The Imperative of Assessing Quality of Life in Patients Presenting to a Pancreaticobiliary Surgery Clinic

Objective The objective of this study was to determine baseline health-related quality of life (QoL) in patients with pancreatic adenocarcinoma (PA), peri-ampullary cancers, and benign pancreaticobiliary (PB) conditions at the time of the first visit to a PB surgery clinic, and to explore the relationship between QoL, demographics, clinical parameters, complications and survival. Summary background data Few studies have examined baseline QoL measures, the impact of co-morbidities, age, gender and smoking on subsequent post-operative complications and survival in patients with PA, related PB cancers, and with benign PB conditions. Methods Data were collected from scheduled patients at a PB surgery clinic between 2013 and 2018. The Brief Pain Inventory, Fact-Hepatobiliary Scale, and Facit-Fatigue questionnaires were administered. QoL parameters were compared between PB cancer patients and those with benign disease. Results 462 individuals with PB cancers and benign diseases exhibited baseline physical well-being, functional well-being, fatigue, and overall QoL at or below the 75th percentile of wellness at the time of the first office visit. Younger age, smoking, and mental health comorbidities contributed significantly to decreased QoL. PA patients were seven times more likely to die in the follow-up period than the benign disease group. Black patients had higher pain scores and were three times more likely to have a post-surgery complication. Gender differences were identified regarding fatigue, pain and overall QoL. Conclusions This large cohort of PB cancer and benign disease patients exhibited significantly impaired baseline QoL. GI problems, weight loss, smoking, cardiovascular, pulmonary disease and history of anxiety and depression contributed significantly to reduced QoL. The study sheds a cautionary light on the burden of PB disease at the time of surgical evaluation and its relationship to diminished QoL.