Hi, welcome to Partners in Pancreatic Cancer. My name is Alok Khorana, and I am a medical oncologist and Director of the GI Cancer Program at the Taussig Cancer Institute of the Cleveland Clinic. I also participate in American Society of Clinical Oncology’s Pancreatic Cancer Guidelines which were recently published in the Journal of Clinical Oncology.
Let’s start with one of the frequently asked questions regarding pancreatic cancer. When should palliative care services be initiated in patients with pancreatic cancer? This is actually a new recommendation of the ASCO guidelines on pancreatic cancer. These recommendations straddle all settings of pancreatic cancer including resectable, locally advanced but unresectable, and metastatic pancreatic cancer. The recommendation really is that palliative care services should be initiated as early as possible and preferably even at the first visit with the pancreatic cancer patient. The reason that we are recommending an early partnership with palliative care is because many patients with pancreatic cancer suffer from a variety of different symptoms. Those symptoms can include pain, loss of appetite, alteration of quality of life, jaundice, and many other symptoms related to the cancer itself or to the effect of the cancer on the patient. We found that many other people have found that partnering with a palliative care physician or team of palliative care specialists can alleviate symptoms faster than partnering with just the oncologists. This allows a different team to come in and help with the management of the care of patients with pancreatic cancer, affecting their symptoms and reducing the need for pain management outside of the care of the oncologist. This generally results in the better well-being of the patient. Hence, the recommendation from the American Society of Clinical Oncology is to partner with palliative care as early as possible in the care of patients with pancreatic cancer. At our institution, that involves having palliative care physicians see the patients pretty much as soon the patient hits the door of the cancer center, and so we often set up coordinated appointments with the palliative care physician at the time of the visit with the medical oncologist. This is not possible in many different institutions where palliative care services may not exist or may not be fully staffed, but even so, the American Society of Clinical Oncology guideline urges oncologists to partner with the palliative care services and get those services for the patients as quickly as possible.
It is also important for patients and families to realize that a referral to palliative care is not the same thing as a referral to hospice. Many people confuse palliative care services with hospice care. They are two totally separate things. Many palliative care physicians may also function as hospice care physicians or may help guide the patients toward hospice. In the setting of an early palliative care partnership, the role of the palliative care physician is to focus on symptom management and to help the oncologist, the patient, and the patient’s family reduce the symptom burden as much as possible. Therefore, the patients should not be concerned that a referral to palliative care has implications outside of the care of their illness. Really, the focus is on reducing the burden of symptoms from pancreatic cancer, and that is best done by partnering with the palliative care physician or other provider from palliative care services as early as possible in the history of pancreatic cancer.
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