The Association Between Patient-Reported Outcomes and Surgical Attrition During Neoadjuvant Therapy for Gastrointestinal Malignancies.

Publisher: Springer Country of Publication: United States NLM ID: 101479627 Publication Model: Electronic Cited Medium: Internet ISSN: 1941-6636 (Electronic) NLM ISO Abbreviation: J Gastrointest Cancer Subsets: MEDLINE

Publication: 2010- : New York : Springer
Original Publication: New York, NY : Humana Press

Patient Reported Outcome Measures* ; Neoadjuvant Therapy*/methods ; Neoadjuvant Therapy*/statistics & numerical data ; Gastrointestinal Neoplasms*/therapy ; Gastrointestinal Neoplasms*/surgery ; Gastrointestinal Neoplasms*/pathology ; Quality of Life*; Humans ; Male ; Female ; Middle Aged ; Prospective Studies ; Aged

Purpose: Neoadjuvant therapy (NT) is increasingly used for gastrointestinal (GI) and hepatopancreatobiliary (HPB) cancers. Risk factors for surgical attrition during NT are poorly understood. A planned secondary analysis of patient-reported outcomes (PROs) from a prospective cohort study of patients undergoing NT was performed to identify factors associated with surgical attrition.
Methods: Adult patients with GI/HPB cancer receiving NT were provided a mobile phone application administering QOL assessments every 30 days and measuring mood/symptoms until NT completion. Univariate and multivariate logistic regression were performed to determine the association between demographic, clinical characteristics, and PROs with surgical attrition (no surgery (NS) versus surgery or watchful waiting (SWW)). Mixed-effects regression models evaluated trends of QOL and symptoms between the cohorts.
Results: Among 104 enrolled patients, mean age was 60.5 ± 11.5 years, 57 (55%) were male, and 95 (91%) were Caucasian. After a mean duration of 3.4 months of NT, 76 (73%) patients underwent SWW, while 28 (27%) did not (NS). Cancer type (HPB vs GI, OR 7.0, CI 2.7-19.3, p < 0.001), comorbidities (OR 1.72, CI 1.0-2.99, p = 0.05), and severe complications during NT (OR 4.2, CI 1.2-15.3, p = 0.03) were associated with NS. There were no differences between longitudinal QOL scores or PROs among patients who underwent SWW versus NS except for the lack of appetite, which was associated with NS (OR 3.6, CI 1.0-12.2, p = 0.04).
Conclusions: Among patients undergoing NT for GI/HPB malignancies, type of cancer, comorbidities, and severe complications during NT were associated with failure to undergo surgery, whereas QOL and PROs were largely not.
Competing Interests: Declarations. Ethics Approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the clinical scientific review committee and institutional review board of The Ohio State University (#2020C0071). Consent to Participate: Informed consent was obtained from all individual participants included in the study. Competing Interests: The authors declare no competing interests.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

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Keywords: Gastrointestinal cancer; Hepatopancreatic biliary cancer; Neoadjuvant therapy; Patient-reported outcomes; Surgical attrition

Date Created: 20241211 Date Completed: 20241211 Latest Revision: 20241211

20241211

10.1007/s12029-024-01153-0

39661262