Oncology

Metastatic Pancreatic Cancer

Supportive Care Improves Outcomes in Metastatic Pancreatic Cancer

clinical study insights by Thomas A. Abrams, MD

Overview

Many patients with metastatic pancreatic cancer experience poor quality of life due to the clinical course and late detection of the disease. Studies have shown that treatment leading to partial response or stable disease leads to gains in quality-adjusted survival and improved quality of life. The American Society of Clinical Oncology (ASCO) Clinical Practice Guidelines state that supportive care should be emphasized in patients with Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥3 and poorly controlled comorbid conditions. The goals of supportive care should be to improve symptoms, reduce hospital admission rates, and preserve quality of life through relief of pain, and prevention or treatment of thromboembolic disease in a multidisciplinary approach. Proper symptomatic management through supportive care is important in patients with metastatic pancreatic cancer because it allows for the administration of treatment to improve outcomes.

Expert Commentary

Thomas A. Abrams, MD

Assistant Professor of Medicine
Harvard Medical School
Senior Physician
Dana-Farber Cancer Institute
Boston, MA

We really underestimate the role that supportive care plays in the treatment of patients with pancreatic cancer and oncology patients in general, but it has been shown repeatedly that early symptom management interventions can have an incredibly significant impact on patients. Supportive care enhances the effect of chemotherapy by preventing quality-of-life degradation and thereby extending survival. It is vital that patients with pancreatic cancer have their symptoms managed aggressively from day one. We are not talking about just pain, although pain is a very significant factor in patients with pancreatic cancer. We see, time and time again, biliary obstructions, nausea, weight loss, fatigue, and we can manage all these symptoms and manage them aggressively. We need to have a systematic way of measuring this, and it is good that many of the studies we have done have shown that these interventions can be effective.

“Supportive care enhances the effect of chemotherapy by preventing that quality-of-life degradation and thereby extending survival.”

Thomas A. Abrams, MD

References

Laquente B, Calsina-Berna A, Carmona-Bayonas A, Jiménez-Fonseca P, Peiró I, Carrato A. Supportive care in pancreatic ductal adenocarcinoma. Clin Transl Oncol. June 13, 2017. doi: 10.1007/s12094-017-1682-6. [Epub ahead of print].

Pelzer U, Blanc JF, Melisi D, et al. Quality-adjusted survival with combination nal-IRI+5-FU/LV vs 5-FU/LV alone in metastatic pancreatic cancer patients previously treated with gemcitabine-based therapy: a Q-TWiST analysis. Br J Cancer. 2017;116(10):1247-1253.

Picozzi V, Narayanan S, Henry Hu X, Vacirca J. Health-related quality of life in patients with metastatic pancreatic cancer. J Gastrointest Cancer. 2017;48(1):103-109.

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.