Pain in Pancreatic Cancer: A Medical Oncologist's View

In the 1988 document "Pain in Pancreatic Cancer: A Medical Oncologist's View," John Horton discussed the symptoms, clinical course, and factors affecting pain control in pancreatic cancer patients, as well as the challenges of medical treatment. Seventy-five percent of patients with pancreatic cancer have tumors in the pancreas head, often presenting with jaundice, anorexia, nausea, vomiting, weakness, and depression. Those with tumors in the body and tail typically experience weight loss, nausea, vomiting, anorexia, weakness, and pain. Pancreatic cancer is characterized by clinical wasting and pain, with survival usually measured in months post-diagnosis. Pain severity and control are influenced by factors such as previous pain, fatigue, fever, insomnia, anorexia, nausea, vomiting, weakness, malaise, anxiety, depression, and drug-drug interactions. Standard chemotherapy has limited effectiveness, with tumor shrinkage and symptomatic improvement in about 10% of patients, and higher response rates in clinical trials due to selective patient inclusion. Side effects from chemotherapy, such as nausea, vomiting, alopecia, and hematologic effects, are significant and can exacerbate pain. New treatments, including biologic response modifiers, also have considerable toxicity. Overall, the medical management of pancreatic cancer is inadequate and complicates pain management for these patients.