Treatments for pancreatic cancer can have debilitating side effects including fatigue, weight loss, and cardiac toxicity, resulting in functional loss and psychological distress. Exercise has been proposed as a therapy to counteract physical and psychological detriments. The case: A 47-year-old male undergoing chemotherapy for stage 3 locally advanced pancreatic cancer. He was cycling during hospital chemotherapy infusions (6 fortnightly cycles of FOLFIRINOX: 5-FU 2, 400 mg/m2, over 48 h: irinotecan 180 mg/m2, oxaliplatin 85 mg/m2, no 5-FU bolus) plus 12 weeks of twice weekly aerobic and resistance exercise. Over 12 weeks, body composition was maintained, and physical function improved, with specific increases in muscular strength of up to 50% and aerobic capacity improving by 9%. Moreover, quality of life, fatigue, psychological distress, and sleep quality improved by 38, 113, 50, and 9%, respectively. Additionally, the participant experienced more severe side effects in week 6, when he did not cycle to a high intensity during hospital infusion and had less total weekly exercise. After cycle 6 (week 11), chemotherapy was halted, and a Whipple resection procedure was successfully performed. It can be concluded that regular aerobic and resistance exercise plus exercise during infusion can attenuate expected decline in physical and mental health with pancreatic cancer treatment and may reduce treatment side effects and have favourable effects on prognosis.

Background In the United Kingdom, national guidance published in 2010 recommended the establishment of specialist teams to improve clinical pathways for patients presenting with malignancies of undefined primary origin (MUO) and cancer of unknown primary (CUP). This study sought to define outcomes of patients referred to a regional MUO/CUP service. Methods Data were collected prospectively on all patients (n = 1225) referred to a regional CUP team over a 10-year period. Patient demographics, clinical, pathological and outcome data were recorded and analysed. Results Confirmed CUP (cCUP) was diagnosed in 25% of patients. A primary metastatic cancer was identified in 36%, 5% were diagnosed with provisional CUP (pCUP), 27% retained the diagnosis of MUO and in 8% a non-cancer diagnosis was made. Median survival was low in all patients with a final malignant diagnosis: primary identified 9.0 months, cCUP 4.0 months, pCUP 1.5 months and MUO 1.5 months. Conclusions Patients presenting with MUO have poor outcomes irrespective of the final diagnosis. These patients need a patient-centred, streamlined, rapid diagnostic pathway. There are clear benefits to primary and secondary care teams having access to a dedicated, multidisciplinary MUO/CUP service, with clinical nurse specialists supporting the patients, to help facilitate this pathway and ensure early oncology review.

Background: Advance (anticipatory) care planning (ACP) requires discussions between patients and healthcare professionals about planning for future deterioration in health. ACP improves care coordination but uptake is limited and often deferred. Aim: We assessed the feasibility and acceptability to patients, carers and general practitioners (GPs) of a primary care ACP intervention for people with incurable oesophageal, gastric or pancreatic cancer. Design and Setting: 12-month feasibility randomised controlled trial in a Scottish Cancer Network. Method: Patients aged 18 or over starting palliative oncology treatment were randomised 1:1 to an ACP intervention or standard care. Intervention patients received an oncologist letter supporting them to request a GP review and ACP public information. Pre-specified analyses included trial recruitment and retention, ACP completion, and quality of life questionnaires (EQ-5D-5L, ICECAP-SCM) at baseline, 6, 12, 24 and 48 weeks. Qualitative interviews with purposive sampling explored patient, carer and GP experiences. Results: Of 99 eligible participants (269 screened), 46% were recruited (n=46) and randomised; 25 to intervention and 21 to control. By 12 weeks, 45% (9/20) intervention patients and 59% (10/17) controls had a documented ACP. Quality of life was maintained at 24 weeks except for physical symptoms but 30% had died. Social norms associating ACP with dying were prevalent among 23 participants interviewed. No psychological or clinical harms were identified. Conclusion: An RCT of ACP for people with incurable cancer in primary care is feasible. Acceptability and timing of care planning depended on patient, carer and GPs attitudes and behaviours. ClinicalTrials.gov Identifier: NCT03719716. Funder: Macmillan