Ruminations

Pancreatic Cancer: Prognosis, Treatment

"We have better chemotherapy drugs [for pancreatic cancer] than in the past, but those standards of care aren't reaching patients.Spreading the reach of the standards of care, starting with a consultation with a medical oncologist, would have a big impact."
Dr. Natalie Coburn, surgical oncologist, Sunnybrook Health Sciences Centre, Toronto

"I'm going to fight this [pancreatic cancer diagnosis]."
"That stuff [chemotherapy] really kicks the slats out of you.. [I suffered bouts of] deep sadness [following chemotherapy sessions]."
Alex Trebek, Jeopardy host

"[By the time tumours are diagnosed, 80 percent are inoperable] and have spread beyond what we can offer for cure."
"The outlook has drastically changed, but the stigma still remains that this is a highly fatal cancer and it probably isn't worth treating."
"But everyone should have the opportunity for treatment. We could achieve better results by getting more people to an oncologist and better access to best practice treatments right now than with new and often expensive experimental drugs in the future." "We also want to raise awareness amongst policy-makers about gaps in the health care system -- how can we ensure people are accessing the standard of care? How can we make it easier to reach a specialist in a timely manner?" Dr. Julie Hallet, surgical oncologist, Sunnybrook Health Sciences Centre

Host of Jeopardy Alex Trebek is only the latest celebrity to be diagnosed with pancreatic cancer. (Ben Hider/Getty Images)

A new study recently published in the Canadian Medical Association Journal, and authored by University of Toronto-associated surgical oncologist Natalie Coburn, co-authored by Julie Hallet, explores the reality that most people diagnosed with pancreatic cancer fail to be offered the opportunity to extend their lives, a reflection of attitudes within the medical community that the disease, usually diagnosed when it has gone beyond mediation, is no longer worth the effort of treatment.

Over ten thousand people diagnosed with advanced pancreatic cancer over an eleven-year period in Ontario saw only 38 percent receiving chemotherapy or were given the option of a combination of chemo and radiation. Of the total number, one-third weren't referred to a medical oncologist specializing in chemotherapy, contrasting sharply with the high rates of treatment offered for other advanced cancers.

Patients with colorectal cancer, for example see a 90 percent opportunity of being treated by a medical oncologist while the majority receive chemotherapy. The diagnosis of advanced (metastatic) pancreatic cancer, with its spread to other parts of the body, has a particularly grim prognosis. This reflects the fact that the disease has a tendency to spread without the appearance of obvious symptoms such as upper abdominal pain or jaundice which occurs when the tumour blocks the bile ducts.

That there is no screening for pancreatic cancer, only exacerbates the situation. This form of cancer represents the fourth leading cause of cancer deaths in Canada, striking men and women equally. The reality currently is, however, that more up-to-date chemotherapy regimens have the capacity to extend mean survival rates for up to a year. Half the patients receiving chemo are able to survive for a year, while the other half can realize a longer survival time. Without therapy, survival is three to six months.

The study used records of 10,881 patients diagnosed with advanced pancreatic adenocarcinoma, accounting for about 80 percent of all cases, between the years 2005 to 2016. Of that number, roughly 27 percent received chemotherapy, while 11 percent benefited from both chemo and radiation. A third of the diagnosed patients were not referred to an oncologist; of those that were, about 60 percent were not given therapy.

Some people refuse chemotherapy because of the toxic side-effects, and the researchers involved in the study did not set out to identify why it was that people weren't given assessments or failed to be treated. And Dr. Hallet, who understands why some people might decide to forego treatment, feels everyone should have the opportunity to opt for it, or decline it.