# The Impact of Biliary Drainage on Quality of Life in Unresectable Biliary and Pancreatic Cancer

## TL;DR

Biliary drainage improves physical health in patients with advanced biliary and pancreatic cancer but worsens other aspects of quality of life.

## Contribution

This study evaluates the impact of biliary drainage on quality of life in patients with unresectable biliary and pancreatic cancers.

## Key findings

- Biliary drainage significantly reduced bilirubin levels but worsened social well-being.
- Despite pruritus relief, overall quality of life declined, emphasizing the need for multidisciplinary care.
- Emotional well-being improved initially but not sustainably, indicating ongoing psychological distress.

## Abstract

Introduction

Obstructive jaundice, a frequent complication of biliary tract and pancreatic malignancies, severely impacts patients’ quality of life (QoL). This condition is prevalent in unresectable cancers, often causing symptoms such as pruritus, anorexia, nausea, vomiting, and cholangitis, which hinder daily activities. Given the global burden of these cancers, the primary aim of the study was to evaluate the impact of biliary drainage on QoL and pruritus in patients with unresectable biliary and pancreatic malignancies. Secondary objectives include assessing changes in individual QoL domains and identifying factors associated with QoL outcomes.

Materials and methods

This prospective observational study was conducted at Meenakshi Mission Hospital and Research Centre, Madurai, from July 2020 to November 2021. The study included 82 patients with inoperable malignant biliary obstruction presenting with obstructive jaundice. Participants underwent either endoscopic retrograde cholangiopancreatography (ERCP; n=47, 57.3%) or percutaneous transhepatic biliary drainage (PTBD; n=35, 42.7%), depending on clinical suitability. QoL and pruritus were assessed at baseline, 1 week, and 4 weeks using validated tools (Functional assessment of cancer therapy-General (FACT-G), Functional assessment of cancer therapy-Hepatobiliary subscale (FACT-HS), and visual analog scale for pruritus (VASP)). Statistical analysis was performed using SPSS v26.0, with significance set at p < 0.05.

Results and discussion

The study involved 82 patients diagnosed with inoperable malignant biliary obstruction and presenting with obstructive jaundice. The mean age of the participants was 63.7 ± 10.5 years, with 58 (70.7%) of them being male. Type 2 diabetes (63.4%) and hypertension (52.4%) were prevalent comorbidities. Most patients had moderate functional impairment (64.6%).

Biliary drainage led to a significant reduction in bilirubin levels, decreasing from 13 mg/dL to 1.3 mg/dL by the fourth week (p < 0.001) but reducing social well-being (p < 0.001). FACT-G, FACT-HS, and hepatobiliary scores declined despite pruritus relief (p = 0.001). While emotional well-being (EWB) improved initially, its effect was not sustained at 4 weeks (p = 0.084), indicating persistent psychological distress.  Despite symptomatic relief, overall QoL declined, emphasizing the need for a multidisciplinary approach incorporating palliative care, nutritional support, and psychological counseling to improve long-term patient outcomes.

Conclusion

The study demonstrates that while biliary drainage significantly improves physical well-being, as evidenced by the reduction in bilirubin levels, there is a decline in the other aspects of QoL, highlighting the complexity of symptom management in patients with malignant biliary obstruction. These findings highlight the need for a comprehensive approach that addresses multiple aspects of well-being in this patient population.