Considerations for the treatment of pancreatic cancer during the COVID-19 pandemic: the UK consensus position

British Journal of Cancer | 8th July 2020

This paper sought to seek consensus from UK clinicians with an interest in pancreatic cancer for management approaches that would minimise patient risk and accommodate for healthcare service restrictions.

The outcomes are described and include recommendations for treatment prioritisation, strategies to bridge to later surgical resection in resectable disease and factors that modify the risk–benefit balance for treatment in the resectable through to the metastatic settings.

Priority is given to strategies that limit hospital visits, including through the use of hypofractionated precision radiotherapy and chemoradiotherapy treatment approaches.

Full detail: Considerations for the treatment of pancreatic cancer during the COVID-19 pandemic: the UK consensus position

 

Only 1 in 10 GPs say they have the tools to diagnose pancreatic cancer

Pancreatic Cancer UK | May 2019 | Only one in ten GPs have the tools needed to diagnose pancreatic cancer in time to treat

A little over 1,000 UK GPs were polled by ComRes on behalf of the charity Pancreatic Cancer UK. 3 per cent of GPs polled said they were very confident they could recognise the symptoms of pancreatic cancer in a patient.  One in 10 (11 per cent) felt they had the necessary tools to recognise the signs of the cancer.  

Over half of GPs (54 per cent)  say that they have some of the tools they need, but could do with more. Of even greater concern is that three in ten (28 per cent) say that they do not have the tools that they need to detect pancreatic cancer at a stage where it is possible to treat. The charity’s findings mark the launch of their new campaign Unite-Diagnose-Save Lives to help fund the first-ever simple test for pancreatic cancer by 2024.

A quarter of pancreatic cancer patients die within a month of diagnosis, making it the quickest killing cancer. Currently no screening or early detection tests exist for the disease and half of all patients (53 per cent) are diagnosed at stage 4. Vague symptoms – such as back pain, indigestion and weight-loss – mean pancreatic cancer often goes undetected until after it has spread, leaving patients ineligible for the only potential cure – surgery to remove their tumour.

GPs who suspect the disease can refer patients for ultrasound, CT, or MRI scans. However nearly half of all pancreatic cancer patients are currently diagnosed via an emergency (such as through visiting A&E). The impact is significant: one-year survival for patients diagnosed through a GP referral is three times higher.

Pancreatic Cancer UK is investing an initial £750,000 in the research and is asking for the public’s support to help ensure a desperately needed breakthrough in diagnosis can be made (Source: Pancreatic Cancer UK).

Read the full press release from Pancreatic Cancer UK 

See also:

Pancreatic Cancer UK The Pancreatic Cancer UK Early Diagnosis Research Alliance

OnMedica GPs need better tools to diagnose pancreatic cancer

£2.17m boost for pancreatic cancer research

University of Liverpool | 2018 | £2.17m boost for pancreatic cancer research

New research in progress at the University of Liverpool, has been awarded over £2 million by Cancer Research UK, to identify differences in blood samples from people with newly diagnosed diabetes, to people who will develop pancreatic cancer and those who will not. Approximately 50 per cent of all people with pancreatic cancer develop diabetes before their diagnosis. At the moment researchers lack a reliable way to distinguish pancreatic cancer-linked diabetes from normal type-2 diabetes, also known as diabetes mellitus.

Now scientists at Liverpool will look for biomarkers (molecules in the blood samples) that could help them to identify people with a diabetes diagnosis who could benefit from further tests. The samples from participants will be stored in a biobank so they can be used in future studies to further research in this area (Source: University of Liverpool).

Read the full news story from University of Liverpool 

 

 

Pancreatic cancer across Europe

Pancreatic Cancer Europe & United European Gastroenterology | November 2018 | Pancreatic cancer across Europe

Today (15 November) is World Pancreatic Cancer Awareness Day, Pancreatic Cancer Europe & United European Gastroenterology have released  Pancreatic cancer across Europe: Taking a united stand. Pancreatic cancer has the lowest survival rate in Europe. Patient outcomes have been largely static for the last forty years, in contrast to the improved outcomes in the treatment of other cancers. 

Image source: ueg.eu

The number of  deaths from pancreatic cancer has almost doubled in the
past thirty years, over 90,000 EU citizens die from pancreatic cancer every year. Forecasts predict that this dreadful disease shows no sign of relenting either, with the number of cases and deaths both estimated to increase by 40% by 2035 (Source: Pancreatic Cancer Europe & United European Gastroenterology).

Read the full report Pancreatic Cancer Across Europe Taking a united stand

 

 

Pancreatic cancer: Quality standard consultation

NICE | July 2018 | Pancreatic cancer: Quality standard consultation

The draft quality standard for Pancreatic cancer is now open for comment

Consultation documents

• Draft quality standard
• Equality impact assessment

Briefing paper NICE have written a briefing paper which includes a brief description of the topic, a summary of each of the suggested quality improvement areas and supporting information.

The consultation is open until 5pm on Thursday 16 August 2018

Full details of the standard and how to comment are available from NICE

 

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

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.

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

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.”

Read the full blog post here

Pancreatic Cancer: Fast or slow?

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

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…

Read the abstract here

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 29.7 mm, P=0.026).

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

Read the abstract here

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

ScienceDaily. Published online: 4 August 2016

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.

Read the full commentary here

Read the research abstract here