PanCAN’s Public Statements

Home For Healthcare Professionals PanCAN’s Public Statements

PanCAN has established the following public statements to be disseminated to healthcare professionals as widely as possible to improve patient care and outcomes. Each statement is supported by the latest guidelines and/or published research as referenced and is vetted by the PanCAN Scientific and Medical Advisory Board.

Symptom evaluation and diagnosis

Pancreatic cancer may cause only vague symptoms. Pain (usually in the abdomen or back), weight loss, jaundice with or without itching, loss of appetite, nausea, change in stool, pancreatitis and recent-onset diabetes are symptoms that may indicate pancreatic cancer. The Pancreatic Cancer Action Network urges you to consider a pancreatic cancer evaluation in individuals displaying one or more of these persistent or unexplained symptoms.

View Sources

  1. Chari ST. Detecting early pancreatic cancer: problems and prospects. Semin Oncol 2077;34:284-294. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17674956.
  2. NCCN Guidelines, Pancreatic Adenocarcinoma Version 2:2010. http://www.jnccn.org/content/8/9/972.full.pdf

Consulting with specialists

Consulting with a pancreatic cancer specialist, a physician who sees a high volume of pancreatic cancer patients, improves outcomes. The Pancreatic Cancer Action Network maintains information about specialists, including surgical, medical and radiation oncologists, gastroenterologists, dietitians and more, for you and your patients.

View Sources

  1. Enewold L, Harlan LC, Tucker T, McKenzie S. Pancreatic cancer in the USA: persistence of undertreatment and poor outcome. J Gastrointest Cancer 2015;46:9-20. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25403828.
  2. NCCN Guidelines, Pancreatic Adenocarcinoma Version 2:2010. http://www.jnccn.org/content/8/9/972.full.pdf
  3. Birkmeyer JD, Siewers AE, Finlayson EVA, et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128-1137. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11948273.
  4. Haj Mohammad N, Bernards N, Besselink MG, et al. Volume matters in the systemic treatment of metastatic pancreatic cancer: a population-based study in the Netherlands. J Cancer Res Clin Oncol 2016;142:1353-1360. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26995276.
  5. Ferrell BR, Temel JS, Temin S, Smith TJ. Integration of palliative care into standard oncology care: ASCO clinical practice guideline update summary. J Oncolo Pract 2017;13:119-121. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28972832.
  6. Wolfgang CL, Herman JM, Laheru DA, et al. Recent progress in pancreatic cancer. CA Cancer J Clin 2013;63:318-348. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23856911.
  7. Katz MH, Wang H, Fleming JB, et al. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol 2009;16:836-847. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19194760.
  8. Barnes JA, Ellis ML, Hwang S, et al. Identification of educational gaps among oncologists who manage patients with pancreatic cancer. J Gastrointestinal Cancer 2017. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29177608.

Supportive care and symptom management

Referring your patients to professionals focused on symptom management and supportive care early in their diagnosis improves outcomes and is critical for patients’ quality of life. The Pancreatic Cancer Action Network offers supportive care information for you and your patients.

View Sources

  1. O’Brien T, Kane CM. Pain services and palliative medicine -- an integrated approach to pain management in the cancer patient. Br J Pain 2014;8:163-171. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26516550.
  2. Bakitas MA, Tosteson TD, Li Z, et al. Early versus delayed initiation of concurrent palliative oncology care: patient outcomes in the ENABLE III randomized controlled trial. J Clin Oncol 2015;33:1438-1445. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25800768.
  3. WHO Expert Committee on Cancer Pain Relief and Active Supportive Care. World Health Organization technical report series; 804. Available at: https://apps.who.int/iris/bitstream/handle/10665/39524/WHO_TRS_804.pdf;jsessionid=3A00A2D8DD9C2010D8C944DFAE7F1CC5?sequence=1.
  4. Bakitas M, Lyons KD, Hegel MT, et al. Effects of a palliative care intervention on clinical outcome in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA 2009;302:741-749. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19690306.
  5. Greer JA, El-Jawahri A, Pirl WF, et al. Randomized trial of early integrated palliative and oncology care. J Clin Oncol 34, 2016 (suppl 26S; abstr 104). Available at: https://meetinglibrary.asco.org/record/136346/abstract.
  6. Boyd AD, Riba M. Depression and pancreatic cancer. J Natl Comp Canc Netw 2007;5:113-116. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17239331.
  7. Deng Y, Tu H, Pierzynski JA, et al. Determinants and prognostic value of quality of life in patients with pancreatic ductal adenocarcinoma. Eur J Cancer 2018;92:20-32. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29413686.
  8. Ferrell BR, Temel JS, Temin S, Smith TJ. Integration of palliative care into standard oncology care: ASCO clinical practice guideline update summary. J Oncolo Pract 2017;13:119-121. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28972832.
  9. Frieden, J. NIH Panel: Treatment of Cancer Pain, Depression and Fatigue Needs More Attention. Oncology Times 2002;9:1,70,74. Available at: https://journals.lww.com/oncology-times/Fulltext/2002/09000/NIH_Panel__Treatment_of_Cancer_Pain%2c_Depression%2c__.1.aspx.

