Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2022; 10(32): 11775-11788
Published online Nov 16, 2022. doi: 10.12998/wjcc.v10.i32.11775
Quality of life and symptom distress after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy
Ya-Fen Wang, Ting-Yao Wang, Tzu-Ting Liao, Meng-Hung Lin, Tzu-Hao Huang, Meng-Chiao Hsieh, Vincent Chin-Hung Chen, Li-Wen Lee, Wen-Shih Huang, Chao-Yu Chen
Ya-Fen Wang, Cancer Center, Chang Gung Memorial Hospital, Chiayi, Taiwan
Ting-Yao Wang, Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
Tzu-Ting Liao, Division of Case Management, Cancer Center, Chang Gung Memorial Hospital, Chiayi, Taiwan
Meng-Hung Lin, Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
Tzu-Hao Huang, Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
Meng-Chiao Hsieh, Wen-Shih Huang, Division of Colorectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
Vincent Chin-Hung Chen, Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi and Chang Gung University, Taoyuan, Taiwan
Li-Wen Lee, Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
Chao-Yu Chen, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi, Taiwan
Chao-Yu Chen, Department of Early Childhood Care and Education, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Chiayi, Taiwan
Author contributions: Wang YF and Wang TY contributed equally to this work; Wang YF, Wang TY, Liao TT, and Chen CY were responsible for the conceptualization, methodology, data curation, and writing—original draft preparation and editing; Lin MH and Wang YF were responsible for the data analysis and software; Huang TH, Chen VCH, Lee LW, Hsieh MC, Huang WS were responsible for resources and supervision; Wang YF received the grants.
Supported by Chang Gung Medical Foundation through grants, No. CMRPG6H0341-43.
Institutional review board statement: The study was reviewed and approved for publication by the Institutional Review Board of Chang Gung Medical Hospital (No. 201800726B0).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author. No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chao-Yu Chen, MD, Assistant Professor, Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi, 6 West Sec, Chia-Pu Road, Puzi 613, Taiwan. b9002031@cgmh.org.tw
Received: May 12, 2022
Peer-review started: May 12, 2022
First decision: August 4, 2022
Revised: August 9, 2022
Accepted: October 17, 2022
Article in press: October 17, 2022
Published online: November 16, 2022
Processing time: 180 Days and 1.3 Hours
ARTICLE HIGHLIGHTS
Research background

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for peritoneal surface malignancy can effectively control the disease, however it is also associated with adverse effects which may affect quality of life (QoL).

Research motivation

Investigations of perioperative QoL and symptom severity after CRS/HIPEC are limited. The impact on QoL of this treatment has also gradually become more important due to socio-economic considerations.

Research objectives

The main objective of this study was to investigate early perioperative QoL after CRS/HIPEC, which has not previously been discussed in Taiwan.

Research methods

We performed an observational, prospective, single-center cohort study and enrolled patients who received CRS/HIPEC at Chang-Gung Memorial Hospital in Chiayi between September 1, 2018 and February 28, 2021. We assessed QoL using the Taiwanese version of the MD Anderson Symptom Inventory (MDASI-T) and European Organization Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). The participants completed the questionnaires before CRS/ HIPEC (S1), at the first outpatient follow-up (S2), and 3 mo after CRS/HIPEC (S3).

Research results

Most patients had a significant decline in physical and role function scores at S2, but they returned to the preoperative status at S3. The most serious symptoms after surgery were fatigue and pain, and pain returned to the preoperative status 3 mo after surgery. There was no significant decline in global health status after surgery. Both items in the MDASI-T were significantly negatively correlated with the EORTC QLQ-C30 results. The important determinants of QoL were age ≥ 55 years old in emotional functioning at S2 (β = -0.40, P < 0.05), and performance status in preoperative physical functioning (β = 21.49, P < 0.05) and role functioning at S3 (β = 29.63, P < 0.05).

Research conclusions

QoL and symptom severity improved or returned to baseline in most categories within 3 mo after CRS/HIPEC. Understanding the clinical course may relieve the patients’ anxiety over their disease. Our findings may help physicians with preoperative consultation and perioperative care.

Research perspectives

As this study had a relatively small sample size and was prospective in design, larger studies with multiple centers and fewer influences factors are warranted to explore the QoL after HIPEC.