title: Quality of life across chemotherapy lines in patients with cancers of the pancreas and biliary tract.
abstract: BACKGROUND
  In patients with cancers of the pancreatic and biliary tract quality of life (QOL) improvement is the main treatment goal, since survival can be prolonged only marginally. Up to date, knowledge on QOL impairments throughout the entire treatment process, often including several chemotherapy lines, is scarce. Our study aimed at investigating QOL trajectories from adjuvant treatment to palliative 3rd-line therapy
  
  
  METHODS
  Patients were included in routine electronic patient-reported outcome monitoring at Kufstein County Hospital at the time of diagnosis and assessed with the EORTC QLQ-C30 during each chemotherapy cycle.
  
  
  RESULTS
  Eighty out of 147 patients with pancreatic cancer or cancer of the bile ducts treated at the Kufstein County Hospital, fulfilled inclusion criteria and could be included in the study (mean age 67.4 years; 53.8% women). Physical, Emotional and Cognitive Functioning, and Global QOL deteriorated across chemotherapy lines, whereas Fatigue, Pain, Dyspnoea, Sleeping Disturbances, Diarrhoea, and Taste Alterations increased. With regard to Physical Functioning, Global QOL, Fatigue, Dyspnoea, Diarrhoea and Taste Alterations, the patients receiving adjuvant or 1st-line palliative chemotherapy did not differ significantly. Most patients in 2nd- or 3rd-line chemotherapy showed significantly higher impairments and symptom burden. However, patients under 1st and 2nd-line treatment showed stable QOL trajectories, whereas 3rd-line patients perceived substantial deteriorations.
  
  
  CONCLUSIONS
  The results suggest early palliative treatment initiation to stabilise QOL on a level as high as possible. The continuous QOL improvement during adjuvant treatment, probably reflecting post-operative recovery, may indicate that deleterious effects of adjuvant chemotherapy on QOL are highly unlikely.
authors.affiliation: Department of Internal Medicine, Kufstein County Hospital, Endach 27, A-6330, Kufstein, Austria. august.zabernigg@bkh-kufstein.at
authors.forename: August
authors.initials: A
authors.lastname: Zabernigg
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Giesinger
authors.forename: Georg
authors.initials: G
authors.lastname: Pall
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Gamper
authors.forename: Klaus
authors.initials: K
authors.lastname: Gattringer
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Wintner
authors.forename: Monika J
authors.initials: MJ
authors.lastname: Sztankay
authors.forename: Bernhard
authors.initials: B
authors.lastname: Holzner
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005706:Gallbladder Neoplasms / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000523:psychology*; D011788:Quality of Life; D011795:Surveys and Questionnaires