Background Pancreatic cancer often presents late, treatment being palliative from diagnosis. Distressing symptoms are common, making quality of life and effective symptom control crucial.
Aim To examine elements of care relating to symptom control of patients referred to hospital palliative care teams (HPCTs) associated with a tertiary hepatobiliary unit, to determine how the service could be improved.
Method The Hepatobiliary MDT identified 78 patients presenting with advanced pancreatic cancer who died from July to December 2010. Data were gathered from hospital and HPCT notes using a proforma.
Results Mean survival from diagnosis was 6.6 months. 65% were referred to HPCTs, most commonly for symptom control (84%), particularly pain (63%), nausea (12%) and anorexia (10%). 12% were referred for psychological support. 53% were reviewed as inpatients, 47% as outpatients. 78% were seen on the day of referral. Physical symptoms highlighted at first assessment were pain (67%), constipation (26%), nausea (20%), anorexia (16%) and fatigue (16%). 88% of those with pain were on an opioid at first assessment; 29% on a regular strong opioid. Others were on regular weak opioids (38%), prn strong opioids (15%) or prn weak opioids (6%). The HPCT recommended an increased dose in 60% of those on regular strong opioids. In 75% of others, commencing a regular strong opioid was advised. 15% of those with pain were on a regular non-steroidal anti-inflammatory drug (NSAID) when first assessed. A regular NSAID was recommended for 10% of remaining patients. 59% had jaundice, 67% of whom underwent biliary drainage procedures. 27% had proven or symptoms suggestive of venous thromboembolism.
Conclusion Patients with advanced pancreatic cancer often have rapidly progressive disease with multiple symptoms, pain being commonest. Strong opioids were underused, possibly reflecting lack of confidence among staff. Consideration should be given to education and pre-emptive discussion, plus possible prescribing, from diagnosis.
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