Pancreatic Cancer Awareness Month: Improving Early Detection With Joseph Kalis, PharmD, BCOP
This November, Oncology Data Advisor is honoring Pancreatic Cancer Awareness Month and helping to raise awareness about early detection in hopes of improving outcomes for patients with this disease. In this interview, Oncology Data Advisor Editorial Board member Joseph Kalis, PharmD, BCOP, Ambulatory Oncology Clinical Pharmacy Specialist at the University of Colorado Health, explains the challenges related to diagnosis and screening, ongoing efforts to develop better detection methods, and messages for both the public and the health care community for maintaining awareness of pancreatic cancer.
Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, we're having this interview in honor of Pancreatic Cancer Awareness Month. I'm joined by one of our Editorial Board members, Dr. Joe Kalis, who is an Ambulatory Oncology Clinical Pharmacy Specialist at the University of Colorado Health. He's here to discuss some of the challenges related to diagnosis and screening of pancreatic cancer, as well as the ongoing research in these areas. Dr. Kalis, thanks so much for coming on the show today.
Joseph Kalis, PharmD, BCOP: Hi Keira, always an honor to be here. Thanks again for having me.
Oncology Data Advisor: I'm excited today that we'll be able to join in on the efforts during the month of November to raise awareness of pancreatic cancer. For background, could you talk a little bit about the incidence and prognosis of pancreatic cancer?
Dr. Kalis: It's certainly one of the more aggressive and poor-prognosis types of cancer out there. If we look at statistics, the National Cancer Institute here in the US reports that about 3.3% of all cancer cases diagnosed annually are pancreatic cancer. However small that number is, it still makes up anywhere from 8% to 10% of cancer-associated deaths, depending on what sources and what year you're consulting with.
Prognosis, unfortunately, is also quite poor. Again, the National Cancer Institute reports that about 12.5% of patients are still alive five years after survival. It's certainly a cancer type that while we have treatments for it, there's still a lot of work to be done in screening and early detection. It really speaks a lot to the need for exactly what we're talking today, the awareness of the disease and recognizing some of those signs and symptoms.
Oncology Data Advisor: You mentioned the need for better screening and early detection. What are some of the factors that make early diagnosis a challenge?
Dr. Kalis: Some of it comes down to the physical location of the pancreas—it's sort of in the upper abdomen but tucked away behind other organs. A lot of the cases I've seen that are found in early stages—stage I or stage II, where perhaps surgery is still an option—are really just incidental findings. Maybe a patient had to have a scan done or tests done for another cause, and then they saw something on the scan, it went into biopsy, and they found out it was pancreatic cancer.
The symptoms, as well, are quite nonspecific, as the term that we as medical folks would use. They're very broad. It could be abdominal pain, it could be a change in bowel movements, or it could be a new-onset low back pain, depending on where in the pancreas the tumor's originating from. There can be other things such as fatigue, jaundice, or weight loss. Essentially, these are symptoms and conditions that there can be many other explanations for.
Talking through the statistics like we just did, if I show up at my primary doctor saying, "I've got some nonspecific abdominal pain, I've got a little diarrhea, and I've had some weight loss," when making their differential diagnosis, they might think, "Okay, perhaps it's something viral. He's trying to lose weight anyway; maybe that's part of it." It can be a little bit of a longer path until the formal diagnosis of pancreatic cancer is established.
Oncology Data Advisor: It's definitely a very challenging disease to diagnose. Along those lines, are there any efforts that are underway to develop early detection or different screening methods?
Dr. Kalis: Absolutely. It's been one of the things I'd consider almost the Holy Grail in pancreatic cancer detection and treatment. There are certainly methods out there now, including imaging, things from computed tomography (CT) scans to magnetic resonance imaging (MRI). A lot of practitioners will use what's called an endoscopic ultrasound, where the tube will go down a patient's throat and then the ultrasound is taken internally.
