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Symptom Management in Pancreatic Cancer

  • Upper Gastrointestinal Cancers (JD Berlin, Section Editor)
  • Published:
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Opinion statement

Despite extensive research that has identified new risk factors, genetic mutations, and therapeutic options, pancreatic ductal adenocarcinoma continues to be a leading cause of cancer related death. Patients with pancreatic cancer, along with their clinicians, must balance realistic hope alongside a life-threatening diagnosis. As the search for treatments to reduce the morbidity and mortality continues, symptom management and quality of life remain the focus of our efforts. In addition to side effects of cancer-directed therapy, patients are at risk for malnutrition, pain, and fatigue. These factors are often overlooked in practice, so a multidisciplinary team is critical in optimizing the care of patients.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74(11):2913–21.

    Article  CAS  PubMed  Google Scholar 

  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67(1):7–30.

    Article  PubMed  Google Scholar 

  3. Koulouris AI, Banim P, Hart AR. Pain in patients with pancreatic cancer: prevalence, mechanisms, management and future developments. Dig Dis Sci. 2017;62(4):861–70.

    Article  CAS  PubMed  Google Scholar 

  4. Drewes AM, Campbell CM, Ceyhan GO, Delhaye M, Garg PK, van Goor H, et al. Pain in pancreatic ductal adenocarcinoma: a multidisciplinary, international guideline for optimized management. Pancreatology. 2018;18(4):446–57.

    Article  PubMed  Google Scholar 

  5. • Balaban EP, Mangu PB, Khorana AA, Shah MA, Mukherjee S, Crane CH, et al. Locally advanced, unresectable pancreatic cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2016;34(22):2654–68 Evidence based society guidelines on treatment of locally advanced, unresectable pancreatic cancer.

    Article  PubMed  Google Scholar 

  6. Woo SM, Song MK, Lee M, Joo J, Kim DH, Kim JH, et al. Effect of early management on pain and depression in patients with pancreatobiliary cancer: a randomized clinical trial. Cancers (Basil). 2019;11(1):79.

  7. Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet (London, England). 2014;383(9930):1721–30.

    Article  Google Scholar 

  8. • Sohal DPS, Kennedy EB, Khorana A, Copur MS, Crane CH, Garrido-Laguna I, et al. Metastatic pancreatic cancer: ASCO clinical practice guideline update. J Clin Oncol. 2018;36(24):2545–56 Updated society guidelines on treatment for metastatic disease, including new evidence of treatment in advanced metastatic pancreatic cancer.

    Article  PubMed  Google Scholar 

  9. de Oliveira R, dos Reis MP, Prado WA. The effects of early or late neurolytic sympathetic plexus block on the management of abdominal or pelvic cancer pain. Pain. 2004;110(1–2):400–8.

    Article  PubMed  Google Scholar 

  10. Wong GY, Schroeder DR, Carns PE, Wilson JL, Martin DP, Kinney MO, et al. Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer: a randomized controlled trial. Jama. 2004;291(9):1092–9.

    Article  CAS  PubMed  Google Scholar 

  11. Lohse I, Brothers SP. Pathogenesis and treatment of pancreatic Cancer related pain. Anticancer Res. 2020;40(4):1789–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Oh TK, Lee WJ, Woo SM, Kim NW, Yim J, Kim DH. Impact of celiac plexus neurolysis on survival in patients with unresectable pancreatic cancer: a retrospective. Propens Score Match Analy Pain Phys. 2017;20(3):E357–e65.

    Google Scholar 

  13. Gasparini G, Pellegatta M, Crippa S, Lena MS, Belfiori G, Doglioni C, et al. Nerves and pancreatic cancer: New insights into a dangerous relationship. Cancers (Basil). 2019;11(7):893.

  14. Ceyhan GO, Bergmann F, Kadihasanoglu M, Altintas B, Demir IE, Hinz U, et al. Pancreatic neuropathy and neuropathic pain--a comprehensive pathomorphological study of 546 cases. Gastroenterology. 2009;136(1):177–86.e1.

    Article  PubMed  Google Scholar 

  15. di Mola FF, di Sebastiano P. Pain and pain generation in pancreatic cancer. Langenbeck's Arch Surg. 2008;393(6):919–22.

    Article  Google Scholar 

  16. Zhu Y, Colak T, Shenoy M, Liu L, Pai R, Li C, et al. Nerve growth factor modulates TRPV1 expression and function and mediates pain in chronic pancreatitis. Gastroenterology. 2011;141(1):370–7.

