Managing Pancreatic Cancer

Updated on 10/13/09

A cancer diagnosis changes your life and the lives of your family members in many ways. Patients and their families often feel shock, anger, sadness, fear, frustration, and confusion when faced with cancer.

You may have questions about how your job, finances, and family relationships will be affected. Your healthcare team can suggest social services and agencies that may be able to help by providing financial aid, transportation, and home care.

Many patients find it helpful to share their thoughts and feelings with other cancer patients who are going through a similar experience. Your healthcare team can refer you to support groups, counseling services, and other related resources.

It is important to share physical and emotional side effects with your healthcare team because there are many options and specialists to help you. Your doctor may recommend that you meet with a clinical dietitian, pain specialist, or physical therapist depending on your individual needs. Your quality of life may be significantly improved by using available resources and working with your doctor and nurses together as a team.

This section contains more on

• Special Nutritional Needs
• Managing Pancreatic Enzymes
• High Blood Sugar
• Preventing Stomach Ulcers
• Follow-up Care
• Finding Support
• End-of-Life Issues

Special Nutritional Needs

Many patients with pancreatic cancer do not feel like eating, especially when they are uncomfortable or tired. In addition, the side effects of treatment such as poor appetite, nausea, and vomiting can make eating difficult.

To keep the body strong, patients should try to take in enough calories and protein to control weight, maintain strength, and promote healing. Eating four or five small meals a day of high-protein, high-calorie foods will help you maintain your weight and your strength. Ask your doctor for a referral to a clinical dietitian who can help you plan your diet and address your specific needs.

You may need to take nutritional supplement drinks and nutritional therapy by tube feeding. A feeding tube is a medical device used to provide nutrition to patients who have problems swallowing. The feeding process is called enteral feeding or tube feeding. Tube feeding may be temporary for the treatment of acute conditions or long term in the case of chronic illnesses. Feeding tubes are not painful and are not easily visible when wearing normal clothes. A dietitian will teach you and your caregiver about nutritional supplements and how to use and manage the tube.

Patients may be transitioned back to eating by mouth when they are able to swallow. Your dietitian will help you with this process. Transitioning from tube feeding to eating should happen gradually since you will need to consume enough calories, protein, and fluid by mouth to maintain your weight.

Managing Pancreatic Enzymes

Pancreatic cancer or the removal of part of your pancreas may change the way your body digests food, by affecting the exocrine cells of the pancreas, which release enzymes that help digest fats and proteins. You may have problems digesting food and absorbing nutrients. To prevent malnutrition, the doctor may prescribe replacements for enzymes the pancreas would normally make.

Pancreas enzymes come in capsule or tablet form, and you should take them with the first bite of every meal or snack, including liquid supplements. Depending on the extent of damage to your pancreas, you may need to take pancreas enzymes the rest of your life.

High Blood Sugar

One of the functions of the pancreas is to make insulin and other hormones that help regulate blood sugar. These hormones are produced by islet cells. The pancreas contains more islet cells than the body needs to maintain normal blood sugar. Most patients maintain a normal level of blood sugar even if half of the pancreas is removed by surgery. However, some people develop high blood sugar after surgery for pancreas cancer and occasionally after receiving radiation, and may need insulin or other medicine to control this condition.

Preventing Stomach Ulcers

You are more likely to develop stomach ulcers after pancreas surgery. Your doctor will prescribe anti-ulcer medicine, such as omeprazole or pantoprazole, to help prevent stomach ulcers.

Follow-up Care

After surgery and treatment, your doctor will tell you what kind of tests you will need to monitor your progress and search for signs that the cancer may have come back, or recurred. These tests can include routine blood tests, CA19-9 levels, and CT scans. You will learn about which symptoms may need your attention. Symptoms to watch out for include pain, increasing fatigue, weight loss, fluid retention, and bowel problems.

Finding Support

Advocacy groups, such as PanCan, can be a valuable resource to provide information and sources of support. You can learn more about the disease, find up-to-date information about research, and talk to survivors and caregivers to learn from their experiences.

Pancreatic Cancer Action Network (PanCan)
www.pancan.org
(877) 272-6226 (Toll free)
PanCan's Patient and Liaison Services (PALS) is a comprehensive, free call-in information program for pancreatic cancer patients, their families and health professionals. All services and educational materials are provided at no charge. PanCan encourages patients and families to learn all they can about pancreatic cancer. Their goal is to help patients learn and understand their options. Please use the PALS program and the information within the Patient Services section of the website to accomplish this goal.
Call toll-free 877-272-6226 or email pals@pancan.org to connect with a PALS Associate.

The Lustgarten Foundation for Pancreatic Cancer Research
www.lustgarten.org
(866) 789-1000 (Toll free)
Patient And Caregiver Education (P.A.C.E.) is a point-of-contact service through the Lustgarten Foundation designed to provide individuals with the information and tools they need to help meet the many challenges associated with pancreatic cancer. P.A.C.E. is staffed by a full-time, licensed social worker, who is available to address patient inquiries, assist with clinical trials searches, conduct individualized information searches and provide customized information and referrals as needed. Call (866) 789-1000

End-of-Life Issues

When doctors cannot control the cancer with available therapies or when patients can no longer tolerate treatments, doctors may prescribe palliative care to help make the patient more comfortable. The patient receives medicines and treatments to control pain and other symptoms, such as constipation, nausea, and shortness of breath.

Some patients remain at home during this time, while others enter a hospital or other facility. In either setting, services are available to help patients and their families cope with the medical, psychological, and spiritual issues surrounding dying. Hospice care often provides such services.

Hospice is not a place. Hospice is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatment. Hospice staff and volunteers offer a specialized knowledge of medical care and pain management. Hospice addresses all symptoms of disease, with a special emphasis on controlling a patient's pain and discomfort. Eighty percent of hospice care is provided in the patient's home, family member's home, or in a nursing home. Inpatient hospice facilities are offered in some areas. Speak with a member of your healthcare team for information on hospice care where you live. Learn more from the Hospice Foundation of American, including how to contact a hospice provider near you.

There may come a time during your cancer treatment when you will be unable to tell your doctor or loved ones what type of medical care you want to receive. This problem may be temporary or ongoing. An advance directive allows you to plan for your care should you are unable to tell others the type of medical care you would like to have. If you have not completed an advance directive and become incapacitated, your doctor and family would have to agree on decisions about life-sustaining treatment.

While advance directives vary from state to state, they fall into three basic types: medical power of attorney, living will, and do-not-resuscitate order.

The medical power of attorney is a legal document in which you give someone the authority to make healthcare decisions for you when you are no longer capable of making them yourself. Healthcare decisions involve any treatment, service, or procedure to maintain, diagnose, or treat your physical or mental condition. A medical power of attorney takes precedence over any other document, as far as healthcare decision making is concerned.

The living will communicates your wishes about specific types of life-sustaining medical care but takes effect only when you are in the terminal or irreversible phase of illness. The out-of-hospital do-not-resuscitate order is signed by a physician and allows a patient to refuse cardiopulmonary resuscitation, or CPR, when outside the hospital. If you do not have this order, healthcare providers, including ambulance personnel, may do everything medically possible to start your heart and help you breathe. Each state has its own requirements.

The end-of-life experience is different for each person. Each individual has unique needs for information and support. The patient's and family's questions and concerns about the end-of-life should be discussed with the healthcare team as they arise.