Improving value in pancreatic cancer care
Screening individuals at high risk for pancreatic cancer and the need for innovative therapies
More people are being diagnosed with—and dying from—pancreatic cancer,1 due in part to an aging population and rising rates of risk factors such as obesity.2 As a result, costs for treating this disease are on the rise.3
Incremental improvements in treatment have been made,4 but pancreatic cancer still carries a poor prognosis.5 Dr. Hani Babiker, a pancreatic cancer specialist at The University of Arizona Cancer Center, offers his thoughts on the meaning of value in pancreatic cancer care and how the care could be improved.
How do you define value in cancer care?
“I define value as pushing ourselves to deliver more comprehensive approaches to providing care for our patients. That means addressing all patient issues and concerns related to their cancer. With my patients, I discuss not only treatment options and goals, but also what foods, vitamins and supplements can help them manage their disease. I refer my patients to social workers who can help them deal with the stress that can accompany a cancer diagnosis. A palliative care physician in our clinic helps patients to control symptoms such as pain, nausea and vomiting. We focus on treating the whole patient. That’s how I seek to provide the best value.”
Does the definition of value change for cancers with low survival rates and few treatment options, such as pancreatic cancer?
“Absolutely. It is difficult to compare the value of treatments across all cancer patients; the options and goals are not the same. We should not deprive pancreatic cancer patients of the most effective treatment options for their particular disease because their prognosis is not as good as patients with other cancers. But when the quantity of life we can offer patients is short, quality of life becomes an increasingly important factor to the value we provide.
Most people with pancreatic cancer experience pain, and I’ve seen firsthand how chemotherapy has helped patients manage that pain.”
Why has progress in pancreatic cancer lagged behind other cancers?
“It is an inherently unique disease. The microenvironment surrounding pancreatic cancer tumors creates a barrier that is difficult for therapies to penetrate. It also suppresses the body’s immune cells that would typically hunt down and eliminate cancer cells. We still have a ways to go in understanding and treating this disease better.”
So how can we continue to improve the value of pancreatic cancer care?
“Pancreatic cancer is tough to diagnose. We usually see patients who are in advanced stages, when the disease has spread beyond the pancreas. As a result, only 20 percent of patients diagnosed are eligible for a surgery known as the Whipple procedure, in which doctors remove the cancerous part of the pancreas. Surgery gives appropriate patients the best chance for a cure.
If we can identify pancreatic cancer earlier, by screening people who are at high risk because of their family or medical history or genetic predisposition, we can potentially treat more patients using the Whipple procedure. We may provide better outcomes and, therefore, may deliver better value, even though hospitalizations and surgeries are expensive.”
What role do innovative therapies play in reducing hospitalizations and improving outcomes?
“Surgery gives patients the best chance for a cure, but less than 20 percent of patients live at least five years after their operation. This statistic highlights the fact that most pancreatic cancers have spread and cannot be cured through surgery alone.
Doctors are now using chemotherapy before and after surgery to improve outcomes in pancreatic cancer. And we are seeing more therapies being developed that may continue to improve survival and, one day, reduce the need for costly hospitalizations and surgeries. In the future, the best way to add value for pancreatic cancer patients will be to invest in better screening and to continue funding research into more treatment options.”
- National Cancer Institute Surveillance, Epidemiology, and End Results Program (SEER). Cancer Stat Facts: Pancreatic Cancer. Available at https://seer.cancer.gov/statfacts/html/pancreas.html. Accessed October 20, 2020.
- American Cancer Society. Pancreatic Cancer Risk Factors. Available at https://www.cancer.org/cancer/pancreatic-cancer/causes-risks-prevention/risk-factors.html. Accessed October 20, 2020.
- Cancer. Costs and Trends in Pancreatic Cancer Treatment. O’Neill, et al. October 15, 2012. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5018231/. Accessed October 20, 2020.
- Recent Advances in the Treatment of Pancreatic Cancer. Roth, et al. February 21, 2020. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043109/. Accessed October 20, 2020.
- American Cancer Society. Survival Rates for Pancreatic Cancer. Available at https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/survival-rates.html. Accessed October 20, 2020.
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