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Objectives: In the UK, guidelines recommend pancreatic enzyme replacement therapy (PERT) to all people with unresectable pancreatic cancer. In 2023, we published a national audit of PERT which showed suboptimal prescribing and wide regional variation in England. The aim of this manuscript was to describe how we used the PERT audit to drive improvements in healthcare., Methods: Building on the PERT audit, we deployed an online dashboard which will deliver ongoing updates of the PERT audit. We developed a collaborative intervention with cancer nurse specialists (CNS) to improve care delivered to people with pancreatic cancer. The intervention called Creating a natiOnAL CNS pancrEatic cancer network to Standardise and improve CarE (COALESCE) will use the dashboard to evaluate improvements in prescribing of PERT., Results: We demonstrated how large databases of electronic healthcare records (EHRs) can be used to improve cancer care. The PERT audit was implemented into a dashboard for tracking the progress of COALESCE. We will measure improvements in PERT prescribing as the intervention with CNS progresses., Conclusions: Improving healthcare is an ongoing and iterative process. By implementing the PERT dashboard, we created a resource-efficient, automated evaluation method enabling COALESCE to deliver a sustainable change. National-scale databases of EHRs enable rapid cycles of audits, providing regular feedback to interventions, working systematically to deliver change. Here, the focus is on pancreatic cancer. However, this methodology is transferable to other areas of healthcare., Implications for Nursing Practice: Nurses play a key role in collecting good quality data which are needed in clinical audits to identify shortcomings in healthcare. Nurse-driven interventions can be designed to improve healthcare. In this study, we capitalize on the unique role of CNS coordinating care for every patient with cancer. COALESCE is the first national collaborative study which uses CNS as researchers and change agents., Competing Interests: Declaration of competing interest BG received research funding from the Laura and John Arnold Foundation, the NHS National Institute for Health Research (NIHR), the NIHR School of Primary Care Research, NHS England, the NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, the World Health Organization, UKRI MRC, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies program; he is a Non-Executive Director at NHS Digital; he also receives personal income from speaking and writing for lay audiences on the misuse of science. BMK is employed as a pharmacist by NHS England and seconded to the Bennett Institute., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Caregivers of patients with cancer play an important role throughout the treatment trajectory. This can be challenging and might infer health and psychosocial problems. This may especially be the case in caregivers of patients with cancers that carry a high risk of recurrence such as cancers of the pancreas, duodenum and bile duct. This study therefore explored the experiences of caregivers of patients attending follow-up after completion of treatment with curative intent for cancers of the pancreas, duodenum and bile duct., Methods: A qualitative study using semi-structured, individual interviews. Data were analysed using content analysis., Results: Ten caregivers of patients attending follow-up after completed curative treatment for cancers of the pancreas, duodenum and bile duct in a specialized gastro-surgical center at a tertiary hospital in the Capital Region of Denmark participated. We identified three themes: "From bystander to enlisted carer", inferring that caregivers felt enlisted as carers during treatment and follow-up, however without sufficient instruction or assessment of their needs. "Lonesome worrying" meaning that caregivers hid their feelings of concern and foreboding, and finally, "Keeping a stiff upper lip" indicating that caregivers outwardly maintained a positive face when interacting with the patient., Conclusion: Caregivers described taking on a substantial burden of care without feeling competent. They experienced distress and emotional isolation which affected their relationship with the patient and their mutual coping. The results indicate a need for health care professionals to facilitate reflection on the needs and roles of both patients and caregivers throughout the treatment trajectory., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Hereditary pancreatic cancer continues to pose challenges to providers, as well as to patients and their families. Pancreatic cancer has a poor prognosis, and individuals with family histories of pancreatic cancer are often motivated to pursue genetic testing. This article reviews various hereditary pancreatic cancer syndromes, as well as pancreatic cancer screening recommendations, options, and limitations.

