Patterns of self-reported symptoms in pancreatic cancer patients receiving chemoradiation

Abstract

Pancreatic cancer is a lethal disease characterized by multiple disease-related symptoms. Chemoradiation therapy is a standard of treatment for locally advanced pancreatic cancer. Although shown to prolong survival, there is little information about treatment-related symptoms or the palliative benefits of chemoradiation. We assessed symptoms of patients with locally advanced pancreatic cancer receiving chemoradiation to determine the prevalence, and co-occurrence, of symptoms and to identify the extent to which symptoms interfered with function. Forty-eight patients were treated with chemoradiation on a Phase I protocol. Patients received radiotherapy (50.4 Gy in 28 fractions), capecitabine (median dose 825 mg/m(2) twice daily), and bevacizumab (2.5-10 mg/kg). Symptom severity and its interference with function were prospectively assessed (at presentation, during, and after chemoradiation) in 43 consenting patients using the M.D. Anderson Symptom Inventory. Results showed that 95% of patients reported at least one of the 13 symptoms assessed at presentation. The most commonly reported symptoms of moderate to severe (>or=5 on a 0-10 scale) intensity at presentation were lack of appetite (24%), pain (19%), fatigue (19%), and sleep disturbance (10%). We observed an increase in patients reporting moderate to severe fatigue, nausea, and sleep disturbance during chemoradiation. McNemar tests for paired binary observations showed the proportion of patients reporting moderate to severe symptoms significantly (P<0.001) decreased after chemoradiation at 94 days follow-up (lack of appetite=7%, pain=7%, fatigue=13%, sleep disturbance=7%). This study demonstrates the feasibility and usefulness of symptom assessment in chemoradiation protocols. Future studies with larger cohorts are needed to further characterize multiple symptoms associated with chemoradiation.

Fig. 1

Mean score of symptoms assessed before chemoradiation (Note: all symptom items were assessed using an 11-point (0 = none; 10 = as bad as you can imagine) numeric rating scale).

Fig. 2

Prevalence of moderate to severe symptoms (≥5, on a 0–10 scale) before, during, and after chemoradiotherapy (n = 43) (Note: all symptom items were statistically significant (P < 0.001) for McNemar test for paired binary response before and after chemoradiation (n = 27). No statistically significant (P > 0.05) differences for survival and disease progression for patients with complete data versus those with missing data Prevalence during treatment was computed as any report of >5 symptom severity during the chemoradiation period).