P55. Understanding Quality of Life and Recovery After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Mixed Methods Analysis

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) are complex, heterogeneous operations that can be difficult for patients to understand and prepare for. We characterize patient perspectives and quality of life (QOL) after CRS-HIPEC using a mixed-methods approach.


Methods:

We conducted a longitudinal study of patients undergoing CRS-HIPEC at a tertiary academic center (2023-2025). QOL surveys were completed preoperatively, then 2 weeks, 1 month, 3 months, and 6 months postoperatively. Recovery and expectations after surgery were assessed. In-depth interviews were conducted with a subset of patients at 6 months to further explore patient perspectives and lessons learned.


Results:

38 patients were included: 74% were female, median age was 51 years, length of stay was 7 days. Primary tumors were low/high-grade appendiceal mucinous neoplasm (32%), appendiceal adenocarcinoma (11%), colon adenocarcinoma (29%), uterine sarcoma (18%) and peritoneal mesothelioma (5%). Median peritoneal cancer index (PCI) was 9 and 100% achieved optimal cytoreduction.

Overall, QOL scores were stable at 6 months compared to preoperatively (Figure). Functional and physical components dropped after surgery but increased to baseline or better by 6 months. Emotional QOL improved slightly after surgery whereas social QOL remained stable.

Mixed methods analysis highlighted 3 important aspects regarding the patient experience. In addition to counseling by their surgeon, patients used the internet or AI (79%), YouTube (29%), and patient support groups (26%) to prepare for CRS-HIPEC, stating there is no better inspiration than meeting patients leading normal lives after HIPEC. Secondly, while most felt almost completely recovered by 6 months, patients admitted that emotional, physical, and functional recovery were more difficult than expected. Many wished they had known the long-term challenges with prolonged post-discharge nausea, diarrhea, and fatigue. Despite these struggles, 100% of patients felt that undergoing CRS-HIPEC was “worth it,” as it gave them hope to control their disease and gain more time with loved ones.


Conclusions:

In our study, recovery after CRS-HIPEC was longer and more challenging than patients expected, yet all believed it was worth it and would go through it again. By 6 months, QOL scores had recovered and patients felt almost back to baseline. Programs to improve preoperative education and incorporate adjunct resources may aid patients in setting expectations and managing their postoperative recovery.