Quality of life and symptom distress after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Table 1 Patients’ characteristics and hyperthermic intraperitoneal chemotherapy parameters, n = 58

Variable	Number	Percentage
Sex
Male	19	32.8
Female	39	67.2
Age at CRS + HIPEC, years (median, range)	60 (22-78)
BMI, kg/m2 (mean, SD)	24.3 (4.5)
ECOG
0-1	55	94.8
2	3	5.2
Comorbidity
Hypertension	17	29.3
Diabetes mellitus	11	19
Hepatitis B	5	8.6
Hepatitis C	6	10.3
Primary or recurrent tumor
Primary	41	70.7
Recurrent	17	29.3
Primary cancer
Colorectal	9	15.5
Ovarian	15	25.9
Gastric	27	46.6
Others	7	12.1
Previous definitive surgery
No	35	60.3
Yes	23	39.7
Previous systemic chemotherapy
Never	22	37.9
1st line	23	39.7
2nd lines or more	13	22.4
PCI (median, range)	5.5 (0-39)
Completeness of cytoreduction score
0	46	79.3
1	8	13.8
2	1	1.7
3	3	5.2
Duration of peritonectomy, mins (median, range)	240 (0-610)
Length of hospital stay, days (median, range)	13 (7-39)
Surgical method
Laparotomy	53	91.4
Laparoscopy	5	8.6
HIPEC regimen
Cisplatin	43	74.1
Non-cisplatin	15	25.9
HIPEC indication
Adjuvant	16	27.6
Curative	39	67.2
Palliation	3	5.2
Duration of HIPEC, mins
60	46	75.9
90	12	20.7
Post-op complications
No	6	10.3
Yes	52	89.7
Post-op complications
Grade I	42	72.4
Grade II	6	10.3
Grade III	3	5.2
Grade IV	1	1.7
Nutrition (PGSGA score)
A	42	85.7
B	7	14.3

BMI: Body mass index; ECOG: Eastern cooperative oncology group performance

status; PCI: Peritoneal carcinomatosis index; PGSGA: Patient-generated subjective global assessment.

Table 2 Descriptive data of the European Organization for Research and Treatment of Cancer Quality of Life-Core 30-item and MD Anderson symptom inventory questionnaires, n = 58

Scales	Items	S1 (n = 58)	S2 (n = 58)	S3 (n = 55)	P value1	The pairwise comparison between S1/S21	The pairwise comparison between S2/S31	The pairwise comparison between S1/S31
QLQ-C30	30	53.5 (8.6)	57.3 (9.8)	54.0 (9.8)	0.066	0.08	0.152	0.96
Global health status	2	60.3 (19.4)	56.6 (15.4)	64.4 (17.5)	0.065	0.486	0.051	0.439
Functional scales	15
Physical functioning	5	82.2 (15.0)	70.5 (19.0)	80.6 (18.2)	0.001	0.001	0.007	0.881
Role functioning	2	78.7 (23.9)	64.1 (23.9)	76.4 (25.2)	0.003	0.004	0.022	0.863
Emotional functioning	4	74.6 (14.8)	78.3 (17.2)	80.6 (17.8)	0.152	0.449	0.743	0.134
Cognitive functioning	2	84.8 (17.2)	85.3 (13.3)	87.3 (18.4)	0.7	0.981	0.807	0.697
Social functioning	2	76.4 (25.8)	74.7 (22.8)	82.7 (20.0)	0.155	0.914	0.157	0.317
Symptom scales	13
Fatigue	3	26.2 (16.5)	37.5 (21.7)	32.1 (16.9)	0.005	0.004	0.269	0.215
Pain	2	14.9 (18.4)	27.0 (19.5)	14.2 (17.7)	< 0.001	0.002	0.001	0.978
Nausea and vomiting	2	9.8 (21.2)	8.0 (16.0)	12.7 (19.0)	0.413	0.875	0.386	0.682
Dyspnea	1	12.1 (17.3)	17.8 (20.0)	9.7 (15.3)	0.044	0.189	0.041	0.756
Insomnia	1	23.6 (27.2)	24.1 (26.3)	21.2 (22.6)	0.813	0.992	0.815	0.876
Appetite loss	1	21.3 (23.9)	27.6 (28.0)	27.3 (22.3)	0.311	0.361	0.998	0.408
Constipation	1	12.1 (23.9)	12.1 (20.4)	17.6 (25.5)	0.357	1	0.424	0.424
Diarrhea	1	12.6 (19.6)	11.5 (19.3)	17.0 (21.2)	0.314	0.949	0.316	0.485
Financial difficulties	1	21.3 (24.7)	21.3 (26.3)	17.0 (23.0)	0.571	1	0.627	0.627
MDASI-T	19
Symptom severity	13	14.8 (12.5)	16.8 (12.8)	15.3 (15.2)	0.726	0.722	0.836	0.98
Degree of interference with life	6	9.6 (9.5)	10.7 (10.0)	7.5 (8.6)	0.186	0.791	0.166	0.468

¹P values were calculated using one-way analysis of variance (ANOVA). Bold: P < 0.05.

