Impact of Pressurized Intraperitoneal Aerosol Chemotherapy on Quality of Life and Symptoms in Patients with Peritoneal Carcinomatosis: A Retrospective Cohort Study

Background . Peritoneal cancer treatment aims to prolong survival, but preserving Quality of Life (QoL) under treatment is also a priority. Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is a novel minimally invasive repeatable treatment modality. The aim of the present study was to assess QoL in our cohort of PIPAC patients. Methods . Analysis of all consecutive patients included from the start of PIPAC program (January 2015). QoL (0–100: optimal) and symptoms (no symptom: 0–100) were measured prospectively before and after every PIPAC procedure using EORTC QLQ-C30. Results . Forty-two patients (M : F = 8 : 34, median age 66 (59–73) years) had 91 PIPAC procedures in total (1 : 4x, 17 : 3x, 12 : 2x, and 12 : 1x). Before first PIPAC, baseline QoL was measured as median of <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mn fontstyle="italic">66</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">2.64</mml:mn></mml:math>. Prominent complaints were fatigue (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mn fontstyle="italic">32</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">4.3</mml:mn></mml:math>) and digestive symptoms as diarrhea (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mn fontstyle="italic">17</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">3.75</mml:mn></mml:math>), constipation (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mn fontstyle="italic">17</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">4.13</mml:mn></mml:math>), and nausea (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mn fontstyle="italic">7</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">2.54</mml:mn></mml:math>). Overall Quality of Life was <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M6"><mml:mn fontstyle="italic">64</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">3.75</mml:mn></mml:math> after PIPAC#1 (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M7"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">0.57</mml:mn></mml:math>), <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M8"><mml:mn fontstyle="italic">61</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">4.76</mml:mn></mml:math> after PIPAC#2 (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M9"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">0.89</mml:mn></mml:math>), and <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M10"><mml:mn fontstyle="italic">70</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">6.67</mml:mn></mml:math> after PIPAC#3 (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M11"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">0.58</mml:mn></mml:math>). Fatigue symptom score was <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M12"><mml:mn fontstyle="italic">44</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">4.86</mml:mn></mml:math> after PIPAC#1 and <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M13"><mml:mn fontstyle="italic">47</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">6.69</mml:mn></mml:math> and <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M14"><mml:mn fontstyle="italic">34</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">7.85</mml:mn></mml:math> after second and third applications, respectively (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M15"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">0.40</mml:mn></mml:math>). Diarrhea (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M16"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">0.31</mml:mn></mml:math>), constipation (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M17"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">0.76</mml:mn></mml:math>), and nausea (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M18"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">0.66</mml:mn></mml:math>) did not change significantly under PIPAC treatment. Conclusion . PIPAC treatment of peritoneal carcinomatosis had no negative impact on patients’ overall QoL and its components or on main symptoms. This study was registered online on Research Registry (UIN: 1608).