Establishing patient support systems

Support for the patient improves quality of life and overall well-being. A support system of caregivers, family, friends, healthcare professionals and a patient advocate is important to address and manage the needs of the patient. The Pancreatic Cancer Action Network offers support and one-to-one, personalized education for your patients and their families through PanCAN Patient Services and the peer-to-peer Survivor & Caregiver Network.

View Sources

  1. Usta YY. Importance of social support in cancer patients. Asian Pac J Cancer Prev 2012;13:3569-3572. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23098436.
  2. Hazelwood DM, Koeck S, Wallner M, et al. Patients with cancer and family caregivers: management of symptoms caused by cancer or cancer therapy at home. HeilberufeScience 2012;3:149-158. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24027658.

Evaluation for surgery

Although 20 percent of pancreatic cancer patients may be eligible for surgery, data show that up to half of those patients are told they are ineligible. It is important for patients to be evaluated by a surgeon who performs a high volume of pancreatic surgeries (more than 15 per year). The Pancreatic Cancer Action Network maintains information on high volume surgeons for you and your patients.

View Sources

  1. NCCN Guidelines, Pancreatic Adenocarcinoma Version 2:2010. http://www.jnccn.org/content/8/9/972.full.pdf
  2. Shapiro M, Chen Q, Huang Q, et al. Associations of socioeconomic variable with resection, stage, and survival in patients with early-stage pancreatic cancer. JAMA Surg 2016;151:338-345. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26581025.
  3. Bilimoria KY, Bentrem DJ, Ko CY, et al. National failure to operate on early stage pancreatic cancer. Ann Surg 2007;246:173-180. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17667493.
  4. La Torre M, Nigri G, Ferrari L, et al. Hospital volume, margin status, and long-term survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am Surg 2012;78:225-229. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22369834.
  5. Eppsteiner RW, Csikesz NG, McPhee JT, et al. Surgeon volume impacts hospital mortality for pancreatic resection. Ann Surg 2009;249:635-640. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19300225.
  6. NCCN Guidelines, Pancreatic Adenocarcinoma Version 2:2010. http://www.jnccn.org/content/8/9/972.full.pdf
  7. Birkmeyer JD, Siewers AE, Finlayson EVA, et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128-1137. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11948273.
  8. Lieberman MD, Kilburn H, Lindsey M, Brennan MF. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 1995;222:638-645. Available at: https://www.ncbi.nlm.nih.gov/pubmed/7487211.
  9. White MG, Applewhite MK, Kaplan EL, et al. A tale of two cancers: traveling to treat pancreatic and thyroid cancer. J Am Coll Surg 2017;225:125-136. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28473189.
  10. Adam MA, Thomas S, Youngwirth L, et al. Defining a hospital volume threshold for minimally invasive pancreaticoduodenectomy in the United States. JAMA Surg 2017;152:336-342. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28030713.
  11. Wagner M, Redaelli C, Lietz M, et al. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 2004;91:586-594. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15122610.
  12. Gordon TA, Burleyson GP, Tielsch JM, Cameron JL. The effects of regionalization on cost and outcome for one general high-risk surgical procedure. Ann Surg 1995;221:43-49. Available at: https://www.ncbi.nlm.nih.gov/pubmed/7826160.
  13. Imperato PJ, Nenner RP, Starr HA, et al. The effects of regionalization on clinical outcomes for a high risk surgical procedure: a study of the Whipple procedure in New York State. Am J Med Qual 1996;11:193-197. Available at: https://www.ncbi.nlm.nih.gov/pubmed/8972936.
  14. Rosemurgy AS, Bloomston M, Serafini FM, et al. Frequency with which surgeons undertake pancreaticoduodenectomy determines length of stay, hospital charges, and in-hospital mortality. J Gastrointest Surg 2001;5:21-26. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11309644.
  15. Sosa JA, Bowman HM, Gordon TA, et al. Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg 1998;228:429-438. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9742926.
  16. Birkmeyer JD, Finlayson SR, Tosteson AN, et al. Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery 1999;125:250-256. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10076608.
  17. Ho V, Heslin MJ. Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy. Ann Surg 2003;237:509-514. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12677147.
  18. Kutlu OC, Lee JE, Katz MH, et al. Open pancreaticoduodenectomy case volume predicts outcome of laparoscopic approach: a population-based analysis. Ann Surg 2018;267:552-560. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28045744.

