubMedCrossRefGoogle Scholar
  30. 30.
    Guner Z, Schmidt U, Dahlke MH, Schlitt HJ, Klempnauer J, Piso P. Cytoreductive surgery and intraperitoneal chemotherapy for pseudomyxoma peritonei. Int J Colorectal Dis 2005;20:155–60PubMedCrossRefGoogle Scholar
  31. 31.
    Stewart JH, Shen P, Russell GB, et al. Appendiceal neoplasms with peritoneal dissemination: outcomes after cytoreductive surgery and intraperitoneal hyperthermic chemotherapy. Ann Surg Oncol 2006;13:624–34PubMedCrossRefGoogle Scholar
  32. 32.
    Miner TJ, Shia J, Jaques DP, Klimstra DS, Brennan MF, Coit DG. Long-term survival following treatment of pseudomyxoma peritonei: an analysis of surgical therapy. Ann Surg 2005;241:300–8PubMedCrossRefGoogle Scholar
  33. 33.
    McQuellon RP, Loggie BW, Fleming RA, Russell GB, Lehman AB, Rambo TD. Quality of life after intraperitoneal hyperthermic chemotherapy (IPHC) for peritoneal carcinomatosis. Eur J Surg Oncol 2001;27:65–73PubMedCrossRefGoogle Scholar
  34. 34.
    Alexander R, Mavroukakis S, Libutti S, et al. Impact of tumor resection (Rxn) and intraperitoneal (IP) chemotherapy (CHRx) on health related quality of life (HRQL) in patients (Pts) with peritoneal surface malignancies (PSM). Proc Soc Surg Oncol 2005;S109Google Scholar
  35. 35.
    Tuttle TM, Zhang Y, Greeno E, Knutsen A. Toxicity and quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol 2006;13:1627–32PubMedCrossRefGoogle Scholar
  36. 36.
    Brucker PS, Yost K, Cashy J, Webster K, Cella D. General population and cancer patient norms for the Functional Assessment of Cancer Therapy—General (FACT-G). Eval Health Prof 2005;28:192–211PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • Richard P. McQuellon
    • 1
  • Gregory B. Russell
    • 2
  • Perry Shen
    • 3
  • John H. StewartIV
    • 3
  • Weston Saunders
    • 1
    • 2
  • Edward A. Levine
    • 3
  1. 1. Department of Internal Medicine, Section of Hematology and OncologyWake Forest University School of MedicineWinston-SalemUSA
  2. 2.Department of Biostatistical Sciences, Section of BiostatisticsWake Forest University School of MedicineWinston-SalemUSA
  3. 3.Surgical Oncology Service, Section of Surgical OncologyWake Forest University School of MedicineWinston-SalemUSA

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