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1.
Clin Transl Gastroenterol ; 15(4): e00685, 2024 Apr 01.
Article in English | MEDLINE | ID: mdl-38299610

ABSTRACT

INTRODUCTION: This study explores how chronic pancreatitis (CP) relates to subclinical cognitive impairment (SCI) and its prevalence, characteristics, risk factors, and effects on patients' quality of life (QoL) and physical performance. METHODS: Patients with fulfilled CP criteria in imaging were prospectively enrolled. Overt encephalopathy, neurodegenerative disorders, decompensated cirrhosis, and sepsis were exclusion criteria. All patients underwent psychometric testing and assessment of health-related QoL, such as mobility and strength. SCI was diagnosed when at least 1 test of the psychometric test battery was pathological. RESULTS: Seventy-one patients were enrolled. The etiology was toxic (alcohol/smoking) in most (49%) of the cases. SCI was prevalent in 41% of the patients while 25% had only 1 and 16% had 2 or more pathological tests. Patients with SCI exhibited diminished overall QoL scores ( P = 0.048), primarily affecting physical functionality ( P < 0.001). This was reaffirmed in mobility tests, where patients with SCI were slower in the timed up-and-go test ( P = 0.008) and showed increased prevalence of abnormal chair rising tests ( P = 0.004). Among all variables analyzed, only alcohol abuse was an independent risk factor of SCI (odds ratio 3.46; P = 0.02) in a multivariable regression model together with the variables age, sex, education, and compensated cirrhosis. Despite SCI affecting global QoL, sleep disturbance seemed to be the strongest variable independently associated with impaired QoL (odds ratio 9.9; P = 0.001). DISCUSSION: The largest study to the subject to date shows that SCI is common in patients with CP and is linked to significant morbidity. These findings suggest the need for addressing modifiable risk factors in patients with CP to improve outcomes.


Subject(s)
Cognitive Dysfunction , Pancreatitis, Chronic , Quality of Life , Humans , Male , Female , Middle Aged , Pancreatitis, Chronic/complications , Pancreatitis, Chronic/psychology , Pancreatitis, Chronic/epidemiology , Risk Factors , Cognitive Dysfunction/etiology , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/diagnosis , Prospective Studies , Adult , Prevalence , Aged , Mobility Limitation , Psychometrics , Physical Functional Performance , Neuropsychological Tests
2.
Article in English | MEDLINE | ID: mdl-36981803

ABSTRACT

Pancreatic cancer is the malignant disease with the highest mortality rate, and it ranks third in the world after lung and colon cancer. Identified factors that increase the risk of developing pancreatic cancer include chronic pancreatitis, radiation therapy to the pancreatic area due to another cancer, diabetes mellitus, obesity, smoking, and age. The objective of this study was to present the current state of knowledge on the quality of life of patients diagnosed with pancreatic cancer, factors that determine QoL, and ways of coping with the disease. The low curability and low survival rates of pancreatic cancer significantly affect the quality of life of patients, often in the form of significant deterioration, especially in terms of mental changes, cognitive functions, and coping with the disease. Cognitive decline with comorbid depression is also typical for patients with this type of cancer. Research has shown that the health-related quality of life of patients with pancreatic cancer is low, so further research is needed to improve the situation in this area.


Subject(s)
Diabetes Mellitus , Pancreatic Neoplasms , Pancreatitis, Chronic , Humans , Quality of Life , Pancreatitis, Chronic/psychology , Comorbidity , Pancreatic Neoplasms/epidemiology , Pancreatic Neoplasms
3.
Pain ; 164(2): 375-384, 2023 02 01.
Article in English | MEDLINE | ID: mdl-36149018

ABSTRACT

ABSTRACT: Pain is common in chronic pancreatitis (CP) and profoundly reduces quality of life (QoL). Multiple underlying mechanisms contribute to a heterogenous pain experience and reduce efficacy of pain management. This study was designed to characterize the distribution of mechanism-based pain phenotypes in painful CP. The data analyzed were collected as part of the PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies, an NCI/NIDDK-funded longitudinal study of the natural history of CP. The PROspective Evaluation of Chronic pancreatitis for EpidEmiologic and translational stuDies includes patient-reported outcome (PRO) measures of pain, medication use, global health, and QoL. Of subjects (N = 681) with CP, 80% experienced abdominal pain within the year before enrollment. Subjects who experienced pain in the week before enrollment (N = 391) completed PROMIS Neuropathic and Nociceptive Pain Quality instruments which were then used to classify them by pain type: 40% had nociceptive, 5% had neuropathic-like, and 32% had both types of pain. The prevalence of having both types of pain was higher among women and subjects with diabetes mellitus, whereas nociceptive-only pain was more prevalent among men and those with pancreatic duct stricture. Other factors, including pain medication use and healthcare utilization, did not differ between groups based on pain type. Subjects in the Both group had significantly worse health and QoL scores relative to those with nociceptive-only pain, suggesting that using psychosocial pain surveys may be useful for understanding pain subtypes in patients with CP. Additional research is needed to identify biochemical and biophysical signatures that may associate with and predict responses to mechanism-specific interventions.


