目的:胰腺癌是一种致死性疾病。许多患者经历癌症相关症状的沉重负担和生活质量差(QOL)。早期姑息治疗以及标准的肿瘤治疗可改善某些癌症类型的生活质量和生存率。晚期胰腺癌(APC)的益处尚未完全量化。
方法:在这项前瞻性病例交叉研究中,我们从三级癌症中心的门诊诊所招募了年龄≥18岁的APC患者.患者在注册后2周内接受了姑息治疗咨询,第一个月每两周随访一次,然后每4周,直到第16周,然后根据需要。主要结果是基线(BL)和第16周之间的QOL变化,通过癌症治疗功能评估-肝胆(FACT-Hep)进行测量。次要结果包括症状控制(ESAS-r),抑郁症,和焦虑(HADS,PHQ-9)在第16周。
结果:在40名患者中,25(63%)为男性,28人(70%)有转移性疾病,31例(78%)ECOG表现状况0-1,31例(78%)接收化疗。年龄中位数是70岁。与第16周时的125.7相比,BL时的平均FACT-hep评分为118.8分(平均变化6.89,[95CI(-1.69-15.6);p=0.11])。在多变量分析中,转移性疾病(平均变化15.3[95CI(5.3-25.2);p=0.004])和年龄<70(平均变化12.9[95CI(0.5-25.4);p=0.04])与生活质量改善相关.转移性疾病患者的症状负担有显著改善(平均变化-7.4[95CI(-13.4至-1.4);p=0.02])。从BL到第16周,抑郁或焦虑没有差异。
结论:对于APC患者,姑息治疗应在早期纳入。因为它可以改善生活质量和症状负担。
背景:Clinicaltrials.gov标识符:NCT03837132。
OBJECTIVE: Pancreatic cancer is a lethal disease. Many patients experience a heavy burden of cancer-associated symptoms and poor quality of life (QOL). Early palliative care alongside standard oncologic care results in improved QOL and survival in some cancer types. The benefit in advanced pancreatic cancer (APC) is not fully quantified.
METHODS: In this prospective
case-crossover study, patients ≥ 18 years old with APC were recruited from ambulatory clinics at a tertiary cancer center. Patients underwent a palliative care consultation within 2 weeks of registration, with follow up visits every 2 weeks for the first month, then every 4 weeks until week 16, then as needed. The primary outcome was change in QOL between baseline (BL) and week 16, measured by Functional Assessment of Cancer Therapy - hepatobiliary (FACT-Hep). Secondary outcomes included symptom control (ESAS-r), depression, and anxiety (HADS, PHQ-9) at week 16.
RESULTS: Of 40 patients, 25 (63%) were male, 28 (70%) had metastatic disease, 31 (78%) had ECOG performance status 0-1, 31 (78%) received chemotherapy. Median age was 70. Mean FACT-hep score at BL was 118.8, compared to 125.7 at week 16 (mean change 6.89, [95%CI (-1.69-15.6); p = 0.11]). On multivariable analysis, metastatic disease (mean change 15.3 [95%CI (5.3-25.2); p = 0.004]) and age < 70 (mean change 12.9 [95%CI (0.5-25.4); p = 0.04]) were associated with improved QOL. Patients with metastatic disease had significant improvement in symptom burden (mean change -7.4 [95%CI (-13.4 to -1.4); p = 0.02]). There was no difference in depression or anxiety from BL to week 16.
CONCLUSIONS: Palliative care should be integrated early in the journey for patients with APC, as it can improve QOL and symptom burden.
BACKGROUND: Clinicaltrials.gov identifier: NCT03837132.