title: Estimating prognosis and palliation based on tumour marker CA 19-9 and quality of life indicators in patients with advanced pancreatic cancer receiving chemotherapy.
abstract: BACKGROUND
  To investigate the prognostic value of quality of life (QOL) relative to tumour marker carbohydrate antigen (CA) 19-9, and the role of CA 19-9 in estimating palliation in patients with advanced pancreatic cancer receiving chemotherapy.
  
  
  METHODS
  CA 19-9 serum concentration was measured at baseline and every 3 weeks in a phase III trial (SAKK 44/00-CECOG/PAN.1.3.001). Patients scored QOL indicators at baseline, and before each administration of chemotherapy (weekly or bi-weekly) for 24 weeks or until progression. Prognostic factors were investigated by Cox models, QOL during chemotherapy by mixed-effect models.
  
  
  RESULTS
  Patient-rated pain (P<0.02) and tiredness (P<0.03) were independent predictors for survival, although less prognostic than CA 19-9 (P<0.001). Baseline CA 19-9 did not predict QOL during chemotherapy, except for a marginal effect on pain (P<0.05). Mean changes in physical domains across the whole observation period were marginally correlated with the maximum CA 19-9 decrease. Patients in a better health status reported the most improvement in QOL within 20 days before maximum CA 19-9 decrease. They indicated substantially less pain and better physical well-being, already, early on during chemotherapy with a maximum CA 19-9 decrease of ≥50% vs <50%.
  
  
  CONCLUSIONS
  In advanced pancreatic cancer, pain and tiredness are independent prognostic factors for survival, although less prognostic than CA 19-9. Quality of life improves before best CA 19-9 response but the maximum CA 19-9 decrease has no impact on subsequent QOL. To estimate palliation by chemotherapy, patient's perception needs to be taken into account.
authors.affiliation: SAKK Coordinating Center, Bern, Switzerland. juerg.bernhard@ibcsg.org
authors.forename: J
authors.initials: J
authors.lastname: Bernhard
authors.forename: D
authors.initials: D
authors.lastname: Dietrich
authors.forename: B
authors.initials: B
authors.lastname: Glimelius
authors.forename: V
authors.initials: V
authors.lastname: Hess
authors.forename: G
authors.initials: G
authors.lastname: Bodoky
authors.forename: W
authors.initials: W
authors.lastname: Scheithauer
authors.forename: R
authors.initials: R
authors.lastname: Herrmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D005221:Fatigue / Q000150:complications; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000150:complications; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000523:psychology*; D011379:Prognosis; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen