Chemo can prolong survival for pancreatic cancer. So why aren't people getting it?

Researchers want to debunk the idea advanced pancreatic cancer, like the kind dealt Alex Trebek, isn't worth treating.

Sharon Kirkey, National Post 4 minute read December 18, 2019

Host of "Jeopardy!" Alex Trebek attends a press conference to discuss the upcoming Man V. Machine "Jeopardy!" competition at the IBM T.J. Watson Research Center on January 13, 2011 in Yorktown Heights, New York. Ben Hider/Getty Images

“I’m going to fight this,” Jeopardy! host Alex Trebek told adoring fans when he shared his pancreatic cancer diagnosis in March. However, most people with Trebek’s cancer aren’t given a fair shot at extending their lifetimes, because of old attitudes the disease isn’t worth treating, a new Canadian study finds.

Of more than 10,000 people diagnosed with advanced pancreatic cancer in Ontario over 11 years, only 38 per cent received chemotherapy, or a combination of chemo and radiation.

One-third didn’t see a medical oncologist — a doctor who specializes in chemotherapy.

That contrasts sharply with high rates of treatment for other advanced cancers. Up to 90 per cent of people with colorectal cancer see a medical oncologist, and the majority receive chemotherapy.

“We have better chemotherapy drugs (for pancreatic cancer) than in the past, but those standards of care aren’t reaching patients,” study author Dr. Natalie Coburn, a surgical oncologist at Sunnybrook Health Sciences Centre and the University of Toronto, said in a statement released with the study.

Advanced or metastatic pancreatic cancer, where the cancer has spread to other parts of the body, can be particularly grim. The disease tends to spread before there are obvious symptoms, like upper abdominal pain, or jaundice (the skin turns yellow) when the tumour blocks the bile ducts. There’s no screening for pancreatic cancer, the fourth leading cancer killer in Canada, of both men and women.  By the time tumours are diagnosed, 80 per cent are inoperable “and have spread beyond what we can offer for cure,” said study co-author Dr. Julie Hallet, a surgical oncologist at Sunnybrook.

There are a lot of people who aren’t that well informed about their options, who don’t know they can reach out for additional care

However, more modern chemo regimens can extend median survival for up to a year — meaning half survive up to 12 months, and the other half beyond that — compared to three to six months without therapy.

“The outlook has drastically changed, but the stigma still remains that this is a highly fatal cancer and it probably isn’t worth treating,” Hallet said.

She and her co-authors looked at two things: who gets a consult to even discuss options, and how many get treatment.

The study was based on the records of 10,881 people diagnosed with advanced pancreatic adenocarcinoma, which accounts for about 80 per cent of all cases, between 2005 and 2016.

Overall, about 27 per cent received chemotherapy, and 11 per cent chemo-radiation.

About a third of those diagnosed didn’t see an oncologist. And, even when they did, about 60 percent didn’t get therapy.

The study didn’t look at why people weren’t assessed or treated. Chemo isn’t indicated for everyone, and some people refuse it, because the side effects can be toxic. (“That stuff really kicks the slats out of you,” Trebek told an audience of the Royal Canadian Geographical Society when he helped open the group’s new Ottawa headquarters. The Sudbury, Ont., native has also suffered bouts of “deep sadness” following chemo sessions, he told Good Morning America.)

Hallet gets why some people might decline treatment. “But everyone should have the opportunity for treatment, which means having a consultation where this can be explained to them, and then making an informed decision,” she said.

“Alex Trebek has a good social network; he’s able to reach out to the right people to get the care he wants to receive,” Hallet said. “And he’s a well-informed man.

“There are a lot of people who aren’t that well informed about their options, who don’t know they can reach out for additional care.”

Chemo can delay the growth of tumours, ease symptoms and extend survival, Hallet said. “We can make quality of life better, for longer.”

The study appears in this week’s issue of the Canadian Medical Association Journal.

An estimated 5,500 Canadians were diagnosed with pancreatic cancer last year; 4,800 died of it.