Study Designed to Help Pancreatic Cancer Patients Make Hard Choices
‘Even aggressive intervention with chemotherapy, radiation or surgery rarely yields more than an extra month to a year of
Aug. 23, 2012 – The short life expectancy of a pancreatic cancer patient, even if the treatment is aggressive, motivated
physicians, medical educators and students to produce a quantitative analysis of this experience that they hope will assist these victims in
making quality-of-life decisions.
Every year, nearly 45,000 Americans are diagnosed with pancreatic cancer. The odds against those stricken by the disease
are truly dismal; pancreatic cancer almost always kills within two years after diagnosis, no matter how it is treated. Even aggressive
intervention with chemotherapy, radiation or surgery rarely yields more than an extra month to a year of survival, depending on the stage of
FDA approves test in humans using an OCT probe small enough to be inserted into pancreas through a biopsy needle:
earlier study reports using targeted endoscopic ultrasound for early detection of pancreatic cancer - Aug. 17, 2011
This raises a tough question: should patients who know they are going to die soon spend a substantial amount of what
little time they have left undergoing aggressive and difficult treatment — treatment likely to bring them only a brief period of additional
"It's about balancing quality and quantity of life, really," said Dr. Casey Boyd, a University of Texas Medical Branch at
Galveston surgery resident and lead author of a paper analyzing the problem in the current issue of Annals of Surgical Oncology.
"For pancreatic cancer we know the quantity of life is short, so maximizing the quality of life is important — and the
best way we can do that is to give patients concrete data that they can look at and use in their treatment decisions."
Boyd and her colleagues approached the issue by drawing on the National Cancer Institute's Surveillance, Epidemiology and
End Results database, examining SEER records for 25,476 pancreatic cancer patients and focusing on two factors that directly affect patients'
lives: hospital days and days spent in medical care. (Hospital days were days spent as hospital inpatients, while medical care days included
days in the hospital as well as other days on which the patient visited a physician, underwent a diagnostic test, or received a treatment).
"This study is the first to bring together hospital and medical care days in pancreatic cancer patients with stage,
treatment and survival, and it gives us a quantitative look at the whole experience of a patient with pancreatic cancer," Boyd said.
that physicians can use the information in this paper to give patients what they need to make critical decisions."
For example, Boyd said, a doctor could draw on the paper to counsel a patient with metastatic pancreatic cancer — the
most common and deadly type.
"The physician could say, if you have chemotherapy you may live four to six weeks longer, but a lot of that time
you're going to be in the hospital, or getting a test, or getting a needle poked in your arm for your chemotherapy," she said. "Some patients
may say, I want that, I want the most life that you can give me."
Others, she noted, might make a different choice if given an accurate picture of the treatment experience.
"They might say, it's not really worth it to me — it's a few extra weeks, but they may be miserable weeks," Boyd said.
"They may decide not to have any treatment and maybe just have hospice, or just spend time with their family."
The ability to help patients make such difficult decisions was the main goal of the study, according to Boyd.
"Really, this paper is about empowering the patient," she said. "We want to provide them with the information they need
to make their own personalized treatment decisions."
Other authors of the Annals of Surgical Oncology article include medical student Daniel Branch, assistant professor
Kristin Sheffield, biostatistician Yimei Han, associate professor Yong-Fang Kuo, Sealy Center on Aging director Dr. James Goodwin and
associate professor Dr. Taylor Riall.
Support for this research was provided by the NCI; the Office of Research, Development and Information, Centers for
Medicare & Medicaid Services; Information Management Services Inc.; the SEER program; and the Cancer Prevention Research Institute of Texas.
The pancreas is a gland behind your stomach and in front of your spine.
It produces juices that help break down food and hormones that help
control blood sugar levels.
Cancer of the pancreas is the
fourth-leading cause of cancer death in the U.S. Some risk factors for
developing pancreatic cancer include
● Long-term diabetes
● Chronic pancreatitis
● Certain hereditary disorders
Pancreatic cancer is hard to catch
early. It doesn't cause symptoms right away. When you do get symptoms,
they are often vague or you may not notice them. They include yellowing
of the skin and eyes, pain in the abdomen and back, weight loss and
fatigue. Also, because the pancreas is hidden behind other organs,
health care providers cannot see or feel the tumors during routine
exams. Because it is often found late and it spreads quickly, pancreatic
cancer can be hard to treat. Possible treatments include surgery,
radiation and chemotherapy.