White Coat, Black Art·DR. BRIAN'S BLOG

Surprising number of people with pancreatic cancer may miss out on life-prolonging treatment

Do patients with pancreatic cancer know their options?
Host of Jeopardy Alex Trebek is only the latest celebrity to be diagnosed with pancreatic cancer. (Ben Hider/Getty Images)

Jeopardy!  host Alex Trebek announced he's undergoing treatment for Stage 4 pancreatic cancer. An estimated 5,500 Canadians will be diagnosed with the disease this year alone. But a surprising number of patients aren't getting the treatments that could offer longer survival. That's according to a study published in the Canadian Medical Association Journal.

The study, by Dr. Julie Hallet, a surgical oncologist at Sunnybrook Health Sciences Centre and her colleagues in Toronto and Winnipeg, found that a large number of patients are missing the opportunity to receive chemotherapy for pancreatic cancer that could prolong their lives.

The study looked at 10,881 patients with a new diagnosis of advanced pancreatic cancer over an 11-year period ending in 2016. Researchers looked at how many patients saw a medical cancer specialist (oncologist) and how many received treatment after consultation.

Overall, only 38 per cent of the patients received life-prolonging chemotherapy. The other 62 per cent of the patients did not.

The main reason why so few patients received information about life-prolonging treatment has to do with whether or not the patient was seen by a medical oncologist. They are experts in the specific chemotherapy that prolongs the lives of patients with pancreatic cancer.

Roughly 65 per cent of the patients in the study had an appointment with a medical oncologist, and they are the patients who were most likely to be offered life-prolonging chemotherapy. Of the patients who did not see a medical oncologist, more than half did not receive the kind of treatment that extends life.

The age of the patient was yet another determining factor in whether or not patients received a fuller list of treatment options. Compared to patients under the of 60, those over 81 years of age were less likely to receive cancer-directed treatment.

It's possible that some patients get discouraged both by the prognosis and by media reports of famous people, like singer Aretha Franklin, who were diagnosed with pancreatic cancer and died soon after. (Stan Honda)

This study is from Ontario. Comparatively speaking, patients in Canada's largest province were more likely to hear about the gamut of options than those living elsewhere. A study from Nova Scotia found that 31 per cent of patients with advanced pancreatic cancer had a consultation with a medical oncologist. In Alberta, the rate was 54 per cent.  

Overall, patients with advanced pancreatic cancer were less likely to see a medical oncologist than patients with other types of metastatic cancer. For instance, a 2014 study in the U.S. found that patients with colorectal cancer are far more likely than those with pancreatic cancer to see a medical oncologist and undergo treatment.

Considering the expected outcomes with this cancer, it's entirely possible that some patients might not decide not to pursue treatment because they are concerned about their quality of life. It's also possible that some patients get discouraged both by the prognosis and by media reports of famous people who were diagnosed with pancreatic cancer and died soon after.

Extending survival rates 

Alex Trebek is only the latest personality to be diagnosed with pancreatic cancer. Others include Aretha Franklin, Steve Jobs, Patrick Swayze, Alan Rickman and Luciano Pavarotti.

It's also possible that doctors aren't telling their patients that treatment is getting better because they aren't keeping up to date or because they aren't impressed by survival figures from the latest treatments.

Current chemotherapy regimes extends median survival for up to 11 months in patients with advanced pancreatic cancer. There are newer treatments that offer some additional hope. An experimental four-drug chemotherapy regime boosted average overall survival to more than 54 months versus 35 months with a single drug. That takes patients close to five-year survival, which is a big development. Then, there's immune therapy that revs up the immune system to attack the cancer or at least keep it in check. Combining immunotherapy with chemotherapy shows promise for treating advanced pancreatic cancer. Gene therapy also shows promise.

The authors of the study in CMAJ concluded that patients should be given objective information about current treatments. They said all patients should have a timely referral to an expert in pancreatic cancer. They emphasized it's important that doctors not impose their own beliefs about pancreatic cancer onto their patients. There's the potential for a stigma surrounding pancreatic cancer as a fatal and untreatable disease that doctors need to debunk.

Patients should be given an opportunity to figure out what treatments (if any) are best for them. And they need to keep their eye on new treatments that are likely to improve survival.

Addendum: Since this blog was first published, Alex Trebek told People magazine that he is responding well to treatment, and is in "near remission," according to his doctors.

 

Jeopardy host Alex Trebek talks about his cancer diagnosis, why he never calls in sick to work and being an optimistic voice for other cancer patients. 11:00

About the Author

Dr. Brian Goldman is a veteran ER physician and an award-winning medical reporter. As host of CBC Radio’s White Coat, Black Art, he uses his proven knack for making sense of medical bafflegab to show listeners what really goes on at hospitals and clinics. He is the author of The Night Shift and The Power of Kindness: Why Empathy is Essential in Everyday Life.

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