Palliative care of the patient with metastatic pancreatic cancer

Cornelia Nițipir, MD, PhD (a,b,c) Maria Alexandra Barbu MD (b,c) Pompilia Moțatu MD (b,c)
Alexandru Filipescu MD, PhD (a,d), Bogdan Popescu MD (b,c) 

(a): University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
(b): Elias Emergency University Hospital, Department of Oncology, Bucharest, Romania
(c): Oncologist
(d): Elias Emergency University Hospital, Department of Gynaecology, Bucharest, Romania

Corresponding author: Dr. Maria Alexandra Barbu, e-mail: m.barbu86@gmail.com

Abstract

Pancreatic cancer is the 12th most common cancer worldwide, with around 338,000 new cases diagnosed in 2012 (2% of the total). In Europe, pancreatic cancer is the 6th leading cause of cancer death. Pancreatic cancer has become the third leading cause of cancer death in the United States, with the lowest five-year survival rates of any solid tumour (8 %). Surgical resection offers the only chance of cure. However, only 15 to 20 percent of patients have a resectable pancreatic cancer at diagnosis, the majority has either locally advanced or metastatic cancer. The best outcomes to date in chemotherapy were achieved with the FOLFIRINOX (fluorouracil plus leucovorin, irinotecan, and oxaliplatin) regimen, demonstrating an 11.1-month median survival. While patients receiving chemotherapy generally report better overall quality of life, extended survival with chemotherapy does not always correspond to reduced symptom burden.

All patients with newly diagnosed pancreatic cancer should have a full assessment of symptom burden, psychological status, and social support as early as possible. Many patients with locally advanced or metastatic disease will benefit from formal palliative care consultation and services. Early referral and initiation of palliative care services improve clinical and quality of care outcomes.

Patients with locally advanced and metastatic pancreatic cancer should be offered aggressive treatment of pain and other symptoms related to the cancer like anorexia and weight loss, depression and anxiety, biliary obstruction, gastric outlet obstruction, ascites, and venous thromboembolism.

Key words: palliative care, pancreatic cancer, pain

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