Is Chemotherapy Suitable for Elderly Patients After Pancreatic Cancer Surgery?

Q: Is Chemotherapy Suitable for Elderly Patients After Pancreatic Cancer Surgery?

Hello： Based on the questions you raised, I can see that you have thought deeply and far about future matters. <br>Pancreatic cancer surgery is considered one of the most complex procedures in surgery (it is difficult to perform, the operation time is extremely long, and the woun

Is chemotherapy suitable for elderly patients after pancreatic cancer surgery?

Dear Dr.
Chen,
I would like to ask you a few questions regarding my mother, who is 88 years old.
She underwent surgery for a pancreatic tumor in mid-May, and nearly three months later, on July 20, her CA 19-9 level was 408.
On August 5, her CA 19-9 level rose to 3390, while her bilirubin and liver function tests remained normal.

I would like to inquire about the following:
1.
Does a CA 19-9 level of 3390 indicate that cancer cells have definitely recurred or metastasized? If so, what are the most likely sites of metastasis?
2.
Is chemotherapy suitable for elderly patients moving forward, or are there better treatment options available?
3.
If chemotherapy is not pursued, what is the estimated survival time?
4.
What methods can be employed to minimize pain for a terminal cancer patient?
5.
How can I best support her in the remaining days?
Thank you.

kk, 50~59 year old female. Ask Date: 2015/08/12

Dr. Chen Yunfang reply Oncology

Hello: Based on the questions you raised, I can see that you have thought deeply and far about future matters.
Pancreatic cancer surgery is considered one of the most complex procedures in surgery (it is difficult to perform, the operation time is extremely long, and the wound takes a longer time to heal).
Recurrence shortly after surgery is quite common (many people experience recurrence within six months).

Question 1: I believe the answer regarding recurrence is affirmative.
Common sites for recurrence include the area near the original pancreatic resection, liver metastasis, lung metastasis, and peritoneal metastasis, among others.
To confirm the location of recurrence, a "computed tomography (CT) scan" is sufficient.
Question 2: Currently, the chemotherapy options available for pancreatic cancer include Gemzar, 5-FU, and TS-1 (which are covered by health insurance), as well as Oxaliplatin, Irinotecan, and Tarceva (which are not covered by health insurance and must be paid out of pocket).
For elderly patients, due to concerns about the toxicity of chemotherapy, I would recommend considering only oral medications, with TS-1 being the first choice (if financially feasible, Tarceva can be added, costing about $1400 per day).
Question 3: If chemotherapy is not administered, the average survival is about three months.
However, with the aforementioned chemotherapy, the average survival extends to about six to nine months.
Question 4: There are many types of pain relief medications available, ranging from moderate analgesics like Tramadol and Ultracet to strong opioids like morphine and fentanyl patches.
Even if the patient can no longer eat towards the end, pain management will not be an issue.
Question 5: This question is the hardest to answer.
I suggest focusing on "companionship." You cannot alleviate her pain, but you can be by her side and ask her what she would like to do.
Accompany her to enjoy some sunshine, reconnect with friends and family she hasn't seen in a while, and share a few more meals together.
You might also consider visiting a temple to ask the Buddha if she can go to the Western Paradise after death.
Death is not something to fear; it is the inevitable conclusion for everyone.
The key is whether you are prepared for it.
Being prepared can lead to a peaceful end.
I hope this answers your questions.

Reply Date: 2015/08/12

More Info

When considering chemotherapy for elderly patients after pancreatic cancer surgery, several factors must be taken into account, including the patient's overall health, the stage of cancer, and the potential benefits versus risks of treatment.
1. CA 19-9 Levels and Cancer Recurrence: The significant increase in CA 19-9 levels from 408 to 3390 suggests a high likelihood of cancer recurrence or progression. CA 19-9 is a tumor marker often elevated in pancreatic cancer, and while it is not definitive for diagnosing recurrence, such a dramatic rise typically indicates that the cancer may have returned or metastasized. Common sites for metastasis in pancreatic cancer include the liver, lungs, and peritoneum. Imaging studies, such as CT scans, are essential to confirm the presence and location of metastases.

2. Chemotherapy for Elderly Patients: The decision to pursue chemotherapy in elderly patients, particularly those over 80, should be made cautiously. While chemotherapy can potentially extend survival and improve quality of life, it can also lead to significant side effects, especially in older adults who may have comorbidities or reduced physiological reserve. In this case, considering the patient's age and health status, oral chemotherapy agents like TS-1 may be preferable due to their generally milder side effects compared to intravenous options. However, the decision should involve a thorough discussion with an oncologist who can assess the patient's specific situation and recommend the best course of action.

3. Survival Without Chemotherapy: If chemotherapy is not pursued, the prognosis for pancreatic cancer is generally poor. Without treatment, the average survival time can be as short as three months, depending on the extent of disease progression and the patient's overall health. Conversely, with appropriate chemotherapy, survival may extend to six to nine months or longer, depending on the individual response to treatment.

4. Pain Management for Terminal Patients: For patients in advanced stages of cancer, effective pain management is crucial. There are various options available, ranging from non-opioid analgesics to strong opioids like morphine and fentanyl patches. Palliative care specialists can provide comprehensive pain management strategies tailored to the patient's needs, ensuring comfort even in the final stages of life.

5. Supporting a Loved One in Their Final Days: The emotional and psychological aspects of caring for a terminally ill loved one are profound. Providing companionship, engaging in meaningful conversations, and facilitating visits with family and friends can enhance the quality of life in their remaining days. Encouraging them to express their feelings, wishes, and any unresolved matters can be therapeutic for both the patient and their family. It’s essential to focus on creating a peaceful and supportive environment, allowing the patient to feel loved and cared for during this difficult time.

In conclusion, the decision regarding chemotherapy for elderly patients after pancreatic cancer surgery should be individualized, weighing the potential benefits against the risks and side effects. Engaging in open discussions with healthcare providers can help families make informed decisions that align with the patient's values and preferences.

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