This document summarizes ways to manage the symptoms of pancreatic cancer, including pain, gastrointestinal issues, weakness, fatigue, and psychological concerns. It discusses treating pain with opioids, adjuvants, and non-opioid medications as well as other treatments like radiation, nerve blocks, and physical therapy. Managing nausea, vomiting, constipation, anorexia, and other GI symptoms is also covered. The document emphasizes the importance of communication with one's healthcare team and notes additional resources for support like palliative care, visiting nurses, and hospice care.

1. Taming the symptoms of pancreatic cancer
Suzana Makowski, MD
Pain & Palliative Care

2. Goals
• What are your goals for today's talk?
• Pain and other physical symptoms
• Psychological, spiritual, and social concerns
• Where to turn?

3. 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

4. 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...

5. 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

6. 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)

7. Other treatments for pain

8. 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

10. Gastrointestinal symptoms
• Nausea
• Vomiting
• Anorexia (loss of appetite)
• Megace
• Dexamethasone
• Small, frequent meals, plastic/wooden utensils
• Constipation
• Senna & colace
• Yakima paste

11. 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.

12. 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...

13. Psychological symptoms
• Anxiety, fear, uncertainty
• Depression, sadness, grief
• Concern for family and future
• Dignity
• Resilience and hope

14. Your team
• Doctors, nurse practitioners
• Nurses
• Social worker
• Psychologist
• Family, friends, chaplains
• When you need more help: palliative care

15. 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

16. Other resources
• The Center for Mindfulness
• www.cancer-pain.org
• www.getpalliativecare.org
• www.betterendings.org

17. 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

18. Thank you
Questions?