Research Report

As you know, pancreatic cancer is a very aggressive tumour that usually affects men and women in their 50-70s. This tumour can spread to lymph-nodes early and this has a significant impact on survival of patients who undergo surgery. Although we are able to remove the tumour and the surrounding tissue with surgery, most of the patients will have recurrent disease during the first 3 years after surgery. At 5 years, only 5-15% of our patients are alive after undergoing a Whipple procedure.

The survival after pancreatic cancer surgery has not improved during the last 30 years. Although we have better chemotherapy treatments, pancreatic cancer has been a very hard tumour to defeat.Many reasons are responsible for these poor results. One of the reasons is that pancreatic cancers are asymptomatic for many months before being diagnosed. And when the tumour is discovered, it has already spread beyond what doctors can see on a CT scan or MRI.

Many surgeons and physicians have been considering that the Whipple procedure is only a palliative therapy. In their opinion, the results are not good enough to suggest that the Whipple procedure should be offered to patients. Although they realize that without undergoing surgery, the mean survival is only 6 months, these doctors say that most of the patients with pancreatic cancer are quite advanced in their age and therefore they should not be operated on.

No previous research has focussed attention to the patients' perspective. As physicians, we recommend some treatments because they are the only available potential way to cure. Despite the fact that the Whipple fails for the majority of our patients, we are able to cure a few of them. Is that sufficient to support surgery for everyone? We don't know.

My interest is to find out. Therefore I would like to use the Probability-Trade-Off (PTO) interview to better understand what patients with pancreatic cancer would decide if fully informed about their condition and the options available to them.

PTO is a formal, structured interview that makes patients go trough a clinical situation. After being fully informed about the nature of the disease, the probabilities of success and failure, the patients are asked to choose between two or more treatments. Then, the probabilities of success and failures are changed in a progressive way so that one treatment becomes more appealing over the others. The difference between the starting probability and the probability when the patient changes her/his mind is called Minimal Probability Trade Off that the individual is willing to accept to undergo a therapy that is more invasive but that can potentially provide a better long term outcome.

This research technique is quite new and has not been used before for pancreatic cancer.

Therefore I think that it would be very important for us to have this research done and help patients and doctors to make better decisions in the future.

- Dr. Molinari