Taming the symptoms of pancreatic cancer

Suzana Makowski, MDPain & Palliative Care

Goals

• What are your goals for today's talk?

• Pain and other physical symptoms

• Psychological, spiritual, and social concerns

• Where to turn?

Managing Pain

• It is common

• Barriers to treatment are many

• What can you do?

• Keep track of your pain and use of medicines

• Work with your doctor, nurse, and pharmacist - team approach

• Address your worries

What doctors need to

know about your Pain

• Location

• Intensity: how bad is it?

• 'Quality': what does it feel like?

• Timeline

• What makes it better/worse

• What have you tried, were there side effects...

Understanding Pain

Management

Definitions:

• Adjuvant: helps the other meds work better.

• Non-opioid: acetaminophen (Tylenol) ibuprofen or naprosen

• Opioid: morphine, oxycodone, fentanyl, hydromorphone (Dilaudid), methadone

Opioids

• Addiction versus dependence versus tolerance

• Long-acting and short-acting (immediate release)

• Pill/liquid versus IV

• Side effects:

• constipation - doesn't go away

• Sleepiness, nausea

• Less common: confusion, twitching (myoclonus)

Other treatments for pain

Pain - other treatments

• Radiation therapy

• ERCP

• Interventional pain (anesthesia)

• Nerve blocks: celiac plexus

• Intraspinal medicine/pumps

• Non-pharmacologic

• Physical therapy, including TENS, compresses

• Psychological/behavioral therapy

• Complementary or alternative therapy

Gastrointestinal symptoms

• Nausea

• Vomiting

• Anorexia (loss of appetite)

• Megace

• Dexamethasone

• Small, frequent meals, plastic/wooden utensils

• Constipation

• Senna & colace

• Yakima paste

Gastrointestinal symptoms

• Nausea and vomiting

• causes: constipation, medications, compression of

intestinal tract.

• treatment: “bowel regimen” for constipation,

medications, procedure (stent) or surgery (bypass, or

ostomy).

• Sometimes a temporary tube may help relieve

symptoms.

Weakness and fatigue

• Let your doctor know

• How are you sleeping?

• There are many causes and treatment is targeted when possible

• Anemia

• Insomnia

• Anxiety, depression, stress

• Other...

Psychological symptoms

• Anxiety, fear, uncertainty

• Depression, sadness, grief

• Concern for family and future

• Dignity

• Resilience and hope

Your team

• Doctors, nurse practitioners

• Nurses

• Social worker

• Psychologist

• Family, friends, chaplains

• When you need more help: palliative care

What is palliative care?

• Treatment that focuses on alleviating suffering, improving sense

of well-being

• It is available at all stages of illness

• It can be offered alone or during other therapies/treatment in

the hospital, and sometimes at home or in a clinic

• It is a team approach - lending support to patients and their

family

• Options in home care support: visiting nurses (bridge or choices

program) and home care through hospice

Other resources

• The Center for Mindfulness

• www.cancer-pain.org

• www.getpalliativecare.org

• www.betterendings.org

Summary

• Work with your team... We're here to help

• Treat and identify symptoms early:

• pain, fatigue, GI symptoms, psychological concerns

You're not alone

We want to help

We can help

Thank you

Questions?