- Environmental and genetic causes of pancreatic cancer: The Queensland Pancreatic Cancer Study was an NHMRC-funded case-control study that enrolled ~700 cases and matched controls. Key findings are:
- While smoking increases risk of pancreatic cancer, ceasing smoking can reduce the risk back to that of a never smoker within 10 years, irrespective of the number of cigarettes smoked. https://www.ncbi.nlm.nih.gov/pubmed/24461200
- Having a first-degree relative who has had pancreatic cancer doubles the risk of developing it. We also found an increased risk in people with a family history of melanoma. https://www.ncbi.nlm.nih.gov/pubmed/27810486
- We analysed the association between different strains of Helicobacter pylori and pooled our results with other published findings. We observed evidence of strain-specific associations, with one strain decreasing risk and one increasing risk. https://www.ncbi.nlm.nih.gov/pubmed/25951801
- We found that living in areas with high ambient ultraviolet radiation was associated with reduced risk of pancreatic cancer. While this may be due to uncontrolled confounding, if the association is causal it might indicate a role for vitamin D. https://www.ncbi.nlm.nih.gov/pubmed/24075798
- Our samples and data have also contributed to the identification of multiple genetic variants that are associated with risk of pancreatic cancer.
We are now focussed on using linked data to identify if commonly used medications such as beta-blockers, statins, or bisphosphonates can alter risk of or survival from pancreatic cancer.
- Patterns of care in patients with pancreatic cancer: We conducted an NHMRC-funded comprehensive review of the medical records of all residents of Queensland or New South Wales diagnosed with pancreatic cancer over an 18-month (NSW) or 2-year (QLD) period (N=~1800). Key findings of this work are:
- People whose pancreatic cancer surgery is performed by a surgeon who performs 4 or fewer of these surgeries per year were more likely to die from a surgical complication and a higher 1-year mortality and worse overall survival than surgeons who performed more of these procedures. https://www.ncbi.nlm.nih.gov/pubmed/27184672
- There was strong evidence of variability in multiple aspects of care (access to surgery, chemotherapy, stenting) depending on sociodemographic factors such as living in a rural or regional area. https://www.ncbi.nlm.nih.gov/pubmed/29573158; https://www.ncbi.nlm.nih.gov/pubmed/29215539; https://www.ncbi.nlm.nih.gov/pubmed/27374480
- We constructed a quality of care score based on a Delphi process. https://www.ncbi.nlm.nih.gov/pubmed/26800012. We found that the overall score was influenced by sociodemographic factors, and that the score was strongly associated with survival. https://www.ncbi.nlm.nih.gov/pubmed/27852184.
In their entirety these results suggest that there is scope for improving the care of patients with pancreatic cancer. We are now collaborating with colleagues at Monash University on an NHMRC-funded project to examine whether providing hospitals and clinicians with structured feedback against a range of quality indicators can lead to improved care.
- Quality of life in patients with pancreatic cancer: We collected comprehensive information about anxiety, depression, quality of life, perception of care coordination, and supportive care needs from 136 patients who had been diagnosed with pancreatic cancer, and a subgroup of their carers. Key findings were:
- A high proportion of patients with pancreatic cancer reported having needs that were not met, with more than half reporting moderate-to-high unmet physical or psychological needs. https://www.ncbi.nlm.nih.gov/pubmed/26123474. This needs persisted over the course of the disease, and were most strongly associated with having pain or anxiety, suggesting that more attention needs to be paid to alleviating these symptoms. https://www.ncbi.nlm.nih.gov/pubmed/27086312
- People caring for patients with pancreatic cancer suffered high levels of anxiety, with 39% having evidence of anxiety. 70% of patients and 58% of carers had quality of life scores below the Queensland population average. https://www.ncbi.nlm.nih.gov/pubmed/28153446
Based on these findings we are now piloting an intervention delivered over the telephone to support patients and their carers. If successful this could be implemented and delivered to all patients, irrespective of where they live or their ability to travel.