Subject(s)
Pancreatitis, Chronic , Quality of Life , Female , Humans , Cross-Sectional Studies , Longitudinal Studies , Pancreatitis, Chronic/complications , Pancreatitis, Chronic/epidemiology , Pancreatitis, Chronic/psychology , Abdominal Pain/epidemiology , Phenotype
5.
Pancreas ; 51(1): 4-12, 2022 01 01.
Article in English | MEDLINE | ID: mdl-35195589

ABSTRACT

ABSTRACT: Chronic pancreatitis (CP) is associated with a high disease burden, extensive negative impact on quality of life, increased rates of depression and anxiety, and significant health care utilization and expenditures. Pain is a hallmark feature of CP, present in up to 90% of patients with this condition, and can lead to high rates of disability, hospitalization, and opioid medication use. Current perspectives on the management of CP have evolved to advocate a multidisciplinary approach which offers new pathways for helping patients manage symptoms. Psychologists play an important role in a multidisciplinary team effort by applying scientifically based psychological principles and techniques to improve pain and adaptation to chronic illness. This review will detail the fundamentals of delivering psychological interventions for adults with CP managed in an outpatient setting. Recommendations for integrating psychological care in multidisciplinary management of CP will be offered. Future directions for psychological care in CP multidisciplinary teams are also discussed.


Subject(s)
Pancreatitis, Chronic/psychology , Patient Care Team , Psychotherapy , Humans , Pain Management/psychology
6.
Pancreatology ; 21(7): 1256-1284, 2021 Oct.
Article in English | MEDLINE | ID: mdl-34391675

ABSTRACT

Pain is the most common symptom in chronic pancreatitis (CP) with a major impact on quality of life. Few validated questionnaires to assess pain in CP exist, and the lack of consensus negatively impacts clinical management, research and meta-analysis. This guideline aims to review generic pain questionnaires for their usability in CP, to outline how pain assessment can be modified by confounding factors and pain types, to assess the value of additional measures such as quality of life, mental health and quantitative sensory testing, and finally to review pain assessment questionnaires used specifically in CP. A systematic review was done to answer 27 questions that followed the PICO (Population; Intervention; Comparator; Outcome) template. Quality of evidence of the statements was judged by Grades of Recommendation, Assessment, Development and Evaluation (GRADE) criteria. The manuscript was sent for review to 36 experts from various disciplines and continents in a multi-stage Delphi process, and finally reviewed by patient representatives. Main findings were that generic pain instruments are valid in most settings, but aspects of pain are specific for CP (including in children), and instruments have to account for the wide phenotypic variability and development of sensitization of the central nervous system. Side effects to treatment and placebo effects shall also be considered. Some multidimensional questionnaires are validated for CP and are recommended together with assessment of quality of life and psychiatric co-morbidities. This guideline will result in more homogeneous and comprehensive pain assessment to potentially improve management of painful CP.


Subject(s)
Abdominal Pain , Chronic Pain , Pain Measurement , Pancreatitis, Chronic , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Abdominal Pain/psychology , Chronic Pain/diagnosis , Chronic Pain/etiology , Chronic Pain/psychology , Consensus , Humans , Pain Measurement/methods , Pancreatitis, Chronic/complications , Pancreatitis, Chronic/psychology , Quality of Life , Surveys and Questionnaires
7.
Clin Transl Gastroenterol ; 12(6): e00373, 2021 06 18.
Article in English | MEDLINE | ID: mdl-34140460