Background: Data on skilled nursing facility utilization among patients undergoing pancreatic surgery remain scarce. We sought to define the incidence of utilization of skilled nursing facilities and determine the impact of skilled nursing facility quality markers on postoperative outcomes among patients who underwent pancreatic surgery., Methods: Medicare Standard Analytic Files were used to identify patients who underwent pancreatic resection during 2013-2015. Nursing Home Compare datasets were used to examine the influence of skilled nursing facility quality as estimated by quality markers (Medicare star ratings) on postoperative outcomes., Results: Among 13,018 patients who underwent pancreatectomy, 2,247 (17.3%) were discharged to a skilled nursing facility. Compared with patients discharged home, patients discharged to a skilled nursing facility were older (median age: 72 [interquartile range 68-76] vs 76 [interquartile range 71-80]), more likely female (44.4% vs 56.8%), and had greater Charlson comorbidity index scores (median score: 3 [interquartile range 2-8] vs 4 [interquartile range 2-8]) (all P < .001). Most patients were discharged to an above-average skilled nursing facility (N = 1,463, 65.1%), and a lesser subset was discharged to a skilled nursing facility with a below-average (N = 490, 21.8%) or average (N = 294, 13.1%) star rating. The 30-day hospital readmission was greatest among patients discharged to a below-average skilled nursing facility (below average N = 217, 44.3%; average N = 110, 37.4%; above average N = 517, 35.3%; P = .002). On multivariate analysis, patients discharged to below-average skilled nursing facilities remained 64% more likely to be readmitted within 30 days (OR 1.64, 1.29-2.02, P < .001). In contrast, 30-day mortality was comparable across the skilled nursing facility star rating categories (P = .08)., Conclusion: Roughly 1 in 6 patients undergoing pancreatic surgery were discharged to a skilled nursing facility. Patients discharged to a below-average skilled nursing facility were more likely to be readmitted compared with patients discharged to an above-average skilled nursing facility., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Recent approaches in treating pancreatic adenocarcinoma, an aggressive disease with limited survival, include the use of liposomal irinotecan as an option when first-line therapy has failed. Liposomal irinotecan has been approved in combination with 5-fluorouracil and leucovorin for patients with metastatic pancreatic cancer. Liposomal irinotecan is a newer therapy requiring oncology nurses to obtain knowledge and skills for proper administrating, monitoring of hypersensitivity reactions during infusion, managing side effects, and providing patient education. Nursing considerations when administering this drug include infusion time, premedication, risk for hypersensitivity reactions and adverse events, and side effects.

Many barriers influence the ability of postoperative cancer patients to reengage in normal physical activities. Training programs have been shown to be effective in helping restore physical activity in patients and in reducing the care burdens of family members. Nurses cannot use physical activity guidelines in their care plan to assess individual needs. The clinical practice guidelines for physical activity in survivorship were published by the National Comprehensive Cancer Network (NCCN) in 2016. These guidelines are used to assess patients' physical status, curable factors, physical barriers, and risk of postoperative pancreatic cancer and diabetes. In line with this assessment tool, the physical activity guidelines, and the recommendations for cancer patients, the authors planned a physical activity training program that addressed the actual needs of patients under their care. Further, the authors provided special notes for a diabetic diet that helped reduce the barriers to resuming physical activity and enhanced independent care efficacy. Meanwhile, the authors encouraged family members to participate in patient-care activities and family mental-health support and to promote patient participation in the training program in order to increase quality of life. The present project demonstrates that this care plan may provide an effective guide for nurses to help other cancer patients resume physical activity.

As palliative care units continue to develop, the provision of end-of-life care for patients with a chronic mental illness needs to be addressed. Aside from the somatic comorbidities to which these patients are particularly exposed and in view of the specificity of psychiatric treatment, the forms of end-of-life support for a patient with schizophrenia are described here, based on the experience of a psychiatric unit in the Var region., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

A nurse learns it's not inappropriate to celebrate life as death approaches.

Background: Somatostatin analogs (SSAs) are a mainstay therapy for the treatment of carcinoid syndrome associated with neuroendocrine tumors (NETs). They are effective for a range of gastroenteropancreatic NETs (GEP-NETs). Lanreotide depot (Somatuline®) is an SSA that is approved for the treatment of GEP-NETs to improve progression-free survival (PFS)., Objectives: The article reviews the efficacy, safety, and administration of lanreotide depot and relates those attributes to considerations and preferences of oncology nurses and their patients., Methods: A review of the literature on the use of lanreotide for the treatment of NETs and carcinoid syndrome was conducted. In addition, the literature on drug delivery and routes of administration was surveyed to provide context for comparative studies related to clinical and patient preferences., Findings: Lanreotide depot prolongs PFS and is well tolerated by patients who expressed satisfaction in the ability to control symptoms related to carcinoid syndrome. Nurses cited several benefits to using lanreotide depot in the clinical setting, including more time saved to address other patient care issues. Attributes of lanreotide depot-including its efficacy, safety and tolerability, dosing and administration, and cost-may contribute to healthcare decisions regarding the treatment and management of NETs.

