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Evaluation of palliative treatments in unresectable pancreatic cancer
Author(s) -
Choi Colin ChanMin,
Choi Julian,
Houli Nezor,
Smith Marty,
Usatoff Val,
Lipton Lara,
Chan Steven
Publication year - 2021
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.16669
Subject(s) - medicine , palliative care , referral , pancreatic cancer , chemotherapy , radiation therapy , cancer , emergency medicine , intensive care medicine , nursing
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.