ABSTRACT

INTRODUCTION: Severe abdominal pain is a cardinal symptom of chronic pancreatitis (CP) associated with a high economic and societal burden. In other chronic pain conditions, cognitive-behavioral therapy (CBT) has demonstrated efficacy in improving patient outcomes (e.g., pain-related disability and depression). However, CBT has not yet been evaluated in adult patients with painful CP. We aimed to (i) evaluate the feasibility and acceptability of an adapted Internet CBT program for CP and (ii) generate pilot data regarding the effects of treatment on patient pain outcomes. METHODS: Thirty adults (mean age = 49.8 years, SD = 12.5; 80% women) with suspected or definite CP were randomized to Internet CBT (Pancreatitis Pain Course) versus control. The Pancreatitis Pain Course has 5 CBT lessons (e.g., thought challenging, relaxation, and activity pacing) delivered over 8 weeks. Pain interference, pain intensity, and quality of life were assessed at pretreatment, posttreatment, and the 3-month follow-up. Qualitative interviews were conducted at posttreatment with a subset of participants. RESULTS: Eighty percent of participants rated the program as highly acceptable; 64.3% completed all 5 lessons. Qualitative data revealed positive perceptions of program features, relevancy, and skills. Patients randomized to Internet CBT demonstrated moderate to large effects in reducing pain intensity and pain interference from baseline to 3 months. The proportion of treatment responders (>30% improvement) was significantly greater in the Internet-CBT group than in the control group (50% vs 13%, Fisher exact t test P = 0.04). DISCUSSION: In this first trial of CBT pain self-management in CP, feasibility, acceptability, and preliminary efficacy for reducing pain and disability were demonstrated. Future definitive trials of CBT are needed.


Subject(s)
Abdominal Pain/therapy , Cognitive Behavioral Therapy/methods , Internet , Pain Management/methods , Pancreatitis, Chronic/psychology , Adult , Aged , Feasibility Studies , Female , Humans , Male , Middle Aged , Minnesota , Pain Management/psychology , Pain Measurement/methods , Pain Measurement/psychology , Young Adult
8.
Pancreas ; 50(2): 153-159, 2021 02 01.
Article in English | MEDLINE | ID: mdl-33565791

ABSTRACT

OBJECTIVES: Chronic pancreatitis (CP) is often associated with poor quality of life. Only a few small associative studies have reported the prevalence of mood disorders in CP. Using a large database, we sought to describe the epidemiology and risk association of anxiety and depression in CP and evaluate their outcomes. METHODS: A multicenter database (Explorys), an aggregate of electronic health record data from 26 US healthcare systems, was surveyed. A cohort of patients with a diagnosis of CP between 2014 and 2019 was identified. Within this cohort, rates of anxiety and depression were calculated. Demographics, comorbidities, and outcomes were described. RESULTS: Of the 30,276,810 individuals in the database (2014-2019), 67,260 patients had a CP diagnosis (0.22%). When compared with patients with no history of CP, patients with CP were more likely to develop anxiety (odds ratio, 6.94; 95% confidence interval, 6.85-7.04) and depression (odds ratio, 5.09; 95% confidence interval, 5.01-5.17). Chronic pancreatitis patients with depression had an increased risk of suicidal ideation compared with controls. CONCLUSIONS: Patients with CP are at a higher risk of developing anxiety and depression compared with those without CP, with overall worse outcomes. Clinicians should screen CP patients and make appropriate referral to psychiatry when indicated.


Subject(s)
Anxiety/epidemiology , Depression/epidemiology , Pancreatitis, Chronic/epidemiology , Adult , Aged , Aged, 80 and over , Anxiety/diagnosis , Anxiety/psychology , Comorbidity , Databases, Factual , Depression/diagnosis , Depression/psychology , Female , Humans , Male , Middle Aged , Pancreatitis, Chronic/diagnosis , Pancreatitis, Chronic/psychology , Prevalence , Psychotropic Drugs/therapeutic use , Retrospective Studies , Risk Assessment , Risk Factors , Substance-Related Disorders/epidemiology , Suicidal Ideation , Time Factors , United States/epidemiology , Young Adult
10.
Dig Dis Sci ; 66(2): 424-433, 2021 02.
Article in English | MEDLINE | ID: mdl-32361924

