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Symptom profiles and palliative care in advanced pancreatic cancer—a prospective study

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Abstract

Objectives

To describe prospectively the prevalence and severity of disease-related symptoms, quality of life (QOL) and need for palliative care in patients with advanced pancreatic cancer.

Patients and methods

Fifty-one patients treated for advanced pancreatic cancer filled in the Edmonton Symptom Assessment Scale (ESAS) for symptom registration and the EORTC QLQ-C30 and QLQ-PAN26 quality of life questionnaires at first contact (baseline) and the ESAS in the following consultations. Need for palliative interventions were registered.

Results

Of the 22 women and 29 men (mean age, 62 years), 20 had locally unresectable cancer, 19 had metastatic disease, and 12 had recurrent disease after curative resection. Forty-six patients died during follow-up (median survival, 99 days). At baseline, patients reported significantly impaired QOL on nine of 15 scales/items (p<0.01) relative to the general population. Fatigue, loss of appetite, and impaired sense of well-being were the most troublesome symptoms on the ESAS, measured to 4.4(±2.8)/5.3(±2.3), 4.4(±3.2)/5.9(±2.7), and 4.0(±2.9)/4.6(±2.7) (mean±SD) at baseline and 8 weeks before death, respectively. Forty-four of the 51 (86%) initial consultations and 107 (58%) of the 185 follow-ups (124 clinical and 61 phone-calls) resulted in palliative care interventions, most frequently changes in opioid or laxative medication and dietary advice.

Conclusions

Patients with advanced pancreatic cancer develop several distressing symptoms. ESAS was useful for assessment of symptom prevalence and intensity and is a clinically adequate method for symptom control. A multidisciplinary approach is necessary for the best palliation of symptoms at the time of diagnosis and during follow-up.

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References

  1. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A et al (1993) The European Organization for Research and Treatment of Cancer: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376

    PubMed  CAS  Google Scholar 

  2. Bachmann P, Marti-Massoud C, Blanc-Vincent MP, Desport JC et al (2003) Summary version of the standards, options and recommendations for palliative or terminal nutrition in adults with progressive cancer (2001). Br J Cancer 89(Suppl 1):S107–S110

    Article  PubMed  Google Scholar 

  3. Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9

    PubMed  CAS  Google Scholar 

  4. Chow E, Wong R, Connolly R, Hruby G, Franssen E, Fung KW et al (2001) Prospective assessment of symptom palliation for patients attending a rapid response radiotherapy program: feasibility of telephone follow-up. J Pain Symptom Manage 22:649–656

    Article  PubMed  CAS  Google Scholar 

  5. Dormann A, Meisner S, Verin N, Wenk LA (2004) Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 36:543–550

    Article  PubMed  CAS  Google Scholar 

  6. Fayers PM, Aaronson N, Bjordal K, Groenvold M, Curran D, Bottomley A (2001) EORTC QLQ-C30 scoring manual (3rd edn). EORTC Quality of Life Group, Brussels, Belgium

  7. Heedman PA, Strang P (2001) Symptom assessment in advanced palliative home care for cancer patients using the ESAS: clinical aspects. Anticancer Res 21:4077–4082

    PubMed  CAS  Google Scholar 

  8. Fitzsimmons D, Johnson CD, George S, Payne S, Sandberg AA et al (1999) Development of a disease specific quality of life (QoL) questionnaire module to supplement the EORTC core cancer QoL questionnaire, the QLQ-C30 in patients with pancreatic cancer. EORTC Study Group on Quality of Life. Eur J Cancer 35:939–941

    Article  PubMed  CAS  Google Scholar 

  9. Hjermstad MJ, Fayers PM, Bjordal K, Kaasa S (1998) Health-related quality of life in the general Norwegian population assessed by the European Organization for Research and Treatment of Cancer core quality-of-life questionnaire: the QLQ=C30 (+3). J Clin Oncol 16:1188–1196

    PubMed  CAS  Google Scholar 

  10. House MG, Choti MA (2004) Palliative therapy for pancreatic/biliary cancer. Surg Oncol Clin N Am 13:491–503,ix

    Article  PubMed  Google Scholar 

  11. Inui A (2002) Cancer anorexia–cachexia syndrome: current issues in research and management. CA Cancer J Clin 52:72–91

    Article  PubMed  Google Scholar 

  12. Jacox A, Carr DB, Payne R (1994) Management of cancer pain. Clinical practice guideline No. 9. AHCPR publication No. 94-0592. Rockville, MD. Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Public Health Service, March 1994, p. 19

  13. Jemal A, Clegg LX, Ward E, Ries LA, Wu X, Jamison PM et al (2004) Annual report to the nation on the status of cancer, 1975–2001, with a special feature regarding survival. Cancer 101(1):3–27

    Article  PubMed  Google Scholar 

  14. Jordhoy MS, Kaasa S, Fayers P, Ovreness T, Underland G et al (1999) Challenges in palliative care research; recruitment, attrition and compliance: experience from a randomized controlled trial. Palliat Med 13:299–310

