Utilizing Patient-Reported Quality of Life Measures to Optimize Individualized Treatment Options for Patients with Cholangiocarcinoma

Abstract

Introduction: Although surgery remains the only curative option for cholangiocarcinoma, for patients with oncologically high-risk disease, it is difficult to reconcile an attempt at resection with the risk of morbidity, recurrence, and impediment to health-related quality-of-life (HRQoL). Neoadjuvant chemotherapy (NAC) is increasingly being utilized for high-risk malignancies; however, its association with functional limitations related to toxicity and HRQoL is not known. Method: Patients engaged in the Cholangiocarcinoma Foundation completed two validated HRQoL surveys: Functional Assessment of Cancer Therapy (FACT)-Hepatobiliary; COmprehensive Score for financial Toxicity (COST). Subscales and composite scores were calculated according to the FACIT-Manual, higher values indicating improved HRQoL. Results: 208pts were enrolled. 75% (n=156) had intrahepatic cholangiocarcinoma, 57% (n=119) underwent resection, of which 47% (n=56) had recurrence. 40% (n=42) received neoadjuvant or perioperative chemotherapy; 60% (n=64) received adjuvant chemotherapy (AC) alone. Among patients with localized non-metastatic unresectable disease, 38% (n=34) received chemotherapy/radiation as definitive treatment. Patients who underwent resection and had disease recurrence still reported improved functional-well-being compared to those who received only chemotherapy/radiation (effect size 0.46, p=0.04; Table1). Patients who received NAC prior to resection reported nearly equivalent HRQoL compared to those who underwent upfront resection followed by AC. Conclusions: Despite a surgeon’s desire to first “do-no-harm”, patients with expectedly poor oncologic outcomes still prefer an attempt at resection as depicted by increased functional-well-being, reflecting contentment with HRQoL and acceptance of their illness. Importantly, administering NAC, particularly in the context of high-risk disease, does not result in reduced HRQoL. Incorporating objective patient-reported outcomes data will aid in patient counseling and optimize individualized treatment plans.