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Review Article| Volume 22, ISSUE 1, P24-33, March 2023

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GI Symptoms in Pancreatic Cancer

Published:December 29, 2022DOI:https://doi.org/10.1016/j.clcc.2022.12.002

      Abstract

      This review will apply a multidisciplinary approach to GI symptoms with attention to symptom assessment (instruments and qualitative aspects), differential diagnosis, and recent findings relevant to management of symptoms and underlying diseases. We conclude that further development of supportive interventions for GI symptoms for both patient and caregivers has the potential to reduce distress from GI symptoms, and anticipate better symptom control with advances in scientific knowledge and improvement of the evidence base.

      Keywords

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      References

        • Park W
        • Chawla A
        • O'Reilly EM.
        Pancreatic cancer: a review.
        JAMA. 2021; 326: 851-862https://doi.org/10.1001/jama.2021.13027
        • Siegel RL
        • Miller KD
        • Fuchs HE
        • Jemal A.
        Cancer statistics, 2021.
        CA Cancer J Clin. 2021; 71: 7-33
        • Moningi S
        • Walker AJ
        • Hsu CC
        • et al.
        Correlation of clinical stage and performance status with quality of life in patients seen in a pancreas multidisciplinary clinic.
        J Oncol Pract. 2015; 11: e216-e221https://doi.org/10.1200/JOP.2014.000976
        • Sun V
        • Ferrell B
        • Juarez G
        • Wagman LD
        • Yen Y
        • Chung V.
        Symptom concerns and quality of life in hepatobiliary cancers.
        Oncol Nurs Forum. 2008; 35: E45-E52https://doi.org/10.1188/08.ONF.E45-E52
        • Beesley VL
        • Janda M
        • Burmeister EA
        • et al.
        Association between pancreatic cancer patients' perception of their care coordination and patient-reported and survival outcomes.
        Palliat Support Care. 2018; 16: 534-543https://doi.org/10.1017/S1478951517000608
        • Khan NN
        • Maharaj A
        • Evans S
        • et al.
        A qualitative investigation of the supportive care experiences of people living with pancreatic and oesophagogastric cancer.
        BMC Health Serv Res. 2022; 22: 213https://doi.org/10.1186/s12913-022-07625-y
        • Wiebe LA.
        A myriad of symptoms: new approaches to optimizing palliative care of patients with advanced pancreatic cancer.
        Am Soc Clin Oncol Educ Book. 2012; : 243-248https://doi.org/10.14694/EdBook_AM.2012.32.15
        • Lee KG
        • Roy V
        • Laszlo M
        • et al.
        Symptom Management in Pancreatic Cancer.
        Curr Treat Options Oncol. 2021; 22: 8https://doi.org/10.1007/s11864-020-00801-4
      1. Moffat GT, Epstein AS, O'Reilly EM. Pancreatic cancer-A disease in need: optimizing and integrating supportive care. Cancer. 2019;125:3927-35. doi: 10.1002/cncr.32423.