Gastroenteropancreatic neuroendocrine tumours (GEP-NET) represent a heterogeneous family of diseases of often challenging clinical management. Although many GEP-NET are slow progressing and frequently less aggressive than neoplasms of other origin, they can metastasise and reduce the life span of the patient. GEP-NET can be functioning (secreting hormones that may cause symptoms and organ damage), but some 60% are non-functioning. Thorough clinical assessment including family history, biochemical tests, radiology and nuclear medicine scans, and histological confirmation are important to tailor the optimal treatment of GEP-NET, which should be managed with a multidisciplinary approach and mainly guided by tumour grading and staging, functioning status, and location of the primary lesion.

Background: Survival for patients with advanced (locally advanced unresectable and metastatic disease) pancreatic cancer is very poor; however, several advances in treatment have been made during the past several years. Gemcitabine (Gemzar®)-based regimens, FOLFIRINOX, and nab-paclitaxel (Abraxane®)-based regimens have demonstrated efficacy in patients with advanced pancreatic cancer. Understanding the unique safety profile of each of these regimens is crucial in helping nurses identify symptoms, develop patient education strategies, and ultimately improve outcomes., Objectives: This article aims to provide background information on and nursing implications of the treatment of patients with advanced pancreatic cancer by exploring the mechanism of action and efficacy and safety profiles of standard treatment regimens., Methods: Key trials of standard treatment regimens used in the treatment of advanced pancreatic cancer were examined with respect to efficacy outcomes and the most commonly observed adverse events. Symptom identification and management strategies are discussed from the nursing perspective., Findings: The current standard treatment options for patients with advanced pancreatic cancer have differences in efficacy and safety profiles. Nurses should educate themselves on these differences, particularly on associated adverse events and their management.

Resection or removal of the pancreas causes loss of parenchyma, which can result in extreme disruption of glucose homeostasis and malabsorption of dietary nutrients. However, islet autotransplantation (IAT) may reduce or prevent the severity of pancreatogenic diabetes. This article explores total pancreatectomy with IAT within the context of pancreatic cancer treatment. At a Glance • The liver is the preferred site for implantation because of easy vascular access. • Following islet autotransplantation, the liver becomes an insulin-producing organ as the transplanted beta cells begin making insulin. • The most significant complication of implantation in the liver is portal vein occlusion because of thrombosis; consequently, a heparin drip is infused for the first seven days postoperatively to prevent portal vein thrombus formation.

Context: Pancreatic cancer presents a wide spectrum of significant symptomatology. The high symptom burden, coupled with a rapidly fatal diagnosis, limits preparation or time for adjustment for both patients and their family caregivers. From the initial diagnosis and throughout the illness experience, the physical and emotional demands of caregiving can predispose caregivers themselves to illness and a greater risk of mortality. Understanding the negative and positive aspects of caregiving for patients with advanced pancreatic cancer will inform interventions that promote positive caregiver outcomes and support caregivers in their role., Objectives: To provide feasibility data for a larger, mixed methods, longitudinal study focused on the experience of family caregivers of patients with advanced pancreatic cancer and preliminary qualitative data to substantiate the significance of studying this caregiver population., Methods: This was a mixed methods study guided by the Stress Process Model. Eight family caregivers of patients with advanced pancreatic cancer from oncology practices of a university-affiliated medical center were surveyed., Results: The pilot results supported the ability to recruit and retain participants and informed recruitment and data collection procedures. The qualitative results provided preliminary insights into caregiver experiences during the diagnosis and treatment phases. Key findings that substantiated the significance of studying these caregivers included the caregiving context of the history of sentinel symptoms, the crisis of diagnosis, the violation of assumptions about life and health, recognition of the circle of association, and contextual factors, as well as primary and secondary stressors, coping strategies, resources, discoveries, gains and growth, associated changes/transitions, and unmet caregiver needs., Conclusion: Findings indicated caregivers' willingness to participate in research, highlighted the negative and positive aspects of the caregiver experience, and reinforced the significance of the future study and the need to develop interventions to support family caregivers in their roles., (Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Informed consent is an ongoing process, and oncology nurses are important advocates to identify information gaps and patient concerns during this process. This article discusses the rights of research participants from a regulatory perspective. Two case scenarios are presented and discussed to describe how nurses can ensure that patients are truly informed and understand the clinical trial process.

