Correlation Between Quality of Life, Nutrition Status, and Disease Stage Among Pancreatic and Periampullary Cancer Patients

Importance: Nutrition status and quality of life (QOL) have been previously correlated in patients with various types of cancers, yet the relationship in pre-treatment pancreatic and periampullary cancer patients remains unknown. Objectives: To determine whether there is an association between pre-treatment nutrition status and QOL, and if either variable is correlated with disease stage. Design, Setting, and Participants: This cross-sectional observational analysis included 110 treatment-naïve patients who presented to The University of Texas MD Anderson Cancer Center (MDACC) for initial surgical evaluation and/or treatment for localized pancreatic cancer or periampullary neoplasm between September 2009 and March 2013. These subjects were part of a larger longitudinal study (“Correlative Study of Nutrition and Quality of Life in Patients with Pancreatic Cancer”), and were selected based on disease staging availability and diagnosis of adenocarcinoma or neuroendocrine tumor of the pancreas or periampullary region. Main Outcome Measures: Nutrition status was measured using the Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire. QOL was assessed using the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire. Disease stage was quantified using the American Joint Commission on Cancer (AJCC) and International Union for Cancer Control (IUCC) “TNM” staging guidelines. Results: PG-SGA scores were significantly negatively associated with total FACT-Hep score (P< 0.001), Physical Well-being (PWB) subscore (P< 0.001), Functional Well-being (FWB) subscore (P< 0.001), and Hepatobiliary (Hep) subscore (P< 0.001). AJCC disease stage was significantly positively associated with PG-SGA score (P=0.004) and significantly negatively associated with total FACT-Hep score (P=0.05), PWB subscore (P=0.02), and Hep subscore (P=0.02). Thus, those subjects with more advanced disease stage tended to have a poorer nutrition status and poorer QOL. Hyperlipidemia/hypercholesterolemia (OR=14.67, P= 0.001), histologic diagnosis (neuroendocrine tumor vs. adenocarcinoma) (OR= 0.19, P= 0.02), and PGSGA score (OR= 1.13, P= 0.004) were found to be significant predictors of AJCC disease stage. Conclusion and Relevance: Pre-treatment nutrition status is significantly correlated with QOL, and both nutrition status and QOL are significantly associated with AJCC disease stage in patients with pancreatic or periampullary cancer. These factors should be taken into consideration when making plan of care decisions to maximize patient QOL during and after treatment.Master of Public Healt