        • Védie AL
        • Neuzillet C.
        Pancreatic cancer: best supportive care.
        Presse Med. 2019; 48: e175-e185https://doi.org/10.1016/j.lpm.2019.02.032
        • Brooks JV
        • Poague C
        • Formagini T
        • Sinclair CT
        • Nelson-Brantley HV.
        The role of a symptom assessment tool in shaping patient-physician communication in palliative care.
        J Pain Symptom Manage. 2020; 59: 30-38https://doi.org/10.1016/j.jpainsymman.2019.08.024
        • Hui D
        • Bruera E.
        The edmonton symptom assessment system 25 years later: past, present, and future developments.
        J Pain Symptom Manage. 2017; 53: 630-643https://doi.org/10.1016/j.jpainsymman.2016.10.370
        • Wang XS
        • Williams LA
        • Eng C
        • et al.
        Validation and application of a module of the M. D. Anderson Symptom Inventory for measuring multiple symptoms in patients with gastrointestinal cancer (the MDASI-GI).
        Cancer. 2010; 116: 2053-2063https://doi.org/10.1002/cncr.24920
        • Chang VT
        • Hwang SS
        • Feuerman M
        • Kasimis BS
        • Thaler HT.
        The memorial symptom assessment scale short form (MSAS-SF).
        Cancer. 2000; 89 (10.1002/1097-0142(20000901)89:5<1162::aid-cncr26>3.0.co;2-y): 1162-1171
        • Fitzsimmons D
        • Johnson CD
        • George S
        • et al.
        Development of a disease specific quality of life (QoL) questionnaire module to supplement the EORTC core cancer QoL questionnaire, the QLQ-C30 in patients with pancreatic cancer. EORTC Study Group on Quality of Life.
        Eur J Cancer. 1999; 35: 939-941https://doi.org/10.1016/s0959-8049(99)00047-7
        • Heffernan N
        • Cella D
        • Webster K
        • et al.
        Measuring health-related quality of life in patients with hepatobiliary cancers: the functional assessment of cancer therapy-hepatobiliary questionnaire.
        J Clin Oncol. 2002; 20: 2229-2239https://doi.org/10.1200/JCO.2002.07.093
        • Maharaj AD
        • Samoborec S
        • Evans SM
        • et al.
        Patient-reported outcome measures (PROMs) in pancreatic cancer: a systematic review.
        HPB (Oxford). 2020; 22: 187-203https://doi.org/10.1016/j.hpb.2019.09.002
        • Macarulla T
        • Hendifar AE
        • Li CP
        • et al.
        Landscape of health-related quality of life in patients with early-stage pancreatic cancer receiving adjuvant or neoadjuvant chemotherapy: a systematic literature review.
        Pancreas. 2020; 49: 393-407https://doi.org/10.1097/MPA.0000000000001507
        • Kouzy R
        • Abi Jaoude J
        • Minsky BD
        • et al.
        Gastrointestinal malignancies and supportive care trials: a snapshot of the last two decades.
        BMJ Support Palliat Care. 2022; 12: 42-45https://doi.org/10.1136/bmjspcare-2020-002538
        • Burrell SA
        • Yeo TP
        • Smeltzer SC
        • et al.
        Symptom clusters in patients with pancreatic cancer undergoing surgical resection: part I.
        Oncol Nurs Forum. 2018; 45: E36-E52https://doi.org/10.1188/18.ONF.E36-E52
        • Burrell SA
        • Yeo TP
        • Smeltzer SC
        • et al.
        Symptom clusters in patients with pancreatic cancer undergoing surgical resection: part II.
        Oncol Nurs Forum. 2018; 45: E53-E66https://doi.org/10.1188/18.ONF.E53-E66
        • Husain A
        • Bezjak A
        • Easson A.
        Malignant ascites symptom cluster in patients referred for paracentesis.
        Ann Surg Oncol. 2010 Feb; 17: 461-469https://doi.org/10.1245/s10434-009-0774-0
        • Tantoy IY
        • Cooper BA
        • Dhruva A
        • et al.
        Changes in the occurrence, severity, and distress of symptoms in patients with gastrointestinal cancers receiving chemotherapy.
        J Pain Symptom Manage. 2018; 55: 808-834https://doi.org/10.1016/j.jpainsymman.2017.10.004
        • Han CJ
        • Reding K
        • Cooper BA
        • et al.
        Symptom clusters in patients with gastrointestinal cancers using different dimensions of the symptom experience.
        J Pain Symptom Manage. 2019; 58: 224-234https://doi.org/10.1016/j.jpainsymman.2019.04.035
        • Holly EA
        • Chaliha I
        • Bracci PM
        • Gautam M.
        Signs and symptoms of pancreatic cancer: a population-based case-control study in the San Francisco Bay area.
        Clin Gastroenterol Hepatol. 2004; 2: 510-517https://doi.org/10.1016/s1542-3565(04)00171-5
        • Carrato A
        • Melisi D
        • Prager G
        • et al.
        Chart review of diagnostic methods, baseline characteristics and symptoms for European patients with pancreatic cancer.
        Future Oncol. 2021; 17: 1843-1854https://doi.org/10.2217/fon-2020-0749
        • Tung S
        • Davis LE
        • Hallet J
        • et al.
        Population-level symptom assessment following pancreaticoduodenectomy for adenocarcinoma.
        JAMA Surg. 2019; 154e193348https://doi.org/10.1001/jamasurg.2019.3348
        • Cloyd JM
        • Tran Cao HS
        • Petzel MQ
        • et al.
        Impact of pancreatectomy on long-term patient-reported symptoms and quality of life in recurrence-free survivors of pancreatic and periampullary neoplasms.
        J Surg Oncol. 2017; 115: 144-150https://doi.org/10.1002/jso.24499
        • Mavros MN
        • Davis LE
        • Hallet J
        • et al.
        Symptom burden of nonresected pancreatic adenocarcinoma: an analysis of 10,753 patient-reported outcome assessments.
        Pancreas. 2020; 49: 1083-1089https://doi.org/10.1097/MPA.0000000000001629
        • Tang CC
        • Von Ah D
        • Fulton JS.
        The symptom experience of patients with advanced pancreatic cancer: an integrative review.
        Cancer Nurs. 2018; 41: 33-44https://doi.org/10.1097/NCC.0000000000000463
        • Andreyev HJN
        • Lalji A
        • Mohammed K
        • et al.
        The FOCCUS study: a prospective evaluation of the frequency, severity and treatable causes of gastrointestinal symptoms during and after chemotherapy.
        Support Care Cancer. 2021; 29: 1443-1453https://doi.org/10.1007/s00520-020-05610-x
        • Laquente B
        • Macarulla T
        • Bugés C
        • et al.
        Quality of life of patients with metastatic pancreatic adenocarcinoma initiating first-line chemotherapy in routine practice.
        BMC Palliat Care. 2020; 19: 103https://doi.org/10.1186/s12904-020-00610-4
        • Johnson AM
        • Wolf S
        • Xuan M
        • Samsa G
        • Kamal A
        • Fisher DA.
        Index symptoms and prognosis awareness of patients with pancreatic cancer: a multi-site palliative care collaborative.
        J Palliat Care. 2021; 8258597211001596https://doi.org/10.1177/08258597211001596
        • Hammad A
        • Davis LE
        • Mahar AL
        • et al.
        Symptom trajectories and predictors of severe symptoms in pancreatic adenocarcinoma at the end-of-life: a population based analysis of 2,538 patients.
        HPB (Oxford). 2019; 21: 1744-1752https://doi.org/10.1016/j.hpb.2019.04.016
        • Huisman C
        • Norgard MA
        • Levasseur PR
        • et al.
        Critical changes in hypothalamic gene networks in response to pancreatic cancer as found by single-cell RNA sequencing.
        Mol Metab. 2022; 58101441https://doi.org/10.1016/j.molmet.2022.101441
        • Talbert EE
        • Guttridge DC.
        Emerging signaling mediators in the anorexia-cachexia syndrome of cancer.
        Trends Cancer. 2022; 8: 397-403https://doi.org/10.1016/j.trecan.2022.01.004
        • Olson B
        • Zhu X
        • Norgard MA
        • Levasseur PR
        • et al.
        Lipocalin 2 mediates appetite suppression during pancreatic cancer cachexia.
        Nat Commun. 2021; 12: 2057https://doi.org/10.1038/s41467-021-22361-3
        • Tang CC
        • Draucker C
        • Tejani M
        • Von Ah D.
        Symptom experiences in patients with advanced pancreatic cancer as reported during healthcare encounters.
        Eur J Cancer Care (Engl). 2018; 27: e12838https://doi.org/10.1111/ecc.12838
        • Lize N
        • Raijmakers N
        • van Lieshout R
        • et al.
        Psychosocial consequences of a reduced ability to eat for patients with cancer and their informal caregivers: a qualitative study.
        Eur J Oncol Nurs. 2020; 49101838https://doi.org/10.1016/j.ejon.2020.101838
        • Lize N
        • Raijmakers N
        • van den Berg M
        Patients with cancer experience high impact of emotional consequences of reduced ability to eat: a cross sectional survey study.
        Eur J Cancer Care (Engl). 2022; 31: e13595https://doi.org/10.1111/ecc.13595
        • Gelhorn HL
        • Gries KS
        • Speck RM
        • et al.
        Comprehensive validation of the functional assessment of anorexia/cachexia therapy (FAACT) anorexia/cachexia subscale (A/CS) in lung cancer patients with involuntary weight loss.
        Qual Life Res. 2019; 28: 1641-1653https://doi.org/10.1007/s11136-019-02135-7
        • Mullee A
        • O'Donoghue A
        • Dhuibhir PU
        • et al.
        Diet and nutrition advice after a solid tumor diagnosis.
        JCO Oncol Pract. 2021; 17: e982-e991https://doi.org/10.1200/OP.20.00685
        • Lize N
        • IJmker-Hemink V
        • van Lieshout R
        • et al.
        Experiences of patients with cancer with information and support for psychosocial consequences of reduced ability to eat: a qualitative interview study.
        Support Care Cancer. 2021; 29: 6343-6352https://doi.org/10.1007/s00520-021-06217-6
      2. NCCN Guidelines Version 1.2022 Palliative Care https://www.nccn.org/professionals/physician_gls/pdf/palliative.pdf. Accessed: August 28, 2022.

        • Arends J
        • Strasser F
        • Gonella S
        • et al.
        Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines.
        ESMO Open. 2021; 6100092https://doi.org/10.1016/j.esmoop.2021.100092
        • Childs DS
        • Jatoi A.
        A hunger for hunger: a review of palliative therapies for cancer-associated anorexia.
        Ann Palliat Med. 2019; 8: 50-58https://doi.org/10.21037/apm.2018.05.08
        • Hamauchi S
        • Furuse J
        • Takano T
        • et al.
        A multicenter, open-label, single-arm study of anamorelin (ONO-7643) in advanced gastrointestinal cancer patients with cancer cachexia.
        Cancer. 2019; 125: 4294-4302https://doi.org/10.1002/cncr.32406
      3. Sexton M, Garcia JM, Jatoi A, Clark CS, Wallace MS. The management of cancer symptoms and treatment-induced side effects with cannabis or cannabinoids. J Natl Cancer Inst Monogr 2021;2021:86-98. doi: 10.1093/jncimonographs/lgab011.

