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