Purpose/objectives: To determine readmission rates post-pancreaticoduodenectomy (PD), readmission reasons following PD, and patients' postoperative education prior to discharge., Design: Retrospective, descriptive study of established medical records of patients who have undergone PD from 2006-2008., Setting: PD cohort from a pancreatic cancer program., Sample: 62 patients aged 18 years or older, diagnosed with pancreatic cancer, who had PD., Methods: Data abstracted from inpatient and outpatient electronic records as per study protocol and entered into Excel® spreadsheet for analysis., Main Research Variables: Incidences of and reasons for readmissions post the PD procedure. Discharge education given to patients prior to discharge., Findings: Patients were discharged at mean postoperative day 11.3. Readmission rate was 28%. Reasons for readmission were dehydration or malnutrition (n = 10, 16%) and surgical site infection (n = 7, 11%); 10% of patients (n = 6) had documented difficulties with dehydration, malnutrition, and failure to thrive noted at follow-up. PD discharge teaching was documented in a mandatory discharge form. No standard curriculum was used., Conclusions: Patients undergoing PD experience an increase in self-care demand postdischarge. Poor discharge education can lead to high rates of readmission, specifically for dehydration and malnutrition, mandating an assessment of patient education prior to discharge., Implications for Nursing: Close attention must be given to the needs of patients with pancreatic cancer postdischarge. Trying to identify the areas of educational deficit at patient readmission could help nurses identify what they can do to minimize preventable complications. Educational focus for patients undergoing PD should be on prevention of dehydration, malnutrition, and surgical site infections.

The median survival of patients with metastatic pancreatic cancer is three to six months, making the diagnosis difficult to accept for patients, family, and healthcare providers. Therapeutic options are improving, but the treatment of advanced disease remains palliative. For oncology nurses, understanding the therapeutic and palliative options can provide these patients and their caregivers with additional information to make appropriate and individualized healthcare decisions.

Nurses are taught a variety of interventions to relieve patient suffering. They are often more comfortable with patient suffering that is physical in nature rather than psychological, existential, and spiritual. Remaining present for patients and families whose suffering cannot be easily relieved is particularly challenging. This article describes how an expert nurse responded to unrelieved suffering and offers insight into ways of being present for patients and families., (Copyright 2011, SLACK Incorporated.)

Understanding how a nurse acts in a particular situation reveals how nurses enact their ethics in day-to-day nursing. Our ethical frameworks assist us when we experience serious ethical dilemmas. Yet how a nurse responds in situations of daily practice is contingent upon all the presenting cues that build the current moment. In this article, we look at how a home care nurse responds to the ethical opening that arises when the nurse enters a person's home. We discuss how the home presents the nurse with knowledge that informs the provision of ethical nursing care. The analysis is based on findings from an interpretive research study in palliative home care in Canada. Through interpretive analysis of a nursing situation we delineate how the nurse engages with the whole and acts inside the moment. The analysis shows how home care nurses are ethically determined to engage with whatever is going on in a patient's home.

Pancreatic cancer is one of the most silently lethal forms of malignancy. With a lack of evidence-based research regarding pancreatic cancer, the evidence-based treatment options are limited. Currently, the best chance for a curative treatment is a pancreatic resection that typically is combined with chemotherapy and/or radiation therapy. The long-term treatment course and overall survival of the patient depend largely on the pathology report generated from the expurgated tissue analysis. After pancreatic resection, patients may experience both general and unique complications that, if not treated appropriately and assessed correctly, can be lethal. Provided here is a general overview of pancreatic resections and their unique postoperative complications for critical-care nurses. As the first-line provider, critical-care nurses assess and manage acute complications, in addition to educating patients to the long-term complications and how to manage them.