    Article  PubMed  CAS  Google Scholar 

  15. Lillemoe KD, Cameron JL, Hardacre JM, Sohn TA, Sauter PK et al (1999) Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial. Ann Surg 230:322–328

    Article  PubMed  CAS  Google Scholar 

  16. Miaskowski C, Portenoy RK (1998) Update on the assessment and management of cancer-related fatigue. Princ Prac Support Oncol Updates 1(2):1–10

    Google Scholar 

  17. Morris JN, Sherwood S (1987) Quality of life of cancer patients at different stages in the disease trajectory. J Chronic Dis 40:545–556

    Article  PubMed  CAS  Google Scholar 

  18. Morris JN, Suissa S, Sherwood S, Wright SM, Greer D (1986) Last days: a study of the quality of life of terminally ill cancer patients. J Chronic Dis 39:47–62

    Article  PubMed  CAS  Google Scholar 

  19. Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H et al (2004) A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 350:1200–1210

    Article  PubMed  CAS  Google Scholar 

  20. Nieveen van Dijkum EJ, Kuhlmann KF, Terwee CB, Obertop H et al (2005) Quality of life after curative or palliative surgical treatment of pancreatic and periampullary carcinoma. Br J Surg 92:471–477

    Article  PubMed  CAS  Google Scholar 

  21. Osoba D, Rodrigues G, Myles J, Zee B, Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16:139–144

    PubMed  CAS  Google Scholar 

  22. Rees E, Hardy J, Ling J, Broadley K, A’Hern R (1998) The use of the Edmonton Symptom Assessment Scale (ESAS) within a palliative care unit in the UK. Palliat Med 12:75–82

    Article  PubMed  CAS  Google Scholar 

  23. Schmier J, Elixhauser A, Halpern MT (1999) Health-related quality of life evaluations of gastric and pancreatic cancer. Hepatogastroenterology 46:1998–2004

    PubMed  CAS  Google Scholar 

  24. Singh SM, Longmire WP Jr, Reber HA (1990) Surgical palliation for pancreatic cancer. The UCLA experience. Ann Surg 212:132–139

    Article  PubMed  CAS  Google Scholar 

  25. Sohn TA, Lillemoe KD, Cameron JL, Huang JJ, Pitt HA, Yeo CJ (1999) Surgical palliation of unresectable periampullary adenocarcinoma in the 1990s. J Am Coll Surg 188:658–666

    Article  PubMed  CAS  Google Scholar 

  26. Stone P, Richardson A, Ream E, Smith AG, Kerr DJ, Kearney N (2000) Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Cancer fatigue forum. Ann Oncol 11:971–975

    Article  PubMed  CAS  Google Scholar 

  27. van Geenen RC, van Gulik TM, Offerhaus GJ, de Wit LT, Busch OR et al (2001) Survival after pancreaticoduodenectomy for periampullary adenocarcinoma: an update. Eur J Surg Oncol 27:549–557

    Article  PubMed  Google Scholar 

  28. van Heek NT, De Castro SM, van Eijck CH, van Geenen RC et al (2003) The need for a prophylactic gastrojejunostomy for unresectable periampullary cancer: a prospective randomized multicenter trial with special focus on assessment of quality of life. Ann Surg 238:894–902

    PubMed  Google Scholar 

  29. Ventafridda V, Tamburini M, Caraceni A, De Conno F, Naldi F (1987) A validation study of the WHO method for cancer pain relief. Cancer 59:850–856

    Article  PubMed  CAS  Google Scholar 

  30. Wong GY, Schroeder DR, Carns PE, Wilson JL, Martin DP et al (2004) Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer: a randomized controlled trial. JAMA 291:1092–1099

    Article  PubMed  CAS  Google Scholar 

  31. Yeo CJ, Sohn TA, Cameron JL, Hruban RH, Lillemoe KD, Pitt HA (1998) Periampullary adenocarcinoma: analysis of 5-year survivors. Ann Surg 227:821–831

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Ullevaal University Hospital HF, N-0407, Oslo, Norway

    Knut Jørgen Labori & Trond Buanes

  2. Department of Oncology, Ullevaal University Hospital HF, Oslo, Norway

    Marianne Jensen Hjermstad

  3. Centre for Palliative Care, Ullevaal University Hospital HF, Oslo, Norway

    Torunn Wester & Jon Håvard Loge

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  1. Knut Jørgen Labori
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  2. Marianne Jensen Hjermstad
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  3. Torunn Wester
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  4. Trond Buanes
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  5. Jon Håvard Loge
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Correspondence to Knut Jørgen Labori.

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Labori, K.J., Hjermstad, M.J., Wester, T. et al. Symptom profiles and palliative care in advanced pancreatic cancer—a prospective study. Support Care Cancer 14, 1126–1133 (2006). https://doi.org/10.1007/s00520-006-0067-0

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  • DOI: https://doi.org/10.1007/s00520-006-0067-0

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