    Article  CAS  PubMed  Google Scholar 

  17. Bapat AA, Hostetter G, Von Hoff DD, Han H. Perineural invasion and associated pain in pancreatic cancer. Nat Rev Cancer. 2011;11(10):695–707.

    Article  CAS  PubMed  Google Scholar 

  18. Wyse JM, Carone M, Paquin SC, Usatii M, Sahai AV. Randomized, double-blind, controlled trial of early endoscopic ultrasound-guided celiac plexus neurolysis to prevent pain progression in patients with newly diagnosed, painful, inoperable pancreatic cancer. J Clin Oncol. 2011;29(26):3541–6.

    Article  PubMed  Google Scholar 

  19. Wyse JM, Chen YI, Sahai AV. Celiac plexus neurolysis in the management of unresectable pancreatic cancer: when and how? World J Gastroenterol. 2014;20(9):2186–92.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Amr YM, Makharita MY. Neurolytic sympathectomy in the management of cancer pain-time effect: a prospective, randomized multicenter study. J Pain Symptom Manag. 2014;48(5):944–56.e2.

    Article  Google Scholar 

  21. Yan BM, Myers RP. Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. Am J Gastroenterol. 2007;102(2):430–8.

    Article  PubMed  Google Scholar 

  22. Morganti AG, Trodella L, Valentini V, Barbi S, Macchia G, Mantini G, et al. Pain relief with short-term irradiation in locally advanced carcinoma of the pancreas. J Palliat Care. 2003;19(4):258–62.

    Article  PubMed  Google Scholar 

  23. Ceha HM, van Tienhoven G, Gouma DJ, Veenhof CH, Schneider CJ, Rauws EA, et al. Feasibility and efficacy of high dose conformal radiotherapy for patients with locally advanced pancreatic carcinoma. Cancer. 2000;89(11):2222–9.

    Article  CAS  PubMed  Google Scholar 

  24. Ebrahimi G, Rasch CRN, van Tienhoven G. Pain relief after a short course of palliative radiotherapy in pancreatic cancer, the Academic Medical Center (AMC) experience. Acta Oncol (Stockholm, Sweden). 2018;57(5):697–700.

    Article  Google Scholar 

  25. Wolny-Rokicka E, Sutkowski K, Grzadziel A, Dorsz Z, Tukiendorf A, Lipinski J, et al. Tolerance and efficacy of palliative radiotherapy for advanced pancreatic cancer: a retrospective analysis of single-institutional experiences. Mol Clin Oncol. 2016;4(6):1088–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Palta M, Godfrey D, Goodman KA, Hoffe S, Dawson LA, Dessert D, et al. Radiation therapy for pancreatic Cancer: executive summary of an ASTRO clinical practice guideline. Pract Radiat Oncol. 2019;9(5):322–32.

    Article  PubMed  Google Scholar 

  27. Lischalk JW, Burke A, Chew J, Elledge C, Gurka M, Marshall J, et al. Five-fraction stereotactic body radiation therapy (SBRT) and chemotherapy for the local management of metastatic pancreatic cancer. J Gastroint Cancer. 2018;49(2):116–23.

    Article  Google Scholar 

  28. Takahara N, Isayama H, Nakai Y, Sasaki T, Saito K, Hamada T, et al. Pancreatic cancer with malignant ascites: clinical features and outcomes. Pancreas. 2015;44(3):380–5.

    Article  PubMed  Google Scholar 

  29. Adam RA, Adam YG. Malignant ascites: past, present, and future. J Am Coll Surg. 2004;198(6):999–1011.

    Article  PubMed  Google Scholar 

  30. Baretti M, Pulluri B, Tsai HL, Blackford AL, Wolfgang CL, Laheru D, et al. The significance of ascites in patients with pancreatic ductal adenocarcinoma: a case-control study. Pancreas. 2019;48(4):585–9.

    Article  PubMed  PubMed Central  Google Scholar 

  31. McDermott WV Jr. Portal hypertension secondary to pancreatic disease. Ann Surg. 1960;152:147–50.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Zervos EE, Osborne D, Boe BA, Luzardo G, Goldin SB, Rosemurgy AS. Prognostic significance of new onset ascites in patients with pancreatic cancer. World J Surg Oncol. 2006;4:16.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Runyon BA, Hoefs JC, Morgan TR. Ascitic fluid analysis in malignancy-related ascites. Hepatology (Baltimore, Md). 1988;8(5):1104–9.