This study was undertaken to determine the effect of home healthcare on the quality of life (QOL) in patients diagnosed with gastrointestinal cancer. A total of 42 patients, who met eligibility criteria, were enrolled in the study and randomly assigned to either a control group or an experimental group. Control group patients received "usual care" defined as pain control and management through the pain clinic. Experimental group patients received pain control through the clinic plus three home visits. During the home visits, their nursing care was guided by an evidence-based protocol developed by the research team. Data were collected on pain, performance, symptoms, and QOL by using previously developed and validated instruments.Significant differences were found between the two groups on physiological function, psychological concerns, and total stress. In the experimental group, there was a significant decrease in pain and increase in performance from baseline to the final data collection period. For the control group, a significant decrease in QOL over the study period was observed. There were no significant differences between the two groups on pain, performance, QOL, and QOL subscales at the final visit.

Objectives: To review the incidence, risk factors, staging, and diagnosis of hepatobiliary malignancies and pancreas cancer as well as nursing challenges associated with managing patients with these tumors., Data Sources: Published research reports, epidemiologic data, patient management guidelines, and institution-based clinical tools., Conclusion: While survival is slowly increasing, morbidity and mortality associated with hepatobiliary and pancreas cancers remains high. Further scientific study is needed to identify methods of detecting these malignancies earlier and to develop therapeutic approaches that will effectively decrease tumor burden while simultaneously palliating disease and treatment-induced consequences including both physical and emotional effects., Implications for Nursing Practice: Nurses need to be familiar with the natural history of these diseases and current and future therapies to facilitate treatment decision-making when options are limited, anticipate and intervene in managing disease and treatment-induced effects, and support clinical research efforts.

A visiting nursing service was provided for a 90-year-old male patient with terminal stage of pancreatic cancer whose prognosis was to live for two to three months. We provided nursing service not only for the patient's pain control but also for the member of the family by giving specific nursing tips as well as mental support. After the patient passed away, the eldest daughter was quoted saying "we could do everything we wanted to from home nursing care." It appeared that she was totally satisfied with our nursing service. We concluded the following caregiver roles based on this clinical example: 1) Try to alleviate a terminal patient's pain as much as possible so that the patient and the family will be at ease. 2) Arrange the care giver's anxiety individually. 3) Guide the care giver a specific know-how that can be accomplished and let the patient and the care giver choose which one they want. 4) Teach the process of the withholding and with drawing of life and try to consolidate the purpose of nursing intentions among the care givers. 5) Respect the patient and caregiver and make the best out of the situation by being flexible.

The aim of this article is to provide information about preoperative and postoperative nursing care for patients with insulinoma. The content is based on a literature review and the author's clinical experience. It describes insulinoma and provides concrete nursing measures for patients with the disease, who face problems of anxiety, risk of injury, risk of infection, nutrition and fluid volume deficit, information provision and emotional support before and after surgery.

Pancreatic cancer is one of the leading causes of cancer death in the United States. Surgical resection of tumors is considered the only curative form of treatment and can occur only when tumors are diagnosed early. Currently, researchers are attempting to develop screening tests to detect pancreatic cancer while at an early stage. Until the tests are perfected, primary care providers need to be aware of the earliest symptoms of pancreatic cancer and know which tests will assist in diagnosing pancreatic cancer at an early stage. The purpose of this article is to educate primary care providers about the early symptoms of pancreatic cancer and appropriate diagnostics to order.

For nurses, end-of-life care isn't just about providing compassion. It is also about two very important legal documents.

Alterations in taste can occur as a result of cancer, cancer treatment, and from a variety of other causes. Cancer patients frequently experience taste alterations, which often go undetected in the clinical setting. This case presentation depicts a 90-year-old client with end-stage pancreatic cancer undergoing chemotherapy treatment with gemcitabine. The symptomatology of taste changes is described. Etiology and rationale for taste changes is presented for the cancer patient population, and for the general population. Review of the cancer literature, research instruments, and goals/outcomes are discussed. The author determined that interventional studies are lacking, and research is needed.

Pancreatic cancer may be considered rare, yet in Canada it is the fourth leading cause of death by cancer in the elderly. This study was conducted in a large tertiary centre to determine the symptoms experienced by patients and the response by health professionals in providing supportive care. This paper reports the results of a retrospective review of health records from patients diagnosed with pancreatic cancer (n = 99). Results indicate that pain, nausea, vomiting, and anorexia were frequently reported. There was a lack of consistency in the documentation of nursing care and little evidence of an organized, planned approach for care delivery. The role of the interdisciplinary health care team and its members in managing this devastating disease and its impact on patient quality of life was difficult to ascertain. The development of an integrated approach to the care of patients with pancreatic cancer is presented.