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Palliative Care

Like many pancreas cancer patients, former patient and donor Skip Viragh experienced significant pain.  Pancreas cancer causes pain because the pancreas is located near several critical organs that are impacted as the cancer grows and spreads. In addition, the pancreas is part of the digestive system and it is where insulin is manufactured, so patients often require nutritional and dietary support. 

“Our mission is to fully take care of patients, and that means not only treating their cancer but the symptoms and side effects it causes as well,” says Thomas J. Smith, M.D., the Harry J. Duffey Family Professor of Palliative Medicine at Johns Hopkins in Baltimore and one of the world’s leading experts in palliative care.

Smith works with Johns Hopkins Kimmel Cancer Center clinicians to help guide the management of cancer-related symptoms, including physical signs such as pain and nutritional issues common to pancreas cancer, but also anxiety, depression, and essentially anything that affects patients’ quality of life.  Smith and team meet with patients to discuss and understand their goals. 

In Viragh’s case, he wanted to return to his home in Florida, but unrelenting pain made it impossible. His doctors tried a variety of approaches to relieve the pain, but nothing worked.  Anesthesiologist and member of the pancreas cancer multidisciplinary care team Michael Erdek, M.D., devised an approach using a tiny plastic tube, known as an intrathecal catheter, to access the spinal cord and deliver drugs to block the nerves sending the pain signals. The procedure worked, and he was able to go home.

As a result, Viragh’s legacy includes palliative care research and clinical trials. A trial inspired by his own experience explores the benefits of using the intrathecal catheter method as an earlier intervention for patients suffering pain.

Another trial, led by Ana De Jesus-Acosta, M.D., addresses malignant ascites, a condition common in pancreas cancer that causes a painful accumulation of fluid in the abdomen. Typically, patients must make frequent trips to the clinic to have the fluid drained, but De Jesus-Acosta is studying a technique that may allow patients to remove the fluid safely and conveniently at home.

Smith also has started a clinical trial to see if patients benefit from seeing a team of palliative care specialists from the time of diagnosis. 

“In lung cancer patients, research showed that this type of care resulted in better quality of life, fewer symptoms, and almost three months longer survival,” Smith says. “It makes sense that having another specialist team helping patients adapt to their illness would help them and their families, and they don’t have to give up anything to be in this trial. They just note their symptoms and let us help them understand their illness and adapt to it. I think Viragh would be very happy to know we are doing this kind of work.”

“The Kimmel Cancer Center considers palliative care a priority,” adds Smith.  “The Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care is a leader in pancreas cancer research and treatment, and our goal is to make sure it is also a leader in the palliative care of patients with pancreas cancer.”

More information about the Palliative Care and Pain Program at Johns Hopkins Kimmel Cancer Center

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