• Managing the Side Effects of Pancreatic Cancer and Its Treatment

    The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
    Medications may help to either prevent or reduce side effects of treatment, or to manage certain side effects once they occur. Since you can develop these symptoms from the treatment and/or from the cancer itself, it is essential that you discuss any concerns you have with your doctor.
    Some of the complications of pancreatic cancer that will require supportive care include the following:

    Development of Diabetes

    If your treatment includes surgery to remove part or all of your pancreas, you may develop diabetes. Diabetes occurs when your body can no longer produce insulin or becomes resistant to the hormone.
    A functioning pancreas produces insulin naturally. Insulin helps you digest food, breaking down carbohydrates into smaller chemical units (glucose) that your body can use for energy or can store for future use. Insulin keeps your blood glucose within a normal, healthy range.
    If your pancreas is not functioning properly, or if you have had surgery to remove some or all of your pancreas, you may develop diabetes and will need to be given insulin, usually in the form of an injection. Treating diabetes includes regularly testing your blood glucose level, giving yourself insulin shots, and monitoring your diet. Your doctor will teach you how to care for this condition.
    Taking Insulin
    The main forms of insulin include:
    • Humulin
    • Novolin
    • Velosulin
    Insulin must be injected just under your skin, often several times a day. The medication can be given through injections with a small syringe or by wearing an insulin pump that automatically and regularly provides a dose of insulin throughout the day. There are a number of different forms of insulin, ranging from short-acting to long-acting varieties. You may need to utilize more than 1 type.
    You’ll probably have to test your blood sugar levels 2 or more times each day to monitor your response to the insulin. Since diet and exercise affect blood sugar levels, you will need to adjust these important aspects of your life.
    Side Effects of Insulin Therapy
    Side effects can occur if blood sugar levels go too high or too low.
    Symptoms of high blood sugar include:
    • Excess thirst
    • Increased appetite
    • Frequent urination
    • Fatigue
    Symptoms of low blood sugar include:
    • Feeling shaky or jittery
    • Lightheadedness or fainting
    • Confusion
    • Sweating
    • Fast heartbeat
    • Blurry vision
    When to Contact Your Doctor
    Always contact your doctor if you have any of the following:
    • Seizures
    • Fainting
    • Chest pain
    • Difficulty breathing
    • Yellow eyes or skin—jaundice
    • Easy bleeding or bruising

    Problems Digesting Food

    As the cancer destroys pancreatic cells, normal digestive function is impaired. In addition, if you have had all or part of your pancreas surgically removed, you may have trouble digesting and using the nutrients from your food. You may need to take enzyme tablets with your meals to help solve this problem.
    Pancrelipase contains enzymes similar to those produced by a healthy pancreas. These enzymes help you digest your food, breaking it down into smaller chemical units that your body can use for energy.
    Always swallow your pill or capsule whole. Do not break up the medication or chew it. Doing so may cause mouth irritation. Your doctor will tell you how many to take, ranging from 1-4, with each meal or snack.
    Possible side effects of pancreatic enzymes include:
    • Mouth irritation
    • Skin rashes
    • Diarrhea
    • Nausea
    • Abdominal cramps or pain
    When to Contact Your Doctor
    Always contact your doctor if you have any of the following:
    • Pain or diarrhea
    • Stools that look greasy or float on the toilet water
    • Difficulty breathing or wheezing

    Weight Loss

    Weight loss may occur when your appetite is severely decreased due to the cancer. You may need to take dietary supplements, drink nutritional supplements, or receive some nutrition through a tube placed directly into your stomach or intestine. Tell your doctor if you are losing weight. You can be referred to a registered dietitian to help maximize your nutritional intake.


    Pain in pancreatic cancer can be quite severe and debilitating. If you are having surgery, your doctor may choose to cut some of the nerves that carry pain messages from your pancreas and the surrounding area to your brain. Alternatively, alcohol can be injected into these nerves to deaden the painful sensations.
    If you are not having surgery, similar types of nerve-deadening injections may be given directly through the skin of the abdomen. You and your doctor should discuss what kinds of pain medications are available. The goal will be to relieve your pain as much as possible, while still allowing you to enjoy as much of life as possible.
    The pain medications commonly given for pancreatic cancer are opioid analgesics:
    • Hydrocodone
    • Morphin
    • Methadone
    • Oxycodone
    • Fentanyl patch
    • Acetaminophen combined with:
      • Oxycodone
      • Hydrocodone
    Possible side effects of opioid analgesics include the following:
    • Lightheadedness or feeling faint
    • Drowsiness
    • Nausea or vomiting
    • Constipation—methylnaltrexone can rapidly relieve this side effect

    Nausea and Vomiting

    Nausea and vomiting may occur if the tumor is blocking part of the gastrointestinal tract, if you are constipated, or as side effects of chemo- or radiation therapy.


    Depression is commonly experienced in patients diagnosed with pancreatic cancer. Often, the depression is noted before the diagnosis of cancer is made. If you are feeling the symptoms of depression—extreme fatigue, lack of interest in things that once mattered to you, mood swings—for at least 2 weeks, talk with your doctor.
    If appropriate, your doctor can recommend therapy, support groups, medications, or other means of managing depression.


    Cruz MD, Young AP, et al. Diagnosis and management of pancreatic cancer. Am Fam Physician. 2014;89(8):626-632.

    Pancreatic cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003131-pdf.pdf. Accessed October 5, 2015.

    Pancreatic cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 23, 2015. Accessed October 5, 2015.

    Pancreatic cancer. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/gastrointestinal-disorders/tumors-of-the-gi-tract/pancreatic-cancer. Updated July 2014. Accessed October 5, 2015.

    6/25/2008 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Thomas J, Karver S, Cooney GA, et al. Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med. 2008;358(22):2332-2343.

    11/30/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: US Food and Drug Administration. Propoxyphene: withdrawal—risk of cardiac toxicity. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm234389.htm. Updated September 5, 2013. Accessed October 5, 2015.

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