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. 2021 May;91(5):915-920.
doi: 10.1111/ans.16669. Epub 2021 Apr 18.

Evaluation of palliative treatments in unresectable pancreatic cancer

Colin Chan-Min Choi  1 , Julian Choi  1   2 , Nezor Houli  1 , Marty Smith  1 , Val Usatoff  1   2 , Lara Lipton  3 , Steven Chan  1   2
Affiliations

Evaluation of palliative treatments in unresectable pancreatic cancer

Colin Chan-Min Choi et al. ANZ J Surg. 2021 May.

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) presents as unresectable disease in 80% of patients. Limited Australian data exists regarding management and outcome of palliative management for PDAC. This study aims to: (i) identify patients with PDAC being managed with palliative intent; (ii) assess the type of palliative management being used.

Methods: A prospectively maintained pancreatic database at Western Health (2015-2017) was used to identify patient demographics; stage and multidisciplinary decision regarding resectability and operative interventions; palliative care; use of chemotherapy, radiotherapy and; management of exocrine and endocrine insufficiency. Data on chemotherapy use, number of hospital admissions, emergency department attendances and intensive care unit admissions 30 days prior to death were recorded.

Results: One-hundred and eleven patients had diagnosis of PDAC, 15% with locally advanced and 45% with metastatic PDAC. Among the locally advanced and metastatic PDAC, 48% received biliary stent insertions, 93% had palliative care referral, 45% received palliative chemotherapy and 10% received radiotherapy. Dietitian referral occurred in 79% and 36% were prescribed with a pancreatic enzyme replacement therapy. Diabetes mellitus was present in 52% of which 31% was new onset. Within 30 days prior to death, 11% patients received palliative chemotherapy, 32% were hospitalized and 11% visited an emergency department more than once. Sixty-five percent died in hospital.

Conclusion: A high proportion of patients diagnosed with locally advanced and metastatic PDAC received palliative care referrals and appropriate level of end-of-life care. Further prospective studies are necessary, examining the management and impacts of pancreatic insufficiency in this group.

Keywords: diabetes mellitus; exocrine pancreatic insufficiency; operative; palliative care; pancreatic neoplasm; surgical procedure.

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