Patient-Reported Outcomes in Prospective Cohort of Patients with Borderline Resectable or Locally Advanced Pancreatic Cancer Undergoing Radiotherapy

Abstract

Among patients with pancreatic cancer, radiotherapy has a role in offering patients local and overall control but data on patient reported outcomes remains scarce. We sought to quantify the patient reported outcomes (PROs) of pancreatic cancer patients receiving radiotherapy (RT) in order to improve patient-physician communication and shared decision making. As part of an IRB-approved study, we prospectively collected PRO data for 57 patients (28 male, 29 female, median age of 68 years [range, 41-83]) with non-metastatic pancreatic cancer who were treated with neoadjuvant chemotherapy (50% FOLFIRINOX, 42% gemcitabine and nab-paclitaxel, 8% other) and RT. Patients received stereotactic body radiation therapy (SBRT) (median dose: 36Gy, 5 fractions for all, n = 13), volumetric modulated arc therapy (VMAT) (median dose: 50.4Gy, 10-28 fractions, n = 20), intensity-modulated radiation therapy (IMRT) (median dose: 62Gy, 10-28 fractions, n = 13), or 3-dimensional conformal radiation treatment (3D-CRT) (median dose: 30Gy, 10-28 fractions, n = 13). All patients were seen by a multidisciplinary care team. PROs were collected using the validated MD Anderson Symptom Inventory for gastrointestinal cancer (MDASI-GI) questionnaire before the start of RT and after completion of RT. We used descriptive statistics to summarize the patients’ characteristics and MDASI-GI scores. We then performed subgroup analyses on the different radiation modalities and used the paired t-test to compare mean between pre-, and post-RT MDASI-GI scores. Median follow up time was 14.0 months and median overall survival was 24.4 months. No significant differences between pre-, and post-RT were found for the composite MDASI-GI score (mean difference: 0.04, 95% CI [-0.23 – 0.32], p = 0.76). Furthermore, there was no significant differences between pre-, and post- therapy for each radiation modality used. The 5 most-severe MDASI-GI items were fatigue, mouth dryness, numbness, taste disturbance, and decreased appetite. Compared to baseline, no increase in the proportion of patients reporting moderate to severe MDASI-GI items was noted in the IMRT group. In the 3D-CRT group, there was no increase in the proportion of patients reporting moderate to severe MDASI-GI items except for appetite (10% increase). Similarly, no change was noted in the SBRT and VMAT groups except for numbness (16% increase) and mouth dryness (8% increase) respectively. Different RT modalities do not seem to affect PROs in a clinically significant way for patients with pancreatic cancer. This may be related to modern medical management and newer radiation technologies. Future studies will investigate additional time points and correlate PRO data with outcomes.