ABSTRACT

BACKGROUND AND AIMS: Leaving against medical advice (LAMA) is an unfortunate occurrence in 1-2% of all hospitalized patients and is associated with worse outcomes. While this has been investigated across multiple clinical conditions, studies on patients with chronic pancreatitis (CP) are lacking. We aimed to determine the prevalence and determinants of this event among patients with CP. METHODS: The Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (NIS), 2007-2014, was used in the study. Patients with LAMA were identified, and the temporal trend of LAMA was estimated and compared among patients with and without CP. We then extracted patients with a discharge diagnosis of CP from the recent years of HCUP-NIS (2012-2014) and described the characteristics of LAMA in these patients. Multivariate logistic regression models were used to evaluate predictors of LAMA. RESULTS: 3.39% of patients with CP discharged against medical advice. LAMA rate in CP patients was higher and increased more steeply at quadruple the rate of those without. More likely to self-discharge were patients who were young, males, non-privately insured, or engaged in alcohol and substance abuse, likewise were those with psychosis and those admitted on a weekend or non-electively. The northeast and for-profit hospitals also had higher odds of LAMA. However, patients transferred from other healthcare facilities have reduced LAMA odds. Among all patients with CP, those with LAMA had shorter length of stay (2.74 [2.62-2.85] days vs. 5.78 [5.71-5.83] days) and lower hospitalization cost $23,271 [$22,171-$24,370] versus $45,472 [$44,381-$46,562] compared to the no-LAMA group. CONCLUSION: LAMA occurs in approximately 1 in 29 patients with CP and is increasing at almost quadruple the rate of those without. Clinicians need to pay closer attention to the identified at-risk groups for ameliorative targeted interventions.


Subject(s)
Pancreatitis, Chronic/epidemiology , Pancreatitis, Chronic/therapy , Patient Acceptance of Health Care , Patient Discharge/trends , Treatment Refusal/trends , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Pancreatitis, Chronic/psychology , Predictive Value of Tests , Prevalence , Retrospective Studies , Treatment Refusal/psychology , Young Adult
11.
Eur J Hum Genet ; 29(1): 29-38, 2021 01.
Article in English | MEDLINE | ID: mdl-32788661

ABSTRACT

Hereditary chronic pancreatitis (HCP) is a genetically determined condition characterized by intermittent acute episodes of pancreatitis and long-term impairment of the exocrine and endocrine pancreatic functions. Genetic test results can have substantial psychological and social consequences for the individuals tested and their families. Nevertheless, little is known so far about the subjective experience of individuals genetically tested for HCP. This qualitative study examines the viewpoints of HCP patients and their relatives in order to identify the psychosocial and ethical implications related to genetic testing within families. Semi-structured qualitative individual interviews and a focus group with HCP patients and their family members were conducted. Data were audio-recorded, transcribed verbatim and analysed using qualitative content analysis. A total of 28 individuals were enrolled in the study: 24 individuals (17 patients, 7 relatives) were interviewed in semi-structured one-on-one interviews and 4 individuals (2 patients, 2 life partners) participated in the focus group. Emerging topics covered (1) genetic testing in childhood, (2) genetic testing within the family and (3) family planning. The study reveals that genetic testing for HCP has a wide influence in familial contexts and is accompanied by normative issues, such as autonomy, reproductive decisions and sharing of information within the family. The results raise the awareness of the complexity of family contexts: familial relationships and dynamics can have great influence on the individual decisions related to genetic testing. Increased understanding of these relational contexts can help health professionals, for example, in counselling, to discuss genetic testing better with patients and families.


Subject(s)
Genetic Testing/ethics , Health Knowledge, Attitudes, Practice , Pancreatitis, Chronic/psychology , Patients/psychology , Adolescent , Adult , Aged , Aged, 80 and over , Family/psychology , Female , Humans , Male , Middle Aged , Netherlands , Pancreatitis, Chronic/diagnosis , Pancreatitis, Chronic/genetics
12.
Pancreatology ; 20(7): 1347-1353, 2020 Oct.
Article in English | MEDLINE | ID: mdl-32948428

ABSTRACT

BACKGROUND AND OBJECTIVES: Chronic pancreatitis (CP) is a debilitating fibro-inflammatory disease with a profound impact on patients' quality of life (QOL). We investigated determinants of QOL in a large cohort of CP patients. METHODS: This was a multicentre study including 517 patients with CP. All patients fulfilled the EORTC QLQ-C30 questionnaire. Questionnaire responses were compared to results obtained from a general reference population (n = 11,343). Demographic characteristics, risk factors (smoking and alcohol consumption), pain symptoms, disease phenotype (complications) and treatments were recorded. A multivariable regression model was used to identify factors independently associated with QOL scores. RESULTS: Included patients had a mean age of 56.3 ± 12.8 years, 355 (69%) were men and 309 (60%) had alcohol aetiology. Compared to the reference population, patients with CP had lower global health status (50.5 vs. 66.1; p < 0.001) as well as reduced scores for all functional scales (all p < 0.001). Additionally, CP patients reported a higher burden for all symptom items, with pain being the most prominent complaint (all p < 0.001). Constant pain (coefficient -11.3; p = 0.02), opioid based pain treatment (coefficient -19.7; p < 0.001) and alcoholic aetiology (coefficient -5.1; p = 0.03) were independently associated with lowered global health status. The final multivariable model explained 18% of the variance in global health status. CONCLUSIONS: Patients with CP have significantly lower QOL compared to a population-based reference population. Factors independently associated with a lowered QOL are constant pain, opioid based pain treatment and alcohol aetiology. However, these factors only explain a fraction of QOL and additional factors need identification.


