Advice on Pancreatic cancer
As you know - pancreatic cancer is extremely difficult to treat and in this case is certainly not curable. What chemotherapy offers is basically a possibility that the cancer can be controlled or limited from advancing as quickly as it might otherwise in the absence of chemo.
I tend to pay less attention to the numbers as much as I do to how the patient looks and feels. If the numbers are rising an pain and discomfort are more and more severe and the patient is not tolerating chemo well then I tend to advocate more to stop the chemo and focus more on pain control and symptom management so the patient can enjoy as much of the remaining days of life as possible with friends and family.
If this patient is feeling well, tolerating chemo well an not having excessive nausea or severe drops in blood counts from Chemo I would keep offering therapy. Otherwise, this may be a time to have a thoughtful discussion of the goals of care so the patient can really voice a preference.
I thank you again for the query and hope my response proves to be helpful and informative. If you have any additional concerns I would be happy to address them.
I agree with the epo shots - they help avoid the need for transfusions.
It is nearly impossible to predict the length of survival. My best estimate given the imaging findings would be that it would be difficult for him to survive longer than 4 to 6 months. There are risks for infections and blood clots which could shorten the duration of life expectancy as well.
Regarding pain control there are patches such as Duragesic which work well. There is also a liquid morphine given under the tongue which can be quite helpful for breakthrough pain.
If he has anxiety I recommend lorazepam 1 mg every 6 hours as needed and also prescribed by his treating doctor.
I thank you for this query during what must be a very challenging time for you. If I can be of additional assistance please let me know.
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