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Recorded for On-Demand Viewing
Recorded for On-Demand Viewing

Hepato-pancreato-biliary

E190: Association between Patient-Reported Outcomes and Surgical Attrition during Neoadjuvant Therapy for Gastrointestinal Malignancies

Introduction: Neoadjuvant therapy (NT) is increasingly used for localized gastrointestinal (GI) and hepatopancreatobiliary (HPB) cancers. Surgical resection after NT leads to improved survival, yet risk factors for attrition during NT are poorly understood. A planned secondary analysis of clinical and patient-reported outcomes (PROs) data from a prospective cohort study of patients undergoing NT was performed to identify factors associated with failure to undergo surgical resection.

Methods: Patients with GI (gastric, colorectal, esophageal) or HPB (pancreas or liver) cancer receiving NT were prospectively equipped with a customized mobile phone application that administered QOL assessments (Functional Assessment of Cancer Therapy-General (FACT-G)) at baseline and every 30 days that measured mood, symptoms, and free-text journaling ad hoc until completion of NT. Complications and outcomes of NT were prospectively recorded. Univariate and multivariate logistic regression were performed to determine the association between demographic, clinical characteristics, and PROs with surgical attrition (no surgery versus surgery or planned watchful waiting) whereas mixed effects regression models evaluated trends of QOL and symptoms between the cohorts.

Results: Among 104 enrolled patients, 40 (38%) and 64 (62%) patients had HPB and GI cancers, respectively. Mean age of the cohort was 60.5±11.5, 57 (55%) were male, and 95 (91%) were Caucasian. After a mean duration of 3.4 months of NT, 76 (73%) patients underwent surgical resection or planned watchful waiting while 28 (27%) did not, most often because of disease progression (n=16, 57%) or death (n=4, 14%). On univariate analysis, 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 not undergoing surgery whereas baseline FACT-G scores were not. There were no differences between longitudinal QOL scores, patient-reported symptoms, or overall symptom burden among patients who underwent SWW versus individuals who did not except for 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. Additional research is needed to identify factors associated with attrition during NT so that patient-centered interventions can be developed and studied.

Learning Objectives:

  • Upon completion, participant will be able to identify the importance of Neoadjuvant therapy in treatment of GI malignancies.
  • Upon completion, participant will be able to identify the risk factors for surgical attrition during neoadjuvant therapy
  • Upon completion, participant will be able to identify areas to improve patients making it to surgery after NT