Subject(s)
Pain/complications , Pancreatitis, Chronic/complications , Pancreatitis, Chronic/psychology , Adult , Aged , Aged, 80 and over , Alcohol Drinking , Analgesics, Opioid/therapeutic use , Cohort Studies , Cross-Sectional Studies , Female , Health Status , Humans , Male , Middle Aged , Pain/drug therapy , Pancreatitis, Alcoholic/complications , Pancreatitis, Alcoholic/psychology , Quality of Life , Risk Factors , Smoking , Surveys and Questionnaires
13.
Am J Gastroenterol ; 115(12): 2077-2085, 2020 12.
Article in English | MEDLINE | ID: mdl-32740078

ABSTRACT

INTRODUCTION: Abdominal pain, frequent in patients with chronic pancreatitis (CP), has a negative impact on quality of life (QOL). Psychiatric comorbidities including anxiety and depression are associated with pain, but their prevalence and effects on QOL in CP have not been quantified. We studied the prevalence of anxiety and depression in patients with CP and their associated patient and disease characteristics and impact on QOL. METHODS: This was a cross-sectional, multicenter prospective study. Patients were screened with the Hospital Anxiety and Depression Scale questionnaire. A Hospital Anxiety and Depression Scale score >7 on the respective anxiety or depression subscales indicated the presence of anxiety or depression and was used as a surrogate for the diagnosis of psychiatric comorbidities. Patient demographics, disease characteristics, QOL (EORTC-QLQ-C30), and pain symptoms (Brief Pain Inventory Short Form) were compared between patients with and without psychiatric comorbidities. RESULTS: One hundred seventy-one patients with CP (mean age 53.8 ± 13.7 years, 60% men) were included. Anxiety and depression were present in 80 (46.8%) and 66 (38.6%) patients, with overlap in 50 (29%). Patients with anxiety or depression reported higher pain prevalence, pain severity, and pain interference scores (all P < 0.001). Psychiatric comorbidities also associated with reduced global health scores and functional subscales (all P < 0.001) and higher symptom burden (P ≤ 0.03). An independent association was noted between global health status and depression (P < 0.001). DISCUSSION: Psychiatric comorbidities are prevalent in patients with CP and associated with pain and QOL. Where the effect of anxiety on QOL may be mediated via pain, depression is independently related to QOL. These findings warrant consideration in the management of patients with CP.


Subject(s)
Anxiety/epidemiology , Depression/epidemiology , Pain/epidemiology , Pancreatitis, Chronic/epidemiology , Quality of Life/psychology , Adult , Aged , Anxiety/psychology , Comorbidity , Cross-Sectional Studies , Depression/psychology , Female , Humans , Male , Middle Aged , Pain/psychology , Pancreatitis, Chronic/psychology , Prevalence , Prospective Studies
14.
Pancreas ; 49(7): 887-890, 2020 08.
Article in English | MEDLINE | ID: mdl-32675785

ABSTRACT

Children with acute recurrent and chronic pancreatitis experience severe abdominal pain that may be intermittent or chronic. Pain is often debilitating, causing interference with academic, social, family, and extracurricular activities that are important to youth. Disruption of these routines and the unpredictability of pain flares place children with pancreatitis at increased risk for development of anxious or depressive symptoms. Pediatric psychologists trained in cognitive-behavioral treatment are well suited to intervene on functional disability and mood disturbance, as well as teach coping skills. In an era where there is movement away from opioids, nonpharmacological strategies have an important place for pain management. In fact, positive outcomes following for children with other recurrent abdominal pain syndromes have been reported for this evidence-based intervention. In addition to pain management, pediatric psychologists can address other co-occurring behavioral and emotional problems in children with pancreatitis, such as needle phobia and poor adherence to the prescribed medical regimen.