MDASI-T: MD Anderson Symptom Inventory - Traditional version; QLQ-C30: Quality of Life-Core 30-item. S1: The first visit before CRS/HIPEC; S2: The second visit at the first outpatient follow-up after CRS/HIPEC; S3: The third visit at the outpatient visit 3 months after CRS/HIPEC. The data are presented as the mean and standard deviation of the scores (in parentheses).

Table 3 Relationships between the European Organization for Research and Treatment of Cancer Quality of Life-Core 30-item and its related factors at three time periods (S1, S2, and S3)

Characteristic	Global health status			Physical functioning			Role functioning			Emotional functioning			Cognitive functioning			Social functioning
	S1	S2	S3	S1	S2	S3	S1	S2	S3	S1	S2	S3	S1	S2	S3	S1	S2	S3
Age	-0.55	-0.96	-0.01	-0.61	-2.291	-1.01	-0.79	-0.83	-2.261	-0.49	1.08	-0.81	-0.7	-0.5	-1.11	-1.21	-2.071	-1.99
Sex	-0.67	0.14	-1.11	-0.03	-0.18	-0.07	-1.33	-0.01	-1.43	0.31	0.33	-0.15	-0.44	0.6	-0.07	-0.56	-0.24	-0.69
ECOG	1.21	-0.84	0.33	2.782	0.56	2.071	3.873	-1.02	1.49	1.29	0.05	0.01	1.92	1.79	-0.69	-0.47	-1.56	-1.04
HTN	-1.23	-0.7	-0.44	-0.56	-0.84	-0.29	-1.47	-0.16	-0.05	-0.3	0.52	-0.11	0.41	-1.07	-0.4	-1.32	-1.23	-0.32
DM	-0.05	-0.41	-2.03	-0.06	-0.32	-2.07	-0.7	0.48	-0.97	-0.48	0.7	-1.2	0.96	0.55	-0.83	-0.77	-1.41	-1.58
HBV	0.24	0.24	1.03	1.39	0.96	0.76	-0.12	0.4	-0.03	-0.07	1.13	0.08	0.19	1.55	0.5	-2.711	-0.54	-0.07
HCV	1.2	0.18	-0.75	0.95	0.36	0.08	-0.49	0.32	0.28	0.17	1.34	0.96	-0.62	-0.15	0.92	-0.41	0.59	-0.07
Primary or recurrent tumor	-0.98	-0.39	-1.04	-2.03	-0.54	-0.82	-1.78	-0.73	-1.32	-0.79	0.94	0.24	-0.15	1.48	0.74	-1.52	0.58	-0.39
Primary cancera	1.36	1.43	1.36	0.48	0.46	0.48	0.43	0.6	0.43	0.63	0.36	0.63	1.12	0.59	1.12	1	0.93	1
Previous definitive surgery	-1.33	-0.83	-1.16	-1.25	-1.12	-1.14	-0.81	-0.66	-0.51	-0.63	0.92	0.27	-0.78	-0.07	-0.26	-1.31	0.24	-0.4
Previous systemic chemotherapy	-1.57	-1.86	-2.151	-0.99	-0.9	-1.1	-1.37	-1.05	-1.52	-0.89	0.43	-0.93	0.29	0.45	-1	-1.37	-0.71	-1.99
PCIb	-0.05	-0.02	0.1	-0.15	-0.12	-0.13	-0.15	-0.12	-0.05	-0.22	-0.04	0.04	-0.11	0.03	-0.01	-0.01	-0.05	-0.05
CCa	0.93	1.14	0.48	1.03	1.07	0.37	0.53	1.07	0.29	1.45	0.06	0.35	0.38	0.53	0.3	0.72	0.85	0.13
Duration of peritonectomy (min)b	-0.06	-0.18	0.11	0.18	-0.21	0.05	0.09	-0.37	-0.01	0.01	0.04	0.09	-0.14	0.04	-0.03	-0.09	-0.04	0.05
LOS (days)b	-0.13	0.14	-0.03	-0.02	0.1	-0.07	0	0.06	-0.12	-0.01	0.2	0.03	-0.26	0.13	-0.05	0.09	0.18	0.07
Surgical method	0.64	-0.01	0.47	0.54	0.3	0.65	1.18	0.72	0.11	2.111	1.6	1.14	0.65	2.872	1.4	2.872	0.72	-0.22
HIPEC regimen	-1.11	-0.63	-0.52	-0.39	0.89	2.561	-0.15	0.07	-0.12	-0.04	-0.35	0.63	-0.66	0.44	1.93	-0.54	-1.38	0.39
HIPEC indicationa	0.95	0.15	1.16	1.34	0.44	0	0.39	0.47	0.01	0.93	0.11	0.15	0.02	0.22	0.08	1.54	1.39	0.15
Duration of HIPEC (mins)	0.82	0.44	0.37	1.01	-0.7	-2.131	0.6	0.48	0.42	0.62	1.28	-0.04	0.01	-1.46	-2.431	0.84	1.38	-0.1
Post-op complicationsa	0.62	0.54	2.05	0.69	0.88	0.19	0.51	0.99	0.67	0.4	0.34	1.34	2.24	1.51	1.25	0.48	1.15	2.61
PGSGA	1.84	0.49	1.08	0.79	0.14	1.28	-1.27	-0.78	0.9	1.16	-0.19	-0.44	1.25	0.42	1.2	-0.55	0.74	0.6
MDASI-T
SSb	-0.483	-0.34	-0.7	-0.38	-0.46	-0.52	-0.3	-0.453	-0.483	-0.342	-0.493	-0.643	-0.543	-0.2	-0.723	-0.24	-0.331	-0.613
DILb	-0.543	-0.493	-0.693	-0.433	-0.633	-0.66	-0.473	-0.603	-0.693	-0.433	-0.433	-0.723	-0.392	-0.281	-0.673	-0.533	-0.523	-0.783