Precision medicine

Patients treated with matched therapies selected through biomarker or genetic testing can live longer. The Pancreatic Cancer Action Network supports guideline recommendations for all patients to undergo genetic testing for inherited mutations at diagnosis and for patients to undergo biomarker testing of their tumor tissue unless clinically contraindicated. PanCAN offers precision medicine information and resources, including our Know Your Tumor® precision medicine service, for you and your patients. Genetic testing for inherited mutations can also inform family members of risk independent of family history.

View Sources

  1. Pishvaian MJ, Blais EM, Brody JR, et al. Overall survival in patients with pancreatic cancer receiving matched therapies following molecular profiling: a retrospective analysis of the Know Your Tumor registry trial. Lancet Oncol. 2020 Apr;21(4):508-518. Available at: https://pubmed.ncbi.nlm.nih.gov/32135080/.
  2. Pishvaian MJ, Bender RJ, Halverson D, et al. Molecular profiling of patients with pancreatic cancer: initial results from the Know Your Tumor initiative. Clin Cancer Res 2018;24:5018-5027. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29954777.
  3. Pishvaian MJ, Blais EM, Brody JR, et al. Outcomes in pancreatic adenocarcinoma (PDA) patients (pts) with genetic alterations in DNA damage repair (DDR) pathways: Results from the Know Your Tumor (KYT) program. J Clin Oncol 37, 2019 (suppl 4; abstr 191). Available at: https://meetinglibrary.asco.org/record/169349/abstract.
  4. Von Hoff DD, Stephenson JJ, Jr., Rosen P, et al. Pilot study using molecular profiling of patients’ tumors to find potential targets and select treatments for their refractory cancers. J Clin Oncol 2010;28:4877-4883. Available at https://www.ncbi.nlm.nih.gov/pubmed/20921468.
  5. Lowery MA, Kelsen DP, Stadler ZK, et al. An emerging entity: pancreatic adenocarcinoma associated with a known BRCA mutation: clinical descriptors, treatment implications, and future directions. Oncologist. 2011;16:1397-1402. Available at: https://www.ncbi.nlm.nih.gov/pubmed/21934105.
  6. Le DT, Uram JN, Wang H, et al. PD-1 Blockade in Tumors with Mismatch-Repair Deficiency. N Engl J Med. 2015;372:2509-2520. Available at https://www.ncbi.nlm.nih.gov/pubmed/26028255.
  7. Schwaederle M, Zhao M, Lee JJ, et al. Impact of Precision Medicine in Diverse Cancers: A Meta-Analysis of Phase II Clinical Trials. J Clin Oncol. 2015;33:3817-3825. Available at https://www.ncbi.nlm.nih.gov/pubmed/26304871.
  8. Schwaederle M, Zhao M, Lee JJ, et al. Association of Biomarker-Based Treatment Strategies With Response Rates and Progression-Free Survival in Refractory Malignant Neoplasms: A Meta-analysis. JAMA Oncol. 2016;2:1452-1459. Available at https://www.ncbi.nlm.nih.gov/pubmed/27273579.
  9. Tsimberidou AM, Hong DS, Ye Y, et al. Initiative for Molecular Profiling and Advanced Cancer Therapy (IMPACT): An MD Anderson Precision Medicine Study. JCO Precis Oncol. 2017;2017. Available at https://www.ncbi.nlm.nih.gov/pubmed/29082359.
  10. Aguirre AJ, Nowak JA, Camarda ND, et al. Real-time Genomic Characterization of Advanced Pancreatic Cancer to Enable Precision Medicine. Cancer Discov. 2018;8:1096-1111. Available at https://www.ncbi.nlm.nih.gov/pubmed/29903880.
  11. Chantrill LA, Nagrial AM, Watson C, et al. Precision Medicine for Advanced Pancreas Cancer: The Individualized Molecular Pancreatic Cancer Therapy (IMPaCT) Trial. Clin Cancer Res. 2015 May 1;21(9):2029-37. Available at: https://pubmed.ncbi.nlm.nih.gov/25896973/.
  12. Lowery MA, Jordan EJ, Basturk O, et al. Real-Time Genomic Profiling of Pancreatic Ductal Adenocarcinoma: Potential Actionability and Correlation with Clinical Phenotype. Clin Cancer Res. 2017 Oct 15;23(20):6094-6100. Available at: https://pubmed.ncbi.nlm.nih.gov/28754816/.
  13. Knudsen ES, O’Reilly EM, Brody JR and Witkiewicz AK. Genetic Diversity of Pancreatic Ductal Adenocarcinoma and Opportunities for Precision Medicine. Gastroenterology. 2016 Jan;150(1):48-63.

