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At the time of diagnosis, only about 20% of patients with pancreatic ductal adenocarcinoma (PDAC) have resectable disease. PDAC treatment necessitates a multidisciplinary approach, and adjuvant chemotherapy after upfront resection is an established means of preventing recurrence. Neoadjuvant chemotherapy (NAT), originally introduced to downstage tumor size, is nowadays more frequently used for selection of patients with favorable tumor biology and to control potential micrometastases. While NAT is routinely applied in locally advanced (LA) PDAC, there is increasing evidence demonstrating benefits of NAT in borderline resectable (BR) PDAC. The concept of NAT has recently been tested in resectable PDAC, but to date NAT has been restricted to clinical trials, as the data are limited and no clear benefits have yet been shown in this patient group. This review summarizes the current evidence for NAT in resectable, BR, and LA PDAC, with a focus on high-level evidence and randomized controlled trials., (© 2020 S. Karger AG, Basel.)

Goals of Work: To define and measure the psychological integration of childhood cancer experiences into a personal biography and to explore the association between integration with illness-related factors and psychosocial conditions., Patients and Methods: Analysis of cancer survivors' narratives on the course of their illness was used to measure integration. Psychosocial condition, body concepts, health locus of control, and illness-related distress were evaluated by questionnaires. Illness factors were assessed by reviewing hospital case notes and sociodemographic factors by a structured interview. Of 72 eligible subjects contacted, 60 agreed to participate., Main Results: High inter-rater correlations established the reliability of the concept of testing integration by narrative analysis. Subjects with good psychological integration of the experience of cancer saw chance as having less to do with illness and health, and perceived illness and therapy retrospectively as more distressing than survivors with poor integration. In contrast, integration did not correlate with distress evoked by present feelings toward illness and therapy or by thoughts of a relapse., Conclusions: Successful integration of the experience of cancer may be associated with the ability to accept painful feelings and to allow them to emerge, and with a readiness to accept responsibility in relation to health and medical care. Assisting young cancer patients and their families to create and maintain their personal narratives of the experience of illness is an important clinical task for all professionals working in paediatric oncology.

Based on the hypothesis that personal narratives help to cope people with stressful life events, 33 adult siblings of former childhood cancer patients were asked how they had experienced illness and treatment of their brother or sister. Analysis of the narratives was used to measure the integration of these experiences into personal biography. Good integration correlated positively with good body concepts. Siblings with good integration also scored lower for fatalistic health locus of control and perceived the illness retrospectively as more distressing than those with poor integration. In contrast, integration did not correlate with distress evoked by present feelings towards illness and therapy or by thoughts of a relapse or a personal cancer illness. The findings of this exploratory investigation may suggest that successful integration of the experiences associated with a brother's or sister's cancer is associated with a trustful relation to the own body and with the ability to accept painful feelings and to allow them to emerge. Assisting siblings of young cancer patients to create and maintain their personal narratives of their experiences can make an important contribution to coping.