Subject(s)
Abdominal Pain/therapy , Chronic Pain/therapy , Mental Disorders/prevention & control , Pancreatitis, Chronic/therapy , Pancreatitis/therapy , Abdominal Pain/psychology , Acute Disease , Adaptation, Psychological , Adolescent , Child , Chronic Pain/psychology , Humans , Mental Disorders/psychology , Pain Management/methods , Pancreatitis/psychology , Pancreatitis, Chronic/psychology , Stress, Psychological/psychology
15.
Pancreatology ; 20(3): 338-346, 2020 Apr.
Article in English | MEDLINE | ID: mdl-32147309

ABSTRACT

BACKGROUND/OBJECTIVES: In Finland the incidence of chronic pancreatitis (CP) is high compared to that in most European countries. Recent epidemiological data is lacking. Our aim was to investigate the current epidemiologic and behavioural data on CP patients in Finland. METHODS: CP patients according to M-ANNHEIM criteria in Tampere University Hospital (TAUH) during 2014-2015 were included. Aetiology, time from diagnosis, pancreatic function, treatment, complications, smoking, alcohol consumption (AUDIT) and quality of life (QoL) (QLQ C30, PAN26) were gathered. RESULTS: 235 CP patients (57 (26-88) years, 65% men) were included. Time since diagnosis was 5.5 (1-41) years. Aetiology was alcohol in 67%, and smoking contributed in 54%. Of these patients 78% continued smoking and 58% continued to consume alcohol even after CP diagnosis. CP related complications were common. Pseudocysts were more common in alcohol related CP than in non-alcohol related CP (60% vs. 38%, p < 0.05). Reported QoL and pain were worse in the CP patients than in controls. Alcohol consumption differed from that of the Finnish population; the CP patients were either total abstainers or heavy alcohol consumers. CONCLUSIONS: CP constitutes a great burden on the health care system and on the patients. The patients frequently develop complications and symptoms and their QoL is inferior to that of controls. The most important measure to halt the progression of CP would be to prevent acute phases and for patients to stop smoking, which does not happen in many CP patients. It would be beneficial to increase awareness among CP patients and medical professionals.


Subject(s)
Pancreatitis, Chronic/epidemiology , Pancreatitis, Chronic/psychology , Quality of Life/psychology , Adult , Aged , Aged, 80 and over , Alcohol Drinking/epidemiology , Exocrine Pancreatic Insufficiency/etiology , Female , Finland/epidemiology , Humans , Male , Middle Aged , Pancreatic Pseudocyst/epidemiology , Pancreatitis, Alcoholic/epidemiology , Pancreatitis, Chronic/etiology , Risk Factors , Smoking/adverse effects , Socioeconomic Factors , Surveys and Questionnaires
16.
J Genet Couns ; 29(6): 971-982, 2020 12.
Article in English | MEDLINE | ID: mdl-32026589

ABSTRACT

Hereditary pancreatitis (HP), a highly penetrant (~80%) autosomal dominant disease associated with PRSS1 variants, causes acute pancreatitis in childhood and chronic pancreatitis by early adulthood. Other clinical features include pain, diabetes, and risk of pancreatic cancer. HP kindreds were prospectively recruited from 1995 to 2015. At enrollment, study participants completed medical and family history questionnaires, and provided samples for genotyping. Participants were recontacted between 2015 and 2017 and asked to complete a survey on concerns and experiences related to HP, PRSS1 testing, and genetic counseling. Data were analyzed with descriptive and thematic methods. Thirty-nine affected participants with HP and 21 unaffected family members completed the survey. Among unaffected family members, 'worry' and 'helplessness' were frequently described as the most difficult problem in their family because of HP, particularly with regard to pain. Three participants described the impact of drug addiction on their family. 'School or work limitations' was the leading financial concern, with 65.5% (36/55) rating it as 'moderately' or 'extremely important.' Unexpectedly, only 62% (21/34) of affected PRSS1 carriers believed the chance for a parent to pass HP to his or her children was 50%, whereas 18% (6/34) believed the chance was 100%. The impact of HP on individuals and families varied, which may reflect the highly unpredictable nature of HP severity and outcomes. Based on current and previously reported findings, an overview of important issues for genetic counselors to consider for counseling HP families is included.


