New Study Provides Recommendations to Manage Pancreatic Cancer Pain

PanCAN’s Precision Promise^SM adaptive clinical trial is designed to bring new treatments to pancreatic cancer patients faster. In addition to therapies that stop the tumor’s growth, participants in Precision Promise will receive best-in-class supportive care. Supportive care focuses on a patient’s comfort, quality of life and total well-being.

The Precision Promise Supportive Care Committee analyzes current clinical practices and scientific literature to define the most appropriate supportive care measures to provide within the trial. In addition to incorporating these learnings into Precision Promise, the committee publishes papers and presents at biomedical conferences to establish best practices that will also benefit patients treated outside of Precision Promise.

PanCAN’s Precision Promise Supportive Care Committee recently published a study outlining the management of pancreatic cancer-associated pain. This follows a paper published in 2019 that focuses on weight loss associated with the disease.

Managing pain is a critical aspect of supportive care. Research through PanCAN’s Patient Registry has shown that 93% of pancreatic cancer patients experience some amount of pain related to their diagnosis. Chronic pain can be emotionally and physically debilitating.

“Pain can be caused by the cancer pushing on nerves, and patients often have pain related to pancreatic enzyme insufficiency,” explained Andrew Coveler, MD, board-certified oncologist at Seattle Cancer Care Alliance (SCCA) and University of Washington (UW) Medical Center and a UW associate professor of medicine and oncology.

Dr. Coveler is a member of PanCAN’s Precision Promise Supportive Care Committee and the principal investigator for the Precision Promise Clinical Trial Consortium site at Fred Hutchinson Cancer Research Center/SCCA/UW. He served as the lead author for the pain management study.

In addition to making a patient feel better and improving their quality of life, research has shown that management of pain can help patients live longer.

“The first step in managing a patient’s pain is understanding the cause of their discomfort,” Dr. Coveler said. “And it’s important for the patient to have an open, ongoing dialogue with their healthcare team about how they’re feeling and any new or worsening side effects or symptoms.”

Determining whether a pancreatic cancer patient is experiencing pancreatic enzyme insufficiency – and prescribing supplemental pancreatic enzymes if appropriate – can improve their pain, weight loss, digestive distress and other symptoms.

For patients whose pain is caused by the tumor pushing on their nerves, pain medication is typically the first intervention. “Currently, the mainstay of pain management is opioids,” said Terry McNearney, MD, co-author of the paper and a consultant for PanCAN. Pancreatic cancer patients often report levels of pain that require prompt attention and use of opioids to offer relief.  But long-term opioid use can result in side effects and risks often not desired or tolerated by the patient.

“Procedures to block the nerves or radiation therapy performed to lessen the pancreatic cancer pain may be considered,” Dr. McNearney said. “An encouraging and important benefit to these procedures is that some patients have reported pain relief to the point where opioid dosing could be stabilized, reduced or discontinued.”

The paper also mentions complementary options, which may include cannabinoids and acupuncture, although data addressing their efficacy in reducing pancreatic cancer pain in patients is lacking.

The researchers call for clinical trials to better study and compare ways to combat pain and to determine the optimal timing for each intervention. They will also continue to learn from information entered into PanCAN’s Patient Registry as well as through the experiences of patients treated within Precision Promise.

“Precision Promise is more than a trial – it’s a platform to find new, better and precise treatments for patients with pancreatic cancer,” Dr. Coveler said. “In addition, it is designed to treat the whole person and is looking at supportive measures in order to improve care overall.”

Contact PanCAN Patient Services for more information about supportive care, including a list of pain and supportive care specialists near you as well as a free supportive care booklet, and for any questions about living with pancreatic cancer.