• Ahmed Hammad, Laura E Davis, Alyson L Mahar, Lev D Bubis, Haoyu Zhao, Craig C Earle, Lisa Barbera, Julie Hallet, and Natalie G Coburn.
• Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of General Surgery, Mansoura University Hospitals, Mansoura, Egypt; ICES, Toronto, Canada.
• HPB (Oxford). 2019 Dec 1; 21 (12): 1744-1752.

BackgroundWe evaluated symptom trajectories and predictors of reporting severe symptoms in the last 6 months of life among non-resected pancreatic adenocarcinoma (PAC) decedents.MethodsA retrospective cohort study of non-resected PAC decedents receiving care at regional cancer centres between January 2007 and December 2015. Symptoms were measured using the Edmonton Symptom Assessment System (ESAS). We described the proportion of patients reporting severe (score ≥7) symptoms by 2-week intervals during the six months prior to death. Multivariable modified Poisson regression models identified predictors of reporting severe symptom scores in the last 6 months of life.Results2538 non-resected PAC decedents treated at regional cancer centres had ≥1 symptom ESAS record in the last six months of life, totaling 10,893 unique symptom assessments. Tiredness was the most commonly reported symptom (59% reporting ≥1 severe score), followed by lack of appetite (57%), impaired-wellbeing (49%) and drowsiness (42%). All symptoms increased closer to death. Older age, female sex, higher comorbidity status, survival less than 6 months, and urban residence were associated with a significantly higher risk of reporting severe symptoms.ConclusionNon-resected PAC patients experience significant symptom burden nearing death. Patient subsets may benefit from personalized supportive care interventions.Copyright © 2019 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

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