Living With Pancreatic Cancer: a Patient and Provider Perspective - Episode 2

Living with Pancreatic Cancer

Kristie L. Kahl: What are some examples of side effects that an individual with pancreatic cancer might encounter?

Dr. Michael Goggin: The side effects are very varied and range from very mild to very severe. And the side effects are often what you might expect: nausea, vomiting and fatigue, are reasonably common. Often it's watching blood tests to make sure that your blood counts don't drop too low. There are sometimes more significant side effects that may be only developed with time like, you know, painful toes from neuropathy. There can be a wide variety of side effects. The more significant statement, though, is to say that historically when we started giving chemotherapy to patients, you know, this is a deadly disease, and what's the point. But the truth is, actually, a lot of patients will feel better after they've been treated, because even if the treatment isn't curative, it will often have an effect on the tumor, enough to reduce some of the symptoms that the patients are having, especially pain. And that that extends to other treatments as well, you're trying to figure out: Should I have this procedure? My tumor is blocking my bile ducts or my stomach and, in fact, you'll often feel a lot better. There is a risk/benefit equation that people are doing. So that's the key question. And that's a question that you can discuss carefully. What are your goals for care? What is your provider advising you to do? And some folks will be going on standard chemotherapy. And there are some therapies that are likely to give you a little bit more side effects, but maybe a little bit more likelihood of longer-term response. Some combinations may be a little bit less toxic, and will work pretty well, but maybe not quite as well. So, you know, that becomes one of the goals of care. And bearing in mind that although there's uncertainty, actually, people will often feel somewhat better once they've had a couple of rounds of therapy.

Kristie L. Kahl: How does this affect quality of life when it comes to side effects?

Dr. Michael Goggin: I think that the challenge for many patients is, if they don't respond to one therapy, then they go to a second-line therapy, perhaps, or even a third-line therapy. And they may want to participate in a clinical trial. And gradually, depending on the chemotherapy, it's very individualized depending on which agent you may not have the bone marrow or the overall reserve, you know, problems with neuropathy or things like that. That can develop over time, that will limit your ability to have therapy. So, a good oncologist will take all this into account and try and manage you appropriately. We've learned to try and understand and maximize response. Also, sometimes a lower dose combination can be very effective, so that oncologists can try and manage what is an appropriate therapy for an individual to try and limit those side effects.

Kristie L. Kahl: How can supportive care play a role in assisting with some of these side effects?

Dr. Michael Goggin: There are strategies for many of the side effects that requires a good a good multidisciplinary team, not only your oncologist, whether it's managing neuropathy with the types of footwear and take good care or the therapies to try and minimize nausea. These are very important to try and make sure that you can manage other aspects of care that are very important for patients’ pancreatic cancer that will keep them stronger, fitter, adequate attention to nutrition and exercise, for example. A patient with pancreatic cancer will often not be able to digest their meals as well if they are not making a pancreatic enzyme. So, the simple act of replacing your pancreas, digestive enzymes and normal function with meals that is often impaired, and may not always be recognized, can help. That's one of the major factors that can cause weight loss. And if you're losing weight very quickly, you'll lack energy. It can even contribute to your mood and well-being.

Exercise is still a question of how much exercise can you do. It's surprising that, even people with other kinds of advanced diseases, have heart failure. And maybe the thing is to rest. And in fact, what we tend to find is exercise has positive benefits. And we suspect that even for improving outcomes from pancreatic cancer, exercise, both the cardiovascular and strength training may have benefits on survival. It certainly can make you feel better. And maintaining a certain strength as best you can is going to improve your quality of life.

So, there are many different components to care and patients with advanced pancreatic cancer. These are important ones. Another one is preventing blood clots, which, unfortunately, are more common with patient pancreatic cancer than with several other cancers. And so taking a shot to prevent clotting is associated with improved survival in many studies. And so that's something that patients should seriously consider. Most people won't get clots, but it is a significant and treatable component of their disease that can have great benefits, and is relatively safe.

Kristie L. Kahl: Are there things, like exercise, that can help with the side effects?

Dr. Michael Goggin: It may help with side effects. You know, as I say, side effects, for example, from chemotherapy: There are drugs that are very potent at doing that, whether they're the kind of traditional chemotherapy, anti-nausea drugs, or even some of the kind of marijuana derivatives that are medical pills for refractory cases, those are very important. But it's surprising how exercise can help people tolerate what might otherwise be significant symptoms, be it the pain or nausea, it is something that is individualized. But it's not maybe something that you're thinking about. But it has a role. I think it's an area that's still being investigated. There's so many important questions in pancreatic cancer. Some of these supportive care questions are still being interrogated to what, what value they actually have, but there is a good deal of circumstantial evidence to suggest that they would help.

Kristie L. Kahl: Are there resources that are available that patients can visit and try to learn more about their supportive care options?

Dr. Michael Goggin: The National Pancreas Foundation has a variety of organizations that are able to provide that care whether it's on their website, or literature available online. If people want to hear from expert physicians, to delve into these areas. And, of course, going to your primary care providers to try and get more specific information is appropriate.