An analysis of how much time people with pancreatic cancer spend in the hospital or in medical care can help clinicians make treatment recommendations that will allow patients with this disease help balance decisions concerning quantity of life and quality of life.
“For pancreatic cancer we know the quantity of life is short, so maximizing the quality of life is important—and the best way we can do that is to give patients concrete data that they can look at and use in their treatment decisions,” explained Casey Boyd, lead author of the study yielding such information, in a statement issued by the University of Texas (UT) Medical Branch at Galveston, where Boyd is a surgery resident.
As noted in the UT statement, most people with pancreatic cancer die within 2 years after diagnosis, and even aggressive intervention with chemotherapy, radiation, or surgery rarely yields more than an extra month to a year of survival. Patients must decide whether difficult treatment is worth slightly prolonged life.
To paint a more accurate picture of the treatment experience, Boyd and her fellow researchers used Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked data to identify 25,476 patients with pancreatic cancer between 1992 and 2005. The investigators described hospital and medical care days per person-month from the time of diagnosis, stratified by stage, treatment, and survival duration.
Hospital/medical care days vary by length of survival and by treatment strategy for persons with pancreatic cancer. Boyd’s team found that for all disease stages, patients were in the hospital a mean of 6.4 days and received medical care a total of 9 days in the first month after diagnosis. These numbers fell to 1.7 and 3.7 days per month, respectively, by the end of the first year. Hospital/medical care days per month of life were higher in patients with shorter survival, but increased sharply at the end of life for all patients, duration of survival not withstanding.
Among persons with locoregional disease, resection was associated with a higher number of hospital/medical care days in the first 4 months after diagnosis, but with fewer days at the end of the first year. Hospital days were similar for those with distant disease, but days in medical care were higher for patients receiving chemotherapy, increasing especially at the end of life.
As Boyd and colleagues wrote in their report for Annals of Surgical Oncology (2012;19:2435-2442), this information will provide realistic expectations and allow for treatment decisions based on patient preferences. For example, elaborated Boyd in the UT statement, a provider could use these data to counsel a patient with metastatic pancreatic cancer. “The physician could say, ‘If you have chemotherapy you may live 4 to 6 weeks longer, but a lot of that time you’re going to be in the hospital.”
The patient can then decide whether he or she would prefer to undergo treatment or not.