        • Del Fabbro E
        • Hui D
        • Dalal S
        • Dev R
        • Nooruddin ZI
        • Bruera E.
        Clinical outcomes and contributors to weight loss in a cancer cachexia clinic.
        J Palliat Med. 2011; 14: 1004-1008https://doi.org/10.1089/jpm.2011.0098
        • Johanson JF
        • Kralstein J.
        Chronic constipation: a survey of the patient perspective.
        Aliment Pharmacol Ther. 2007; 25: 599-608https://doi.org/10.1111/j.1365-2036.2006.03238.x
        • McMillan SC
        • Williams FA
        Validity and reliability of the constipation assessment scale.
        Cancer Nurs. 1989; 12: 183-188https://doi.org/10.1097/00002820-198906000-00012
        • Hannon B
        • Dyck M
        • Pope A
        • et al.
        Modified Edmonton Symptom Assessment System including constipation and sleep: validation in outpatients with cancer.
        J Pain Symptom Manage. 2015; 49: 945-952https://doi.org/10.1016/j.jpainsymman.2014.10.013
        • Wickham RJ.
        Assessment of constipation in patients with cancer.
        J Adv Pract Oncol. 2016; 7: 457-462
        • Hunt CW
        • Cavallaro PM
        • Bordeianou LG.
        Metrics Used to Quantify Fecal Incontinence and Constipation.
        Clin Colon Rectal Surg. 2021; 34: 5-14https://doi.org/10.1055/s-0040-1714245
        • Davies A
        • Leach C
        • Caponero R
        • et al.
        MASCC recommendations on the management of constipation in patients with advanced cancer.
        Support Care Cancer. 2020; 28: 23-33https://doi.org/10.1007/s00520-019-05016-4
        • Larkin PJ
        • Cherny NI
        • D La Carpia
        • Guglielmo M
        • Ostgathe C
        • Scotté F
        • CI Ripamonti
        • ESMO Guidelines Committee
        Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines.
        Ann Oncol. 2018; 29: iv111-iv125https://doi.org/10.1093/annonc/mdy148
      4. PAL 17. Available at: https://www.nccn.org/professionals/physician_gls/pdf/palliative.pdf. Accessed: August 28, 2022.

      5. PAL-18. Available at: https://www.nccn.org/professionals/physician_gls/pdf/palliative.pdf. Accessed: August 28, 2022.

        • Bossi P
        • Antonuzzo A
        • Cherny NI
        • et al.
        Electronic address: [email protected] Diarrhoea in adult cancer patients: ESMO clinical practice guidelines.
        Ann Oncol. 2018; 29 (Suppl): iv126-iv142https://doi.org/10.1093/annonc/mdy145
        • Navari RM
        • Pywell CM
        • Le-Rademacher JG
        • et al.
        Olanzapine for the treatment of advanced cancer-related chronic nausea and/or vomiting: a randomized pilot trial.
        JAMA Oncol. 2020; 6: 895-899https://doi.org/10.1001/jamaoncol.2020.1052
        • Hardy JR
        • Skerman H
        • Philip J
        • et al.
        Methotrimeprazine versus haloperidol in palliative care patients with cancer-related nausea: a randomised, double-blind controlled trial.
        BMJ Open. 2019; 9e029942https://doi.org/10.1136/bmjopen-2019-029942
        • Hardy J
        • Skerman H
        • Glare P
        • et al.
        A randomized open-label study of guideline-driven antiemetic therapy versus single agent antiemetic therapy in patients with advanced cancer and nausea not related to anticancer treatment.
        BMC Cancer. 2018; 18: 510https://doi.org/10.1186/s12885-018-4404-8
        • Davis M
        • Hui D
        • Davies A
        • et al.
        MASCC antiemetics in advanced cancer updated guideline.
        Support Care Cancer. 2021; 29: 8097-8107https://doi.org/10.1007/s00520-021-06437-w
      6. PAL-15. Available at: https://www.nccn.org/professionals/physician_gls/pdf/palliative.pdf. Accessed: August 28, 2022.

