Quality of Life Among Patients With Locally Advanced Pancreatic Cancer: A Prospective Nationwide Multicenter Study
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Cancer Center Amsterdam, Amsterdam, the Netherlands
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Cancer Center Amsterdam, Amsterdam, the Netherlands
Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
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Cancer Center Amsterdam, Amsterdam, the Netherlands
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Cancer Center Amsterdam, Amsterdam, the Netherlands
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Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Cancer Center Amsterdam, Amsterdam, the Netherlands
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Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Background: Health care providers of patients with cancer should discuss the impact of treatment, such as multiagent chemotherapy and surgery, on quality of life (QoL). However, in the era of shared decision-making, data on QoL in locally advanced pancreatic cancer (LAPC) remain scarce. Methods: We performed a prospective multicenter study involving patients with LAPC across 13 Dutch centers. These patients were included in both the LAPC registry and the Dutch Pancreatic Cancer Project (PACAP; ClinicalTrials.gov identifier: NCT03513705). The study evaluated QoL over time and assessed the impact of treatment. The primary outcome was global health status (GHS) based on the EORTC Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Secondary outcomes included functioning and symptom scores from the EORTC QLQ-C30 and the EORTC QLQ Pancreatic Cancer Module (QLQ-PAN26). Outcomes were measured at diagnosis and at 3-month intervals up to 12 months. Outcomes were compared over time and between groups, with both statistical and clinical significance (Δ ≥10 points) evaluated. Results: A total of 170 patients completed at least one QoL-questionnaire. Most patients (n=152; 89%) received tumor-directed treatment, including 116 (68%) who received chemotherapy (± radiotherapy) alone and 36 (21%) who underwent chemotherapy (± radiotherapy) followed by resection; 18 (11%) patients received best supportive care (BSC). At baseline, GHS was highest among patients who received chemotherapy + resection (mean [SD], 70 [16]) compared with those receiving chemotherapy alone (mean [SD], 64 [20]) and BSC (mean [SD], 48 [21]) (P=.001). The overall mean [SD] GHS at baseline was 63 [20] and remained stable over time (P=.27), including in patients receiving tumor-directed treatment (P=.57). One-third of the QoL subscales (9/28) showed statistically and clinically significant changes over time. Improvements were observed in appetite loss, pancreatic pain, and hepatic symptoms, although patients reported increased diarrhea, flatulence, altered bowel habits, and financial difficulties. Over time, patients reported reduced fear of future health, but a decline in health care satisfaction. Conclusions: This multicenter study demonstrated that general QoL remained stable during the first year in patients with LAPC, 89% of whom received tumor-directed treatment. Certain symptoms worsened and deserve greater attention from health care providers. These findings can guide shared decision-making and improve symptom management.
Submitted October 12, 2023; final revision received September 14, 2024; accepted for publication November 18, 2024. Published online February 19, 2025.
L.W.F. Seelen and S. Augustinus contributed equally and are co-first authors.
H.W.M. van Laarhoven and I.Q. Molenaar are co-senior authors.
Author contributions: Study concept or design: Seelen, Augustinus, Stoop, Sprangers, Besselink, van Santvoort, van Laarhoven, Molenaar. Study conduct & data acquisition or analysis: Seelen, Augustinus, Stoop, van Alphen, Sprangers, Besselink, van Santvoort, van Laarhoven, Molenaar. Data interpretation: All authors. Writing—original draft: Seelen, Augustinus, Stoop. Writing—review and editing: All authors.
Data availability statement: The data underlying this article will be shared on reasonable request to the corresponding author.
Disclosures: Dr. van Laarhoven has disclosed receiving grant/research support from Amgen, AstraZeneca, Auristone, Bristol Myers Squibb, Incyte, Merck, Orca Bio, and Servier; serving as a scientific advisor for AstraZeneca, Bristol Myers Squibb, Benecke, Daiichi Sankyo, JAAP, MEDtalks, Novartis, Servier, and Travel Congress Management; and serving as a consultant for Amphera, Astellas Pharma, BeiGene, Daiichi Sankyo, and Myeloid Therapeutics. The remaining authors have disclosed that they have not received any financial considerations from any person or organization to support the preparation, analysis, results, or discussion of this article.
Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2024.7091. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.
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