
Stage 4 Pancreatic Cancer - rateofchange
Someone close to me was just diagnosed with stage 4 pancreatic cancer which extended to the liver.<p>Wondering if folks on HN might have references to some of the latest advances in the treatment of this troublesome kind of cancer.  An internet search yields lots of links but it is difficult to understand which are worth drilling down into.<p>Hoping people on HN with experience in the domain might be able to offer guidance.  The objective is to present her doctor with information she might not be aware of (can&#x27;t assume everyone is up to date with the latest research, tools, trials, etc.).<p>Thanks.
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brudgers
In cancer diagnosis, Stage Four indicates that the cancer has spread from the
primary organ to other organs. There is no stage five.

With cancers of high mortality -- and pancreatic cancer is one -- quality of
life is a usually a sound primary focus. Quality of life means different
things to different people of course. For some people, the terrible side
effects of highly aggressive treatments with debilitating surgeries and
radical chemo-therapy are worth the price. For others, palliative treatments
to lessen the worst symptoms of their disease allows them to be more present
and whole during the time they have left.

Oncology is a job just like anything else. Some oncologists focus on patient
care. Some on business. You can throw as much money as you got and then some
on cutting your friend's body and dumping toxic chemicals into her blood just
for the sake of "doing something" because there's an oncologist out there who
wants a new dock for a new boat at their lake house.

Or you can find an oncologist who will do the best by your friend in good
faith and provide an accurate prognosis based on hard to live with experience.

Even if that means you don't hear what you wished someone would say.

My beloved is a clinical social worker. Thirty years mostly in hospice and
oncology. Our relationship has involved a lot sad conversations about the ways
people die.

There's a spectrum between calmly surrounded by loved ones and confused,
mutilated, and painfully stuffed with tubes.

It's not your choice.

Good luck.

~~~
rateofchange
Yes, this is a sobering diagnosis. And it has spread to the liver, which
likely means the prognosis is far worse.

I take your point about quality of life for what might remain. These are tough
decisions those of us around her are going to have to make.

I have friends who have reported about acquaintances who beat pancreatic
cancer diagnosis and went on to live twenty or thirty years. I suspect these
were early onset rather than stage four.

This company seems to have had early success with metastatic pancreatic
cancer. We've reached out to see what they have to say.

[https://nantkwest.com/nantkwest-and-immunitybio-to-
initiate-...](https://nantkwest.com/nantkwest-and-immunitybio-to-initiate-a-
phase-2-study-of-immunotherapy-for-metastatic-pancreatic-cancer/)

From the article:

"Pancreatic cancer kills an estimated 47,000 people annually; it is the fourth
leading cause of cancer-related death in the U.S., and 57,600 new cases are
expected in 2020. Less than 5% of these patients will live for more than five
years after diagnosis, and the median survival prognosis is 5 to 8 months."

The end of that paragraph is quite sobering.

~~~
brudgers
One thing I didn't cover is that "cancer" isn't one thing.

And neither is pancreatic cancer.

Steve Jobs had a rarer and less aggressive form.

That's why he lived with his diagnosis as long as he did.

His pancreatic cancer was a different pancreatic cancer from the most common
pancreatic cancer.

The median survival rate for pancreatic cancer is low because it tends to be
diagnosed late.

This is the case with your friend because the cancer is at stage four.

In terms of quality of life, seeking enrollment in a clinical trial involves a
lot of meetings and paperwork and often travel.

Keep in mind that the driving force of the clinical trial you link is a
business venture with a medical component.

The trial is randomized which means some enrollees won't get the treatment
being tested.

In terms of anecdotal evidence of long survival, misdiagnosis is a real
possibility as one goes further and further back, e.g. a person diagnosed in
1955 who lived to 1985.

I'm not sure why the patient can't make their own decisions, but I don't have
all the facts.

I am sorry that you are dealing with this.

~~~
rateofchange
> I'm not sure why the patient can't make their own decisions, but I don't
> have all the facts.

She is older (85+) and not equipped to navigate the more complex aspects of
this.

This is also where the quality of life part becomes far more significant. At
this age...given the likely prospects...it might make more sense to go for
quality of life and make good memories during whatever time might remain than
anything else. These are difficult topics to discuss and even more difficult
options to consider because it isn't all about making purely analytical
decisions.

The current guidance is a six week course of chemo followed by an evaluation
of outcomes to support further actions.

~~~
brudgers
I talked with my beloved outlining what you've described. Nearly all stage
four chemo-therapy is palliative. It is a tradeoff between symptoms of the
disease and side-effects of the chemo chemicals. The advice was to try chemo
and see how it goes, if the side-effects are too much then stop. There's no
reason to complete a palliative treatment that's not palliative. The goal of
the treatment is to reduce the tumor burden on the patient.

My advice from years of living with someone who helps people going through
what you and those around you are going through:

1\. Bring in hospice as soon as the patient qualifies. Helping people through
the dying process is what they do everyday. There's counseling for the
patient, the care-givers, and other family members. Before during and after.
There are also chaplin services. And of course nursing.

2\. Right now all the healthcare protocols are new and conservative due to
Covid-19. Hospice will have the best grasp on what institutionalization of the
patient will entail, how to navigate the new reality should
institutionalization happen, and how best to avoid it under the current
circumstances.

3\. There is unlikely to be a sudden shift in family dynamics in terms of
relationships. If people have always been close, that's probably the way it
will stay. If people have always been unhappy with each other, plans should
presume that that's the way it will stay...this probably won't suddenly fix
tense relationships.

There is an analytic view, but it is difficult to accept and feels rude to
articulate. Yet, we all know that life only lasts not long enough. And making
the most of the not long enough is entirely rational.

Again, I sorry you are going through this and hope it all goes as peacefully
as it can.

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schoen
I offer my sympathies because that is one of the most serious diagnoses one
can possibly receive. :-(

I'm sure you, your friend, and her doctor know about

[https://clinicaltrials.gov/ct2/results?cond=Pancreatic+Cance...](https://clinicaltrials.gov/ct2/results?cond=Pancreatic+Cancer+Stage+IV&term=&cntry=&state=&city=&dist=)

I think it was using this search that my stepmother successfully and
relatively quickly got into a nearby trial for a different cancer, though
unfortunately it didn't save her.

~~~
rateofchange
Thanks for the link. Just starting to get into this so, no, I didn't know
about this resource.

Yes, this is bad.

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cell9840179419
I am afraid solution for a cancer so serious as this (let's not forget Steve
Jobs died of this inspite of arguably endless resources) is not in information
search. She needs a good doctor aside from her oncology team.

I have lost a colleague who sat 6 ft away from me at work, and 6 months
younger. The end comes pretty fast. My heartfelt sympathies.

There is one variant which can be cured. Jobs had that actually. If she got
that and it did not metastise she may survive. It is her best hope.

------
architect
If you haven’t seen this already you might wanna check out this article
[https://www.sciencedaily.com/releases/2020/05/200512151941.h...](https://www.sciencedaily.com/releases/2020/05/200512151941.htm)
Good luck and hope your friend can recover fast!

~~~
rateofchange
Will do. Looks interesting. Thanks.

A friend of mine, who was diagnosed with prostate cancer, went through a
radical change of diet. This included juicing lots of vegetables and cutting
out most meats.

He thinks the dietary adjustment played an important role in his cancer
disappearing five years ago.