        • Brøndum L
        • Markfoged B
        • Finderup J.
        Acupuncture as a tool to reduce nausea in terminally ill patients.
        Scand J Caring Sci. 2021; https://doi.org/10.1111/scs.12991
        • Davis M
        • Hui D
        • Davies A
        • et al.
        Medical management of malignant bowel obstruction in patients with advanced cancer: 2021 MASCC guideline update.
        Support Care Cancer. 2021; 29: 8089-8096https://doi.org/10.1007/s00520-021-06438-9
        • Madariaga A
        • Lau J
        • Ghoshal A
        • et al.
        MASCC multidisciplinary evidence-based recommendations for the management of malignant bowel obstruction in advanced cancer.
        Support Care Cancer. 2022; 30: 4711-4728https://doi.org/10.1007/s00520-022-06889-8
        • Obita GP
        • Boland EG
        • Currow DC
        • Johnson MJ
        • Boland JW.
        Somatostatin analogues compared with placebo and other pharmacologic agents in the management of symptoms of inoperable malignant bowel obstruction: a systematic review.
        J Pain Symptom Manage. 2016; 52 (901-19.e1)https://doi.org/10.1016/j.jpainsymman.2016.05.032
        • Navari RM.
        Nausea and vomiting in advanced cancer.
        Curr Treat Options Oncol. 2020; 21: 14https://doi.org/10.1007/s11864-020-0704-8
        • Mehta A
        • Ezer H.
        My love is hurting: the meaning spouses attribute to their loved ones' pain during palliative care.
        J Palliat Care. 2003; 19: 87-94
        • Foley KM.
        Pain syndromes and pharmacologic management of pancreatic cancer pain.
        J Pain Symptom Manage. 1988; 3: 176-187https://doi.org/10.1016/0885-3924(88)90028-0
        • Paice JA
        • Mulvey M
        • Bennett M
        • et al.
        AAPT diagnostic criteria for chronic cancer pain conditions.
        J Pain. 2017; 18: 233-246https://doi.org/10.1016/j.jpain.2016.10.020
        • Ceyhan GO
        • Bergmann F
        • Kadihasanoglu M
        • et al.
        Pancreatic neuropathy and neuropathic pain–a comprehensive pathomorphological study of 546 cases.
        Gastroenterology. 2009; 136: 177-186.e1https://doi.org/10.1053/j.gastro.2008.09.029
        • Wang J
        • Chen Y
        • Li X
        • Zou X.
        Perineural invasion and associated pain transmission in pancreatic cancer.
        Cancers (Basel). 2021; 13: 4594https://doi.org/10.3390/cancers13184594
        • Okusaka T
        • Okada S
        • Ueno H
        • et al.
        Abdominal pain in patients with resectable pancreatic cancer with reference to clinicopathologic findings.
        Pancreas. 2001; 22: 279-284https://doi.org/10.1097/00006676-200104000-00009
        • Carr RA
        • Roch AM
        • Zhong X
        • et al.
        Prospective evaluation of associations between cancer-related pain and perineural invasion in patients with resectable pancreatic adenocarcinoma.
        J Gastrointest Surg. 2017; 21: 1658-1665https://doi.org/10.1007/s11605-017-3513-z
        • Uc A
        • Andersen DK
        • Apkarian AV
        • et al.
        Pancreatic pain-knowledge gaps and research opportunities in children and adults: summary of a national institute of diabetes and digestive and kidney diseases workshop.
        Pancreas. 2021; 50: 906-915https://doi.org/10.1097/MPA.0000000000001899
        • Cherny NI.
        Chronic cancer pain syndromes.
        in: Cherny NI Fallon MT Kasa S Portenoy RK Currow DC Oxford Textbook of Palliative Medicine. 6th edition. Oxford University Press, New York, NY2021: 345-363 (Chapter 7.4)
        • Kelsen DP
        • Portenoy RK
        • Thaler HT
        • et al.
        Pain and depression in patients with newly diagnosed pancreas cancer.
        J Clin Oncol. 1995; 13: 748-755https://doi.org/10.1200/JCO.1995.13.3.748
        • Balzano G
        • Dugnani E
        • Crippa S
        • et al.
        A preoperative score to predict early death after pancreatic cancer resection.
        Dig Liver Dis. 2017; 49: 1050-1056https://doi.org/10.1016/j.dld.2017.06.012
        • Terwee CB
        • Nieveen Van Dijkum EJ
        • Gouma DJ
        • et al.
        Pooling of prognostic studies in cancer of the pancreatic head and periampullary region: the Triple-P study.
        Triple-P Study Group Eur J Surg. 2000; 166: 706-712https://doi.org/10.1080/110241500750008466
        • Azizoddin DR
        • Knoerl R
        • Adam R
        • et al.
        Cancer pain self-management in the context of a national opioid epidemic: experiences of patients with advanced cancer using opioids.
        Cancer. 2021; 127: 3239-3245https://doi.org/10.1002/cncr.33532
        • Ruskin A
        • Falker CG
        • Edens EL
        • Bauer MR.
        An interdisciplinary approach to metastatic pancreatic cancer and comorbid opioid use disorder treatment within a VA health care system.
        Fed Pract. 2021; 38 (Suppl): S66-S71https://doi.org/10.12788/fp.0160
        • Brooks JV
        • Poague C
        • Formagini T
        • Roberts AW
        • Sinclair CT
        • Keirns CC.
        Palliative care's role managing cancer pain during the opioid crisis: a qualitative study of patients, caregivers, and clinicians.
        J Pain Symptom Manage. 2020; 60: 1127-1135https://doi.org/10.1016/j.jpainsymman.2020.06.039
        • Merlin JS
        • Khodyakov D
        • Arnold R
        • et al.
        Expert panel consensus on management of advanced cancer-related pain in individuals with opioid use disorder.
        JAMA Netw Open. 2021; 4e2139968https://doi.org/10.1001/jamanetworkopen.2021.39968
        • Fitzgerald Jones K
        • Khodyakov D
        • Arnold R
        • et al.
        Consensus-based guidance on opioid management in individuals with advanced cancer-related pain and opioid misuse or use disorder.
        JAMA Oncol. 2022; e222191https://doi.org/10.1001/jamaoncol.2022.2191
        • Sohi G
        • Lao N
        • Caraceni A
        • et al.
        Nonopioid drug combinations for cancer pain: a systematic review.
        Pain Rep. 2021; 7: e995https://doi.org/10.1097/PR9.0000000000000995
        • Cloyd JM
        • Hyman S
        • Huwig T
        • et al.
        Patient experience and quality of life during neoadjuvant therapy for pancreatic cancer: a systematic review and study protocol.
        Support Care Cancer. 2021; 29: 3009-3016https://doi.org/10.1007/s00520-020-05813-2
        • Fusaroli P
        • Jenssen C
        • Hocke M
        • et al.
        EFSUMB guidelines on interventional ultrasound (INVUS), Part V - EUS-guided therapeutic interventions (short version).
        Ultraschall Med. 2016; 37: 412-420https://doi.org/10.1055/s-0035-1553742
        • Teoh AYB
        • Dhir V
        • Kida M
        • et al.
        Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel.
        Gut. 2018; 67: 1209-1228https://doi.org/10.1136/gutjnl-2017-314341
        • Wyse JM
        • Battat R
        • Sun S
        • et al.
        Practice guidelines for endoscopic ultrasound-guided celiac plexus neurolysis.
        Endosc Ultrasound. 2017; 6: 369-375
        • Masuda T
        • Kuramoto M
        • Shimada S
        Splanchnicectomy for pancreatic cancer pain.
        Biomed Res Int. 2014; 2014941726https://doi.org/10.1155/2014/941726
        • Carvajal G.
        Pancreatic cancer related pain: review of pathophysiology and intrathecal drug delivery systems for pain management.
        Pain Physician. 2021; 24: E583-E594
        • Ebrahimi G
        • Rasch CRN
        • van Tienhoven G.
        Pain relief after a short course of palliative radiotherapy in pancreatic cancer, the Academic Medical Center (AMC) experience.
        Acta Oncol. 2018; 57: 697-700https://doi.org/10.1080/0284186X.2017.1400692
        • Buwenge M
        • Arcelli A
        • Cellini F
        • et al.
        Pain relief after stereotactic radiotherapy of pancreatic adenocarcinoma: an updated systematic review.
        Curr Oncol. 2022; 29: 2616-2629https://doi.org/10.3390/curroncol29040214
        • Syrjala KL
        • Jensen MP
        • Mendoza ME
        • Yi JC
        • Fisher HM
        • Keefe FJ.
        Psychological and behavioral approaches to cancer pain management.
        J Clin Oncol. 2014; 32: 1703-1711https://doi.org/10.1200/JCO.2013.54.4825
        • Novy DM
        • Aigner CJ.
        The biopsychosocial model in cancer pain.
        Curr Opin Support Palliat Care. 2014; 8: 117-123https://doi.org/10.1097/SPC.0000000000000046
        • Winger JG
        • Ramos K
        • Steinhauser KE
        • et al.
        Enhancing meaning in the face of advanced cancer and pain: qualitative evaluation of a meaning-centered psychosocial pain management intervention.
        Palliat Support Care. 2020; 18: 263-270https://doi.org/10.1017/S1478951520000115
        • Miaskowski C
        • Dodd M
        • West C
        • et al.
        Randomized clinical trial of the effectiveness of a self-care intervention to improve cancer pain management.
        J Clin Oncol. 2004; 22: 1713-1720https://doi.org/10.1200/JCO.2004.06.140
        • Thomas ML
        • Elliott JE
        • Rao SM
        • Fahey KF
        • Paul SM
        • Miaskowski C.
        A randomized, clinical trial of education or motivational-interviewing-based coaching compared to usual care to improve cancer pain management.
        Oncol Nurs Forum. 2012; 39: 39-49https://doi.org/10.1188/12.ONF.39-49
        • Sheinfeld Gorin S
        • Krebs P
        • Badr H
        • et al.
        Meta-analysis of psychosocial interventions to reduce pain in patients with cancer.
        J Clin Oncol. 2012; 30: 539-547https://doi.org/10.1200/JCO.2011.37.0437
        • Porter LS
        • Steel JL
        • Fairclough DL
        • et al.
        Caregiver-guided pain coping skills training for patients with advanced cancer: results from a randomized clinical trial.
        Palliat Med. 2021; 35: 952-961https://doi.org/10.1177/02692163211004216
        • Dai L
        • Liu Y
        • Ji G
        • Xu Y.
        Acupuncture and Derived therapies for pain in palliative cancer management: systematic review and meta-analysis based on single-arm and controlled trials.
        J Palliat Med. 2021; 24: 1078-1099https://doi.org/10.1089/jpm.2020.0405
        • Yang J
        • Wahner-Roedler DL
        • Zhou X
        • et al.
        Acupuncture for palliative cancer pain management: systematic review.
        BMJ Support Palliat Care. 2021; 11: 264-270https://doi.org/10.1136/bmjspcare-2020-002638
        • Deng G.
        Integrative medicine therapies for pain management in cancer patients.
        Cancer J. 2019; 25: 343-348https://doi.org/10.1097/PPO.0000000000000399
        • Fisher E
        • Moore RA
        • Fogarty AE
        • et al.
        Cannabinoids, cannabis, and cannabis-based medicine for pain management: a systematic review of randomised controlled trials.
        Pain. 2021; 162 (Suppl): S45-S66https://doi.org/10.1097/j.pain.0000000000001929
        • Coveler AL
        • Mizrahi J
        • Eastman B
        • et al.
        Pancreas cancer-associated pain management.
        Oncologist. 2021; 26: e971-e982https://doi.org/10.1002/onco.13796
        • Lohse I
        • Brothers SP.
        Pathogenesis and treatment of pancreatic cancer related pain.