Subject(s)
Pancreatitis, Chronic/genetics , Adult , Aged , Aged, 80 and over , Female , Genetic Counseling , Heterozygote , Humans , Male , Medical History Taking , Middle Aged , Mutation , Pancreatitis, Chronic/psychology , Penetrance , Trypsin/genetics , Young Adult
17.
Pancreatology ; 20(2): 193-198, 2020 Mar.
Article in English | MEDLINE | ID: mdl-31952917

ABSTRACT

BACKGROUND: Paraduodenal pancreatitis is a focal form of chronic pancreatitis that affects the groove area between the duodenum and the head of the pancreas. Consensus regarding surgical or nonsurgical management as the best treatment option is still lacking. METHODS: We retrospectively evaluated all patients managed for PP at The Pancreas Institute of the University Hospital Trust of Verona from 1990 to 2017. The outcomes of surgical vs. medical treatment with regard to pain control, quality of life and pancreatic insufficiency were evaluated through specific questionnaires. RESULTS: The final study population consisted of 75 patients: 62.6% underwent surgery, and 37.4% were managed without surgery. All surgical procedures consisted of pancreaticoduodenectomy. The median follow-up from the diagnosis of paraduodenal pancreatitis was 60 (12-240) months. Patients who underwent surgery experienced a similar incidence of steatorrhea (44.7 vs. 52.6%; p = 0.4) but a significantly higher incidence of diabetes (59.6 vs. 10.7%; p < 0.01) when compared to those managed without surgery. There was no difference in terms of reported chronic pain (Graded Chronic Pain Scale, median 0 vs. 1; p = 0.1) and quality of life (Pancreatitis QoL Instrument, median 82 vs. 79; p = 0.2). However, surgical patients reported a worse level of self-care activities associated with glycemic control (Diabetes Self-Management Questionnaire, median 20 vs. 28, p = 0.02). CONCLUSION: In patients affected by paraduodenal pancreatitis, surgery and medical therapy seem to obtain similar results in terms of quality of life and pain control. However, surgery is associated with an increased prevalence of postoperative diabetes with consequent relevant issues with self-care management. Surgery should be considered only in selected patients after adequate medical treatment.


Subject(s)
Diabetes Mellitus/etiology , Duodenal Diseases/surgery , Pain Management/methods , Pancreaticoduodenectomy/methods , Pancreatitis, Chronic/surgery , Postoperative Complications/epidemiology , Quality of Life , Adult , Aged , Aged, 80 and over , Diabetes Mellitus/psychology , Duodenal Diseases/drug therapy , Duodenal Diseases/psychology , Female , Glycemic Control , Humans , Incidence , Male , Middle Aged , Pain Measurement , Pancreatitis, Chronic/drug therapy , Pancreatitis, Chronic/psychology , Postoperative Complications/drug therapy , Postoperative Complications/psychology , Retrospective Studies , Self Care , Steatorrhea/epidemiology , Steatorrhea/etiology , Surveys and Questionnaires
18.
Oncol Nurs Forum ; 46(5): E159-E170, 2019 09 01.
Article in English | MEDLINE | ID: mdl-31424454

ABSTRACT

OBJECTIVES: To compare fatigue and quality of life (QOL) between individuals with pancreatogenic diabetes after total pancreatectomy (TP) and pancreaticoduodenectomy (PD). SAMPLE & SETTING: 50 individuals (14 after TP and 36 after PD) were recruited from a pancreatic surgical outpatient department. A final sample of 39 matched individuals (13 after TP and 26 after PD) were included in the final analysis. METHODS & VARIABLES: A comparative cross-sectional approach was used. Variables were fatigue and QOL. The Fatigue Symptom Inventory and European Organisation for the Research and Treatment of Cancer Quality-of-Life Questionnaire-Core 30 were used. Data went through propensity score one-to-two matching. Generalized estimating equation was used to compare fatigue and QOL. RESULTS: The groups showed no statistically significant difference in fatigue intensity and overall QOL. The TP group had significantly longer fatigue duration, perceived higher interference of functioning, lower physical function, and a higher level of insomnia. IMPLICATIONS FOR NURSING: Future studies with a larger sample and longitudinal design will help identify the trajectory of fatigue and QOL in individuals with pancreatogenic diabetes post-TP and PD.


Subject(s)
Carcinoma, Pancreatic Ductal/complications , Diabetes Mellitus/etiology , Fatigue/etiology , Pancreatectomy/methods , Pancreatic Neoplasms/complications , Postoperative Complications/etiology , Quality of Life , Adult , Carcinoma, Pancreatic Ductal/psychology , Carcinoma, Pancreatic Ductal/surgery , Cross-Sectional Studies , Diabetes Mellitus/drug therapy , Diabetes Mellitus/psychology , Female , Humans , Hypoglycemic Agents/therapeutic use , Male , Middle Aged , Neuroendocrine Tumors/complications , Neuroendocrine Tumors/psychology , Neuroendocrine Tumors/surgery , Pancreatic Neoplasms/psychology , Pancreatic Neoplasms/surgery , Pancreatitis, Chronic/complications , Pancreatitis, Chronic/psychology , Pancreatitis, Chronic/surgery , Postoperative Complications/epidemiology , Postoperative Complications/psychology , Propensity Score , Severity of Illness Index , Surveys and Questionnaires
19.
Sci Rep ; 9(1): 7318, 2019 05 13.
Article in English | MEDLINE | ID: mdl-31086257

