Together Episode 3

A pancreatic cancer patient, together with her husband, experiences the challenges of a clinical trial treatment while maintaining hope for their future.

Melanie

Melanie Strassburg
Pancreatic Cancer

"I’d like to believe that I can beat it. I’m here fighting the fight of my life. It’s a daily battle and I want to be here to share the time with my family."

 

Ask the Experts

Roswell Park Cancer Institute’s medical experts featured in the Cancer Can’t Win documentary “Together” answer questions about pancreatic cancer and treatment recommendations.

Does insurance pay for clinical trials?

 
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To participate in a clinical trial, we do discuss with patients the reasons that we would recommend a clinical trial. One of the big questions that comes up during the discussion is, "Are there financial challenges in going on a clinical trial?" and one of the big questions is whether the insurance company would pay for the clinical trial. In a clinical trial setting, there are two components to the cost, categorically speaking. There is the standard of care cost and the research cost. The research cost is the research drug itself, and additional procedures and tests that need to be done because the patient is on a clinical trial. Those are considered research costs, which typically are covered by the research study itself. Whereas the standard of care costs, such as the routine blood test to be drawn before chemotherapy, the routine visits to the doctor's office, the administration of standard chemo drugs — those are considered standard of care costs. For standard of costs, they are typically being billed to the insurance company. Most of the time, the insurance that most patients have, their policy does cover the standard of care costs while they go on a clinical study.

Wen Wee Ma, MBBS

Are there ways to treat cancer-related fatigue?

 
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Fatigue, or low-energy level, is a very common symptom of cancer patients, especially when they're on chemotherapy. There are a few ways that we approach this problem. During the consultation with the medical team, the providers will go through various tests looking for anemia or hypothyroidism, which are the common causes of fatigue. During chemotherapy time, most patients will likely feel tired for a few days. In some patients, that fatigue may list a bit longer or shorter, depending on their reaction to the chemotherapy. What I often advise my patients is recognizing that there's definitely going to be some downtime around the chemotherapy administration period and to plan their activities accordingly. I advise them not to overdo it for the few days they're on chemotherapy and then plan accordingly for the days following that. In addition to that, other things that patients can do are continue to participate in activities, or low-level exercises, that their bodies can tolerate to help continue to maintain their stamina. The other part is, of course, make sure that the patients are eating healthy, nutritious diets.

Wen Wee Ma, MBBS

What is personalized medicine?

 
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Personalized medicine is a relatively recent term that's been brought into cancer care. Another term that is similar to that is precision medicine — people use either term. Basically what it means is, in the world of genomic technologies that we have today — and genomic technologies are those tools that we can use to examine the various characteristics of cancer at a molecular level — now, these genomic technologies are being used to characterize or define treatments for patients. So, personalized medicine means that your cancer has this particular genomic change, or change in the DNA. We identify that change and that associates you with a specific therapy that hopefully is better and less toxic than anything you previously would have received as standard of care.

Carl Morrison, MD, DVM

What is The Center for Personalized Medicine?

 
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The Center for Personalized Medicine at Roswell Park specifically addresses the problem of, how do we identify those genomic changes in your cancer that would be associated with a specific therapy. First and foremost, among identifying those genomic technologies is a new technology called Next Generation Sequencing. Roswell Park has invested millions of dollars in bringing this technology to cancer care. We've had to develop supercomputer clusters, buy new equipment, train new people, hire new people, develop new reporting structures, and develop new tools to analyze data. We're one of the few institutions in the country that have this capability. Early in January, we'll be rolling this out to the care of patients at Roswell Park, identifying these genomic changes that associate with personalized care and it will change treatment for patients at Roswell Park. We're really excited about these changes. We think all the patients will be too. The clinicians already are. We'll be able to provide answers that people have been looking for, for quite a while.

Carl Morrison, MD, DVM

What can caregivers offer at Roswell Park?

 
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Cancer affects many people including the patient, their caregiver, the family and close friends. It's not unusual, and it's very common, for the caregivers and family members to feel very overwhelmed while taking care of their loved ones. At Roswell Park, we have a unique team of caregivers that includes not just the medical team, but also psychologists, the palliative care team, nutritionists and social workers. All of us work together to try to figure it out for the patient and provide recommendations to help support the patient and also their family caregiver. The best part about Roswell Park is that we not only treat the cancer, but we treat the whole patient.

Wen Wee Ma, MBBS

What happens if a patient has trouble eating, or no appetite?

 
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It is common for patients to feel anorexic, or lose their appetite, when they have cancer or are on chemotherapy. One way to improve their appetite is to make their food more palatable. When one is diagnosed with cancer and receives chemotherapy, it is definitely not a time to go on a dieting plan. I often advise my patients to eat what appeals to them the most. For example, if they like ice cream, they should definitely go for that. If they like spaghetti with meatballs, they should definitely go for that. I tell my patients this is not a time to go on special diets. The other thing is to continue to have a fairly active lifestyle, as much as their condition allows them. That will obviously stimulate the body to want to have more food. With that, it can help to build up a little more appetite. Of course, there's also the other option. As providers, we can prescribe certain medication to help stimulate the diet. In general, I would prefer to try the previous two options before we try medication.

Wen Wee Ma, MBBS

What if someone becomes chemoresistant?

 
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Chemoresistance is a description of a process where the cancer becomes less responsive, less susceptible to the effect of chemotherapy treatment. It is, unfortunately, a very common event in treatment of most cancers. Over a period of treatment, the cancer starts to grow again and cause symptoms. There are various reasons why that would happen. One of the common causes, we think, is because the cancer develops another biological process to overcome that initial cancer treatment. So, a lot of times in the clinic, we will then proceed to a different chemotherapy drug, but that is a process that we keep on seeing repeatedly with the current standard chemo drugs. So it becomes very exciting for us then, in clinical trials, to look at new treatments, new drugs that have less side effects that can potentially overcome the resistance to those chemo treatments. In that sense, I think we are in the process, and we continue to have a lot of research looking into how we can overcome this chemoresistance.

Wen Wee Ma, MBBS

Why is pancreatic cancer diagnosed so late?

 
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Pancreatic cancer is one of those cancers that is diagnosed at a very late stage. There are various reasons for that. One of the reasons is because the pancreas itself is in the back of the abdomen, we'll call it the retroperitoneum. During surgery, to get to the pancreas, a surgeon has to go through many layers. The pancreas itself is stuck right in the back, where it has a lot of room to grow. During development of cancer in the pancreas, it may take some time before the cancer itself starts causing problems, that patients start presenting with symptoms. That's one of the big reasons why pancreatic cancer is typically diagnosed in the late stages.

Wen Wee Ma, MBBS