        Anticancer Res. 2020; 40: 1789-1796https://doi.org/10.21873/anticanres.14133
        • Drewes AM
        • Campbell CM
        • Ceyhan GO
        • et al.
        Pain in pancreatic ductal adenocarcinoma: a multidisciplinary, International guideline for optimized management.
        Pancreatology. 2018; 18: 446-457https://doi.org/10.1016/j.pan.2018.04.008
        • Bozzetti F.
        Chemotherapy-induced sarcopenia.
        Curr Treat Options Oncol. 2020; 21: 7https://doi.org/10.1007/s11864-019-0691-9
        • Gannavarapu BS
        • Lau SKM
        • Carter K
        • et al.
        Prevalence and survival impact of pretreatment cancer-associated weight loss: a tool for guiding early palliative care.
        J Oncol Pract. 2018; 14: e238-e250https://doi.org/10.1200/JOP.2017.025221
        • Muscaritoli M
        • Lucia S
        • Farcomeni A
        • et al.
        Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study.
        Oncotarget. 2017; 8: 79884-79896https://doi.org/10.18632/oncotarget.20168
        • Bachmann J
        • Heiligensetzer M
        • Krakowski-Roosen H
        • Büchler MW
        • Friess H
        • Martignoni ME.
        Cachexia worsens prognosis in patients with resectable pancreatic cancer.
        J Gastrointest Surg. 2008; 12: 1193-1201https://doi.org/10.1007/s11605-008-0505-z
        • Martin L
        • Senesse P
        • Gioulbasanis I
        • et al.
        Diagnostic criteria for the classification of cancer-associated weight loss.
        J Clin Oncol. 2015; 33: 90-99https://doi.org/10.1200/JCO.2014.56.1894
        • Martin L
        • Muscaritoli M
        • Bourdel-Marchasson I
        Diagnostic criteria for cancer cachexia: reduced food intake and inflammation predict weight loss and survival in an international, multi-cohort analysis.
        J Cachexia Sarcopenia Muscle. 2021; 12: 1189-1202https://doi.org/10.1002/jcsm.12756
        • Cloyd JM
        • Nogueras-González GM
        • Prakash LR
        • et al.
        Anthropometric changes in patients with pancreatic cancer undergoing preoperative therapy and pancreatoduodenectomy.
        J Gastrointest Surg. 2018; 22: 703-712https://doi.org/10.1007/s11605-017-3618-4
        • Jager-Wittenaar H
        • Ottery FD.
        Assessing nutritional status in cancer: role of the patient-generated subjective global assessment.
        Curr Opin Clin Nutr Metab Care. 2017; 20: 322-329https://doi.org/10.1097/MCO.0000000000000389
        • Boléo-Tomé C
        • Monteiro-Grillo I
        • Camilo M
        • Ravasco P.
        Validation of the Malnutrition Universal Screening Tool (MUST) in cancer.
        Br J Nutr. 2012; 108: 343-348https://doi.org/10.1017/S000711451100571X
        • Rubenstein LZ
        • Harker JO
        • Salvà A
        • Guigoz Y
        • Vellas B.
        Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF).
        J Gerontol A Biol Sci Med Sci. 2001; 56: M366-M372https://doi.org/10.1093/gerona/56.6.m366
        • Kondrup J
        • Rasmussen HH
        • Hamberg O
        • Stanga Z
        • Ad Hoc ESPEN Working Group
        Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials.
        Clin Nutr. 2003; 22: 321-336https://doi.org/10.1016/s0261-5614(02)00214-5
        • Reber E
        • Schönenberger KA
        • Vasiloglou MF
        • Stanga Z.
        Nutritional risk screening in cancer patients: the first step toward better clinical outcome.
        Front Nutr. 2021; 8603936https://doi.org/10.3389/fnut.2021.603936
        • Cederholm T
        • Jensen GL
        • Correia MITD
        • et al.
        GLIM criteria for the diagnosis of malnutrition - a consensus report from the global clinical nutrition community.
        Clin Nutr. 2019; 38: 1-9https://doi.org/10.1016/j.clnu.2018.08.002
        • Hendifar AE
        • Petzel MQB
        • Zimmers TA
        • et al.
        Pancreas cancer-associated weight loss.
        Oncologist. 2019; 24: 691-701https://doi.org/10.1634/theoncologist.2018-0266
        • Muscaritoli M
        • Arends J
        • Bachmann P
        • et al.
        ESPEN practical guideline: clinical nutrition in cancer.
        Clin Nutr. 2021; 40: 2898-2913https://doi.org/10.1016/j.clnu.2021.02.005
        • Reece L
        • Hogan S
        • Allman-Farinelli M
        • Carey S.
        Oral nutrition interventions in patients undergoing gastrointestinal surgery for cancer: a systematic literature review.
        Support Care Cancer. 2020; 28: 5673-5691https://doi.org/10.1007/s00520-020-05673-w
        • Baldwin C
        • Spiro A
        • Ahern R
        • Emery PW.
        Oral nutritional interventions in malnourished patients with cancer: a systematic review and meta-analysis.
        J Natl Cancer Inst. 2012; 104: 371-385https://doi.org/10.1093/jnci/djr556
        • de van der Schueren MAE
        • Laviano A
        • Blanchard H
        • Jourdan M
        • Arends J
        • Baracos VE
        Systematic review and meta-analysis of the evidence for oral nutritional intervention on nutritional and clinical outcomes during chemo(radio)therapy: current evidence and guidance for design of future trials.
        Ann Oncol. 2018; 29: 1141-1153https://doi.org/10.1093/annonc/mdy114
        • Caccialanza R
        • Laviano A
        • Bosetti C
        • et al.
        Clinical and economic value of oral nutrition supplements in patients with cancer: a position paper from the survivorship care and nutritional support working group of alliance against cancer.
        Support Care Cancer. 2022; https://doi.org/10.1007/s00520-022-07269-y
        • Alderman B
        • Allan L
        • Amano K
        • et al.
        Multinational Association of Supportive Care in Cancer (MASCC) expert opinion/guidance on the use of clinically assisted nutrition in patients with advanced cancer.
        Support Care Cancer. 2022; 30: 2983-2992https://doi.org/10.1007/s00520-021-06613-y
        • Hopkinson JB
        • Fenlon DR
        • Okamoto I
        • Wright DN
        • Scott I
        • Addington-Hall JM
        • Foster C.
        The deliverability, acceptability, and perceived effect of the Macmillan approach to weight loss and eating difficulties: a phase II, cluster-randomized, exploratory trial of a psychosocial intervention for weight- and eating-related distress in people with advanced cancer.
        J Pain Symptom Manage. 2010; 40: 684-695https://doi.org/10.1016/j.jpainsymman.2010.02.015
        • Molassiotis A
        • Brown T
        • Cheng HL
        • et al.
        The effects of a family-centered psychosocial-based nutrition intervention in patients with advanced cancer: the PiCNIC2 pilot randomised controlled trial.
        Nutr J. 2021; 20: 2https://doi.org/10.1186/s12937-020-00657-2
        • Senesse P
        • Isambert A
        • Janiszewski C
        • et al.
        Management of cancer cachexia and guidelines implementation in a comprehensive cancer center: a physician-led cancer nutrition program adapted to the practices of a country.
        J Pain Symptom Manage. 2017; 54: 387-393.e3https://doi.org/10.1016/j.jpainsymman.2017.01.010
        • Muscaritoli M
        • Arends J
        • Aapro M.
        From guidelines to clinical practice: a roadmap for oncologists for nutrition therapy for cancer patients.
        Ther Adv Med Oncol. 2019; 11https://doi.org/10.1177/1758835919880084
        • Gärtner S
        • Krüger J
        • Aghdassi AA
        • et al.
        Nutrition in pancreatic cancer: a review.
        Gastrointest Tumors. 2016; 2: 195-202https://doi.org/10.1159/000442873
        • Emanuel A
        • Krampitz J
        • Rosenberger F
        • Kind S
        • Rötzer I.
        Nutritional interventions in pancreatic cancer: a systematic review.
        Cancers (Basel). 2022; 14: 2212https://doi.org/10.3390/cancers14092212
        • Hicks AM
        • Chou J
        • Capanu M
        • Lowery MA
        • Yu KH
        • O'Reilly EM
        Pancreas adenocarcinoma: ascites, clinical manifestations, and management implications.
        Clin Colorectal Cancer. 2016; 15: 360-368https://doi.org/10.1016/j.clcc.2016.04.014
        • Korpi S
        • Salminen VV
        • Piili RP
        • Paunu N
        • Luukkaala T
        • Lehto JT.
        Therapeutic procedures for malignant ascites in a palliative care outpatient clinic.
        J Palliat Med. 2018; 21: 836-841https://doi.org/10.1089/jpm.2017.0616
        • Mori M
        • Morita T
        • Yokomichi N
        • et al.
        Validation of the edmonton symptom assessment system: ascites modification.
        J Pain Symptom Manage. 2018; 55: 1557-1563https://doi.org/10.1016/j.jpainsymman.2018.03.016
        • Easson AM
        • Bezjak A
        • Ross S
        • Wright JG.
        The ability of existing questionnaires to measure symptom change after paracentesis for symptomatic ascites.
        Ann Surg Oncol. 2007; 14: 2348-2357https://doi.org/10.1245/s10434-007-9370-3
        • Hopkinson JB.
        Psychosocial impact of cancer cachexia.
        J Cachexia Sarcopenia Muscle. 2014; 5: 89-94https://doi.org/10.1007/s13539-014-0142-1
        • Garcia JM
        • Dunne RF
        • Santiago K
        • et al.
        Addressing unmet needs for people with cancer cachexia: recommendations from a multistakeholder workshop.
        J Cachexia Sarcopenia Muscle. 2022; 13: 1418-1425https://doi.org/10.1002/jcsm.12910
        • Wheelwright S
        • Darlington AS
        • Hopkinson JB
        • Fitzsimmons D
        • Johnson C.
        A systematic review and thematic synthesis of quality of life in the informal carers of cancer patients with cachexia.
        Palliat Med. 2016; 30: 149-160https://doi.org/10.1177/0269216315588743
        • Oberholzer R
        • Hopkinson JB
        • Baumann K
        • et al.
        Psychosocial effects of cancer cachexia: a systematic literature search and qualitative analysis.
        J Pain Symptom Manage. 2013; 46: 77-95https://doi.org/10.1016/j.jpainsymman.2012.06.020
        • Schiessel DL
        • Baracos VE.
        Barriers to cancer nutrition therapy: excess catabolism of muscle and adipose tissues induced by tumour products and chemotherapy.
        Proc Nutr Soc. 2018; 77: 394-402https://doi.org/10.1017/S0029665118000186
        • Kordes M
        • Larsson L
        • Engstrand L
        • Löhr JM.
        Pancreatic cancer cachexia: three dimensions of a complex syndrome.
        Br J Cancer. 2021; 124: 1623-1636https://doi.org/10.1038/s41416-021-01301-4
        • Fearon K
        • Strasser F
        • Anker SD
        • et al.
        Definition and classification of cancer cachexia: an international consensus.
        Lancet Oncol. 2011; 12: 489-495https://doi.org/10.1016/S1470-2045(10)70218-7
        • Peterson SJ
        • Mozer M.
        Differentiating sarcopenia and cachexia among patients with cancer.
        Nutr Clin Pract. 2017; 32: 30-39https://doi.org/10.1177/0884533616680354
        • Wheelwright SJ
        • Hopkinson JB
        • Darlington AS
        • et al.
        Development of the EORTC QLQ-CAX24, a questionnaire for cancer patients with cachexia.
        J Pain Symptom Manage. 2017; 53: 232-242https://doi.org/10.1016/j.jpainsymman.2016.09.010
      7. PAL 13. Available at: https://www.nccn.org/professionals/physician_gls/pdf/palliative.pdf. Accessed: August 28, 2022.