ABSTRACT

Chronic pancreatitis (CP) is a fibrotic disorder of the pancreas leading to clinical sequelae like pain and an excess of comorbidity including cardiovascular disease and cancers. The aim of this study was to determine the relationship between systemic inflammation and quality of life in patients with CP. Patients were prospectively recruited and underwent a quality of life assessment (EORTC QLQ-C30 and PAN 28). The serum inflammatory profile was assessed using an MSD 30-plex array. The relationship between clinical variables, inflammatory cytokines and quality of life was determined by a GLM-MANOVA and the individual impact of significant variables evaluated by a second ANOVA. In total, 211 patients with a median age of 53 years were recruited across 5 European centres. Gender, age, nicotine and alcohol abuse were clinical variables associated with altered quality of life. Systemic inflammation with high levels of pro-inflammatory cytokines (Eotaxin, IL-1ß, IL-7, IL-8, IL-12/IL-23p40, IL-12p70, IL-13, IL-16, IP-10, MCP-1, MCP-4, MDC, MIP-1a, TARC, TNFß) was associated with diminished quality of life in general and specific domains including pain, physical and cognitive functioning. As conclusion, CP is associated with a systemic inflammatory response that has a negative impact on quality of life and accelerates aging.


Subject(s)
Cognition/physiology , Pain/immunology , Pancreatitis, Chronic/complications , Quality of Life , Systemic Inflammatory Response Syndrome/immunology , Adult , Age Factors , Aged , Aged, 80 and over , Aging/immunology , Aging/psychology , Cytokines/blood , Female , Humans , Inflammation Mediators/blood , Male , Middle Aged , Pain/blood , Pain/psychology , Pancreatitis, Chronic/blood , Pancreatitis, Chronic/immunology , Pancreatitis, Chronic/psychology , Prospective Studies , Sex Factors , Surveys and Questionnaires/statistics & numerical data , Systemic Inflammatory Response Syndrome/blood , Systemic Inflammatory Response Syndrome/psychology , Young Adult
20.
Wiad Lek ; 71(3 pt 2): 653-657, 2018.
Article in Ukrainian | MEDLINE | ID: mdl-29783241

ABSTRACT

OBJECTIVE: Introduction: The relevance of study, assessment and prediction of the life quality of patients with chronic pancreatitis to improve the provision of medical care and rehabilitation is high, since it allows to solve a number of important medical, social and economic problems of society. The aim: The aim: To study, evaluate and develop a model for the quality of life assessment in patients with chronic pancreatitis. PATIENTS AND METHODS: Materials and methods: The primary material was the results of a sociological study of patients with chronic pancreatitis conducted by the authors - 300 questionnaires. To achieve the goal of the study, a systematic approach with the use of medical-sociological, medical-statistical, bibli-semantic methods was used. RESULTS: Results: The average quality of life of patients with chronic pancreatitis was 55.73 ± 0.50%, among men - 58.67 ± 0.72%, among women - 53.15 ± 0.64%. As the age-specific rate increases, the quality of life index tends to decrease from 67.53 ± 0.90% in the group of men of 18-30 years to 46.27 ± 1.47% in the group over 70 years. In female patients, 63.21 ± 1.42% to 44.64 ± 0.85%, respectively. According to the data of the correlation-regression analysis, limitations in a psychological sphere has the most significant effect on the quality of life of patients with a coefficient of pair correlation of -0.742, then come restrictions in nutrition (rxy = -0.696), restrictions in a physical sphere (rxy = -0.651) and social sphere (rxy = -0.606). CONCLUSION: Conclusions: The proposed model of the quality of life assessment of a patient with chronic pancreatitis allows us to determine groups of limitations and to use it to predict the quality of life, and develop a set of measures aimed at improving the quality of life.


Subject(s)
Pancreatitis, Chronic/psychology , Quality of Life/psychology , Self Concept , Activities of Daily Living , Adaptation, Psychological , Adult , Aged , Attitude to Health , Female , Humans , Male , Middle Aged , Surveys and Questionnaires , Young Adult
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