1. Pancreas Cancer Patient Management
2010 Cancer Plan Stakeholder’s Meeting
October 21, 2010

2. Goal 12: Elevate the Quality of Cancer Care in Maine
to meet or Exceed national standards
Objective 12.1:
• Conduct one to three State of Maine Cancer
Outcomes studies per year to monitor
concordance with National Comprehensive
Cancer Network clinical practice guidelines
Objective 12.2:
• Support at least three professional development
opportunities per year

3. Goal 13: Increase access to quality cancer care
Objective 13.1:
• Improving online resources and assuring at least
one public presentation per year of the Maine
Cancer Outcomes studies
Objective 13.2:
• Support the maintenance of ACoS CoC-accredited
cancer programs

4. Goal 13: Increase access to quality cancer
care
Objective 13.3:
• Discuss financial, geographic and resource
barriers to guideline-directed cancer care in
Maine at one regional professional meeting per
year
Objective 13.4:
• Increase clinical trial enrollment in Maine to 2%

5. Incidence of Invasive Pancreatic Cancer,
Maine 2004-2008
Year Number
2004 204
2005 219
2006 189
2007 181
2008 199
992
*Includes only Behavior Code (3). Excludes
histologies greater than 9590.

6. Distribution of Invasive Pancreatic Cancer by
Regional Node, Maine 2004-2008 combined
Nodes analysis Number Percent
All nodes examined
negative 63 6.3
1 or more nodes positive 85 9.2
Positive aspir. Lymph node 4 0.4
No nodes examined 761 76.1
Unknown 79 8
992 100

7. Distribution of Pancreatic Adenocarcinoma by
treatment, Maine 2004-2008
Treatment Number Percent
R only 19 2.6
C only 201 27.2
C &R only 127 17.2
S only 37 5.0
S & C only 14 1.9
S & C & R 60 8.1
Unk R (no S & C) 1 0.1
Unk R (no S & yes C) 1 0.1
Recommended & Unk admin C (no S &
R) 8 1.1
C (no R & Unk S) 1 0.1
Unk S (No S & R) 7 0.9
Unk S & R (no C) 1 0.1
None 262 35.5
Total 739 100.0
S=Surgery, C= Chemotherapy, R=Radiation Therapy, Unk=

8. What about Maine?
• No standard protocol for
neoadjuvant therapy
• Retrospective review of neoadjuvant
cases may allow for “proof of
practice”
• Statewide cooperative protocol will
allow for seamless patient
management

9. Proposal
• Accept a protocol for neoadjuvant
therapy
• Multi-institutional retrospective
review of neoadjuvant cases
• Share patient care components

10. Regional Care Pathway
• 37 hospitals with different patient care
components
• 4 hospitals with panc ca volume
• Shared navigator system to centralize care
• Shared diagnostic and therapeutic
protocols (including neoadjuvant protocol)

11. Patient Care Components
• Medical oncology
• Surgical oncology
• Radiation oncology
• Radiology
– Pancreas protocol CT
– MRI
• Interventional GI
– EUS
– ERCP

12. Patient Care Components
• Pain & Palliative care
• Genetics
• Oncology nursing
• Upper GI navigator