Pancreatic cancer—A disease in need: Optimizing and integrating supportive care

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy that continues to be challenging to treat. PDAC has the lowest 5‐year relative survival rate compared with all other solid tumor malignancies and is expected to become the second‐leading cause of cancer‐related death in the United States by 2030. Given the high mortality, there is an increasing role for concurrent anticancer and supportive care in the management of patients with PDAC with the aims of maximizing length of life, quality of life, and symptom control. Emerging trends in supportive care that can be integrated into the clinical management of patients with PDAC include standardized supportive care screening, early integration of supportive care into routine cancer care, early implementation of outpatient‐based advance care planning, and utilization of electronic patient‐reported outcomes for improved symptom management and quality of life. The most common symptoms experienced are nausea, constipation, weight loss, diarrhea, anorexia, and abdominal and back pain. This review article includes current supportive management strategies for these and others. Common disease‐related complications include biliary and duodenal obstruction requiring endoscopic procedures and venous thromboembolic events. Patients with PDAC continue to have a poor prognosis. Systemic therapy options are able to palliate the high symptom burden but have a modest impact on overall survival. Early integration of supportive care can lead to improved outcomes.

Reply to Nutritional support in pancreatic cancer

“…We would very much like to thank Caccialanza et al for their letter highlighting the very important consideration of early and continual nutritional support in the management of patients with pancreatic ductal adenocarcinoma (PDAC) for optimizing outcomes and quality of life. Their opinions and recommendations for the early recognition of nutritional problems, completing nutritional screenings, and referral to nutritional specialists for individualized diet care plans and nutritional counseling are perfectly aligned with the goal of our review article for early and innovative supportive care strategies in patients with PDAC. Regular nutritional counseling by clinical nutritionists and all medical care providers is beneficial throughout the disease course with seamless integration into the management strategy for strengthened patient education, awareness, and advocacy .…”

“…As mentioned in our review article, we also recommend a normal, well‐balanced diet consumed in small, frequent meals that are rich in protein; avoids high‐fat foods or refined/simple carbohydrates; and is accompanied by pancreatic enzyme replacement therapy to significantly improve malabsorption, abdominal pain, and quality of life . Enteral nutrition (EN) is superior for improving the nutritional status of patients with PDAC compared with parenteral nutrition and is the preferred method whenever possible .…”

Nutritional support in pancreatic cancer

“…As mentioned in our review article, 1 we also recommend a normal, well-balanced diet consumed in small, frequent meals that are rich in protein; avoids high-fat foods or refined/simple carbohydrates; and is…”

“…As the authors state, malnutrition and sarcopenia are factors acknowledged to be strongly associated with a limited tolerance for chemotherapy, postsurgical complications, short survival, and poor quality of life in patients with PDAC . Hence, prompt and appropriate nutritional support is mandatory in all patients with pancreatic cancer beginning with the early phases of the disease.…”

“…As the authors state, malnutrition and sarcopenia are factors acknowledged to be strongly associated with a limited tolerance for chemotherapy, postsurgical complications, short survival, and poor quality of life in patients with PDAC. [1][2][3] Hence, prompt and appropriate nutritional support is mandatory in all patients with pancreatic cancer beginning with the early phases of the disease. To guarantee the best possible effectiveness, appropriate and well-timed multidisciplinary management by professionals with specific skills and training (ie, dietitians and clinical nutritionists), also involving artificial nutrition, are required as soon as indicated.…”