    Article  CAS  Google Scholar 

  34. Kumar A, Sharma P, Arora A. Review article: portal vein obstruction--epidemiology, pathogenesis, natural history, prognosis and treatment. Aliment Pharmacol Ther. 2015;41(3):276–92.

    Article  CAS  PubMed  Google Scholar 

  35. Nakao A, Kanzaki A, Fujii T, Kodera Y, Yamada S, Sugimoto H, et al. Correlation between radiographic classification and pathological grade of portal vein wall invasion in pancreatic head cancer. Ann Surg. 2012;255(1):103–8.

    Article  PubMed  Google Scholar 

  36. Saif MW, Kaley K, Lamb L. Pancreatic adenocarcinoma complicated by Sinistral portal hypertension. Cureus. 2016;8(7):e689.

    PubMed  PubMed Central  Google Scholar 

  37. Li XB, Zhao L, Liao Q, Xu Q, Zhang TP, Cong L, et al. Gastroesophageal varices (bleeding) and splenomegaly: the initial manifestations of some pancreatic body and tail carcinoma. Chin Med J. 2015;128(4):558–61.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Rosado ID, Bhalla S, Sanchez LA, Fields RC, Hawkins WG, Strasberg SM. Pattern of venous collateral development after splenic vein occlusion in an extended Whipple procedure (Whipple at the splenic artery) and long-term results. J Gastroint Surg. 2017;21(3):516–26.

    Article  Google Scholar 

  39. Chen KT, Devarajan K, Hoffman JP. Morbidity among long-term survivors after pancreatoduodenectomy for pancreatic adenocarcinoma. Ann Surg Oncol. 2015;22(4):1185–9.

    Article  PubMed  Google Scholar 

  40. Qi X, Feng J, Shao X, Xu Y, Li H, Guo X. Portal hypertension in a patient with recurrent pancreatic Cancer after radiotherapy and systemic chemotherapy. J Clin Exper Hepatol. 2018;8(1):106–8.

    Article  Google Scholar 

  41. Rosen AA, Iseri O, Fishbein G, Knodell RG. Nodular regenerative hyperplasia: a cause of ascites and hepatomegaly after chemotherapy for leukemia. Am J Gastroenterol. 1991;86(1):86–8.

    CAS  PubMed  Google Scholar 

  42. Kim JH, Lee SC, Oh SY, Song SY, Lee N, Nam EM, et al. Attenuated FOLFIRINOX in the salvage treatment of gemcitabine-refractory advanced pancreatic cancer: a phase II study. Cancer Commun (London, England). 2018;38(1):32.

    Article  CAS  Google Scholar 

  43. Hicks AM, DeRosa A, Raj M, Do R, Yu KH, Lowery MA, et al. Visceral thromboses in pancreas adenocarcinoma: systematic review. Clin Colorectal Cancer. 2018;17(2):e207–e16.

    Article  PubMed  Google Scholar 

  44. Ansari D, Ansari D, Andersson R, Andren-Sandberg A. Pancreatic cancer and thromboembolic disease, 150 years after trousseau. Hepatobil Surg Nutri. 2015;4(5):325–35.

    Google Scholar 

  45. Maeda A, Chen Y, Bu J, Mujcic H, Wouters BG, DaCosta RS. In vivo imaging reveals significant tumor vascular dysfunction and increased tumor hypoxia-inducible factor-1alpha expression induced by high single-dose irradiation in a pancreatic tumor model. Int J Radiat Oncol Biol Phys. 2017;97(1):184–94.

    Article  CAS  PubMed  Google Scholar 

  46. Liu CD, Tilch L, Kwan D, McFadden DW. Vascular endothelial growth factor is increased in ascites from metastatic pancreatic cancer. J Surg Res. 2002;102(1):31–4.

    Article  CAS  PubMed  Google Scholar 

  47. Dominguez-Munoz JE, Nieto-Garcia L, Lopez-Diaz J, Larino-Noia J, Abdulkader I, Iglesias-Garcia J. Impact of the treatment of pancreatic exocrine insufficiency on survival of patients with unresectable pancreatic cancer: a retrospective analysis. BMC Cancer. 2018;18(1):534.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  48. Yamada Y, Yamaguchi A, Harada M, Kurasawa Y, Hara Y, Yamazaki D, et al. Protein concentration of refractory ascites in cancer patients is reflected by the presence and severity of peritoneal and liver metastasis. Therapeut Apheres Dialy. 2017;21(3):263–9.