It would be great if we could develop a way to look for things in a blood test. There are some biomarkers used now, including one called cancer antigen 19-9, or CA 19-9 is what you'll hear for short. While it can be measured or detected in a blood draw, it's unfortunately not specific to just pancreatic cancer. It could be elevated if somebody has a gallstone or cirrhosis, so it can't be used by itself as a way of diagnosing or even really screening for pancreatic cancer. You'd still need the imaging and some of those other pieces to complete the puzzle.
Going on now across many tumor types, researchers are looking at circulating tumor DNA (ctDNA), which is essentially DNA fragments from the cancer that we know are linked to a certain cancer type. I'm personally curious to see how that research bears fruition in what it might tell us in pancreatic cancer. But I think with the screening tools we have now, if we were to broadly screen everybody over the age of 50, I've seen some statistics that would indicate that there would be a very large number of false positives. Folks that don't actually have cancer would have to go through that journey and the mental anxiety and anguish and testing, hopefully to find out that they don't have it. So, screening can be a challenge, both in terms of what tests we have available, but then also how sensitive and how accurate really are those tests.
Oncology Data Advisor: It's great to hear that there are all of these directions being explored to improve diagnosis and screening. In light of November being Pancreatic Cancer Awareness Month, is there anything you would most like to share about the disease in hopes of raising more awareness of it, both for the health care community as well as the public?
Dr. Kalis: Absolutely. It's certainly a bad actor of a disease, as some of my mentors would call it. I think what I would encourage folks to do is continue to be self-aware of their own bodies and their own health. If something odd or unusual is happening, you're often the first person that notices it because you're living in that body. If there is something that has caught you off guard or by surprise, if you're thinking, "Yeah, I've got this abdominal pain," if it's caught your attention and it's out of the ordinary, I would say don't hesitate to get it checked out. If it turns out to be nothing, well, then at least it's nothing, and you continue throughout the course of daily life from there.
Where we are in the research and science with pancreatic cancer right now is early detection, and this is really the key. Even if we find one of those odd, nonspecific symptoms, we catch it early. Surgery could be an option, radiation's an option, and you may or may not need to have chemotherapy, but it's really the cases we catch early on that are the ones that do better long-term.
Oncology Data Advisor: That's great to know. Is there anything else related to pancreatic cancer that you'd like to mention today?
Dr. Kalis: I'd say that we've got treatment options available. There's still a lot of research ongoing with chemotherapy and some of the sequencing. We've made, unfortunately, slower progress with pancreatic cancers in terms of chemotherapy treatments compared to others like breast and colon and lung, simply because it's a lot harder to actually get chemotherapies into the pancreatic tumors. There's this thicker outer layer called the stroma that is difficult to even get smaller drugs through. A lot of the strategies now are involving coding or disguising chemotherapies in such a way that it's almost able to pass undetected into the tumor.
So, I'd say if somebody that you know or a loved one is diagnosed, it's not without hope. We've got treatments out there, and the science is advancing. But again, get those signs and symptoms, anything odd or unusual, checked out as soon as you can.
Oncology Data Advisor: These are all really great messages to hear, so thank you so much for coming on today and helping us to raise awareness of pancreatic cancer this month. I'm looking forward to hearing more about all of the research that's underway to improve treatment outcomes for people with this disease. Thank you again.
Dr. Kalis: My pleasure. Hope to see you all again soon.
About Dr. Kalis
Joseph Kalis, PharmD, BCOP, is an Ambulatory Oncology Clinical Pharmacy Specialist at the University of Colorado Health. In this position, he educates patients about their chemotherapy and immunotherapy treatments, reviews treatment plans and dose adjustments, and assists with supportive care. Dr. Kalis' professional interests include multiple myeloma and hematologic malignancies. He enjoys teaching learners from all walks of life. Dr. Kalis has spoken extensively for continuing education programs, along with having published various peer-reviewed papers on oncology and pharmacy.
For More Information
Pancreatic Cancer Action Network (2023). Pancreatic Cancer Awareness Month 2023. Available at: https://pancan.org/facing-pancreatic-cancer/change-the-course/
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.