The pancreatic cancer surgical program at Duke Cancer Institute (DCI) has achieved some of the lowest operative mortality rates in the U.S. for pancreatic surgery, with a 30-day mortality rate under 2%. Kevin Naresh Shah, MD, and Garth S. Herbert, MD, two members of this team who practice at Duke Cancer Center Raleigh, attribute the team’s success to rigorous monitoring, a commitment to operational safety, and an expansive, multidisciplinary effort.
Shah says there are two factors for examining outcomes in patients with pancreatic cancer: how long patients live with a combination of surgery and multi-agent chemotherapies, and patients’ quality of life.
“The way we perform pancreatic cancer surgery has changed significantly. We determine a surgical technique that is best for the patient. Some need open surgery, while others qualify for minimally invasive and robotic approaches,” says Shah.
After surgery, the team gets patients to timely supportive treatment, with the vast majority of patients needing chemotherapy starting on schedule.
“We also want to minimize complications and ensure our treatment is consistent with each patient’s priorities and values,” says Shah.
Duke Health pancreatic cancer patients can book rapid, 48-hour appointments at Duke Raleigh Hospital and Duke Health Durham. Call the Oncology Access Center at 1-866-DUKE-123 to refer a patient, or contact the new patient scheduler at 919-485-2500 option 1.
Multidisciplinary pancreatic cancer experts
Having expert physicians and institutional knowledge in treating pancreatic cancer is a distinguishing aspect of the DCI team. Patients have support to navigate their care in a coordinated, informed way from their first touchpoint and throughout their treatment.
Pancreatic cancer treatment requires an integrated effort from multiple specialist groups. “Medical oncology, surgical oncology, radiation oncology, nutrition, social work, nurse navigation, and other support services are all vitally important,” says Shah.
“We have nurse navigators helping patients with appointment scheduling, fellowship-trained radiologists with pancreatic cancer expertise, advanced endoscopists performing endoscopic ultrasounds, and nutritionists to help patients adapt to lifestyle changes after surgery,” says Herbert.
As a destination program for pancreatic cancer treatment, many patients travel to Shah and Herbert for care. For non-local patients, the team can collaborate with outside medical and oncology groups after surgery to ensure patients receive optimal therapies in their hometown.
High-risk screening and research trials
An insidious disease with a high mortality rate, pancreatic cancer usually is diagnosed in an advanced stage. The disease incidence is relatively low, and there isn’t a premalignant biomarker to support proactive screening protocols for patients with an average risk.
Patients at high-risk of pancreatic cancer, however, can participate in DCI’s high-risk screening program. Patients receive a formal genetic evaluation and biannual screening alternating an MRI and endoscopic ultrasound every six months. “We have detected incidental pancreas cancers in this population, which wouldn’t happen without a screening protocol like ours,” says Shah.
High-risk patients may also qualify for leading-edge clinical trials that are unique to DCI. One open clinical trial is examining the use of an anti-inflammatory to reduce the risk of pancreas cancer in high-risk patients.
In addition to clinical trial offerings, pancreatic cancer patients receiving treatment at DCI get tumor genetic testing. “We can profile each patient’s tumor to identify certain vulnerabilities amenable to targeted treatment — that isn’t available everywhere,” says Herbert.
The team has invested in other trials to test novel interventions. “We’re on the verge of opening a few exciting trials to include interventions that may reduce liver metastases, as well as another that involves personalized vaccine therapies,” says Herbert. “A breakthrough could change how we manage patients in the future,” says Shah.