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New pancreatic cancer guidelines call for multidisciplinary care
Last Updated: 2016-06-10
By Will Boggs MD
NEW YORK (Reuters Health) - The management of patients with pancreatic cancer should begin with CT scans and proceed to multidisciplinary collaboration to formulate treatment and care plans and disease management, according to three new clinical practice guidelines from the American Society of Clinical Oncology (ASCO).
"We emphasize the need for multidisciplinary care with a team approach to clinical decision making," Dr. Alok Khorana from Cleveland Clinic in Cleveland, Ohio, told Reuters Health by email. "In addition we have highlighted the need to work with palliative care physicians early in the course of the illness."
Dr. Khorana and more than a dozen colleagues formulated the ASCO clinical practice guidelines for patients with potentially curable pancreatic cancer; patients with locally advanced, unresectable pancreatic cancer; and patients with metastatic pancreatic cancer.
The detailed guidelines appear in the May 31 Journal of Clinical Oncology. All three guidelines begin with a recommendation for a multiphase CT scan of the abdomen and pelvis, and patients with more advanced disease should also have a CT scan of the chest.
All patients should have a careful evaluation of their baseline performance status, symptom burden, and comorbidity profile. There should also be a thorough discussion of the goals of care, patient preferences, and support systems.
Patients with potentially curable pancreatic cancer should undergo primary surgical resection of the primary tumor and regional lymph nodes, and some patients should receive preoperative therapy or postoperative adjuvant chemotherapy.
Patients with locally advanced, unresectable pancreatic cancer or metastatic pancreatic cancer should generally receive systemic therapy with combination regimens that depend on a variety of criteria specified in the guidelines.
"For metastatic disease, the goals are cancer control, in parallel with maintenance of quality of life," Dr. Davendra P. S. Sohal of Cleveland Clinic, who also worked on the guidelines, told Reuters Health by email.
All patients should be offered information about clinical trials for which they might be eligible.
"Clinical trials are the only way to make progress for future and current patients and I would encourage all patients to seek such trials and their family members to support them through clinical trials," Dr. Khorana said. "It truly takes a village, and partnership between patients, physicians, and research funding organizations is essential to improving outcomes in this highly lethal illness."
"Given its unfortunate rise in the rankings of cancer-related deaths, federal, philanthropic, and industry sources should fund research into this illness in a fashion commensurate with its clinical impact," Dr. Khorana added.
While each clinical practice guideline focuses on a specific stage of pancreatic cancer, their dual focus is to help with the clinical decision-making process and to help patients and their families to access and use palliative care services.
SOURCE: http://bit.ly/1OgAfI8, http://bit.ly/1UqI7Ds and http://bit.ly/1tgOjYy
J Clin Oncol 2016.