^aF coefficients;

^br coefficients;

¹P < 0.05;

²P < 0.01;

³P < 0.001.

BMI: Body mass index; CC: Completeness of cytoreduction; DIL: Degree of interference with life; DM: Diabetes mellitus; ECOG: Eastern Cooperative Oncology Group performance status; HBV: hepatitis B; HCV: hepatitis C; HTN: Hypertension; PCI: Peritoneal carcinomatosis index; PGSGA: Patient-Generated Subjective Global Assessment; SS: Symptom severity; LOS: Length of hospital stay; MDASI-T: MD Anderson Symptom Inventory-Taiwan version. S1: The first visit before CRS/HIPEC; S2: The second visit, the first outpatient follow-up visit after CRS/HIPEC; S3: The third visit, the outpatient visit 3 mo after CRS/HIPEC.

Table 4 Multiple regression analysis of QoL at the three time periods (S1, S2, and S3)

Characteristic		Global health status			Physical functioning			Role functioning			Emotional functioning			Cognitive functioning			Social functioning
		S1	S2	S3	S1	S2	S3	S1	S2	S3	S1	S2	S3	S1	S2	S3	S1	S2	S3
Agea		-0.04	-0.09	-0.2	0.12	0.12	0.05	0.44	-0.11	0.36	-0.06	-0.401	-0.06	-0.22	0.1	-0.04	0.15	0.33	0.23
Sexa		-3.42	3.04	-0.9	-1.51	0.03	-0.02	-8.47	4.16	-7.64	2.26	3.28	2.86	-3.84	2.48	3.1	1.91	3.41	-0.02
ECOGa		11.48	-3.84	6.95	21.491	8.54	15.71	14.12	-15.01	29.631	4.44	-6.42	-7.51	12.7636	6.65	-16.7	-15.26	-17.76	-13.8
HBVa		1.14	-2.14	-7.53	-7.03	-11.47	-9.52	-2.91	-9.5	-2.33	0.34	-8.79	-5.72	5.04	-11.76	-12.04	4.86	-2.02	-8.07
Previous systemic chemotherapya		7.88	4.22	5.17	5.12	0.63	-0.89	9.32	-0.47	2.49	3.04	-6.04	-5.53	-0.57	-2.98	-3.83	6.84	-1.42	-0.12
Surgical methoda		-4.57	-0.44	0.86	-2.74	0.36	8.32	7.11	8.92	-4.39	9.93	10.61	11.54	-7.77	17.232	16.781	33.222	16.73	2.54
HIPEC regimena		0.65	1.41	6.69	-0.93	-7.51	-6.67	-3.94	-4.08	4.79	-2.55	-0.21	-0.23	-0.85	-2.09	-5.98	-1.76	6.71	-0.76
MDASI-T
	SSa	-0.451	-0.07	-0.542	-0.21	-0.15	-0.01	-0.17	-0.15	0.18	-0.1	-0.41	-0.11	-0.682	0.07	-0.521	0.23	0.06	0.10
	DILa	-0.751	-0.711	-0.64	-0.44	-1.081	-1.372	-0.78	-1.393	-2.113	-0.611	-0.651	-1.493	-0.32	-0.461	-0.781	-1.483	-1.042	-1.893
Adjusted R2		0.4	0.28	0.63	0.35	0.47	0.55	0.32	0.41	0.58	0.27	0.4	0.58	0.37	0.32	0.64	0.45	0.37	0.65

^aβ coefficients;

¹P < 0.05;

²P < 0.01;

³P < 0.001.

DIL: Degree of interference with life; ECOG: Eastern Cooperative Oncology Group performance status; HBV: Hepatitis B; SS: Symptom severity; MDASI-T: MD Anderson Symptom Inventory-Taiwan version. S1: The first visit before CRS/HIPEC; S2: The second visit, the first outpatient follow-up visit after CRS/HIPEC; S3: The third visit, the outpatient visit 3 mo after CRS/HIPEC.