P55: Defining Values and Quality of Life of Cancer Survivors following Cytoreductive Surgery and HIPEC: An International Study

Friday, March 24, 2023

6:11 PM – 6:16 PM

Location: SSO HUB: Rare/Metastatic Cancers Zone

Poster Presenter(s)

Chelsea Knotts, MD

Surgical Oncology Fellow
Allegheny Health Network
Pittsburgh, Pennsylvania, United States

Disclosure(s): No financial relationships to disclose

Author(s)

Chelsea Knotts, MD

Surgical Oncology Fellow
Allegheny Health Network
Pittsburgh, Pennsylvania, United States

Disclosure(s): No financial relationships to disclose
TF

Tamara Floyd, MD

Peritoneal Surface Malignancy Fellow
Allegheny Health Network, United States

Disclosure information not submitted.
FS

Falls Samantha, DO

General Surgery Resident
Allegheny Health Network, United States

Disclosure information not submitted.
Conor M. Maxwell, DO (he/him/his)

General Surgery Resident
Allegheny Health Network
Pittsburgh, Pennsylvania, United States

Disclosure information not submitted.
David L. Bartlett, MD

System Chair
Allegheny Health Network Cancer Institute
Pittsburgh, Pennsylvania, United States

Disclosure information not submitted.
Patrick Wagner, MD

Director, AHN Cancer Institute Division of Complex General Surgical Oncology
Allegheny Health Network
Pittsburgh, Pennsylvania, United States

Disclosure(s): No financial relationships to disclose
NB

Nathan Bahary, MD, Ph.D.

Division Chief, Medical Oncology
Allegheny Health Network, United States

Disclosure information not submitted.
Casey J. Allen, MD

Assistant Professor, Division of Surgical Oncology
Allegheny Health Network
Pittsburgh, Pennsylvania, United States

Disclosure(s): No financial relationships to disclose

Disclosure(s):

Chelsea Knotts, MD: No financial relationships to disclose

Patrick Wagner, MD: No financial relationships to disclose

Casey J. Allen, MD: No financial relationships to disclose

Introduction: Advances in treatment of peritoneal surface malignancies including cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS±HIPEC) have led to long-term survivorship, yet the subsequent quality of life (QOL) and values of these patients are unknown. This study provides an assessment of international cancer patients who underwent CRS±HIPEC.

Methods: Survivors were offered surveys via online support groups. Novel items assessed how patients prioritized value metrics including experience, costs, longevity, and well-being. Using the Short Form-12 validated questionnaire, health-related physical (P-QOL) and mental (M-QOL) well-being were compared to the general population and other gastrointestinal and hepatopancreaticobiliary (GI/HPB) cancer surgery survivors.

Results: 453 GI/HPB surgical patients responded from 6 continents. 74 underwent CRS±HIPEC and were 54±12y, 87% female, 92% white. Respondents averaged 29mo from diagnosis, with a maximum survival of 20y. Sites of primary malignancy included appendiceal (51%), colorectal (17%), ovarian/fallopian (12%), mesothelioma (5%), and others (15%). With a moderate level of agreement (W=39%), rankings of value metrics among respondents were predictable (p < 0.001). Longevity and functional independence were ranked highest; treatment experience and cost of treatment were lowest (p < 0.001). Those who underwent CRS±HIPEC or other GI/HPB surgery reported the same rank-order. In CRS±HIPEC survivors, both M-QOL (44±13) and P-QOL (41±11) were lower than the general population (50±10); p< 0.001. Impairments persist throughout survivorship, but M-QOL improves over time (Figure; p< 0.05).When comparing CRS±HIPEC to other GI/HPB cancer surgeries survivors, M-QOL (43±13 vs 43±14, p=0.85) and P-QOL (40±11 vs 42±12, p=0.41) were similar.

Conclusions: Although CRS±HIPEC survivors experience long-term mental and physical health impairments, it is similar to survivors of other GI/HPB cancer surgery and their QOL improves significantly throughout survivorship. As CRS±HIPEC survivors prioritize longevity above all other values, survival benefit may outweigh a temporary reduction in QOL.

Learning Objectives:

Upon completion, participant will be able to define the different components in the framework for a value incentivized healthcare system.
Upon completion, patient will be able to describe how the effect of HIPEC/CRS on M-QOL and P-QOL over time.
Upon completion, participants will be able to recognize how HIPEC/CRS survivors prioritize the different values in healthcare.