Dr Cardin on the Influence of Comorbidities on Treatment Selection in Pancreatic Cancer

Dana B. Cardin, MD, MSCI, associate professor of medicine, hematology and oncology, Vanderbilt-Ingram Cancer Center, discusses the importance of identifying comorbidities and high-risk features when determining the optimal treatment approach for patients with pancreatic cancer.

Identifying comorbid conditions in patients with pancreatic cancer is vital for navigating treatment options in this space, as the presence of a given condition may discourage the use of certain therapies, Cardin begins. For example, some patients may already experience challenges with eating and drinking. These patients should not be recommended to receive chemotherapy, which are commonly associated with nausea or vomiting, Cardin says. Other agents may cause nerve-related adverse effects (AEs) that could exacerbate pre-existing neuropathy or nerve damage from conditions like diabetes, Cardin adds.

ECOG performance status can also be used to predict patient responses to treatment, and determine the optimal treatment approach, Cardin continues. This describes a patient's ability to perform activities of daily living such as personal care, walking, cooking meals, going to work, or running errands, she expands. If patients have a limited functional status, certain treatment-related AEs may more significantly impact their quality of life and outcomes, , Cardin explains.

For patients being considered for surgery as a part of their treatment approach, it is especially important to assess their frailty, Cardin emphasizes. A patient’s frailty and number of medical comorbidities directly correlates with their likelihood of experiencing complications after pancreaticoduodenectomy, she says.

Lastly, a patient's nutritional status should be noted. Malnutrition is commonly observed in patients with pancreatic cancer and may affect both performance status and a patient’s responses to treatment, Cardin concludes.