Clinical trials

Pancreatic cancer patients who participate in clinical research have better outcomes. Clinical trials can advance research and improve treatment options. The Pancreatic Cancer Action Network offers clinical trials information personalized for you and your patients.

View Sources

  1. About Clinical Trials, via Cancer.Net: https://www.cancer.net/research-and-advocacy/clinical-trials/about-clinical-trials, accessed 02/19
  2. Clinical Research Versus Medical Treatment, via FDA.gov: https://www.fda.gov/ForPatients/ClinicalTrials/ClinicalvsMedical/default.htm, accessed 02/19
  3. NIH Clinical Research Trials and You: The Basics, via NIH.gov: https://www.nih.gov/health-information/nih-clinical-research-trials-you/basics, accessed 02/19
  4. Hoos WA, James PM, Rahib L, et al. Pancreatic cancer clinical trials and accrual in the United States. J Clin Oncol 2013;31:3432-3438. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23960185.
  5. NIH Clinical Research Trials and You: Why Should I Participate in a Clinical Trial?, via NIH.gov: https://www.nih.gov/health-information/nih-clinical-research-trials-you/why-should-i-participate-clinical-trial, accessed 02/19
  6. NCCN Guidelines, Pancreatic Adenocarcinoma Version 2:2010. http://www.jnccn.org/content/8/9/972.full.pdf
  7. Sarkar RR, Matsuno R, Murphy JD. Pancreatic cancer: survival in clinical trials versus the real world. J Clin Oncol 2016;34:216. Available at: http://ascopubs.org/doi/abs/10.1200/jco.2016.34.4_suppl.216.
  8. Pancreatic Cancer Action Network’s Clinical Trial Finder, via clinicaltrials.pancan.org: https://clinicaltrials.pancan.org/hcp, accessed 02/19
  9. Engebretson A, Matrisian L, Thompson C. Patient and caregiver awareness of pancreatic cancer treatment and trials. J Gastrointest Oncol 2016;7:228-233. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27034790.

High risk individuals (first-degree relatives)

Guidelines now indicate an increased risk of pancreatic cancer in individuals with a first-degree relative who has had the disease. If the person with pancreatic cancer had genetic testing and the results were negative, the first-degree relative does not need to get genetic testing. If the results were positive or unknown, the Pancreatic Cancer Action Network recommends that the first-degree relative consult with a genetic counselor to determine if they should obtain genetic testing for inherited cancer risk and consider a surveillance program.

