Short-Term Quality of Life Outcomes Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Abstract

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment of peritoneal malignancies (PM). However, it can also adversely affect patients' quality of life (QoL). Aim: This study reports short-term QoL outcomes following CRS and HIPEC and compares the QoL trajectories between patients with more extensive cancer to those with less extensive disease. Methods: Patients undergoing CRS and HIPEC at a single referral center between April 2017 and April 2018 were prospectively recruited. QoL was measured using short-form 36 version 2. Physical (PCS) and mental component scores (MCS) were scored according to the manual (higher scores reflect better QoL). Data were collected at baseline, predischarge, 3 and 6 months postoperatively. PCS and MCS trajectories were described. Results: Of 68 patients, 62 (91%) entered the study. Median PCS decreased from baseline to predischarge but this then recovers and improves beyond baseline by 3 months (43.4 IQR 35.2-55.2, 34.3 IQR 27.3-43.5, 48.1 IQR 37.6-52.5). Median MCS declined marginally postoperatively but improves above baseline by 3 months and continues to improve at 6 months (49.6 IQR 43.5-55.7, 47.8 IQR 39.9-55.0, 51.2 IQR 43.7-57.3, 56.2 IQR 42.8-58.6). Using a PCI (peritoneal carcinoma index, a staging system for the extent of disease from 0-39, higher value denotes more extensive disease) ≥ 15, patients with high PCI were found to have worse PCS at baseline (36.5 vs 48.9, P < 0.005). Despite nonstatistically significant differences in MCS between high PCI and low PCI patients, there is a clinically significant trend among patients with high PCI in that the trajectory for MCS is one of continued decline. Conclusion: Short-term QoL after CRS and HIPEC is acceptable. QoL returned to baseline quicker than anticipated. Further studies are needed to describe the long-term QoL and in particular, the relationship between PCI and QoL needs further evaluation.