Prognosis and duration

Localised (early stage) pancreatic cancer

This group includes only 20% of those with pancreatic cancer, they are likely to have presented with painless jaundice and gone on to have major surgery as treatment of their pancreatic cancer. Unless major complications such as pancreatic fistula develop as a result of surgery they are likely to be recovered from surgery and any adjuvant therapy within 6-9 months of starting treatment.

Those with pancreatic fistula will require a year to recover and get back to normal activities. These people are likely to attend hospital very frequently and may have a surgical drain and/or wound dressings to manage for many months. They are likely to be on a supervised diet and take multiple prescribed drugs. They are likely to require help with washing and dressing wounds, possibly with getting dressed and be unable to manage a complex diet and supplements without help or support. Fatigue is likely to limit both mobility and self care.

Once recovery is made from surgery and adjuvant treatment there may be a period of health where normal activities are possible. For some there will be an ongoing need to treat diabetes and take pancreatic enzyme supplements to maintain weight and health. For many this will be a short period, median survival after surgical treatment of early stage pancreatic cancer is only around 2 years. Where treatment is very disabling but long term prognosis is good, an award for the duration of treatment with review is appropriate. Around 15% will still be alive after five years.

Advanced / Recurrent disease

In this group needs are unlikely to be identified unless there are ongoing complications from surgery. Because of the poor outcome for this group any awards made during treatment should be for an indefinite period. The majority of this group will develop recurrent disease within two years of treatment; they are likely to have any of the symptoms of the advanced cancer group and at this stage once recurrent disease has developed, projected survival is less than six months.

In all cases where needs are identified, it is appropriate to make indefinite awards as life is likely to be short. If disease recurs, survival and disabling effects are as for advanced pancreatic cancer.

Life awards are recommended even if palliative treatment has appeared to restore health.

Hormone producing or ‘islet’ cell tumours

Needs are unlikely to be identified during treatment except where there are severe complications after surgery – recovery may take up to a year. It is recommended time limited awards are made to coincide with the anticipated end of the recovery period. In the typical case a full return to health is expected. In the rare case where islet tumours are not amenable to surgery or there is metastatic disease treat as an advanced pancreatic cancer case.

All information must be taken into account when considering the duration of disabling effects and the duration of disabling effects must be based on the particular circumstances of the individual claimant.

Amended November 2008