    Article  CAS  Google Scholar 

  49. Ouyang H, Wang P, Meng Z, Chen Z, Yu E, Jin H, et al. Multimodality treatment of pancreatic cancer with liver metastases using chemotherapy, radiation therapy, and/or Chinese herbal medicine. Pancreas. 2011;40(1):120–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Pockros PJ, Esrason KT, Nguyen C, Duque J, Woods S. Mobilization of malignant ascites with diuretics is dependent on ascitic fluid characteristics. Gastroenterology. 1992;103(4):1302–6.

    Article  CAS  PubMed  Google Scholar 

  51. Lee CW, Bociek G, Faught W. A survey of practice in management of malignant ascites. J Pain Symptom Manag. 1998;16(2):96–101.

    Article  CAS  Google Scholar 

  52. Becker G, Galandi D, Blum HE. Malignant ascites: systematic review and guideline for treatment. Eur J Cancer (Oxford, England : 1990). 2006;42(5):589–97.

    Article  Google Scholar 

  53. Stephenson J, Gilbert J. The development of clinical guidelines on paracentesis for ascites related to malignancy. Palliat Med. 2002;16(3):213–8.

    Article  CAS  PubMed  Google Scholar 

  54. O'Neill MJ, Weissleder R, Gervais DA, Hahn PF, Mueller PR. Tunneled peritoneal catheter placement under sonographic and fluoroscopic guidance in the palliative treatment of malignant ascites. AJR Am J Roentgenol. 2001;177(3):615–8.

    Article  CAS  PubMed  Google Scholar 

  55. Schumacher DL, Saclarides TJ, Staren ED. Peritoneovenous shunts for palliation of the patient with malignant ascites. Ann Surg Oncol. 1994;1(5):378–81.

    Article  CAS  PubMed  Google Scholar 

  56. Nio Y, Iguchi C, Itakura M, Nishi T, Hashimoto K, Takeda H, et al. Placement of an expandable metallic stent improves the efficacy of chemoradiotherapy for pancreatic cancer with malignant portal vein stenosis or obstruction. Anticancer Res. 2009;29(8):3329–35.

    CAS  PubMed  Google Scholar 

  57. Yamakado K, Nakatsuka A, Tanaka N, Fujii A, Isaji S, Kawarada Y, et al. Portal venous stent placement in patients with pancreatic and biliary neoplasms invading portal veins and causing portal hypertension: initial experience. Radiology. 2001;220(1):150–6.

    Article  CAS  PubMed  Google Scholar 

  58. Cavazzoni E, Bugiantella W, Graziosi L, Franceschini MS, Donini A. Malignant ascites: pathophysiology and treatment. Int J Clin Oncol. 2013;18(1):1–9.

    Article  PubMed  Google Scholar 

  59. Bachmann J, Heiligensetzer M, Krakowski-Roosen H, Büchler MW, Friess H, Martignoni ME. Cachexia worsens prognosis in patients with resectable pancreatic cancer. J Gastrointest Surg. 2008;12(7):1193–201.

  60. Pausch T, Hartwig W, Hinz U, Swolana T, Bundy BD, Hackert T, et al. Cachexia but not obesity worsens the postoperative outcome after pancreatoduodenectomy in pancreatic cancer. Surgery. 2012;152(3 Suppl 1):S81–8.

  61. Hendifar A, Osipov A, Khanuja J, Nissen N, Naziri J, Yang W, et al. Influence of body mass index and albumin on perioperative morbidity and clinical outcomes in resected pancreatic adenocarcinoma. PLoS One. 2016;11:e0152172.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  62. Yildirim BA, Özdemir Y, Colakoglu T, Topkan E. Impact of presence and degree of pretreatment weight loss in locally-advanced pancreatic cancer patients treated with definitive concurrent chemoradiotherapy. Pancreatology. 2016;16(4):599–604.

  63. Nemer L, Krishna SG, Shah ZK, Conwell DL, Cruz-Monserrate Z, Dillhoff M, et al. Predictors of pancreatic cancer-associated weight loss and nutritional interventions. Pancreas. 2017;46(9):1152–7.

  64. • Hendifar AE, Petzel MQB, Zimmers TA, Denlinger CS, Matrisian LM, Picozzi VJ, et al. Pancreas cancer-associated weight loss. Oncologist. 2019;24(5):691–701.Comprehensive review article on cancer associated weight loss and algorithm to provide clinical care.

