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Advise researchers looking at abdominal pain

Study title: Best Pain Control in Patients with Pancreatic Cancer Study (BAC-PAC Study).

Institution: Norwich Medical School University of East Anglia, Norwich, led by Prof Andrew Hart, Professor of Gastroenterology, Norwich Medical School and Honorary Consultant Gastroenterologist at The Norfolk and Norwich University Hospital, Norwich. The study team includes medical oncologists, senior and junior physicians, medical statisticians and health economists.

About the study: Patients with pancreatic cancer (PAC) have severe abdominal pain and are prescribed strong pain killing tablets called opiates. An example of a strong opiate tablet is morphine. Unfortunately, these opiate tablets may cause severe side-effects which lower patients’ quality of life, and may also not completely relieve patients’ pain. This situation is extremely unpleasant and distressing for patients and their families. Therefore, new treatments for better controlling pain are needed, which have less side-effects.

Possible options include one of two procedures which either i) block the nerves that transmit the pain or ii) relieve any blockages caused by the cancer which gives pain. Both these take about 45 minutes, are done as a day case and involve the patient swallowing a small flexible telescope. They are called endoscopic treatments (ETs) for pain. We do not yet know whether ETs are better than taking strong opiate tablets. This is an area we want to research to see which is the best treatment for pain. However, before we can do this research in a big trial, we need to first find out some important things. These are if: i) patients with PAC are well enough for ETs ii) do patients have a preference for either ETs or strong opiates iii): can we use CT scans to predict which patients develop the worst pain, iv) which of the two ETs may be best for particular patients and v) are patients with PAC willing to complete questionnaires to research this area. To do this, patients diagnosed with PAC in Norfolk will be invited to be involved. At the end of the research we will know the best way to conduct a big trial assessing which is the best treatment for pain ETs or strong opiate tablets. 

Type of opportunity: The researchers are asking for Pancreatic Cancer UK Research Involvement Network members will consider reviewing the BAC-PAC protocol to comment on the design of the study and if the level of involvement requested from patients seems appropriate. The latter include when is the best time and what is the best way to apporach patients to consider participating, and the content  of the questionnaires assessing areas such as pain levels and quality of life.

When will this opportunity be recruiting/taking place?: Prof Hart is seeking PPI on our project over the next few months. If the study was funded, recruitment of patients would start next year in August 2018.

What will participants be asked to do?: Participants in a future study would be asked to complete short questionnaires every two weeks, between diagnosis to end of life, on their: pain levels, use of pain killing drugs, quality of life and use of medical resources. These questionnaires are completed at home and returned to the research office. Participation would naturally be voluntary, and deciding not to participate would not influence their care in any way. Participants have the opportunity to decline to answer certain questions, and may not complete all questionnaires. Public and patient involvement is sought on the protocol as this is a study which must be conducted with great sensitivity in a patient group with sadly a poor prognosis.

Who can take part?: Involvement of people affected by pancreatic cancer is sought from patients and carers with pancreatic cancer to comment on the draft proposal, to help improve it and make it more likely that it will get funding. 

How will the study benefit people affected by pancreatic cancer?: If the protocol is approved by the regulatory authorities, this first BAC-PAC research study would commence recruiting patients in August 2018. This first stage of the research is to show a future big trial of assessing the best way to give pain relief is feasible. If this was demonstrated then patients with inoperable pancreatic cancer would benefit as they would have the best treatment to control their pain with the minimum side effects. Better pain control would improve quality of life and possibly survival times.

What next/who to contact: If you would like to help advise this study, please contact Professor Andrew Hart:

E: a.hart@uea.ac.uk