961 Quality of life (qol) in chronic pancreatitis (cp) is determined by constant pain, disability, current smoking and associated co-morbidities
Machicado JD, Amann S, Anderson M, et al. 961 Quality of Life (QOL) in Chronic Pancreatitis (CP) Is Determined by Constant Pain, Disability, Current Smoking and Associated Co-Morbidities. Gastroenterology. 2016; 150(4):S191-S192:A961.
Background: CP has a profound effect on health related quality of life (HRQOL) when compared with non-disease controls. Most data on QOL among CP patients are limited to assessing the short and long term impact of surgical treatments. Few studies have reported on predictors of QOL in unselected patients with CP. Our aim was to identify factors that determine the HRQOL in a large prospectively ascertained cohort of CP patients.
Methods: We used data on 1,024 CP patients enrolled in the North American Pancreatitis Study-2 studies from 26 US centers from 2000-2014. CP was defined by definitive evidence on imaging studies or histology. Information on demographics, alcohol and tobacco use, comorbidities, symptoms, etiology, disease phenotype and treatments was obtained from responses to detailed questionnaires completed by patients and physicians. Patients completed questions on their pain experience (presence, pattern), and QOL (Short Form-12 [SF12 v2] survey). Physical (PCS) and mental (MCS) component summary scores were calculated from responses to SF-12 survey. Mean (sd) PCS and MSC scores in general population is 50±10, and a difference of 3 points is clinically relevant. Multivariable linear regression models determined independent predictors of QOL.
Results: Mean age of patients was 50.4±14.6 years, 55% were male, 75% were white, 50% had physician-defined alcohol etiology. Ninety-two percent patients reported pain - as intermittent and mild-moderate by 13%, intermittent and severe by 24%, constant mild-moderate by 6%, and constant mildmoderate with episodes of severe or constant severe by 49%. Disability due to pain was reported by 27% patients. Mean PCS and MCS scores were 36.7±11.7 and 42.4±12.2 respectively. On multivariable analyses, factors with significant and clinically relevant negative impact on both physical and mental QOL were constant pain, disability, current smoking and associated co-morbidities (Table 1). Disability showed an interaction with sex and resulted in an additional 3.72 point decrease in mental QOL in women. The incremental effect of select factors is shown in Figure 1. Variables in the final multivariable models explained 27% of the variance in physical and 17% of the variance in mental QOL scores. Interestingly, pancreatic morphology, exocrine and/or endocrine insufficiency, prior endotherapy, prior pancreatic surgery and duration of CP had no significant independent effect on QOL.
Conclusion: Constant pain, pain-related disability, current smoking, and concurrent co-morbidities significantly affect QOL in CP patients. Prior endoscopic or surgical treatments did not have an independent effect on QOL. Further research is needed to identify factors impacting QOL that are not explained by our analyses.