Symptom appraisal and help-seeking in people with symptoms suggestive of pancreatic cancer

This study sought to explore symptom appraisal and help-seeking among patients referred to secondary care for symptoms suggestive of pancreatic cancer | BMJ Open

N0009298 Cancer of the pancreas; photomicrograph

Pancreatic cancer has poor survival rates due to non-specific symptoms leading to later diagnosis. Understanding how patients interpret their symptoms could inform approaches to earlier diagnosis.

Qualitative analysis of semistructured in-depth interviews. Data were analysed iteratively and thematically, informed by the Model of Pathways to Treatment.

Time from first symptoms to first presentation to healthcare ranged from 1 day to 270 days, median 21 days. We identified three main themes. Initial symptom appraisal usually began with intermittent, non-specific symptoms such as tiredness or appetite changes, attributed to diet and lifestyle, existing gastrointestinal conditions or side effects of medication. Responses to initial symptom appraisal included changes in meal type or frequency, or self-medication. Symptom changes such as alterations in appetite and enjoyment of food or weight loss usually prompted further appraisal. Triggers to seek help included a change or worsening of symptoms, particularly pain, which was often a ‘tipping point’. Help-seeking was often encouraged by others. We found no differences in symptom appraisal and help-seeking between people diagnosed with cancer and those with other conditions.

Full reference: Mills, K. et al. (2017) Understanding symptom appraisal and help-seeking in people with symptoms suggestive of pancreatic cancer: a qualitative study. BMJ Open. 7:e015682.

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Can search engine data save lives from pancreatic cancer?

Gerd Gigerenzer discusses how search engines use big data analytics to “diagnose” your state of health | BMJ Opinion

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Image source: NIH Image Gallery – Flickr // CC BY-NC 2.0

Image shows pancreatic desmoplasia. Pancreatic cancer is associated with a vast desmoplastic reaction in which the connective tissue around the tumor thickens and scars. 

Imagine this warning popping up on your search engine page: “Attention! There are signs that you might have pancreatic cancer. Please visit your doctor immediately.” Just as search engines use big data analytics to detect your book and music preferences, they may also “diagnose” your state of health.

Microsoft researchers have claimed that web search queries could predict pancreatic adenocarcinoma. A retrospective study of 6.4 million users of Microsoft’s search engine Bing identified first-person queries suggestive of a recent diagnosis, such as “I was told I have pancreatic cancer, what to expect.” Then the researchers went back months before these queries were made and looked for earlier ones indicating symptoms or risk factors, such as blood clots and unexplained weight loss. They concluded that their statistical classifiers “can identify 5% to 15% of cases, while preserving extremely low false-positive rates (0.00001 to 0.0001)”, and that “this screening capability could increase 5-year survival.” The New York Times reported: “The study suggests that early screening can increase the five-year survival rate of pancreatic patients to 5 to 7 percent, from just 3 percent.”

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Pancreatic Cancer: Fast or slow?

Seton-Rogers, S. Nature Reviews Cancer | Research Highlights. Published online 11 November 2016

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Despite extensive research into pancreatic ductal adenocarcinoma (PDAC), the disease continues to have high mortality rates. The most widely accepted model of PDAC development is stepwise, involving sequential acquisition of independent mutations in several key oncogenes and tumour suppressors, leading to the development of aggressive disease from precursor lesions termed…

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The impact of diabetes mellitus on survival following resection and adjuvant chemotherapy for pancreatic cancer

Kleeff, J. et al. (2016) British Journal of Cancer.115, pp. 887-894

Background: Diabetes mellitus is frequently observed in pancreatic cancer patients and is both a risk factor and an early manifestation of the disease.

Methods: We analysed the prognostic impact of diabetes on the outcome of pancreatic cancer following resection and adjuvant chemotherapy using individual patient data from three European Study Group for Pancreatic Cancer randomised controlled trials. Analyses were carried out to assess the association between clinical characteristics and the presence of preoperative diabetes, as well as the effect of diabetic status on overall survival.

