Longer time to surgery was not associated with overall survival (hazard ratio 0♹9, 95 per cent c.i. Oncological outcomes included overall survival, resection rate and R0 resection rate.Ī total of 2027 patients were included, of whom 677, 665 and 685 had a short, intermediate and long time interval to surgery respectively. Time to surgery was defined as days between the final preoperative MDT meeting and surgery, categorized in tertiles (short interval, 18 days or less intermediate, 19-32 days long, 33 days or more). Patients scheduled for pancreatoduodenectomy and who were discussed in an MDT meeting from May 2012 to December 2016 were eligible. This was a retrospective population-based cohort study of patients with pancreatic head and periampullary malignancies included in the Netherlands Cancer Registry. This study aimed to assess the impact of time to surgery on oncological outcomes. Research on how best to coordinate this is crucial.ĭutch guidelines indicate that treatment of pancreatic head and periampullary malignancies should be started within 3 weeks of the multidisciplinary team (MDT) meeting. Pain and anxiety had respectively the strongest associations with these domains.Ĭareful and continued attention to pain control and psychological morbidity is paramount in addressing significant unmet needs, particularly for people with metastatic disease. The prevalence of needs was highest in the physical/daily living and psychological domains (both 53 % at baseline). ![]() People with pain (OR 4.9, CI 1.5-15.4), metastatic disease (OR 2.7, CI 0.7-10.0) or anxiety (OR 2.5, CI 0.7-8.6) had substantially higher odds of reporting needs at their next survey. Higher levels of pain (OR 6.1, CI 2.4-15.3), anxiety (OR 3.3, CI 1.5-7.3) and depression (OR 3.2, CI 1.7-6.0) were significantly associated with current needs. The overall proportion of patients reporting ≥1 moderate-or-high-level need did not significantly change over time (baseline = 70 % to 4 months = 75 %), although there was a non-significant reduction in needs for patients who had a complete resection (71 to 63 %) and an increase in patients with locally advanced (73 to 85 %) or metastatic (66 to 88 %) disease. Weighted generalised estimating equations were used to identify factors associated with having ≥1 current or future moderate-to-high unmet need. The validated survey measured 34 needs across five domains. This study aims to determine if the supportive care needs of people with pancreatic cancer change over time and identify the factors associated with current and future unmet needs.Īustralian pancreatic cancer patients completed a self-administered survey at 0-6 months post-diagnosis (n = 116) then follow-up surveys 2 (n = 82) and 4 months (n = 50) later. This review will also emphasize palliative care and discuss some avenues of research that show early promise. Numerous randomized control trials, none definitive, of adjuvant chemotherapy and CRT have been conducted and are summarized in this review, along with recent developments in how unresectable disease can be subcategorized according to the potential for eventual curative resection. ![]() For resectable pancreatic cancer, presumed micrometastases provide the rationale for adjuvant chemotherapy and chemoradiation (CRT) to supplement surgical management. Research in chemotherapy for metastatic disease has made only modest progress and the standard of care remains the purine analog gemcitabine. ![]() Most patients who do undergo resection will go on to die of their disease. The best chance for long-term survival is complete resection, which offers a 3-year survival of only 15%. Most patients survive less than 1 year chemotherapeutic options prolong life minimally. Pancreatic adenocarcinoma carries a dismal prognosis and remains a significant cause of cancer morbidity and mortality.
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