Pancreatic cancer (pC) is a highly virulent neoplasm with an exceedingly poor prognosis. Using conventional therapy, cure remains an elusive goal, with <5% of all patients surviving for five years. Palliation is frequently difficult to achieve. Pain is a common, severe symptom experienced by most patients. There are few if any studies prospectively evaluating the prevalence and characteristics of pain and psychological distress in PC patients; the usefulness of therapeutic modalities such as surgery, radiation or chemotherapy in relieving pain has not been well established. MSKCC has a large pC patient base, highly experienced pain and psychiatry Services, and a group of surgeons, radiation therapists, gastroenterologists and medical oncologists who have a close working relationship, who have ongoing research interests in PC, and have a demonstrated commitment to co-operative studies via The Pain Network. We propose two prospective randomized therapeutic studies: (1) an institutional study to prospectively evaluate pain and psychological distress in unresectable patients, treated with intra-operative palladium brachytherapy versus brachytherapy plus intra-peritoneal and intravenous chemotherapy: (2) to compare the analgesic efficacy and side effects of two alternative methods of opiod administration (continuous subcutaneous infusion versus epidural administration) in patients with refractory pain from PC. All patients will be studied prior to and following treatment, using previously validated pain-assessment and psychological instruments, and effects of the individual therapies compared over time. These proposals offer the opportunity to assess the ability of state-of-the-art therapy to impact on PC-related pain and psychological distress, and to separate out the component parts of pain and distress.
