August 1, 2017

A novel, holistic approach to pancreatic cancer treatment at Royal North Shore Hospital has seen survival rates consistently beat the state average.

The multi-disciplinary approach to patient care includes a dedicated nurse who ensures continuity and makes sure every patient benefits from all the expertise on offer.

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Data from 2010-2016 shows the one- and five-year survival rates for pancreatic cancer treated at the North Shore campus are at 33 and 13 per cent respectively, compared to 28 and less than 10 per cent across NSW.

The North Shore results are far stronger than those recorded in the United Kingdom in the same period - 21 per cent after one year, and three per cent after five years.

The North Shore results are far stronger than those recorded in the United Kingdom in the same period - 21 per cent after one year, and three per cent after five years.

Half the pancreatic cancer surgeries carried out in NSW each year (around 140) occur on the North Shore campus. A total of 442 patients have been managed in the Northern Sydney Local Health District (NSLHD) during the study period.

Pancreatic cancer is the fourth leading cause of cancer deaths in the world and is expected to become the second.

There is no early detection. Depending on the location of the cancer, patients present with jaundice, pain, and/or vomiting. Diagnosis is made through a CT scan.

Professor Stephen Clarke, who heads NSLHD's cancer services, said these data show that, if operable, 34 per cent of pancreatic cancer patients survive long-term – ie, more than five years, with a negligible chance of recurrence.

"This figure is superior to results from the UK, US and other centres in NSW; however, there is clearly room for improvement," Prof Clarke said.

"We are now working to try and increase the number of operable patients by giving chemotherapy and/or chemotherapy plus radiation therapy prior to surgery. 

"For inoperable patients, our survival rates are 12 per cent better than in the UK and five per cent better than in other sites in NSW - demonstrating the importance of high-quality, experienced, multi-disciplinary care for pancreatic cancer patients."

More recently, a new clinic which focusses on patients' post-surgery gives them access to ongoing care to avoid common complications like osteoporosis, diabetes and malnutrition.

Dr Anubhav Mittal, a pancreatic surgeon working who founded the Pancreatic Exocrine Insufficiency Clinic at Royal North Shore, said removing or partly-removing a pancreas – which makes insulin and produces digestive enzymes – affected digestive function.

"This new clinic addresses the post-operative nutritional problems which we know affects survival – that is, we are now also trying to minimise the impact of taking out the pancreas," Dr Mittal said.

"At the clinic, post-pancreatic resection patients are given a comprehensive, formal assessment which includes, amongst other things, blood tests, bone density scanning and quality of life questionnaires.

"Most patients attending the clinic need help with their nutrition, including the supply of enzymes which are given in tablet form."

One patient to benefit from the North Shore approach, and the new clinic, is Allambie Heights man Des Cottle.

Mr Cottle was diagnosed with duodenal cancer in May 2015 after taking a day off work for what he thought was a stomach bug. Luckily, an alert GP at a clinic – where Mr Cottle had gone for a medical certificate – realised something was amiss and arranged immediate tests.

Just days later, he underwent an arduous 12-hour operation with Dr Mittal to which also saw part of his pancreas removed.

Without the surgery, his prognosis was grim: death within four weeks due to starvation.

Mr Cottle, who had 18 chemotherapy sessions over 24 weeks, is now cancer-free.

In fact, he feels so confident about his future he's taken on a five-year work project.

He said the new clinic had made him "heaps more confident" about continuing to successfully manage the effects of his surgery.

With reduced pancreatic function due to having part of the pancreas removed, Mr Cottle has to take extra care with his diet in order to ensure he has adequate nutrition.

As his digestion is affected, he needs special medication to bolster his digestive juices.

"Because of the clinic I have a really good understanding of how the medication works, and when to take more depending on what I have eaten," Mr Cottle said.