Impact of Surgical and Medical Treatment in All Stages of Pancreatic Cancer on Patients’ Health-related Quality of Life: A Nationwide Study

Purpose: Pancreatic cancer itself has a profound impact on health-related quality of life (HRQoL). It has been suggested that both surgical and medical treatment may impact HRQoL negatively, especially in the setting of pancreatic cancer. We aimed to explore the impact of surgical and medical treatment in all stages of pancreatic cancer on patients’ HRQoL. Method: This nationwide cohort study includes patients diagnosed with all stages pancreatic cancer, using HRQoL data from the Dutch Pancreatic Cancer Project (PACAP) and clinical data from the Netherlands Cancer Registry (2015-2020). Patients were divided into three groups: 1) resection for localized pancreatic cancer (R-PDAC), 2) chemotherapy only for localized pancreatic cancer (C-PDAC) and 3) chemotherapy for metastatic disease (M1-C-PDAC). HRQoL was assessed using the EORTC QLQ-C30 Global Health Score (GHS), range 0-100 at baseline (prior to treatment), during treatment, 0-3 months and 3-6 months after treatment. Additionally, all other subscales of the QLQ-C30 and PAN26 were evaluated. Clinical significance was determined according to the methods of Osoba and colleagues, with an absolute difference (AD) of ≥10 considered as clinically relevant. The effect of treatment on HRQoL over time in the various groups was examined using linear mixed models. Results: Overall, 1352 patients were included at baseline, of whom 579 (42.8%) in the R-PDAC, 279 (20.6%) in the C-PDAC, and 293 (21.7%) in the M1-C-PDAC group. The mean (SD) GHS at baseline was 71 (19), 65 (19), and 66 (21) in the three groups respectively. In the R-PDAC group the GHS decreased without clinical relevance during treatment (AD: 4; p=0.003), and restored to baseline 3-6 months thereafter (table 1). No significant changes in GHS were observed in the other treatment groups. In all groups, emotional functioning improved without clinical relevance during treatment (AD: 5, p<.001 ; AD: 7, p<.001; AD: 6, p=0.012 respectively) and remained stable thereafter. In both the C-PDAC and M1-C-PDAC group, pain improved without clinical relevance during treatment (AD: 7, p=0.012; AD: 9, p=0.002 respectively). Conclusion: In this nationwide study, HRQoL remained stable during 6 months of surgical and medical treatment in all stages of pancreatic cancer. This suggests that patients can be informed that treatment itself does not clinically worsen HRQoL.Tabled 1FP02-06. Table 1. Health Related Quality of Life in patients with pancreatic cancer according to treatment group as assessed by linear mixed modelsBefore treatmentDuring treatment0-3 months after treatment3-6 months after treatmentNo. Q.Mean (SE)No. Q.Mean (SE), p valueNo. Q.Mean (SE), p valueNo. Q.Mean (SE), p valueR-PDAC (n = 579)27971 (1)37867 (1), p = 0.00326969 (1), p = 0.21113474 (2), p = 0.056C-PDAC (n = 279)13365 (2)15268 (2), p = 0.1988867 (2)), p = 0.3906367 (2), p = 0.308M1-C-PDAC (n = 293)13566 (2)15165 (2), p = 0.60410866 (2), p = 0.9604462 (2), p = 0.251All values are on a scale from 0 to 100, expressed in means with standard deviation (SD) with p value as compared to before treatment. High scores of GHS indicate good quality of life. GHS, Global Health Score; No. Q, number of questionnaires available for analysis. Open table in a new tab All values are on a scale from 0 to 100, expressed in means with standard deviation (SD) with p value as compared to before treatment. High scores of GHS indicate good quality of life. GHS, Global Health Score; No. Q, number of questionnaires available for analysis.