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 your 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

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 be afraid to go out, be afraid others will reject them, or feel angry or upset, even if the effects of treatment may not show on the outside of the body.

Find out more about how to cope with problems of self-esteem and body image.

Pain with pancreatic cancer is most often related to the location of the tumour and its effect on other structures (such as nearby tissues, nerves, blood vessels, bile and pancreatic ducts or other organs) as the cancer progresses. People may also have pain after surgery for pancreatic cancer.

Pain management is an important part of improving the quality of life for people with pancreatic cancer. There are a number of ways to manage pain from pancreatic cancer.

Pain medicines are commonly used to treat pain from pancreatic cancer. Your doctor will determine the type and dose of pain medicine that work best for you. The most common type of pain medicines used are opioids, such as morphine. Special medicines are also used to treat nerve pain.

Pain medicines are taken at regularly scheduled times. They may be taken by mouth (orally), injection, a patch on the skin (transdermally) or a needle in a vein (intravenously). Many pain medicines have side effects such as constipation and nausea. Your doctor may prescribe stool softeners or laxatives and antinausea drugs to help prevent these side effects.

Nerve blocks may be used to treat pain caused by a damaged nerve. The celiac plexus is a mass of nerves at the back of the abdomen. Pancreatic cancer can cause pain if it affects these nerves. During a celiac plexus nerve block, a local anesthetic and medicine to block pain are injected into the celiac plexus to deaden the nerves.

Surgery may be used to treat pain caused by a blockage in the bile duct or duodenum. Surgery may involve placing a tube (stent) to hold the bile duct or duodenum open. Surgery may also be used to bypass a blockage.

Radiation therapy alone or in combination with chemotherapy can also help control pain. These therapies can shrink a tumour that is pressing on a nerve or other organ and causing pain.

Physical, psychological and complementary therapies can also be used to manage pain. These include massage, relaxation methods and deep breathing.

Find out more about pain.

It is common for people with pancreatic cancer to have nutrition problems. You may not be able to digest fat if the pancreas is removed or isn’t working properly, or if the bile or pancreatic ducts are blocked. A blockage can be treated by placing a stent into the duct to hold it open. You may be given pancreatic enzymes to help with digestion. Medicines such as steroids can help to improve a loss of appetite.

Getting proper nutrition during cancer treatment is important, so talk to your healthcare team if you have any of the following.

Nausea and vomiting are common side effects of treatments for pancreatic cancer. There are ways to prevent and manage nausea and vomiting.

When the pancreas doesn’t work properly, or the bile and pancreatic ducts are blocked, not enough digestive enzymes and bile are released into the small intestine. Pancreatic cancers can also release cytokines into the blood. Cytokines change how the body uses nutrients and can cause the body to burn calories faster than they are replaced.

These problems can lead to weight loss and fatigue, which can have a great effect on your quality of life, your ability to do daily activities and how you respond to treatment. It is important for you to maintain your weight even if your appetite has changed. Proper nutrition helps the body fight disease and cope with the effects of pancreatic cancer treatment. Find out more about nutrition for people living with cancer.

If you have pancreatic cancer, you may have different types of diarrhea. Some people may have clay-coloured stools if the bile duct is blocked. Some people may have floating stools when the pancreas doesn’t make enough enzymes that help the intestines digest food and absorb nutrients.

Making some changes in your diet can help to relieve diarrhea. One of the most important things in managing diarrhea is drinking enough fluids to stay hydrated.

Your doctor may prescribe vitamin supplements if you have floating stools because your intestines aren’t taking up nutrients properly (called malabsorption). You should also try to avoid high fat, greasy or fried foods because you may have difficulty digesting these.

Find out more about diarrhea and how to manage it.

Loss of appetite is a common problem for people with pancreatic cancer. It can be caused by surgery, medicines, taste changes or the cancer itself.

Your healthcare team can help you cope with loss of appetite, improve your interest in food and increase your appetite. Find out more about how to manage taste changes and loss of appetite.

Pancreatic enzymes help the body digest food by breaking down fats, proteins and carbohydrates. People with pancreatic cancer often don’t have enough pancreatic enzymes to break down food, which means that their intestines can’t absorb nutrients from food. The most common side effect of not enough pancreatic enzymes is constipation.

Your doctor may prescribe digestive enzymes to help improve digestion and absorption of food. Take digestive enzymes with every meal or snack that contains fat, especially meat, dairy products, bread and desserts. For best results, take the enzymes at the beginning of the meal or snack and throughout the meal.

Fatigue causes a person to feel more tired than usual and can interfere with daily activities and sleep. Many people with pancreatic cancer experience fatigue as part of the disease or a side effect of treatment. Fatigue can be caused by anemia, specific drugs or depression. It may also be related to toxic substances that are made when cancer cells break down and die. Pancreatic cancer often causes nutrition problems, which can make fatigue worse. It can be hard to cope when you are feeling very tired and don’t have a lot of energy.

Find out more about fatigue.

You may develop diabetes if all or part of your pancreas is removed. This is because there is less insulin made by the pancreas. You will have to take insulin to help regulate your blood sugar. You will also need to learn how to test your blood sugar levels.

Dumping syndrome is a group of symptoms that occurs when food moves too fast from the stomach into the small intestine. Dumping syndrome may occur following surgery for pancreatic cancer. It sometimes occurs immediately following a meal or up to 3 hours after a meal.

Symptoms include:

• bloating
• cramping
• vomiting
• diarrhea
• sweating

Treatment includes changes in diet, medicines and surgery.

Find out more about dumping syndrome.

Most people with pancreatic cancer will have jaundice. It is caused by a blockage in the bile duct or by liver damage. Symptoms of jaundice include:

• yellowing of the skin and whites of the eyes
• dark yellow urine
• clay-coloured stool
• severely itchy, dry skin

Skin problems from jaundice may be relieved by anti-itching medicines and oil-based or anti-itch creams. You can also try using mild soap and taking baking soda baths.

Surgery may be used to relieve a blockage in a bile duct. It may be used to place a stent to hold the duct open or to bypass the blockage. These procedures allow the bile to drain around the blockage and improve jaundice.

A bowel obstruction occurs when the large or small intestine becomes blocked and contents can’t pass through. The blockage can be due to:

• a pancreatic tumour growing into or pressing against the intestine
• certain medicines that affect the digestive tract, such as pain medicines and antidiarrheal drugs

Symptoms of bowel obstruction include:

• abdominal pain
• swelling of the abdomen
• nausea
• vomiting
• constipation
• diarrhea

A bowel obstruction may be treated with resting the bowel or with surgery. If you need to take opiate pain medicine, your healthcare team will talk to you about a bowel care regimen to help prevent bowel obstruction. This regimen includes regular use of laxatives.

Find out more about bowel obstruction.

Ascites is an abnormal buildup of fluid in the abdomen that can occur with some cancers.

Symptoms of ascites include:

• swelling of the abdomen
• abdominal discomfort
• shortness of breath
• weight gain
• nausea
• vomiting

Paracentesis is usually done to relieve ascites. During paracentesis, a thin needle or tube is inserted through the skin into the abdominal cavity to remove fluid. Sometimes chemotherapy is used to relieve ascites.

Find out more about ascites.

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