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%.

Conclusion: 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.

Figures

Figure 1

Overall survival by baseline scores of tiredness (cut-off points: 50, 77) and pain (cut-off points: 71, 92). Both indicators have a range from 0 to 100, with higher scores indicating a better condition. P-values are based on log-rank test.

Figure 2

Mean changes (N=85) in QOL (95% CI) between baseline and different periods relative to the time point of best CA 19-9 response. Four periods were defined: ⩾21 days (period 1) or <21 days (2) before best response, and <21 days (3) or ⩾21 days (4) after best response. Higher scores indicate an improvement. A meaningful change is defined as a mean change of ⩾8 points from baseline in either direction.

Figure 3

Individual changes in pain between baseline and different periods relative to the time point of best CA 19-9 response, split by the cut-off of N=14) vs ⩾50%: (N=71) maximum decrease. Four periods were defined: ⩾21 days (period 1) or <21 days (2) before best response, and <21 days (3) or ⩾21 days (4) after best response. Higher scores indicate an improvement. A meaningful change is defined as a mean change of ⩾8 points from baseline in either direction.