Palliative care for pancreatic cancer

Most cases of pancreatic and bile duct cancer are found when the cancer is at an advanced stage. Even if metastatic cancer can’t be cured, in some cases it’s possible to slow down its progression. Symptoms can be relieved with palliative care.

There are about 1,300 new cases of pancreatic cancer and about 300 new cases of bile duct or gallbladder cancer in Finland per year. Most cases of pancreatic or bile duct cancer are found when the cancer is at an advanced stage, meaning that the cancer has spread (metastasised) to other internal organs or the bones. Even if metastatic cancer can’t be cured, chemotherapy can sometimes be used to slow down its progression, and symptoms can be relieved with palliative care.

It’s important to let your attending physician and other members of your care team know about any symptoms you’re experiencing, because symptoms caused by metastases can be managed effectively. Palliative care, aimed at symptom management, is provided alongside chemotherapy , and continues after other treatments are stopped, in other words when moving to palliative care intent.

Important

You don’t have to cope with your symptoms alone

Be sure to tell your attending physician and members of the nursing staff about your symptoms. Although effective cancer treatment also relieves the symptoms, other treatment methods are often needed as well. Good symptom management does not affect other aspects of cancer treatment, but rather, these different approaches enhance one another and help you live a life that is as good and active as possible.

Symptoms depend on where the tumour and metastases are located. Pancreatic and bile duct cancers typically spread to the liver, abdominal cavity, and lungs, but sometimes to other organs as well. Read on for more information about the most common symptoms caused by metastases.

Yellow skin (jaundice)

Pancreatic and bile duct cancers often block the bile duct, leading to disruptions in bile flow. As a result, the skin and whites of the eyes turn yellow, urine turns dark, and because the pigmented substance in the bile can’t reach the colon and give stools their regular brown colour, stools turn gray. The skin and whites of the eyes turning yellow (also called “jaundice”) is often the first symptom of pancreatic or bile duct cancer. Obstructed bile ducts may be widened by placing a prosthesis, also called a stent. The stent is usually inserted into the bile duct through the stomach using an endoscopy procedure. This will gradually make the jaundice better.

Pain

There is a nerve bundle (also called “plexus”) near the pancreas and bile duct. If a tumour presses on the nerve bundle, it causes pain beginning in the upper abdomen and sometimes radiating to the back. Morphine-like pain medicines, as well as medicines for treating nerve pain, are effective in treating this pain. Additionally, it may be possible to use a plexus block to stop the nerves from sending pain signals. The plexus block procedure is done using computed tomography (CT) guidance.

Shortness of breath and other respiratory symptoms

In many cases, individual metastases in the lungs don’t cause any major symptoms. As the metastases increase in number, they may cause shortness of breath or coughing. Shortness of breath can be treated with medications, radiation therapy (if a tumour is obstructing the bronchi), or by removing excess fluid from around the lungs.

Liver metastases and build-up of fluid in the abdomen

In many cases, individual metastases in the liver don’t cause any major symptoms. Symptoms usually first appear once there is a large number of metastases and liver function starts to suffer. Impaired liver function causes swelling (oedema) in the legs and feet, a build-up of fluid in the abdomen, and bile flow disruptions, leading to fatigue and loss of appetite.

A build-up of fluid in the abdominal cavity can also be caused by the cancer spreading to the abdomen. As a result, the belly becomes large and swollen. The fluid can be removed either by performing a one-time ascitic tap or by inserting a drainage catheter that can be used to remove the fluid over the course of several days. This usually provides immediate symptom relief. Fatigue and loss of appetite can be relieved with corticosteroids, while compression bandaging or socks can be used to relieve oedema.

Bowel function disorders

Cancer can spread to the abdominal cavity and disrupt bowel function, causing nausea and constipation. Both nausea and constipation can be relieved effectively with medications.

Sometimes a bowel obstruction may occur. This may require surgery. Symptoms of bowel obstruction include constipation, nausea, vomiting, and stomach pain. Bowel obstruction requires acute medical treatment – contact the unit responsible for your care or visit the emergency department. In the case of advanced cancer, if surgery is not an option, symptoms of bowel obstruction can also be relieved with medication.

Fatigue and loss of appetite

Advanced cancer causes fatigue and leads to a gradual loss of appetite. Pancreatic and bile duct cancers also cause malnutrition. In advanced cancer, enhanced nutrition therapy may not improve the patient’s condition; at this stage, it’s more important to have small, frequent portions of energy-dense foods according to the patient’s preferences. Ways to try and reduce fatigue include getting fresh air and appropriate physical activity. It’s also important to adhere to a regular sleep-wake cycle. Additionally, corticosteroid medicines can be used to ease fatigue and improve appetite temporarily. At the end of life, the patient’s strength decreases, fatigue intensifies, and the need for sleep and rest increases.

Psychological strain

Having an illness puts strain on the mind too. Living with a long-term illness includes both good and bad moments. It’s good to talk to the care team about how you’re coping mentally. Depression and anxiety can be managed both by talking and with medication. Peer support may also be helpful.

While cancer treatment is still ongoing, it’s advisable to contact the unit responsible for your care if your general condition worsens, you develop symptoms that interfere with your life, or your symptoms get worse. Units specialised in cancer treatment have expertise in palliative care, including symptom relief and pain management. All cancer units in university hospitals, and most central hospitals, have palliative care units that can help with symptom management. Psychosocial support and talk support is also available. It’s a good idea to get acquainted with the local palliative unit while undergoing active cancer treatment, so that palliative care can be offered and planned early on.

When it’s time to end active cancer treatment, palliative care continues – at this point, the patient should be assigned a care provider in charge of their palliative care, and provided with a palliative care plan. No one should be left to cope with their illness alone.

At the end of life, the care provider in charge of the patient’s care preferably attends to the patient either at or close to the patient’s home. This can be a palliative outpatient clinic, inpatient ward at a regional hospital (formerly health centre hospital), home hospital, palliative ward, or a hospice. For assistance with essential care needs, home care services are employed. The important thing is to have a plan ready for where to get help at any time of the day or week.

At the end of life, going to the emergency department is a taxing experience. That’s why it’s preferably avoided by cooperating with the care team ahead of time to prepare a plan for what to do if the patient’s condition gets worse or if their symptoms change. Unless it’s an acute medical emergency, it’s advisable to contact the unit responsible for the patient’s care before visiting the emergency department. If the patient has pre-existing access to home hospital services, a nurse or doctor can visit the patient at home and assess the situation, if necessary, or make arrangements for transfer to inpatient care (support ward) without the need to visit the emergency department.

Palliative services

Most common symptom