clinical topic updates

Multidisciplinary Supportive Care and Symptomatology in Pancreatic Cancer

by Philip A. Philip, MD, PhD

Overview

Effective supportive care is vital to reduce symptoms and improve quality of life in patients with metastatic pancreatic cancer, especially because of its associated short survival time (Gooden 2013). Current treatment guidelines state that supportive care should be stressed in patients with ECOG performance status of 3 or greater along with poorly controlled comorbid conditions (Sohal et al 2016). Supportive care to support symptom management should be done in a multidisciplinary approach (Laquente et al 2017). There is no standard approach to interventions included in supportive care in clinical trials in patients with cancer where supportive care is a treatment arm (Lee et al 2015). Clinical trials often define the use of supportive therapies as being at the discretion of the treating physician. Generally, there is no standardization of routine physical, psychological, and social assessments, and the most common interventions include analgesics, radiotherapy, blood transfusions, and antibiotics (Lee et al 2015). Management of symptoms with supportive care in patients with pancreatic cancer alleviates symptoms, relieves pain, and preserves quality of life, thereby allowing for the administration of antitumor treatment, possibly improving outcomes (Laquente et al 2017). As part of supportive care in patients with metastatic pancreatic cancer, multimodality treatment may lead to improved quality of life, symptomatology, and better outcomes (Lee et al 2015; Dose 2017; Sperti 2015).

Expert Commentary

Philip A. Philip, MD, PhD, FRCP

Professor of Oncology and Internal Medicine
Vice President for Medical Affairs
Barbara Ann Karmanos Cancer Institute
Wayne State University School of Medicine
Detroit, MI

Patients need good supportive care to power through the treatment for metastatic pancreatic cancer. Multidisciplinary supportive care is extremely important in pancreatic cancer and other cancers associated with a lot of symptomatology. Having a good supportive care program for the patient is very important, and there should be an extremely low threshold for referring a patient to a supportive care specialist, to make sure that the patient is being treated and supported well. Also, many patients with metastatic pancreatic cancer need psychological support, which helps them tolerate the treatment and handle the toxicities better. When I start treatment in my practice, I tend to see the patient every week for the first few weeks. That way, I have a good idea of how the patient is tolerating the treatment early on and I can be proactive in terms of controlling the side effects.

"Patients need good supportive care to power through the treatment for metastatic pancreatic cancer. Multidisciplinary supportive care is extremely important in pancreatic cancer and other cancers associated with a lot of symptomatology."

Philip A. Philip, MD, PhD

References

Dose AM, Rhudy LM. Perspectives of newly diagnosed advanced cancer patients receiving dignity therapy during cancer treatment. Support Care Cancer. 2018;6(1):187-195.

Gooden HM, White KJ. Pancreatic cancer and supportive care–pancreatic exocrine insufficiency negatively impacts on quality of life. Support Care Cancer. 2013;21(7):1835-1841.

Laquente B, Calsina-Berna A, Carmona-Bayonas A, Jiménez-Fonseca P, Peiró I, Carrato A. Supportive care in pancreatic ductal adenocarcinoma. Clin Transl Oncol. 2017;19(11):1293-1302.

Lee RT, Ramchandran K, Sanft T, Von Roenn J. Implementation of supportive care and best supportive care interventions in clinical trials enrolling patients with cancer. Ann Oncol. 2015;26(9):1838-1845.

Sohal DP, Mangu PB, Khorana AA, et al. Metastatic Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2016;34(23):2784-2796.

Sperti C, Moletta L, Merigliano S. Multimodality treatment of recurrent pancreatic cancer: Myth or reality? World J Gastrointest Oncol. 2015;7(12):375-382.

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