  65. Purcell SA, Elliott SA, Baracos VE, Chu QS, Prado CM. Key determinants of energy expenditure in cancer and implications for clinical practice. Eur J Clin Nutr. 2016;70(11):1230–8.

  66. Purcell SA, Elliott SA, Baracos VE, Chu QSC, Sawyer MB, Mourtzakis M, et al. Accuracy of resting energy expenditure predictive equations in patients with cancer. Nutr Clin Pract. 2019;34(6):922–34.

  67. Phillips ME. Pancreatic exocrine insufficiency following pancreatic resection. Pancreatology. 2015;15(5):449–55.

  68. Bartel MJ, Asbun H, Stauffer J, Raimondo M. Pancreatic exocrine insufficiency in pancreatic cancer: a review of the literature. Dig Liver Dis. 2015;47(12):1013–20.

  69. Rahib L, Westermann A, Barkin JA, Hoos W, Moravek C, Matrisian L, et al. Frequency of appropriate use of pancreatic enzyme replacement therapy (PERT) and symptomatic response in pancreatic cancer patients. Am J Gastroenterol. 2017;112:S23.

    Article  Google Scholar 

  70. Gruber ES, Jomrich G, Tamandl D, Gnant M, Schindl M, Sahora K. Sarcopenia and sarcopenic obesity are independent adverse prognostic factors in resectable pancreatic ductal adenocarcinoma. PLoS One. 2019;14:e0215915.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Tan BHL, Birdsell LA, Martin L, Baracos VE, Fearon KC. Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic cancer. Clin Cancer Res. 2009;15(22):6973–9.

  72. Martin L, Senesse P, Gioulbasanis I, Antoun S, Bozzetti F, Deans C, et al. Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol. 2015;33(1):90–9.

  73. Werner K, Kullenberg de Gaudry D, Taylor LA, Keck T, Unger C, Hopt UT, et al. Dietary supplementation with n-3-fatty acids in patients with pancreatic cancer and cachexia: marine phospholipids versus fish oil - a randomized controlled double-blind trial. Lipids Health Dis. 2017;16(1):104.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  74. Basile D, Parnofiello A, Vitale MG, Cortiula F, Gerratana L, Fanotto V, et al. The IMPACT study: early loss of skeletal muscle mass in advanced pancreatic cancer patients. J Cachexia Sarcopenia Muscle. 2019;10(2):368–77.

  75. Ali R, Baracos VE, Sawyer MB, Bianchi L, Roberts S, Assenat E, et al. Lean body mass as an independent determinant of dose-limiting toxicity and neuropathy in patients with colon cancer treated with FOLFOX regimens. Cancer Med. 2016;5(4):607–16.

  76. Prado CMM, Baracos VE, McCargar LJ, Mourtzakis M, Mulder KE, Reiman T, et al. Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin Cancer Res. 2007;13:3264–8.

    Article  CAS  PubMed  Google Scholar 

  77. Dalal S, Hui D, Bidaut L, Lem K, Del Fabbro E, Crane C, et al. Relationships among body mass index, longitudinal body composition alterations, and survival in patients with locally advanced pancreatic cancer receiving chemoradiation: a pilot study. J Pain Symptom Manag. 2012;44:181–91.

    Article  Google Scholar 

  78. Kazemi-Bajestani SM, Mazurak VC, Baracos V. Computed tomography-defined muscle and fat wasting are associated with cancer clinical outcomes. Semin Cell Dev Biol. 2016;54:2–10.

  79. Cousin S, Hollebecque A, Koscielny S, Mir O, Varga A, Baracos VE, et al. Low skeletal muscle is associated with toxicity in patients included in phase i trials. Invest New Drugs. 2014;32(2):382–7.

  80. Di Sebastiano KM, Yang L, Zbuk K, Wong RK, Chow T, Koff D, et al. Accelerated muscle and adipose tissue loss may predict survival in pancreatic cancer patients: the relationship with diabetes and anaemia. Br J Nutr. 2013;109:302–12.

    Article  PubMed  CAS  Google Scholar 

  81. Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg. 2011;98(2):268–74.

  82. Prado CM, Sawyer MB, Ghosh S, Lieffers JR, Esfandiari N, Antoun S, et al. Central tenet of cancer cachexia therapy: Do patients with advanced cancer have exploitable anabolic potential? Am J Clin Nutr. 2013;98(4):1012–9.

