Palliative and supportive care of patients with pancreatic cancer.

Pancreatic cancer tends to be diagnosed at a relatively late stage of disease and often secondary to significant complaints of pain. In addition there is evidence of higher rates of depressive symptoms at diagnosis in pancreatic cancer than in other forms of cancer. These factors, along with the specific tumor anatomy and pathophysiology of pancreatic cancer make palliative considerations central to the care of patients with the disease. The palliative and supportive approach must first include an aggressive evaluation of pain, mood, and emotional symptoms. Attention should be paid to the specific nature of pain complaints and attempts made to make accurate clinicopathological correlates for the pain. Assessment should be complete and ongoing. Pain treatments include pharmacotherapy, invasive anesthetic and surgical procedures, and supportive attention to side effects and other symptoms of disease and treatment. Depression often appears at higher rates than documented in other cancer patients and can be independent of pain complaints and other symptoms present in the preterminal phases of illness. Depression should be treated with pharmacotherapy and supportive psychotherapy as indicated. Hospice should be considered early on in the treatment relationship and can provide pain and symptom management services as well as play an important role in providing emotional support to the patient and family. Attention to pain, mood, psychological distress, and other quality of life issues can often allow for successful treatment of symptoms and improvement in functioning even in the setting of late stage pancreatic cancer.