From what I see in the clinic and in my approach to this disease, the quality-of-life aspects to me are the biggest challenge: specifically, weight loss. When I approach pancreatic cancer, it is from that spectrum. About 85% of patients present with very significant weight loss. Often, they are weak and fatigued, and their functional status is poor. How to optimally manage them is what I am concerned with. I think that is where we have the biggest challenge ahead of us. Of course, systemic treatment is one approach. But how do we get these patients the nutrition that they need? How do we replace the pancreatic enzymes? How do we establish multidisciplinary care teams? If you are able to address all of the aspects of pancreatic cancer and understand the disease better with patients getting the best care possible, I think that will really help the current approach. Right now chemotherapy is effective, but a lot of patients are not getting it in first line and second line. I think that is a big issue.

I also think the symptomatic challenges are great. They are difficult to manage, and we need to keep patients in touch with not only the cancer issues but the symptomatic issues and particularly weight loss and pain management. Another very important topic when discussing challenges is early detection. We really do not have a way to do this in a reliable fashion. Pancreatic cancer is a disease where even when there is a visible tumor that is very early and resectable, patients are still not doing well. They are still cured in a very small minority of patients. So, we need to be finding this disease when it’s not even radiographically appreciable, and there are companies looking at cancer blood tests and tools to diagnose cancer before it is a clinically appreciable entity. That is the kind of bold thinking we need to dramatically reduce not only the mortality of this disease but the incidence of this disease. We are seeing this disease creep up in incidence, and although the treatment approaches that we have implemented have improved 5-year survival, now we are in the low double digits for all comers. It is clear that we need a multi-pronged approach: not just treatment of the disease itself but also early detection, and that will be the critical factor in improving outcomes with this disease.