        • Roeland EJ
        • Bohlke K
        • Baracos VE
        • et al.
        Management of Cancer Cachexia: ASCO guideline.
        J Clin Oncol. 2020; 38: 2438-2453https://doi.org/10.1200/JCO.20.00611
        • Kiss N
        • Loeliger J
        • Findlay M
        • et al.
        Clinical oncology society of Australia: position statement on cancer-related malnutrition and sarcopenia.
        Nutr Diet. 2020; 77: 416-425https://doi.org/10.1111/1747-0080.12631
        • Latenstein AEJ
        • Dijksterhuis WPM
        • Mackay TM
        • et al.
        Cachexia, dietetic consultation, and survival in patients with pancreatic and periampullary cancer: a multicenter cohort study.
        Cancer Med. 2020; 9: 9385-9395https://doi.org/10.1002/cam4.3556
        • Nasrah R
        • Van Der Borch C
        • Kanbalian M
        • Jagoe RT.
        Defining barriers to implementation of nutritional advice in patients with cachexia.
        J Cachexia Sarcopenia Muscle. 2020; 11: 69-78https://doi.org/10.1002/jcsm.12490
        • Prado CM
        • Purcell SA
        • Laviano A.
        Nutrition interventions to treat low muscle mass in cancer.
        J Cachexia Sarcopenia Muscle. 2020; 11: 366-380https://doi.org/10.1002/jcsm.12525
        • Amano K
        • Baracos VE
        • Hopkinson JB.
        Integration of palliative, supportive, and nutritional care to alleviate eating-related distress among advanced cancer patients with cachexia and their family members.
        Crit Rev Oncol Hematol. 2019; 143: 117-123https://doi.org/10.1016/j.critrevonc.2019.08.006
        • Hopkinson JB.
        The psychosocial components of multimodal interventions offered to people with cancer cachexia: a scoping review.
        Asia Pac J Oncol Nurs. 2021; 8: 450-461https://doi.org/10.4103/apjon.apjon-219
        • Solheim TS
        • Laird BJA
        • Balstad TR
        • et al.
        Cancer cachexia: rationale for the MENAC (Multimodal-Exercise, Nutrition and Anti-inflammatory medication for Cachexia) trial.
        BMJ Support Palliat Care. 2018; 8: 258-265https://doi.org/10.1136/bmjspcare-2017-001440
        • Yao L
        • Petrosyan A
        • Fuangfa P
        • Lenchik L
        • Boutin RD.
        Diagnosing sarcopenia at the point of imaging care: analysis of clinical, functional, and opportunistic CT metrics.
        Skeletal Radiol. 2021; 50: 543-550https://doi.org/10.1007/s00256-020-03576-9
        • Mintziras I
        • Miligkos M
        • Wächter S
        • Manoharan J
        • Maurer E
        • Bartsch DK.
        Sarcopenia and sarcopenic obesity are significantly associated with poorer overall survival in patients with pancreatic cancer: systematic review and meta-analysis.
        Int J Surg. 2018; 59: 19-26https://doi.org/10.1016/j.ijsu.2018.09.014
        • Hsueh HY
        • Pita-Grisanti V
        • Gumpper-Fedus K
        • et al.
        A review of physical activity in pancreatic ductal adenocarcinoma: epidemiology, intervention, animal models, and clinical trials.
        Pancreatology. 2022; 22: 98-111https://doi.org/10.1016/j.pan.2021.10.004
        • Naito T
        • Uchino J
        • Kojima T
        • et al.
        A multicenter, open-label, single-arm study of anamorelin (ONO-7643) in patients with cancer cachexia and low body mass index.
        Cancer. 2022; 128: 2025-2035https://doi.org/10.1002/cncr.34154
        • Lavriv DS
        • Neves PM
        • Ravasco P.
        Should omega-3 fatty acids be used for adjuvant treatment of cancer cachexia?.
        Clin Nutr ESPEN. 2018; 25: 18-25https://doi.org/10.1016/j.clnesp.2018.02.006
        • Simon L
        • Baldwin C
        • Kalea AZ
        • Slee A.
        Cannabinoid interventions for improving cachexia outcomes in cancer: a systematic review and meta-analysis.
        J Cachexia Sarcopenia Muscle. 2022; 13: 23-41https://doi.org/10.1002/jcsm.12861
        • Xu B
        • Cheng Q
        • So WKW.
        Review of the effects and safety of traditional Chinese medicine in the treatment of cancer cachexia.
        Asia Pac J Oncol Nurs. 2021; 8: 471-486https://doi.org/10.4103/apjon.apjon-2130
        • Barkin JS
        • Goldberg RI
        • Sfakianakis GN
        • Levi J.
        Pancreatic carcinoma is associated with delayed gastric emptying.
        Dig Dis Sci. 1986; 31: 265-267https://doi.org/10.1007/BF01318117
        • Pasricha PJ
        • Parkman HP.
        Gastroparesis: definitions and diagnosis.
        Gastroenterol Clin North Am. 2015; 44: 1-7https://doi.org/10.1016/j.gtc.2014.11.001
        • Leung J
        • Silverman W.
        Diagnostic and therapeutic approach to pancreatic cancer-associated gastroparesis: literature review and our experience.
        Dig Dis Sci. 2009; 54: 401-405https://doi.org/10.1007/s10620-008-0354-3
        • Malamood M
        • Roberts A
        • Kataria R
        • Parkman HP
        • Schey R.
        Mirtazapine for symptom control in refractory gastroparesis.
        Drug Des Devel Ther. 2017; 11: 1035-1041https://doi.org/10.2147/DDDT.S125743
        • Kumar N
        • Barai S
        • Gambhir S
        • Rastogi N.
        Effect of mirtazapine on gastric emptying in patients with cancer-associated anorexia.
        Indian J Palliat Care. 2017; 23: 335-337https://doi.org/10.4103/IJPC.IJPC_17_17
        • Baddeley E
        • Mann M
        • Bravington A
        • et al.
        Symptom burden and lived experiences of patients, caregivers and healthcare professionals on the management of malignant bowel obstruction: a qualitative systematic review.
        Palliat Med. 2022; 36: 895-911https://doi.org/10.1177/02692163221081331
        • Merchant SJ
        • Brogly SB
        • Booth CM
        • et al.
        Management of cancer-associated intestinal obstruction in the final year of life.
        J Palliat Care. 2020; 35: 84-92https://doi.org/10.1177/0825859719861935
        • Goldberg JI
        • Goldman DA
        • McCaskey S
        • Koo DJ
        • Epstein AS.
        Illness understanding, prognostic awareness, and end-of-life care in patients with gi cancer and malignant bowel obstruction with drainage percutaneous endoscopic gastrostomy.
        JCO Oncol Pract. 2021; 17: e186-e193https://doi.org/10.1200/OP.20.00035
        • Hoppenot C
        • Hlubocky FJ
        • Chor J
        • Yamada SD
        • Lee NK.
        Gaps in patient-physician communication at the time of malignant bowel obstruction from recurrent gynecologic cancer: a qualitative study.
        Support Care Cancer. 2022; 30: 367-376https://doi.org/10.1007/s00520-021-06441-0
        • O'Connor OJ
        • Diver E
        • McDermott S
        • et al.
        Palliative gastrostomy in the setting of voluminous ascites.
        J Palliat Med. 2014; 17: 811-821https://doi.org/10.1089/jpm.2013.0397
      8. Siddappa PK, Hawa F, Prokop LJ, et al. Endoscopic pancreatic duct stenting for pain palliation in selected pancreatic cancer patients: a systematic review and meta-analysis. Gastroenterol Rep (Oxf) 2021;9:105-14. doi: 10.1093/gastro/goab001.