  83. Mintziras I, Miligkos M, Wächter S, Manoharan J, Maurer E, Bartsch DK. Sarcopenia and sarcopenic obesity are significantly associated with poorer overall survival in patients with pancreatic cancer: Systematic review and meta-analysis. Int J Surg. 2018;59:19–26.

  84. Mourtzakis M, Prado CMM, Lieffers JR, Reiman T, McCargar LJ, Baracos VE. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008;33(5):997–1006.

  85. Berry AJ. Pancreatic enzyme replacement therapy during pancreatic insufficiency. Nutr Clin Pract. 2014;29:312–21.

    Article  CAS  PubMed  Google Scholar 

  86. Partelli S, Frulloni L, Minniti C, Bassi C, Barugola G, D'Onofrio M, et al. Faecal elastase-1 is an independent predictor of survival in advanced pancreatic cancer. Dig Liver Dis. 2012;44:945–51.

    Article  CAS  PubMed  Google Scholar 

  87. Perez MM, Newcomer AD, Moertel CG, Go VLW, Dimagno EP. Assessment of weight loss, food intake, fat metabolism, malabsorption, and treatment of pancreatic insufficiency in pancreatic cancer. Cancer. 1983;52(2):346–52.

  88. Sikkens ECM, Cahen DL, De Wit J, Looman CWN, Van Eijck C, Bruno MJ. A prospective assessment of the natural course of the exocrine pancreatic function in patients with a pancreatic head tumor. J Clin Gastroenterol. 2014;48(5):e43–6.

  89. Del Fabbro E, Hui D, Dalal S, Dev R, Nooruddin ZI, Bruera E. Clinical outcomes and contributors to weight loss in a cancer cachexia clinic. J Palliat Med. 2011;14(9):1004–8.

  90. MacCiò A, Madeddu C, Gramignano G, Mulas C, Floris C, Sanna E, et al. A randomized phase III clinical trial of a combined treatment for cachexia in patients with gynecological cancers: evaluating the impact on metabolic and inflammatory profiles and quality of life. Gynecol Oncol. 2012;124:417–25.

    Article  PubMed  CAS  Google Scholar 

  91. Vashi P, Popiel B, Lammersfeld C, Gupta D. Outcomes of Systematic Nutritional Assessment and Medical Nutrition Therapy in Pancreatic Cancer. Pancreas. 2015.

  92. DomÃnguez-Muñoz JE, Nieto-Garcia L, Iglesias-Garcia J. Impact of diagnosis and treatment of pancreatic exocrine insufficiency (PEI) on survival of patients with unresectable pancreatic cáncer (PC). Pancreatology. 2013.

  93. Safdi M, Bekal PK, Martin S, Saeed ZA, Burton F, Toskes PP. The effects of oral pancreatic enzymes (Creon 10 capsule) on steatorrhea. Pancreas. 2006;33:156–62.

    Article  CAS  PubMed  Google Scholar 

  94. Ma X, Wang H, Zhang P, Xu L, Tian Z. Association between small intestinal bacterial overgrowth and toll-like receptor 4 in patients with pancreatic carcinoma and cholangiocarcinoma. Turk J Gastroenterol. 2019.

  95. Ruiz Garcia V, Lopez-Briz E, Carbonell Sanchis R, Gonzalvez Perales JL, Bort-Marti S. Megestrol acetate for treatment of anorexia-cachexia syndrome. Cochrane Database Syst Rev. 2013;3:Cd004310.

    Google Scholar 

  96. Reuter SE, Martin JH. Pharmacokinetics of Cannabis in Cancer Cachexia-anorexia syndrome. Clin Pharmacokinet. 2016;55(7):807–12.

    Article  CAS  PubMed  Google Scholar 

  97. Tuca A, Jimenez-Fonseca P, Gascon P. Clinical evaluation and optimal management of cancer cachexia. Crit Rev Oncol Hematol. 2013;88(3)625–36.

  98. Thompson KL, Elliott L, Fuchs-Tarlovsky V, Levin RM, Voss AC, Piemonte T. Oncology evidence-based nutrition practice guideline for adults. J Acad Nutr Diet. 2017;117(2):297–310.e47.

  99. Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62(4):243–74.

  100. Dev R, Wong A, Hui D, Bruera E. The evolving approach to management of cancer cachexia. Oncology (Williston Park, NY). 2017;31(1):23–32.

