Helen Gooden

Defining research priorities for pancreatic cancer in Australia: results of a consensus development process

IntroductionPancreatic cancer (PC) is the sixth leading cause of cancer death in Australia and the fourth in the United States, yet research in PC is lagging behind that in other cancers associated with a high disease burden. In the absence of agreed processes to reliably identify research areas which can deliver significant advances in PC research, the Cancer Council NSW established a strategic partnership with the NSW Pancreatic Cancer Network to define critical research issues and opportunities that could accelerate progress in this field in Australia.Materials and methodsThe process consisted of five distinct stages: a literature review on recent progress in PC research, semi-structured expert interviews, a Delphi process, consumer focus groups, and a nominal group process. Information collected at each step informed the development of subsequent stages.ResultsThe results from these steps were refined by the nominal group into a set of seven specific pancreatic cancer research goals. The goals were disseminated and led to a new funding scheme for key PC research priorities.DiscussionThis prioritisation exercise provided a much needed “road map” for research prioritisation in PC and served as a checklist to researchers applying for PC research grants to confirm how their research can contribute towards accelerating progress in PC research in Australia.

Describing Patterns of Care in Pancreatic Cancer: A Population-Based Study.

Objectives Despite pancreatic cancer being the fifth highest cause of cancer death in developed regions, there is a paucity of population-based management details for patients with pancreatic cancer. The objective of this study was to reflect on current practice and outcomes to facilitate future improvement. Methods A comprehensive population-based patterns-of-care study in 2 Australian states was conducted. Patients diagnosed with pancreatic adenocarcinoma between July 2009 and June 2011 were identified by cancer registries, and detailed clinical data were collected from medical records. Results Data were collected for 1863 patients, 96% of those eligible. The majority resided in major cities; their median age was 72 years, and 54% were men. Over half of the cases (58%) had metastatic disease at diagnosis. Resection was attempted for 20% of patients but only completed in 15%. The uptake of adjuvant chemotherapy (76%) and the proportion alive at 1-year (22%) were higher than reported in previous population-based reports. Of those with no complete surgical resection, 43% received palliative chemotherapy. Conclusions This population-based overview of the management of patients with pancreatic cancer suggests that, despite evidence that the proportion surviving and the use of adjuvant chemotherapy has increased, there may still be underutilization of cancer-directed therapies.

A tsunami of unmet needs: pancreatic and ampullary cancer patients' supportive care needs and use of community and allied health services

People diagnosed with pancreatic cancer have the worst survival prognosis of any cancer. No previous research has documented the supportive care needs of this population. Our objective was to describe peoples needs and use of support services and to examine whether these differed according to whether or not patients had undergone surgical resection.

Factors associated with quality of care for patients with pancreatic cancer in Australia

Objectives: To develop a composite score for the quality of care for patients with pancreatic cancer in Australia; to determine whether it was affected by patient and health service‐related factors; to assess whether the score and survival were correlated.

Using a Delphi process to determine optimal care for patients with pancreatic cancer

Overall 5‐year survival for pancreatic cancer is ∼5%. Optimizing the care that pancreatic cancer patients receive may be one way of improving outcomes. The objective of this study was to establish components of care which Australian health professionals believe important to optimally manage patients with pancreatic cancer.

Perceptions of Cancer of Unknown Primary Site – A National Survey of Australian Medical Oncologists

Despite being the sixth most common cause of cancer death in Australia, cancer of unknown primary (CUP) site remains poorly understood.

Chemotherapy in patients with unresected pancreatic cancer in Australia: A population-based study of uptake and survival

Palliative chemotherapy improves symptom control and prolongs survival in patients with unresectable pancreatic cancer, but there is a paucity of data describing its use and effectiveness in everyday practice. We explored patterns of chemotherapy use in patients with unresected pancreatic cancer in Australia and the impact of use on survival.

Biliary stenting in patients with pancreatic cancer: results from a population-based cohort study

Objective We aimed to describe management of biliary obstruction (BO) in the context of pancreatic cancer within a population-based cohort. Methods We examined management of BO in 1863 patients diagnosed as having pancreatic cancer in 2010/2011. We used descriptive statistics and logistic regression to describe patterns of biliary stent usage, complications and duration of patency, associations between preoperative stenting and surgical outcomes, and between patient factors and management of jaundice. Results Almost half of the people in the cohort (n = 909) were jaundiced within 12 months of diagnosis. Two-thirds of these had at least 1 stent inserted. Preoperative stenting, mostly with plastic stents, occurred for 72% of patients who experienced jaundice prior to an attempted resection but was not associated with surgical outcomes. Seventy percent of the jaundiced patients who did not have an attempted resection were stented. Metal stents were less frequently replaced within 30 days than plastic (9% vs 42%). Living in a rural area was associated with reduced likelihood of having jaundice managed. Conclusions Plastic stents were still used frequently, despite guidelines recommending metal in most contexts. Patients living in rural areas were less likely to have BO managed. This work highlights the need to monitor current practice.

Risk factors for current and future unmet supportive care needs of people with pancreatic cancer. A longitudinal study (vol 24, pg 3589, 2016)

1 Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia 2 School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia 3 Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia 4 University of New South Wales, Sydney, Australia 5 Cancer Nursing Research Unit, University of Sydney, Sydney, Australia 6 Discipline of Surgery, Western Sydney University, Sydney, Australia

A qualitative exploration of patient and carer perspectives on pancreatic exocrine insufficiency due to pancreatic cancer

Pancreatic exocrine insufficiency (PEI) is a condition that commonly occurs due to pancreatic cancer and is known to cause weight loss and have a negative impact upon quality of life. The purpose of this qualitative study is to explore patient and carer perspectives on the experience of PEI in pancreatic cancer and gain a better understanding of the implications of treatment. Semi-structured interviews were conducted with 14 patients and 9 carers recruited from palliative care and medical oncology services in the Adelaide region. Sampling continued until saturation of key themes. A critical thematic analysis was conducted. The study findings corroborated the findings from a previous study in quality of life and pancreatic cancer1 and also extended clinical knowledge on the impact of the symptoms that patients and carers described. The presence and severity of PEI may be underestimated by using the presence of weight loss, steatorrhoea and abdominal pain to the clinical syndrome of PEI. Where patients and carers described treatment failure with pancreatic enzyme replacement therapy, new findings gave explanations for this. The results from this study suggest that further research needs to be done to compare the traditional clinical model assessing the presence of PEI in pancreatic cancer with a systematic approach to evaluation to increase the accuracy of clinical diagnosis, accessibility of treatment and monitoring of therapy. Reference Gooden HM, White KJ.Pancreatic cancer and supportive care – pancreatic exocrine insufficiency negatively impacts on quality of life. Support Care Cancer 2013;27(7):1835–1841