        • Ballinger AB
        • McHugh M
        • Catnach SM
        • Alstead EM
        • Clark ML.
        Symptom relief and quality of life after stenting for malignant bile duct obstruction.
        Gut. 1994; 35: 467-470https://doi.org/10.1136/gut.35.4.467
        • Barkay O
        • Mosler P
        • Schmitt CM
        • et al.
        Effect of endoscopic stenting of malignant bile duct obstruction on quality of life.
        J Clin Gastroenterol. 2013; 47: 526-531https://doi.org/10.1097/MCG.0b013e318272440e
        • Apadula L
        • Capurso G
        • Arcidiacono PG.
        Patient-reported experience measure in pancreatobiliary endoscopy: a systematic review to highlight areas for improvement.
        Eur J Gastroenterol Hepatol. 2021; 33: 832-838https://doi.org/10.1097/MEG.0000000000001957
        • Krouse RS.
        Malignant bowel obstruction.
        J Surg Oncol. 2019; 120: 74-77https://doi.org/10.1002/jso.25451
        • Perinel J
        • Adham M.
        Palliative therapy in pancreatic cancer-palliative surgery.
        Transl Gastroenterol Hepatol. 2019; 4: 28https://doi.org/10.21037/tgh.2019.04.03
      9. PAL 20. Available at: https://www.nccn.org/professionals/physician_gls/pdf/palliative.pdf. Accessed: August 28, 2022.

