Focus on Quality of Life With mPDAC

Don't Be Afraid to Speak Up

"A lot of times, patients don't ask the right questions. There's a back and forth that goes on inside their head: Is this symptom really from the cancer? Is it really important for me to talk about this symptom to my oncology team? What if they stop my treatment because of it?" Shariff says. "They try to write off a lot of their symptoms until they become big problems and need care in the ER. Once they do report symptoms, things get better."

Pain, in particular, can keep you from doing the things you love, so tell your team when you need to try something new to get it under control. This might be a combination of medications and complementary approaches. For instance, acupuncture, which uses thin needles to stimulate specific nerves throughout your body, has helped many people.

Nurture From Within

You need nutrients to support your healthy cells and to gain energy, but treatments can take away your appetite. "We can give appetite stimulants," Shariff says, "but the first thing I always address is, are you actually absorbing nutrients from what you're eating?" Not only isn't your pancreas making insulin, it's also not making the enzymes you need to absorb nutrients in food. Talk to your doctor about pancreatic replacement enzymes for better digestion and, if needed, anti-nausea meds.

"I would also emphasize getting nutritional counseling from someone who understands diabetes and pancreatic cancer," Shariff says. An oncology nutritionist can let you know the right amounts of fat, protein, and carbs and the role fiber plays. She points out that many cancer patients are told to eat anything to counter weight loss. "That is the wrong advice for someone with pancreatic cancer and diabetes, because if they eat whatever they want, their sugar goes up and they lose more weight because they do not have insulin to process that sugar into fat and protein. It goes right through their body and causes a lot of havoc while it does that."

When you're ready to eat, focus on foods that give you the most bang for your bite. Start with protein, like red meat, chicken, and fish. Add a rainbow of vegetables; whole grains like oatmeal, barley, and quinoa; and healthy fats like extra-virgin olive oil, avocados, seeds, and nuts. Some foods that might not agree with you are dairy, sugar (including too much high-sugar fruit like bananas), artificial sweeteners, and packaged/processed foods. Stay hydrated with water. Skip sugary drinks, caffeinated beverages, and green tea – despite its benefits, more than two cups a day might interfere with your treatment.

 Move as Much as You Can

Exercise is a powerhouse treatment: It helps you maintain muscle and feel stronger, gives mental boosts by lowering anxiety and stress, and can even improve your appetite. "Even if you're lying in bed, you can take two cans of beans and start moving," Shariff says. "You don't need a lot of equipment – spend $5 on resistance bands, and use them while you're watching TV. Start very slow and low, but do something within the realm of your ability. Moving muscles stimulates your appetite as well."

If you feel overwhelmed by just the thought of moving, ask your care team for a starter plan you can build on over time. Working with a physical therapist  is another great way to begin.

Expand Your Care Team

One of the challenges of getting the care you need is that you may not live near a large cancer center with a staff of specialists trained to manage your side effects. Shariff says that "85% of cancer patients get their treatment at community cancer centers." To answer the needs of cancer patients and their oncologists, she and her husband, Aabid, an expert in machine learning, launched Citrus Oncology. It's a virtual multi-specialty clinic connecting cancer patients with specialists who can address their specific treatment side effects.

These "symptom specialists," as she calls them, include neurologists, cardiologists, nephrologists, dermatologists, and psychologists. They have active virtual practices in Ohio, Texas, Florida, and South Carolina, and you can request that your oncology team contact them online. "The average wait time to get in to see any specialist is three to six months. If you're a cancer patient, you don't have that time. We do our MD-to-MD consultations within a flat 72 hours, and our virtual visits are completed within one week."

In many areas, this collaborative care is called palliative care. Available to anyone with a serious medical condition, its priority is enhancing your quality of life. Think of it this way: Your cancer team focuses on treating your cancer, and your palliative care team focuses on helping you feel as good as possible. You might see palliative care providers at a cancer center, a hospital, a medical office, or even in your own home. Ask your cancer doctor for a referral for palliative care as early as you can in your cancer journey, or look for services near you through the Provider Directory of the organization Get Palliative Care.

Get Emotional Support

It's normal to feel anxious and depressed about having cancer and going through treatment. Many people have "scanxiety," the fear of having another imaging study. Manage these negative emotions with the help of a mental health therapist. In fact, research shows it should be part of your overall care program. Ask your care team about all available resources to help you cope. You might see a psychiatrist for depression or anxiety medication or join a support group where you can share your experiences and learn from others dealing with the same challenges and worries.

"At Duke, we're creating PhD psychology-led support groups where patients can talk about how they're feeling," Shariff says. "This is so relevant for patients to feel like they can connect with someone going through a similar path. No cancer journey is the same – every individual is unique. But if there are crossroads where things intersect, I think it's very helpful to hear that and learn from it."

If your cancer center can't connect you to a support group, check out the Pancreatic Cancer Action Network (PanCAN) Survivor & Caregiver Network. Its volunteers are pancreatic cancer survivors and caregivers from across the country, available to talk to you or even your family members one-on-one. PanCAN can also connect you with a patient services navigator, someone who can guide you through your journey, offer support, and help you access care services.

Reset Your Focus

"The one thing that I learned after having deep conversations with my patients is to compartmentalize each day," Shariff says. "That allows you to focus on trying to make the best use of today, what you have in front of you. It's a hard thing to do, easier said than done, but mindfulness about what you want to do today is very important for those having the word 'cancer' in their dictionary."

Shariff also talks to her patients about resetting their expectations. "If they believe that they're going to go back to their pre-cancer body or pre-cancer life, that can make them not value what they have today. The pre-cancer person is different than the post-cancer person. You have changed emotionally, physically, mentally, in every way. So thinking that you're going to go back to the way you were two years ago, before cancer treatment, results in a lot of unhappiness over where you are. This is just a new you. So, take every day as it comes. Try to compartmentalize, don't think about the past, and don't worry about the future. Just live for the today."