    Google Scholar 

  101. Solheim TS, Laird BJA, Balstad TR, Bye A, Stene G, Baracos V, et al. Cancer cachexia: rationale for the MENAC (multimodal - exercise, nutrition and anti-inflammatory medication for cachexia) trial. BMJ Support Palliat Care. 2018;8:258–65.

    Article  PubMed  Google Scholar 

  102. Hinz A, Krauss O, Hauss JP, Hockel M, Kortmann RD, Stolzenburg JU, et al. Anxiety and depression in cancer patients compared with the general population. Eur J Cancer Care. 2010;19(4):522–9.

    Article  CAS  Google Scholar 

  103. Pinquart M, Duberstein PR. Depression and cancer mortality: a meta-analysis. Psychol Med. 2010;40(11):1797–810.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  104. Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr. 2004;32:57–71.

    Article  Google Scholar 

  105. Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S. The prevalence of psychological distress by cancer site. Psycho-oncology. 2001;10(1):19–28.

    Article  CAS  PubMed  Google Scholar 

  106. Shakin EJ, Holland J. Depression and pancreatic cancer. J Pain Symptom Manag. 1988;3(4):194–8.

    Article  CAS  Google Scholar 

  107. Joffe RT, Rubinow DR, Denicoff KD, Maher M, Sindelar WF. Depression and carcinoma of the pancreas. Gen Hosp Psychiatry. 1986;8(4):241–5.

    Article  CAS  PubMed  Google Scholar 

  108. Fras I, Litin EM, Pearson JS. Comparison of psychiatric symptoms in carcinoma of the pancreas with those in some other intra-abdominal neoplasms. Am J Psychiatry. 1967;123(12):1553–62.

    Article  CAS  PubMed  Google Scholar 

  109. Yaskin J. Nervous symptoms at earliest manifestations of cancer of the pancreas. J Am Med Assoc. 1931;96:1664–8.

    Article  Google Scholar 

  110. Turaga KK, Malafa MP, Jacobsen PB, Schell MJ, Sarr MG. Suicide in patients with pancreatic cancer. Cancer. 2011;117(3):642–7.

    Article  PubMed  Google Scholar 

  111. Green AI, Austin CP. Psychopathology of pancreatic cancer. A psychobiologic probe. Psychosomatics. 1993;34(3):208–21.

    Article  CAS  PubMed  Google Scholar 

  112. Cosci F, Fava GA, Sonino N. Mood and anxiety disorders as early manifestations of medical illness: a systematic review. Psychother Psychosom. 2015;84(1):22–9.

    Article  PubMed  Google Scholar 

  113. Boyd AD, Riba M. Depression and pancreatic cancer. J Nat Comprehen Cancer Network. 2007;5(1):113–6.

    Article  Google Scholar 

  114. Kenner BJ. Early detection of pancreatic cancer: the role of depression and anxiety as a precursor for disease. Pancreas. 2018;47(4):363–7.

    Article  PubMed  PubMed Central  Google Scholar 

  115. Jacobsson L, Ottosson JO. Initial mental disorders in carcinoma of pancreas and stomach. Acta Psychiatr Scand Suppl. 1971;221:120–7.

    Article  CAS  PubMed  Google Scholar 

  116. Bettison TM, Nahm CB, Gill AJ, Mittal A, Malhi GS, Samra JS. Understanding the pathophysiology of psychological distress and pancreatic cancer: a systematic review. Pancreas. 2018;47(4):376–81.

    Article  PubMed  Google Scholar 

  117. Botwinick IC, Pursell L, Yu G, Cooper T, Mann JJ, Chabot JA. A biological basis for depression in pancreatic cancer. HPB. 2014;16(8):740–3.

    Article  PubMed  PubMed Central  Google Scholar 

  118. Breitbart W, Rosenfeld B, Tobias K, Pessin H, Ku GY, Yuan J, et al. Depression, cytokines, and pancreatic cancer. Psycho-oncology. 2014;23(3):339–45.

    Article  PubMed  Google Scholar 

  119. Berard RM, Boermeester F, Viljoen G. Depressive disorders in an out-patient oncology setting: prevalence, assessment, and management. Psycho-oncology. 1998;7(2):112–20.

    Article  CAS  PubMed  Google Scholar 

  120. Walker J, Hansen CH, Martin P, Symeonides S, Gourley C, Wall L, et al. Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): a multicentre randomised controlled trial in patients with lung cancer. Lancet Oncol. 2014;15(10):1168–76.

