Relation between Quality of Life and Survival in Patients with Pancreatic and Periampullary Cancer: A Multicenter Cohort Analysis

Background: A relation between quality of life (QoL) and survival has been demonstrated for several types of cancer, yet is unclear for patients with pancreatic/periampullary cancer. Methods: Analysis of QoL data from a prospective multicenter patient reported outcome registry in patients with pancreatic/periampullary carcinoma registered in the nationwide Netherlands Cancer Registry (2015-2018). Baseline and delta QoL (i.e. baseline - three months) was assessed with the Happiness, EORTC QLQ-C30 and QLQ-PAN26 questionnaires. The relation between QoL and survival was assessed with Cox regression models and additional prognostic value of separate items with Nagelkerke's R2 . Results: For the baseline and delta analyses, 233 and 148 patients were available. The majority had pancreatic adenocarcinoma (n=194, 83.3%), stage III disease (n=77, 33.0%), with a median overall survival of 13.6 months. Multivariate analysis using baseline scores, indicated several scales to be of prognostic value for the total cohort (i.e. happiness today, role functioning, diarrhea, pancreatic pain, body image, all P < 0.05) and for patients without resection (i.e. satisfaction with life, physical/cognitive functioning, summary score, fatigue, pain, constipation, diarrhea, body image, all P < 0.05). Except for diarrhea, all QoL items accounted for >5% of the additional explained variance. Multivariate analysis using delta QoL revealed that only constipation was of prognostic value for the total cohort. Conclusion: In a multicenter cohort of patients with pancreatic/periampullary carcinoma, QoL scores predicted survival, regardless of patient, tumor and treatment characteristics. QoL scores may thus be used for shared decision making regarding disease management and choice of treatment.