Supportive care for pancreatic cancer

Supportive care helps people meet the physical, practical, emotional and spiritual challenges of pancreatic cancer. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.

Recovering from pancreatic cancer and adjusting to life after treatment is different for each person, depending on where the cancer was in the body, the stage of the cancer, the organs and tissues removed during surgery, the type of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. A person who has been treated for pancreatic cancer may have the following concerns.

How a person feels about themselves is called self-esteem. Body image is how a person sees their own body. Pancreatic cancer and its treatments can affect a person's self-esteem and body image. Often this is because cancer or cancer treatments may result in body changes, such as:

• scars
• hair loss
• skin changes
• changes in body weight
• loss of a body part, such as the pancreas or part of the stomach or small intestine
• loss of body function, such as ability to control blood sugar (diabetes) or normal digestion
• yellowing of the skin and whites of the eyes (jaundice)

Some of these changes can be temporary. Others will last for a long time or be permanent.

For many people, body image and how they think other people see them is closely linked to self-esteem. It may be a real concern for them and can cause considerable distress. They may feel angry or upset, afraid to go out or afraid others will reject them, even if the effects of treatment may not show on the outside of the body.

Find out more about coping with body image and self-esteem worries.

Diabetes (also called diabetes mellitus) is a chronic disease in which the pancreas can't make enough insulin or the body can't properly use the insulin it makes. Since the body needs insulin to use and store glucose (a type of sugar) for energy, diabetes leads to high blood sugar levels without proper management. If part or all of your pancreas is removed during surgery for pancreatic cancer, you may develop diabetes.

If you develop diabetes, you will have it for the rest of your life. Your healthcare team will help you to create a plan based on your needs to help manage diabetes and maintain your quality of life. This may include:

• changes to your diet and keeping track of what you eat
• changes to your physical activity habits
• checking your blood glucose levels throughout the day with a blood glucose monitor
• taking insulin, which is given either through a needle or a device called an insulin pump to give you insulin throughout the day through a small tube that can stay in the body for several days (called a cannula)
• medications that increase the amount of insulin your pancreas makes or that change your body's response to insulin or glucose to lower blood glucose
• medications to lower blood pressure
• medications to lower cholesterol

Managing diabetes can take time to get used to. Ask your healthcare team any questions you may have about diabetes after pancreatic cancer and its impact on your life.

It is common for people with pancreatic cancer to have problems eating and digesting food after treatment. These problems are caused by the loss of the pancreas and other organs involved in digestion, such as the gallbladder, the part of the stomach that connects to the small intestine (pylorus) and the first segment of the small intestine (duodenum).

Nutritional problems may include:

• difficulty digesting fatty foods such as fried food and deli meat (called fat intolerance)
• abdominal pain after eating
• loss of appetite
• nausea and vomiting
• diarrhea
• constipation
• increased gas or bloating
• dumping syndrome

Getting proper nutrition during and after pancreatic cancer treatment is important. Your healthcare team, including a registered dietitian, can help you maintain nutrition as well as deal with any treatment side effects.

If you have your entire pancreas removed during surgery to treat pancreatic cancer, you will be given pancreatic enzymes in the form of a pill to replace enzymes that the pancreas would have released so you can digest food properly. Your doctor may also recommend other drugs or supplements to help with nutritional problems.

Find out more about nutrition and cancer.

Many people have advanced or late-stage pancreatic cancer when they are diagnosed. Advanced cancer means that the cancer is unresectable or has spread and is unlikely to be cured. Treatment for unresectable pancreatic cancer is focused on relieving symptoms, controlling the cancer and improving quality of life.

People with advanced pancreatic cancer are often in poor health because their pancreas and surrounding organs (such as the liver, gallbladder and small intestine) are no longer working properly. Talk to your healthcare team about ways to manage the following symptoms:

• fatigue
• pain, often in the abdomen and back, which can get worse with advanced cancer and may be difficult to manage in the late stages of the disease
• jaundice and extreme itching (pruritis)
• nausea and vomiting
• loss of appetite
• fluid buildup in abdomen( ascites)
• fluid buildup in the limbs (edema)
• a bowel obstruction

Find out more about choosing care and treatment for advanced cancer.

To make decisions that are right for you, ask your healthcare team questions about supportive care.