FONO Series: Integrative Management of Pancreatic Cancer: Treatment Strategies for Digestive Symptoms
1 CE (.5 rx) Approved by AANP, CONO & OBNM
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Heather Wright, ND, FABNO
Speaker Biography:
Dr. Heather Wright is founder of Goodapplewellness.com, a telehealth consulting practice, and is currently a co- Research Director for KNOWintegrativeoncology.org- a database of human studies in integrative oncology. Having graduated from Bastyr University in Seattle in 2005, Dr. Wright then worked as an integrative provider within the department of internal medicine at Claxton Hepburn Medical Center in upstate NY. Dr. Wright completed naturopathic oncology training at a cancer treatment hospital in Philadelphia Pennsylvania and became a Fellow of the American Board of Naturopathic Oncology (FABNO) in 2011. Dr. Wright worked in hospital based cancer care for 10 years, advancing academic research projects and having team trained 8 other naturopathic fellows. After writing and running a clinical trial for pancreatic cancer patients receiving intravenous vitamin C, Dr. Wright has been active in working with patients diagnosed with pancreatic cancer since 2014. In addition, Dr. Wright serves to advance the mission of several boards including the Oncology Association of Naturopathic Physicians, The Cancer Support Community & Gilda’s Club of Greater Philadelphia, The Pennsylvania Association of Naturopathic Physicians, and Cancerchoices.org. Dr. Wright believes all people diagnosed with cancer should have access to safe integrative and supportive therapies as part of their cancer care.
Abstract:
A high frequency of cancer patients experience digestive tract symptoms of exocrine pancreatic insufficiency (EPI) at diagnosis. History of pancreatic surgery, radiation treatment, location of primary tumor, liver or peritoneal involvement, and gallbladder and liver function are important contributing factors. Multidisciplinary providers including GI specialists, medical oncologists, nutritionists and naturopathic doctors often recommend various interventions such as digestive enzymes, diet modification, anti-emetics, and supplements to support reduction in digestive symptoms. For the purpose of this lecture I will focus on evidence based recommendations for optimizing treatment of EPI using Pancreatic Enzyme Replacement Therapy (PERT) in combination with interventions that support reduction of symptoms and may benefit overall nutritional status and quality of life (QoL). These may include: proton pump inhibitors, bicarbonate, anti-emetics, anti-diarrheals, demulcents, pectins and nutrients such as magnesium, zinc, B12, vitamin D3, and vitamin A.
I will also recommend evidence-based tools for assessment of nutrition status and symptoms in pancreatic cancer. Tools like the NCCN-FACT Hepatobiliary-Pancreatic Symptom index, PACADI tool, and the EORTC Pan 26 questionnaire can be useful to clinicians in assessing the benefit of supportive care interventions. The goal of integrative management of pancreatic cancer is to improve quality and quantity of life with focus for optimizing digestive health and nutrition status first and foremost.
Improved QoL in pancreatic cancer has recently been associated with survival advantage in a large prospective phase III clinical trial.
Learning Objectives:
Risks for Pancreatic cancer
Normal digestive physiologic synchrony and pathways that are disrupted in pancreatic cancer
Symptoms of Pancreatic exocrine insufficiency and testing
Validated tools for assessing supportive care interventions in pancreatic cancer
Evidence based treatment of pancreatic insufficiency with dosing guidance for lipase based pharmacologic therapies
Nutrition goals and guidelines for people with pancreatic cancer
Therapeutic approaches for diarrhea, gas & bloating, nausea, neuropathy, mucositis, stomatitis
Natural therapies currently being investigated in pancreatic cancer