Quality of life of patients with end-stage peritoneal metastasis treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC)

Our plain-English summary of Quality of life of patients with end-stage peritoneal metastasis treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC), by K. Odendahl, W. Solass, C. Demtröder, et al (European Journal of Surgical Oncology, 2015).

The study

• Authors: K. Odendahl, W. Solass, C. Demtröder, U. Giger-Pabst, J. Zieren, C. Tempfer, M.A. Reymond
• Journal: European Journal of Surgical Oncology
• Published: 2015;41(10):1379-85
• Cited by: 103 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Quality of Life (QoL) plays an important role in patients with peritoneal metastasis and is deteriorating continuously until death. Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is an innovative palliative treatment of peritoneal metastasis. We present the first QoL results under PIPAC therapy.

Methods: Retrospective analysis of QLQ30 questionnaire results during repeated courses of PIPAC applications in palliative patients with pretreated peritoneal metastasis.

Results: 91 patients (M:F = 40:51, median age 64 (34-77) years) with 158 PIPAC applications were analyzed. 86% patients had previously received systemic chemotherapy. Peritoneal metastasis was advanced (Peritoneal Carcinomatosis Index I = 16 ± 10). At admission, only moderate impairment of functioning (62-83%) and symptom scores (17-47%) was observed. 48 patients received at least 2 PIPAC every 6 weeks. After PIPAC # 1, the global physical score deteriorated slightly (from 82% to 75%), but improved after PIPAC # 2 (up to 89%). Gastrointestinal symptoms (nausea/vomiting, constipation, diarrhoea, anorexia) remained stable under PIPAC therapy.

Conclusions: Quality of life was relatively high in this group of patients with advanced, pretreated peritoneal metastasis, explaining their wish for further therapy. Functioning scores and disease-related symptoms were not altered for at least 3 months in the patients able to receive repeated PIPAC. Except for a transient moderate increase of pain scores, PIPAC did not cause therapy-related QoL deterioration, especially no gastrointestinal symptoms.

Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

In plain English

This was a retrospective review of quality-of-life questionnaires collected routinely at one German university hospital from patients with advanced peritoneal metastasis (cancer spread to the abdominal lining). The patients were treated with PIPAC, which sprays chemotherapy as a pressurized aerosol into the abdomen during keyhole surgery. Of the 91 patients who completed at least one EORTC QLQ-C30 questionnaire, 4 had mesothelioma. Most of the others had stomach, ovarian or colorectal cancer. The article does not discuss asbestos. At admission, physical functioning averaged 75%. Among 48 patients who had at least two treatments six weeks apart, functional scores did not get worse over 3 months, and stomach and bowel symptoms stayed largely constant. Pain scores rose from 28% to 37% after the first treatment. Three of the 91 patients died in hospital, two from bowel injuries linked to PIPAC. No statistical comparisons were made. The authors concluded that quality of life stabilized under PIPAC but urged caution. The study was retrospective, sicker patients stopped answering, and the results cannot be extended to other patients.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Observational, retrospective analysis of routinely collected quality-of-life (registry) data; descriptive statistics only, no comparative statistics
• Who was studied: 91 patients (51 women, 40 men) with advanced, mostly previously treated peritoneal metastasis who completed at least one QoL questionnaire, out of 170 admitted for PIPAC between July 2012 and January 2014 at a German university hospital (tertiary care center). 48 completed at least two questionnaires. Cancer origins included stomach (29), ovarian (25), colorectal (14), appendix (6), cancer of unknown primary (6), mesothelioma (4) and others (7).
• Exposure: Not an asbestos exposure study. The treatment studied was PIPAC at 6-week intervals: pressurized aerosol of cisplatin 7.5 mg/m2 followed by doxorubicin 1.5 mg/m2 body surface. 14 patients with colorectal cancer instead received oxaliplatin 92 mg/m2.
• Main results:
  • At admission, functioning and symptom scores in the 91 patients were moderately altered. For example, physical functioning was 75% (plus or minus 28%).
  • When the 91 patients were grouped by time to death, most functional and symptom scales deteriorated continuously during the last months of life.
  • In the 48 patients who received at least 2 PIPAC applications, functional scores did not deteriorate further over 3 months.
  • In the same 48 patients, gastrointestinal symptom scores (nausea/vomiting, appetite loss, constipation, diarrhoea) remained largely constant.
  • Pain score rose after the first PIPAC (from 28% to 37%) and then improved again (32%).
  • Hospital mortality was 3 of 91 patients (3.3%), or 1.9% of 158 PIPAC procedures. Two deaths were related to PIPAC (bowel access injuries followed by peritonitis) and one was due to disease progression. There was one grade 4 and 8 (8.8%) grade 3 adverse events.
  • Median survival after the first PIPAC application was 13.4 months, with a mean follow-up of 12.0 months.
• The authors' conclusion: The authors concluded that quality of life stabilized under PIPAC: functional scores remained stable, gastrointestinal symptoms did not worsen, and only pain increased slightly and temporarily. They said the results should be considered with caution.
• Limitations the authors state:
  • The study was retrospective.
  • Self-selection bias: the most affected patients stopped filling out questionnaires.
  • Stability applied only to patients able to keep receiving PIPAC. 5 patients with severe adverse events did not continue, so the results cannot be extrapolated to other patients.
  • It is unclear whether the stabilization reflected disease control or relief from side-effects of earlier systemic chemotherapy.
  • The authors could not determine how long quality of life remains stable or what proportion of patients truly benefit.
  • The numbers cannot be directly compared with results after systemic chemotherapy or with patients who did not receive PIPAC.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Ovarian cancer, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Quality of Life, Metastasis, Chemotherapy, Palliative Care.

Related studies

• Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: An international survey study — M. Nowacki, M. Alyami, et al. (2018)
• Unresectable peritoneal metastasis treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC) leading to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — M. Alyami, F. Mercier, et al. (2021)
• Oxaliplatin use in pressurized intraperitoneal aerosol chemotherapy (PIPAC) is safe and effective: A multicenter study — O. Sgarbura, M. Hübner, et al. (2019)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• Multicentric initial experience with the use of the pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the management of unresectable peritoneal carcinomatosis — M. Alyami, J. Gagniere, et al. (2017)
• Quality of life in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is it worth the risk? — N. Tsilimparis, C. Bockelmann, et al. (2013)

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