        • Gooden HM
        • White KJ.
        Pancreatic cancer and supportive care–pancreatic exocrine insufficiency negatively impacts on quality of life.
        Support Care Cancer. 2013; 21: 1835-1841https://doi.org/10.1007/s00520-013-1729-3
        • Othman MO
        • Harb D
        • Barkin JA.
        Introduction and practical approach to exocrine pancreatic insufficiency for the practicing clinician.
        Int J Clin Pract. 2018; 72: e13066https://doi.org/10.1111/ijcp.13066
        • Tseng DS
        • Molenaar IQ
        • Besselink MG
        • van Eijck CH
        • Borel Rinkes IH
        • van Santvoort HC.
        Pancreatic exocrine insufficiency in patients with pancreatic or periampullary cancer: a systematic review.
        Pancreas. 2016; 45: 325-330https://doi.org/10.1097/MPA.0000000000000473
        • Bartel MJ
        • Asbun H
        • Stauffer J
        • Raimondo M.
        Pancreatic exocrine insufficiency in pancreatic cancer: a review of the literature.
        Dig Liver Dis. 2015; 47: 1013-1020https://doi.org/10.1016/j.dld.2015.06.015
        • Vanga RR
        • Tansel A
        • Sidiq S
        • El-Serag HB
        • Othman MO
        Diagnostic performance of measurement of fecal elastase-1 in detection of exocrine pancreatic insufficiency: systematic review and meta-analysis.
        Clin Gastroenterol Hepatol. 2018; 16: 1220-1228https://doi.org/10.1016/j.cgh.2018.01.027
        • Roeyen G
        • Berrevoet F
        • Borbath I
        • et al.
        Expert opinion on management of pancreatic exocrine insufficiency in pancreatic cancer.
        ESMO Open. 2022; 7100386https://doi.org/10.1016/j.esmoop.2022.100386
        • Carnie LE
        • Farrell K
        • Barratt N
        • et al.
        Pancreatic enzyme replacement therapy for patients diagnosed with pancreaticobiliary cancer: validation of an algorithm for dose escalation and management.
        Pancreas. 2021; 50: 1254-1259https://doi.org/10.1097/MPA.0000000000001906
        • Gupta A
        • Nshuti L
        • Grewal US
        • et al.
        Financial burden of drugs prescribed for cancer-associated symptoms.
        JCO Oncol Pract. 2022; 18: 140-147https://doi.org/10.1200/OP.21.00466
        • Barkin JA
        • Westermann A
        • Hoos W
        • et al.
        Frequency of appropriate use of pancreatic enzyme replacement therapy and symptomatic response in pancreatic cancer patients.
        Pancreas. 2019; 48: 780-786https://doi.org/10.1097/MPA.0000000000001330
        • Landers A
        • Donaldson F
        • Brown H
        • McKenzie C
        • Pendharkar S.
        The impact of pancreatic enzyme replacement therapy on patients with advanced pancreatic adenocarcinoma: a systematic review and narrative synthesis.
        Pancreas. 2022; 51: 405-414https://doi.org/10.1097/MPA.0000000000002049
        • Satoi S
        • Takahara N
        • Fujii T
        • et al.
        Synopsis of a clinical practice guideline for pancreatic ductal adenocarcinoma with peritoneal dissemination in Japan; Japan Peritoneal malignancy study group.
        J Hepatobiliary Pancreat Sci. 2022; 29: 600-608https://doi.org/10.1002/jhbp.1085
        • Bleicher J
        • Lambert LA.
        A palliative approach to management of peritoneal carcinomatosis and malignant ascites.
        Surg Oncol Clin N Am. 2021; 30: 475-490https://doi.org/10.1016/j.soc.2021.02.004
        • Janda M
        • Neale RE
        • Klein K
        • et al.
        Anxiety, depression and quality of life in people with pancreatic cancer and their carers.
        Pancreatology. 2017; 17: 321-327https://doi.org/10.1016/j.pan.2017.01.008
        • Kim Y
        • Baek W.
        Caring experiences of family caregivers of patients with pancreatic cancer: an integrative literature review.
        Support Care Cancer. 2022; 30: 3691-3700https://doi.org/10.1007/s00520-021-06793-7
        • Keefe FJ
        • Ahles TA
        • Porter LS
        • et al.
        The self-efficacy of family caregivers for helping cancer patients manage pain at end-of-life.
        Pain. 2003; 103: 157-162https://doi.org/10.1016/s0304-3959(02)00448-7
        • Ristau P
        • Oetting-Roß C
        • Büscher A.
        Coping in patients with pancreatic cancer: a scoping review and narrative synthesis.
        BMJ Support Palliat Care. 2021; https://doi.org/10.1136/bmjspcare-2021-003266
        • Barrett M
        • Uí Dhuibhir P
        • Njoroge C
        • et al.
        Diet and nutrition information on nine national cancer organisation websites: a critical review.
        Eur J Cancer Care (Engl). 2020; 29: e13280https://doi.org/10.1111/ecc.13280
        • Demir IE
        • C Mota Reyes
        • Alrawashdeh W
        • et al.
        Future directions in preclinical and translational cancer neuroscience research.
        Nat Cancer. 2021; 1: 1027-1031https://doi.org/10.1038/s43018-020-00146-9
        • Shi DD
        • Guo JA
        • Hoffman HI
        • et al.
        Therapeutic avenues for cancer neuroscience: translational frontiers and clinical opportunities.
        Lancet Oncol. 2022; 23: e62-e74https://doi.org/10.1016/S1470-2045(21)00596-9