    Article  PubMed  Google Scholar 

  121. Walker J, Hansen CH, Martin P, Symeonides S, Ramessur R, Murray G, et al. Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. Lancet Psychiatry. 2014;1(5):343–50.

    Article  PubMed  Google Scholar 

  122. Purohit DR, Navlakha PL, Modi RS, Eshpumiyani R. The role antidepressants in hospitalised cancer patients. (a pilot study). J Assoc Physicians India. 1978;26(4):245–8.

    CAS  PubMed  Google Scholar 

  123. Barnes AF, Yeo TP, Leiby B, Kay A, Winter JM. Pancreatic cancer-associated depression: a case report and review of the literature. Pancreas. 2018;47(9):1065–77.

    Article  PubMed  Google Scholar 

  124. Carrato A, Falcone A, Ducreux M, Valle JW, Parnaby A, Djazouli K, et al. A systematic review of the burden of pancreatic cancer in Europe: real-world impact on survival, quality of life and costs. J Gastroint Cancer. 2015;46(3):201–11.

    Article  CAS  Google Scholar 

  125. Rayner L, Price A, Evans A, Valsraj K, Hotopf M, Higginson IJ. Antidepressants for the treatment of depression in palliative care: systematic review and meta-analysis. Palliat Med. 2011;25(1):36–51.

    Article  PubMed  Google Scholar 

  126. Park HY, Lee BJ, Kim JH, Bae JN, Hahm BJ. Rapid improvement of depression and quality of life with escitalopram treatment in outpatients with breast cancer: a 12-week, open-label prospective trial. Prog Neuro-Psychopharmacol Biol Psychiatry. 2012;36(2):318–23.

    Article  CAS  Google Scholar 

  127. Moss EL, Simpson JS, Pelletier G, Forsyth P. An open-label study of the effects of bupropion SR on fatigue, depression and quality of life of mixed-site cancer patients and their partners. Psycho-oncology. 2006;15(3):259–67.

    Article  PubMed  Google Scholar 

  128. Lydiatt WM, Bessette D, Schmid KK, Sayles H, Burke WJ. Prevention of depression with escitalopram in patients undergoing treatment for head and neck cancer: randomized, double-blind, placebo-controlled clinical trial. JAMA Otolaryngol Head Neck Surg. 2013;139(7):678–86.

    PubMed  Google Scholar 

  129. Luo J, Chen JJ, Deguzman C, Mustian K, Insco M, Fisher G, et al. Symptoms and palliative care needs of pancreatic adenocarcinoma patients. J Palliat Med. 2014;17(6):640–1.

    Article  PubMed  PubMed Central  Google Scholar 

  130. Steinhorn DM, Din J, Johnson A. Healing, spirituality and integrative medicine. Ann Palliat Med. 2017;6(3):237–47.

    Article  PubMed  Google Scholar 

  131. Jang A, Kang DH, Kim DU. Complementary and alternative medicine use and its association with emotional status and quality of life in patients with a solid tumor: a cross-sectional study. J Alternat Complement Med (New York, NY). 2017;23(5):362–9.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Hematology/Oncology, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Suite AC 1042C, Los Angeles, CA, 90048, USA

    Kristina G. Lee MD, MPH, Meghan Laszlo MS, RD, CSO, Shant Tomassian MD & Andrew E. Hendifar MD, MPH

  2. Department of Hematology/Oncology, UCLA-Olive View Medical Center, Los Angeles, CA, USA

    Kristina G. Lee MD, MPH

  3. Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Varun Roy MD

  4. Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Katelyn M. Atkins MD, PhD

  5. Department of Supportive Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Katrina J. Lin MD

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Correspondence to Andrew E. Hendifar MD, MPH.

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Kristina G. Lee declares that she has no conflict of interest. Varun Roy declares that he has no conflict of interest. Meghan Laszlo has received compensation from VIVUS for service as a consultant. Katelyn M. Atkins declares that she has no conflict of interest. Katrina J. Lin declares that she has no conflict of interest. Shant Tomassian declares that he has no conflict of interest. Andrew E. Hendifar has received research funding from The Pancreatic Cancer Action Network (PanCAN), Ipsen, and Merck, and has received compensation from Ipsen and AAA for service as a consultant.

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Lee, K.G., Roy, V., Laszlo, M. et al. Symptom Management in Pancreatic Cancer. Curr. Treat. Options in Oncol. 22, 8 (2021). https://doi.org/10.1007/s11864-020-00801-4

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