Results: In total, 1105 patients were included in the analysis, of whom 257 (23%) had confirmed diabetes and 848 (77%) did not. Median (95% confidence interval (CI)) unadjusted overall survival in non-diabetic patients was 22.3 (20.8–24.1) months compared with 18.8 (16.9–22.1) months for diabetic patients (P=0.24). Diabetic patients were older, had increased weight and more co-morbidities. Following adjustment, multivariable analysis demonstrated that diabetic patients had an increased risk of death (hazard ratio: 1.19 (95% CI 1.01, 1.40), P=0.034). Maximum tumour size of diabetic patients was larger at randomisation (33.6 vs 29.7mm, P=0.026).

Conclusions: Diabetes mellitus was associated with increased tumour size and reduced survival following pancreatic cancer resection and adjuvant chemotherapy.

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Pancreatic cancer resists personalized medicine: What researchers are doing to fight back

ScienceDaily. Published online: 4 August 2016

B0007659 Pancreatic cancer cells

Image source: Anne Weston, LRI, CRUK – Wellcome Images // CC BY-NC-ND 4.0

Image shows false colour scanning electron micrograph of pancreatic cancers cells grown in culture.

Researchers are taking a new, patient-directed approach to treating pancreatic cancer. Rather than relying on conventional cell lines that have defined effective drug targets for other types of cancers, they are creating and sequencing cell lines from a cancer patient’s own tissue. Their results reveal that pancreatic tumors are more varied than previously thought and that drug sensitivity is unique to each patient.

In the study, the team turned to a library of cancer drugs, representative of what’s available to patients, and tested each individually against a panel of different cell lines: either conventional pancreatic cell lines, which are often used by researchers and pharmaceuticals, or cell lines that the team developed directly from cancer patients. While conventional pancreatic cell lines were more sensitive to standard drugs used in pancreatic cancer treatment, cell lines from patients were not, with only a “handful” responding to any single-agent treatment.

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MRI shows slight edge over CT in detecting pancreatic tumours

Smyth, D. Cancer Nursing Practice. Vol 15(5). pp. 15-15. Published in print: 10 June 2016

 

Pancreatic cancer is a significant cause of cancer mortality, with a poor five-year survival rate: 5% compared with 85% or more for breast cancer. In this Chinese study, two independent examiners undertook a retrospective analysis of the records of 38 patients with pathologically proven disease and surgically treated curative or palliative disease. They looked at whether there was a difference in the rates of detection and staging of the disease in two non-invasive diagnostic measures: computed tomography (CT) and magnetic resonance imaging (MRI).

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A tunable delivery platform to provide local chemotherapy for pancreatic ductal adenocarcinoma

Indolfi, L. et al. Biomaterials. Volume 93, July 2016, Pages 71–82.

Pancreatic ductal adenocarcinoma (PDAC) is one of the most devastating and painful cancers. It is often highly resistant to therapy owing to inherent chemoresistance and the desmoplastic response that creates a barrier of fibrous tissue preventing transport of chemotherapeutics into the tumor. The growth of the tumor in pancreatic cancer often leads to invasion of other organs and partial or complete biliary obstruction, inducing intense pain for patients and necessitating tumor resection or repeated stenting.

Here, we have developed a delivery device to provide enhanced palliative therapy for pancreatic cancer patients by providing high concentrations of chemotherapeutic compounds locally at the tumor site. This treatment could reduce the need for repeated procedures in advanced PDAC patients to debulk the tumor mass or stent the obstructed bile duct. To facilitate clinical translation, we created the device out of currently approved materials and drugs. We engineered an implantable poly(lactic-co-glycolic)-based biodegradable device that is able to linearly release high doses of chemotherapeutic drugs for up to 60 days. We created five patient-derived PDAC cell lines and tested their sensitivity to approved chemotherapeutic compounds.

These in vitro experiments showed that paclitaxel was the most effective single agent across all cell lines. We compared the efficacy of systemic and local paclitaxel therapy on the patient-derived cell lines in an orthotopic xenograft model in mice (PDX). In this model, we found up to a 12-fold increase in suppression of tumor growth by local therapy in comparison to systemic administration and reduce retention into off-target organs. Herein, we highlight the efficacy of a local therapeutic approach to overcome PDAC chemoresistance and reduce the need for repeated interventions and biliary obstruction by preventing local tumor growth. Our results underscore the urgent need for an implantable drug-eluting platform to deliver cytotoxic agents directly within the tumor mass as a novel therapeutic strategy for patients with pancreatic cancer.

Read the abstract here