View Sources

  1. NCCN Guidelines, Genetic/Familial High-Risk Assessment: Breast, Ovarian and Pancreatic Version 1.2021. https://www.nccn.org/professionals/physician_gls/pdf/genetics_bop.pdf, accessed 10/20.
  2. NCCN Guidelines, Pancreatic Adenocarcinoma Version 1.2019. https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf, accessed 02/19
  3. Hu C, Hart SN, Polley EC, et al. Association between inherited germline mutations in cancer predisposition genes and risk of pancreatic cancer. JAMA 2018;319:2401-2409. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29922827.
  4. NCCN Guidelines, Genetic/Familial High-Risk Assessment: Breast and Ovarian Version 3.2019. https://www.nccn.org/professionals/physician_gls/pdf/genetics_screening.pdf, accessed 02/19
  5. Stoffel EM, McKernin SE, Brand R, et al. Evaluating susceptibility to pancreatic cancer: ASCO provisional clinical opinion. J Clin Oncol 2019;37:153-164. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30457921.
  6. Yurgelun MB, Chittenden AB, Morales-Oyarvide V, et al. Germline cancer susceptibility gene variants, somatic second hits, and survival outcomes in patients with resected pancreatic cancer. Genet Med 2019;21:213-223. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29961768.

Nutritional care and support

Optimal nutritional care, including supplemental pancreatic enzymes, improves patient outcomes and is critical for quality of life. The Pancreatic Cancer Action Network recommends you and your patients consult with a dietitian. PanCAN offers information about diet and nutrition and can help you find registered dietitians with oncology experience for your patients.

View Sources

  1. Marin Caro MM, Laviano A, Pichard C. Nutritional intervention and quality of life in adult oncology patients. Clin Nutr 2007;26:289-301. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17368656.
  2. Fieker A, Philpott J, Armand M. Enzyme replacement therapy for pancreatic insufficiency: present and future. Clin Exp Gastroenterol 2011;4:55-73. Available at: https://www.ncbi.nlm.nih.gov/pubmed/21753892.
  3. Tseng DS, Molenaar IQ, Besselink MG, et al. Pancreatic exocrine insufficiency in patients with pancreatic or periampullary cancer: a systematic review. Pancreas 2016;45:325-330. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26495777.
  4. Friess H, Michalski CW. Diagnosing exocrine pancreatic insufficiency after surgery: when and which patients to treat. HPB (Oxford) 2009;11 Suppl 3:7-10. Available at: https://www.ncbi.nlm.nih.gov/pubmed/20495626.
  5. Landers A, Muicroft W, Brown H. Pancreatic enzyme replacement therapy (PERT) for malabsorption in patients with metastatic pancreatic cancer. BMJ Support Palliat Care 2016;6:75-79. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25164613.
  6. Phillips ME. Pancreatic exocrine insufficiency following pancreatic resection. Pancreatology 2015;15:449-455. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26145836.
  7. Hendifar AE, Petzel MQB, Zimmers TA, et al. Pancreas cancer-associated weight loss. Oncologist 2018. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30591550.
  8. Davidson W, Ash S, Capra S, et al. Weight stabilisation is associated with improved survival duration and quality of life in unresectable pancreatic cancer. Clin Nutr 2004;23:239-247. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15030964.

Sharing health data

Deidentified patient health data provides researchers with crucial details that can lead to improved treatments and better patient outcomes. The Pancreatic Cancer Action Network encourages patients to share their health data with trusted parties such as PanCAN’s Patient Registry.

View Sources

  1. Bouchardy C, Rapiti E, Benhamou S. Cancer registries can provide evidence-based data to improve quality of care and prevent cancer deaths. Ecancermedicalscience 2014;8:413. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24834114.
  2. Basch E, Deal AM, Kris MG, et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol 2016;34:557-565. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26644527.
  3. Velikova G, Booth L, Smith AB, et al. Measuring quality of life in routine oncology practice improves communication and patient well-being: a randomized controlled trial. J Clin Oncol 2004;22:714-724. Available at: https://www.ncbi.nlm.nih.gov/pubmed/14966096.
  4. Basch E, Pugh SL, Dueck AC, et al. Feasibility of patient reporting of symptomatic adverse events via the patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE) in a chemoradiotherapy cooperative group multicenter clinical trial. Int J Radiat Oncol Biol Phys 2017;98:409-418. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28463161.
  5. Clinical Outcome Assessment (COA) Qualification Program, via FDA.gov: https://www.fda.gov/drugs/developmentapprovalprocess/drugdevelopmenttoolsqualificationprogram/ucm284077.htm, accessed 02/19

Updated Oct. 26, 2020


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