Improving the management of pain and cachexia in pancreatic cancer: Development of a patient-centred evidence-based pathway

Abstract Background Incidence of pancreatic cancer is increasing worldwide and is likely to become the third commonest cause of cancer death in UK by 2030. Approximately 75% of people with pancreatic cancer suffer with pain and over 50% have cachexia (weakness and wasting of the body). However, there is considerable uncertainty regarding management of these distressing symptoms. We aim to identify the best interventions through systematic reviews and meta-analyses; and then will perform surveys and focus groups to reach a consensus in development of a care pathway that is acceptable to patients and ready to assess for feasibility of introduction in NHS. Methods We will compare the relative benefits and harms of different interventions for pain in unresectable pancreatic cancer and for prevention and treatment of cachexia due to pancreatic cancer, through systematic reviews (SR) and network meta-analysis. Data obtained will feed into two online surveys. (1) Patients/carers will rank interventions (identified from SR) in order of preference/acceptability. (2) Healthcare professionals will score interventions (identified from SR) on scale 1-10 according to feasibility of delivery in NHS. Four focus groups will be conducted to evaluate findings and discuss areas of contention, to enable consensus in the development of the care pathway. Results Project is currently in progress. Funding was awarded from April 2022 (NIHR202727). Both systematic review protocols were prospectively registered on PROSPERO in May 2022 (CRD42022333239/CRD42022333241). Approval by University College London Research Ethics Committee (23563/001) was received in December 2022. Data analysis is underway, expected to end by October 2023. Surveys and focus groups will be conducted thereafter. The online surveys will be primarily distributed via Pancreatic Cancer UK, but website links will also be made available on the PROSPERO records. The project is due to end in April 2024 and results will be published within 12 months of project completion. Conclusions This will be the first systematic review and network meta-analysis on these topics, thus enabling multiple treatment comparisons, additive effects and interaction models for different treatment combinations. We will also identify gaps in existing research that cause uncertainty in decision-making in management of pain and cachexia in pancreatic cancer. Through the surveys and focus group discussions, key stakeholders including patients, carers, and healthcare professionals, will facilitate the development of an evidence-based care pathway, ensuring both end-user acceptability and feasibility of delivery within NHS. Findings will be disseminated through patient group websites, conferences, and publication, irrespective of results, in peer-reviewed journals.