Pancreatic Cancer Tumor Board Janet Ely, MSN, FNP, AOCNP, APCHN - PDF document

3/19/2018 Pancreatic Cancer Tumor Board Janet Ely, MSN, FNP, AOCNP, APCHN Diane Koeller, MS, MPH, LCG Jennifer May, RD, CD Nicole Messier, BSN, RN, OCN, ONN‐CG • Fred (74); presented to PCP with jaundice, bilirubin 8.6 • 4/20/16‐CT abdomen; 3.6 cm pancreatic head mass with biliary ductal dilatation • 4/22/16‐EUS/ERCP; pancreatic head mass abutting portal vein but no obvious vascular invasion, stent placed. Biopsy confirms pancreatic ductal adeno ca • Referral to UGI MDC • Chest CT; no metastatic disease • 4/25/16‐case reviewed at UGI tumor board w/recommendation for neoadjuvant chemotherapy x 4 cycles, oncology consult 4/28 1

3/19/2018 • 5/9/18 FOLFIRINOX initiated • C1 & 2‐nausea, abdominal pain, diarrhea, anorexia and fatigue • Referral to dietician • Palliative care referral • C3 & C4‐tx changed to FOLFOX • 7/8/16‐CT c/a‐decrease in size of pancreatic head mass to 2.4 cm, no obvious vascular involvement or metastatic disease • 7/25/16‐surgical consult; plan for Whipple after cycle 6 • 8/30/16‐Whipple; ypT2ypN1 (1/17 LNs, margins negative) • Review at UGI tumor board; 2 additional cycles FOLFOX to complete total of 4 months of systemic therapy • Completes chemotherapy on 11/3/17 • 2/16/17‐CT c/a; no evidence of recurrence • Oncology f/u; feeling well, no issues • Ca 19‐9 522 (147 on 12/15, 61 on 10/18) • 4/20/17‐Ca 19‐9 928 • 5/1/17 CT c/a‐2 new liver lesions c/w metastatic disease • Oncology f/u‐chemotherapy recommended • 5/11/17‐Gemzar initiated • 6/1/17‐Ca 19‐9 675, tolerating chemo well w/o toxicity 2

3/19/2018 • 8/3/17‐Ca 19‐9 997, bilirubin 1.4 • 8/8/17‐CT c/a‐liver lesions stable, new soft tissue mass at surgical site resulting in biliary ductal dilatation suspicious for local recurrence • 8/18/17‐PTC placement, CBD brushings highly suspicious for malignant cells • 9/7/17‐oncology f/u; feeling better, jaundice resolved. Gemzar re‐started • Reviewed at UGI tumor board; recommendation for consideration of palliative radiation to help reduce risk of local recurrence causing future obstruction • 9/29/17‐radiation oncology consult; palliative radiation offered, pt declined • Systemic treatment continued • 11/9/17‐Gemzar given; pt feeling well, active • 12/23/17‐to ED w/fever, blood cultures + for Klebsiella pneumonia, admitted • CT a/p‐cholangitis, progression of local recurrence and metastatic disease in liver • Pt chose to d/c home for holiday; decision made to transition to hospice • Passed away 2/9/18 at Vermont Respite House 3