Relevant Study: Patient and Clinician Perspectives on Clinically-Meaningful Outcomes in Advanced Pancreatic Cancer

SIMPLE SUMMARY: Pancreatic cancer has a dismal prognosis and is one of the deadliest cancers globally. This prospective investigator-designed longitudinal questionnaire study aimed to evaluate expectations and priorities of patients with advanced pancreatic cancer and their clinicians. Results revealed that there is a mismatch between patient and physician views about the aims, priorities and expected benefit from the treatment for advanced pancreatic cancer. The main findings were that patients significantly overestimated the expected length of time extension that chemotherapy would offer, and when making decisions about treatment options: patients prioritised length of survival, while physicians thought that patients would prioritise the best balance between side-effects and survival. Overall, patients in this study had significantly higher hopes for treatment leading to life extension, compared to their physicians, and also had a lot of fear and worry about the future with poor symptom scores and quality of life. ABSTRACT: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a poor prognosis and significant symptom burden. This prospective observational study aimed to evaluate expectations and priorities of patients with advanced PDAC and their clinicians through a study survey and two quality of life (QoL) questionnaires (QLQ-C30 and PAN26) at three time-points: baseline (T1), before (T2) and after (T3) their 1st on-treatment CT scan. Over a 1-year period, 106 patients were approached, 71 patients and 12 clinicians were recruited. Choosing between treatment options, patients prioritised: 54% overall survival (OS), 26% balance between side-effects and OS, 15% could not choose and 5% favoured symptom control. These were significantly different from the clinician’s answers (p < 0.001). Patients who prioritised OS had higher symptom burden (p = 0.03) and shorter OS compared to those who prioritised balance (p = 0.01). Most (86%) patients had personal goals they wanted to reach; clinicians knew of these in 12% of instances. Patient and clinicians’ views regarding survival improvement from chemotherapy were significantly different: 81% of clinicians and 12% of patients thought 1–2 or 3–6 months extension, 58% of patients and 0% physicians thought 1–5 or >5 years (p < 0.001). At T1, patients had low QoL and worst symptoms were: ‘Future worries’, ‘planning of activities’, fatigue and pain. Patients were willing to accept significantly higher amounts of side-effects as a trade-off for extra time, than clinicians thought (p < 0.001). Overall, there are significant discrepancies between patient and clinicians’ views about the aims, priorities and expected extension of life.