Pancreatic cancer and its treatment can lead to long lasting medical problems, such as diabetes, indigestion or diarrhoea, but quite often these problems are treatable.
Many patients with pancreatic cancer develop diabetes months before their doctors diagnose the disease. Diabetes may also develop during or after treatment. People with diabetes commonly feel thirsty, pass a lot of urine, feel hungry, weak and lose weight. People’s vision may be affected too. The body may still make some insulin, but not enough. Doctors can sometimes control diabetes by changing a person’s diet alone, or by diet and tablets taken by mouth. Sometimes people need injections of insulin too. For more about diabetes see Healthtalkonline – Diabetes Type 2
Some people had developed diabetes before learning that they had pancreatic cancer. For instance, Steve was very thirsty and his vision had deteriorated (see ‘Signs and symptoms of pancreatic cancer’
). His doctors prescribed injections of insulin.
Carol’s diabetes was diagnosed at the same time as her pancreatic cancer in 2008 and she started daily injections of insulin. In 2009, having had surgery for the cancer, Carol saw an endocrinologist. He told her the unexpected news that what was left of her pancreas was functioning again and that she could stop her injections.
People may need to consult a dietitian because their need for a low calorie diet to help control their diabetes conflicts with their need for a high calorie diet to regain weight lost as a result of their cancer symptoms and its treatment.
After its initial diagnosis and treatment people’s diabetes was usually managed in primary care but Richard’s (Interview 22) GP was reluctant to do this because his cancer meant that his needs differed from those of other diabetic patients.
Eating and digestion
The pancreas makes enzymes which help people to digest their food. Many people with pancreatic cancer have bowel problems because insufficient digestive juice reaches the duodenum due to a blocked pancreatic duct or as a result of surgery. Thus people with pancreatic cancer cannot digest fats normally. These people usually take medicines, such as antacids and Creon capsules, which contain a mixture of digestive enzymes extracted from the pancreas of pigs, to aid their digestion. No-one we interviewed reported any side effects of Creon.
Lesley is a vegetarian so at first she was not happy about taking Creon. She asked the Vegetarian Society and was reassured that she had no choice about taking Creon and was still a vegetarian. If she stopped taking it she lost weight rapidly.
Bob had not been prescribed Creon but learnt about it on the internet when he was concerned about feeling nauseous on eating. He asked his specialist for it. Steve said that if he ate a fatty meal without Creon he felt bloated and uncomfortable. People usually worked out how much Creon they should take according to what they were eating. People sometimes had diarrhoea if they didn’t calculate the optimal dose. Some had had to increase the dose of Creon over time to counter their symptoms.
Most people said that taking Creon helped their digestion, but it had not worked for Simon’s wife, not even when she followed advice to open the capsules and sprinkle the contents on her food.
Some people said that taking Creon enabled them to eat anything they wanted to, even in large quantities, whereas others still could not tolerate some foods. Ann said it was difficult learning what she could and couldn’t eat and that she no longer enjoyed cooking as it gave her nausea. A few people mentioned that they found it difficult to digest meat and so chose fish and eggs instead. Phil managed small meals without any Creon. He could still eat all the foods he used to eat but in smaller quantities.
Some people, such as Adrian, found it hard to eat enough to maintain body weight. Their doctors suggested eating small portions at frequent intervals. Their dietitians often recommended special drinks to boost their protein and calorie intake, but Lilian said she disliked them because they were so sweet; Hamish said they had given him diarrhoea. Adrian said that, like food, they made him feel too full. Lilian also said it was difficult to gain weight because she didn’t like some of the high calorie foods that she was recommended to eat, such as milk puddings, pastry and cakes. Fred had to eat his last meal before 7 pm to prevent indigestion and discomfort during the night. Hamish found it hard to eat enough because of bloating; he said his taste buds were not working and his food tasted like cardboard. Some people, such as May, still had bowel problems and lost weight in spite of taking Creon. May also took omeprazole to reduce gastric acid, and metoclopramide, which her doctor prescribed for nausea or vomiting.
Some people took many medicines. Peter (Interview 43), for example, took Creon and domperidone, which helps to move food faster through the gut, and helps to prevent nausea, bloatedness and regurgitation. He also took cyclizine, an antihistamine used to treat sickness or dizziness. At times he also took loperamide (Imodium), which is used to treat diarrhoea. This drug slows the forward movement of intestinal contents by the intestinal muscles. He also took thiamine (vitamin B1), and painkillers. Fred took about 13 tablets each day, including Creon, and iron tablets.