Quality of life of patients with metastatic pancreatic adenocarcinoma initiating first‐line chemotherapy in routine practice
Authors: A. García Velasco, T. Macarulla, C Bugés Sánchez, M. Martín, C. García, C. Pericay, S. Merino, L. Visa, T. Martín, M. Pedraza, B. Carnero, R. Guardeño, L. Pellín, D. Vilanova, B. Laquente
Journal: Annals of Oncology (2018)

Introduction: Considering the physical decline of patients with metastatic pancreatic adenocarcinoma (mPAC), the assessment of quality of life (QoL) becomes a matter of major concern. We aimed to assess the QoL of mPAC patients treated with first‐line chemotherapy in routine practice. Methods: This observational, prospective, multicenter study included mPAC patients who were prescribed first‐line chemotherapy between 2014 and 2015 in 12 Spanish centers. Treatment and clinical characteristics were recorded at chemotherapy start (baseline). Patients' QoL, ECOG, and Karnofsky index (KI) were measured at baseline, at days 15 and 30, and every 4 weeks up to 6 months of chemotherapy. QoL was measured using the EORTC QLQ‐C30 global health status (QLQ) and EQ-5D questionnaires. Other endpoints included treatment response, overall survival (OS), and progression‐free survival (PFS). Results: The study sample included 116 patients with a median age of 65 years (range 37‐84). Metastases were mostly hepatic (75%). mPAC was recurrent in 22% of patients and de novo in 78%. At baseline, 33 patients (44.6%) presented > 10% weight loss in the last 3 months. ECOG was 0‐1 and 2 in 82% and 18% of patients, respectively, and KI was 70‐80 and 90‐100 in 48% and 52% of patients, respectively. Median OS was 9.0 months (95% CI 6.5‐11.1) and median PFS was 6.0 months (95% CI 4.6‐7.8); the objective response rate (ORR) was 32%, and 38% of patients had stable disease. At all follow-up visits ≥46.8% of patients showed better QoL than at baseline: 65.5% of patients improved their QoL in at least one visit, 17.2% showed a decline in all visits, and 17.2% a decline or a stable score. Patients with either KI 70-80 or ECOG 2 showed a significant trend towards a greater improvement of the QoL than the corresponding groups with higher performance status (PS) score (p ≤ 0.01 for both PS scales). From 2nd month on, QLQ scores of patients with baseline KI 70-80 and patients with baseline ECOG 2 were comparable to those with KI 90-100 and ECOG 0-1, respectively. Within the first 3 months, patients with either partial/complete response or stable disease had higher QLQ scores than those who progressed (p = 0.008). The analysis of each item of the QLQ scale revealed an improvement in pain, appetite, and sleep disturbance throughout treatment. Median OS and PFS were higher in patients with baseline QLQ ≥50 (OS 10.6 [95%CI 8.2-14.9] and PFS 7.8 [4.6-8.4]) than those with QLQ <50 (OS 5.5 [2.7-9.7] and PF 4.8 [2.3-5.5]). No significant relationships were observed regarding the EQ-5D score. Conclusion: The EORTC QLQ‐C30 questionnaire is suitable for measuring the QoL of mPAC patients undergoing chemotherapy and its baseline score is associated with OS and PFS. Most patients with poor PS at baseline improved their QoL during the first month of chemotherapy, reaching a QLQ score comparable with patients with higher PS scores at 2nd month and following.