Other research we have funded
Pancreatic Cancer Action (PCA) is funding researchers at the University of Cambridge to identify the key symptoms associated with pancreatic cancer in order to inform consumer awareness campaigns and underpin the development of general-practice-based interventions aimed at earlier diagnosis of pancreatic cancer.
The mixed methods design involves a questionnaire-based study of patients referred to hospital for a range of potential pancreatic symptoms, and an in-depth qualitative interview study. It is expected that approximately a third of the patients in the study will be subsequently diagnosed with cancer, which will enable the researchers to compare their responses to those from patients with a non-cancer diagnosis.
Since starting this study in November 2010, a total of 945 study packs have been sent out, with 262 participants completing the questionnaire and being recruited into the study. The study team will track the pathway from first recognition of symptoms via first presentation to their GP and referral to hospital, to diagnosis.
To date, 24 study participants have been interviewed to provide further information on their understanding of their symptoms and the factors involved when deciding to make an appointment to see their doctor. These in-depth interviews are providing a rich understanding of patient interpretation of symptoms and the language used by patients to describe these symptoms.
Enhanced Recovery Project
The enhanced recovery programme for pancreatic surgery was about improving the outcome of surgery, speeding up the recovery period and reducing complications after surgery. This type of treatment plan had been introduced in several areas of surgery and had shown a dramatic reduction in the patient’s length of stay in hospital and also the number of patients who suffered from complications after major surgery.
This project provided evidence that early nutritional intervention as part of enhanced recovery protocol could reduce length of stay and could get pancreatic cancer patients to their adjuvant chemotherapy faster and in better shape. This has the potential to save lives.
The use of the enhanced recovery principles in pancreatico-duodenectomy (PD) also known as Whipples procedure was documented in only three studies123, and did not include any aspect of nutritional or pancreatic enzyme therapy – which is what made this project unique.
What was involved
This year-long project involved patients undergoing a nutritional assessment before their operation including screening for diabetes, pancreatic exocrine insufficiency (PEI) with the intention to start them on pancreatic enzymes, Proton Pump Inhibitors (PPIs – drugs that reduce the amount of acid produced in your stomach) and other nutritional supplements before they underwent surgery. Patients were educated in adjusting their own enzyme dose and were assessed using non-invasive techniques including grip strength, body weight and body mass index (BMI).
The benefits anticipated for the patients were:
- Earlier symptom control (Steatorrhoea, Nausea, Weight loss, Reflux)
- More intensive support in the pre-operative period
- More preparation for admission
- Better symptom control post operatively
- Potentially less weight loss in the pre and post operative phase
- Shorter length of stay
- Nutritionally optimised prior to surgery, which is associated with fewer post operative complications.
- The ability to fully participate in their pre and post operative care such as chemotherapy and/or chemo-radiotherapy.
As a result of the positive outcomes of this project, enhanced recovery principles have been adopted by the team at Royal Surrey County Hospital caring for patients undergoing surgery for pancreatic cancer.
- Kennedy EP, Rosato EL, Sauter PK, Rosenberg LM, Doria C, Marino IR, et al. Initiation of a critical pathway for pancreaticoduodenectomy at an academic institution–the first step in multidisciplinary team building. J Am Coll Surg 2007; 204:917-23. ↩
- Berberat PO, Ingold H, Gulbinas A, Kleeff J, Müller MW, Gutt C, et al. Fast track- different implications in pancreatic surgery. J Gastrointest Surg 2007; 11:880-7. ↩
- Balzano G, Zerbi A, Braga M, Rocchetti S, Beneduce A, Di Carlo V. Fast-track recovery programme after pancreaticoduodenectomy reduces delayed gastric emptying. Br J Surg 2008; 95:1387-93. ↩
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