2 Clinical Need and Practice
2.1 Pancreatic adenocarcinoma is a common cancer with an annual incidence rate of around 12 per 100,000. In 1997 there were an estimated 5,730 people (2,740 men and 2,990 women) diagnosed with pancreatic cancer in England and Wales. Of these 75% (4,320: 1,940 men and 2,380 women) were over 65 years of age.
2.2 The annual mortality rate from pancreatic cancer is almost identical to the incidence rate (11 per 100,000) as the prognosis is extremely poor. The 1-year survival rate is generally low at around 12%, and less than 3% of patients survive to 5 years.
2.3 The symptoms of pancreatic cancer are wide-ranging, including jaundice, nausea, diarrhoea, weight loss, loss of appetite, and severe pain. The vast majority of patients present with advanced disease and symptoms significantly reduce the patients' quality of life.
2.4 Potentially curative surgery is currently a treatment option for around 4% of the overall patient population. As the majority of cases are diagnosed at advanced stages, palliative care will often be the best that can be offered to relieve symptoms and the outcomes remain poor.
2.5 Palliative surgery and endoscopic placement of biliary drainage stents can be used to control complications of the pancreatic cancer such as jaundice and gastric outlet obstruction, thus improving quality of life.
2.6 Alternative treatment options include chemotherapy and radiotherapy. It is estimated that around 10-15% of patients diagnosed with pancreatic cancer currently receive chemotherapy.
2.7 5-fluorouracil (5-FU) has been the standard chemotherapy used in the UK over recent years, with evidence suggesting a small survival advantage and improvements in quality of life (QoL) in a proportion of patients with pancreatic cancer. 5-FU is administered using a variety of doses and schedules but the response rate rarely exceeds 20% and no consistent effect on disease-related symptoms or survival has been demonstrated.