Beth Rice, Health and Policy Manager at Pancreatic Cancer Action, discusses the challenges facing the treatment and diagnosis of pancreatic cancer during the COVID-19 pandemic.
Pancreatic cancer is the deadliest of the UK’s 22 most common cancers. Around 10,000 cases of pancreatic cancer are diagnosed in the UK every year and sadly approximately 9,500 people a year die of the disease: this averages out to around one person an hour. The five-year survival rate is under 8% and has remained almost static for decades.
These are grim statistics. However, survival is possible. Currently, four out of five cases of pancreatic cancer are diagnosed during the later stages of the disease. Early diagnosis, in time for surgery, can increase survival by up to 30% and offer the chance of a cure. For those not eligible for surgery, earlier diagnosis increases quality and quantity of life. Pancreatic cancer has a high symptom burden, affecting all aspects of a patient’s life. The earlier a patient is diagnosed, the more treatment options are available, and the better treatment is tolerated.
The importance of early diagnosis
Early diagnosis is a challenge for pancreatic cancer. The disease often presents with serious but vague symptoms that patients and doctors do not always immediately recognise as possible pancreatic cancer. Early stage symptoms such as indigestion, abdominal pain, mid-back pain and nausea may not prompt people to visit their doctor until later stages of their disease, when jaundice develops or symptoms become uncontrolled. Knowledge on the part of both members of the public and healthcare professionals of pancreatic cancer, its symptoms and the risk factors associated with the condition is vital to early diagnosis – particularly as there is currently no simple diagnostic or screening tool available to aid diagnosis.
Pancreatic cancer is less common then other cancers such as breast and bowel; and screening the entire population for the disease is currently not possible. Research work is ongoing to identify people who are at high risk of developing pancreatic cancer and who would benefit from regular surveillance. This includes research studies across the UK such as EUROPAC, investigating people with familial pancreatic cancer, BRCA and other gene mutations and monitoring them with regular scanning.
This research work, and other projects including those investigating patients with newly diagnosed diabetes, helps to understand the factors that increase the chances of pancreatic cancer and who is at high risk. Currently, we do not know all the risks associated with the disease and most cases appear to occur out of the blue. However, there are some factors that increase the risk of pancreatic cancer and being aware of these helps people to be aware of their personal risk and manage it.
Understanding and mitigating risk
The chance of developing pancreatic cancer increase with age; and it is more likely to occur in patients who have been diagnosed with diabetes or chronic pancreatitis. A family history of pancreatic cancer and the presence of some genetic mutations and diseases also increase the risk of the disease. These risk factors are non-modifiable: they cannot be changed. But being aware of these risks is important and can give people the option to take part in pancreatic cancer monitoring for early diagnosis.
Pancreatic cancer is also affected by modifiable risk factors: behaviours which can be changed to reduce the risk. Smoking increases the chance of developing many cancers, including pancreatic. The more a person smokes, the greater the risk. Obesity is also associated with pancreatic cancer. Stopping smoking, eating a balanced diet and exercising regularly can help to manage this.
The most important thing anyone should do if they are worried about the risk or a symptom of pancreatic cancer is to seek medical help. Referrals and accident and emergency presentations for cancer have dramatically reduced over the COVID-19 pandemic and are yet to fully recover. Pancreatic cancer messaging must reach everyone to promote early diagnosis and prevent the disease being left even further behind. Despite the pandemic, the NHS is open for business, this may mean changes to appointments in some cases, but patients are still being seen every day.
Pancreatic cancer and COVID-19
Seeking medical help as soon as possible is especially important to help medical professionals prioritise people with potential pancreatic cancer throughout the COVID-19 pandemic. Every step of the pathway for pancreatic cancer has been affected from patients presenting at their GPs, to diagnostics, treatment and supportive care.
Endoscopy and other diagnostics for the disease were reduced to almost zero during the pandemic and there have been reductions in surgery, chemotherapy and other supportive treatments for pancreatic cancer. There are multiple possible reasons for this: patients with pancreatic cancer are vulnerable to COVID-19 and complications from the disease; therefore in some cases, delaying treatment may be for the patient’s benefit, to protect them from the pandemic. In other cases, services were unable to take place due to the pandemic.
Services in many places have now started to recover; and the NHS has worked hard to ensure that patients with cancer symptoms or a confirmed diagnosis can receive the care that they need. However, as we move into winter and then into 2021, we must see pancreatic cancer patients prioritised to prevent further reductions in survival rates. The backlog in diagnostics and treatments seen in the first wave of the pandemic must be prioritised and prevented from happening again.
Delays in pancreatic cancer diagnosis and treatment can lead to the tumour growing or spreading and reducing treatment options for patients and their quality of life. Patients with pancreatic cancer are often equally, if not more, concerned about their disease than about COVID-19 – and for good reason. Patients must be protected from COVID-19 without sacrificing their care.
Research and innovation
Restoring services in light of COVID-19 requires innovation for patients, new pathways to diagnosis and treatment, and new options to reduce COVID-19 risk and treat the cancer effectively. Historically, pancreatic cancer research and treatment has faced a number of problems. Firstly, research for the disease is chronically underfunded and has been for decades. Spending is increasing with some promising results, but funding for big leaps forward as seen in other cancer types, has not been present.
Secondly, pancreatic cancer is a disease with relatively low numbers of patients diagnosed each year and a high mortality. There are few biomarkers or tools to allow for early diagnostic research. Recruiting early stage patients to research and reaching a sufficient level of recruitment can be challenging in pancreatic cancer. A culture of research must be well embedded; and patients need to receive support with symptom control to be in the best possible health to receive treatment and be fit enough to take part in trials.
However, research is beginning to yield potential results. Personalised medicine and treatments based on the genetic makeup of the tumour could hold potential treatment options for patients with pancreatic cancer. For example, identifying those with BRCA gene mutations allows for the most effective treatments to be delivered, such as platinum-based chemotherapy followed by Olaparib. We must support projects to identify new treatment options for pancreatic cancer and increase funding to make the research environment easier to operate in.
In summary, early diagnosis is essential for pancreatic cancer outcomes including quality of life and survival. Pancreatic cancer faces many challenges, especially alongside the COVID-19 pandemic, but early diagnosis and survival is possible. Pancreatic Cancer Action works to raise public awareness of the disease, provide learning and support for health care professionals and fund vital early diagnosis research. We act as advocates for patients and their families and will continue to campaign for patients throughout the pandemic and beyond.
Health and Policy Manager
Pancreatic Cancer Action