Patient Resiliency and Cachexia Biology

Pancreatic diseases inflict a huge burden of suffering on patients, dramatically impacting their quality of life. Patients with pancreatitis frequently have severe pain that requires prolonged hospital stays and significantly limits their activities once discharged; after recovery, many suffer from malnutrition. In patients with pancreatic cancer, even small pancreatic tumors will induce cachexia, a major barrier during treatment in addition to quality of life.

The Brenden-Colson Center for Pancreatic Care is dedicated to improving patient resiliency and quality of life through supporting research critical for understanding drivers of cachexia, malnutrition, and other debilitating symptoms. We are discovering novel treatment options and anticipate that increasing resiliency will decrease the length of post-surgical hospital stays and increase survival time.

Ongoing Research Projects

While the exact mechanisms linking pancreatic cancer to cachexia are unknown, our physicians and researchers are working to identify anti-cachexia agents and blood-based biomarkers. The ultimate goal is to integrate these discoveries into our Pre-habilitation program, which is designed to help patients become as healthy as possible before surgery or chemotherapy through nutritional, pharmaceutical, and behavioral therapy.

  • Some of our current research focuses on understanding the role of pancreatic cancer extracellular vesicles (submicron-sized particles secreted by cells) in neuroinflammation and visceral pain.
  • We are also investigating how metabolic reprogramming and undernutrition impact pancreatic cancer cachexia.

Dr. Aaron Grossberg is leading an effort to incorporate cachexia metrics into the Pancreas Translational Tumor Board and our clinical workflow. His lab is optimizing a method to quantify muscle wasting by analyzing pre-surgical CT images. Implementing this metric would provide vital prognostic information to clinicians and could be used to better understand patient outcomes.

The following projects represent our commitment to a multifaceted approach to pancreatic cancer and cachexia research. 

  • Muscle biomarkers of cachexia, surgical and oncologic outcomes in pancreatic cancer – Aaron Grossberg
  • Evaluating the role of neoadjuvant therapy on pancreatic cancer resection outcomes – Aaron Grossberg
  • How metabolic reprogramming in the liver impacts tissue wasting, physiology, and survival in pancreatic cancer – Aaron Grossberg
  • Sarcopenia analysis in pancreatic cancer – Stephanie Krasnow
  • ACTO: A Phase 2, Pilot Randomized Trial of Olanzapine in the Treatment of Cancer Cachexia  – Eric Roeland
  • RIVER PDAC: A Phase 2b/3, Randomized, Double-Blind Study to Investigate the Efficacy, Safety, and Tolerability of Ponsegromab (PF-06946860) Compared with Placebo, Both with Background First-Line Chemotherapy in Adult Participants with Cachexia and Metastatic Pancreatic Ductal Adenocarcinoma – Eric Roeland
  • Understanding the role of Myc in pancreatic cancer cachexia – Rosalie Sears
  • Using tissue microarrays from patient samples to study pancreatitis – Rosalie Sears
  • Developing and characterizing new models of pancreatic cancer cachexia – Teresa Zimmers
  • Investigating the role of OSM-OSMR in the pancreatic tumor microenvironment’s effect on cachexia – Teresa Zimmers

Resources

Many people with pancreatic cancer lose weight without trying. When that weight loss keeps going, takes muscle with it, and does not turn around with eating more, it has a name: cachexia (ka-KEK-see-uh). It is sometimes called wasting syndrome.

What Makes It Different
Cachexia is not simply the result of eating less. It is a change in how the body uses fuel, driven by the cancer itself and by the body's inflammatory response to it.

In cachexia, the body breaks down muscle and fat for energy even when you are eating. That is why the scale can keep moving down, and why strength can fade, despite real effort at the table.

This is also what separates cachexia from a treatment side effect. Nausea, mouth sores, and taste changes make eating harder, and they matter — but cachexia is a separate condition that can continue even when those symptoms are well controlled.

Why It Happens
Researchers are still working out the full picture, but several things happen at once:

  • Signals from the tumor and the immune system change how muscle and fat tissue behave.
  • The body burns more energy at rest than it used to.
  • Appetite signals in the brain are turned down, so hunger fades.
  • In pancreatic cancer, the pancreas may not release enough digestive enzymes, so food passes through without being fully absorbed.

This is not your fault.
Cachexia is caused by the disease, not by willpower, not by the food choices you made, and not by how hard you are trying. Naming it accurately is the first step to treating it.

OHSU Specific Resources:

Cachexia Resources:

Exercise Resources:

Other Resources:

Classes for Caregivers

Powerful Tools for Caregivers
A six-week educational series for unpaid family caregivers caring for a relative or friend with a chronic illness. Classes focus on caregiver well-being, managing stress and difficult emotions, communicating needs, and making caregiving decisions. Registration is required.

Oregon Department of Human Services Family Caregiver Support Program
Connects Oregon family caregivers with local services and support. Depending on eligibility and availability, services may include home-delivered meals, transportation, legal assistance, counseling, caregiver support groups, and respite care.

Getting your Community Involved

My Cancer Circle
An online tool that can help families organize support from friends and community members, including meals, transportation, and other caregiving needs. Caregivers can also share updates and coordinate times when they may need a break or additional help.

CaringBridge
A free online platform for sharing health updates with family and friends and coordinating support during a health journey.

Meal Train
An online tool that helps family, friends, and community members coordinate meals for someone experiencing an illness or other significant life event.

Additional Caregiver Support

4th Angel Mentoring Program
A national peer mentorship program for people with cancer and their caregivers. Participants are matched with trained volunteer mentors based on their cancer experience. Mentoring is generally provided virtually or by phone, making the program available beyond Cleveland.

Independent Choices
An Oregon Medicaid program that may allow eligible individuals to receive cash benefits for certain in-home services and hire their own service providers. Eligibility and available services vary.

Oregon Long-Term Care Options
Information from the Oregon Department of Human Services about in-home and long-term care services. Depending on individual needs and eligibility, support may range from help around the home to assistance with bathing, dressing, medications, and other daily activities.

Care.com
An online service for finding private-pay caregivers who may provide services such as companionship, housekeeping, child care, and support with daily needs. Availability, qualifications, services, and costs vary by provider.

Suggested Reading for Caregivers

  • Always on Call: When Illness Turns Families into Caregivers by Carol Levine
  • American Cancer Society Complete Guide to Family Caregiving: The Essential Guide to Cancer Caregiving at Home, by Peter S. Houts, Julia A. Bucher, and Terri Ades
  • Cancer Caregiving A to Z: An At-Home Guide for Patients & Families, by American Cancer Society
  • Caregiving: The Spiritual Journey of Love, Loss, and Renewal, by Beth Witrogen McLeod
  • Help Me Live: 20 Things People with Cancer Want You to Know, by Lori Hope
  • Helping Yourself Help Others: A Book for Caregivers, by Rosalynn Carter and Susan Golant
  • Loving, Supporting, and Caring for the Cancer Patient: A Guide to Communication, Compassion, and Courage, by Stan Goldberg
  • The Human Side of Cancer: Living with Hope, Coping with Uncertainty, by Jimmie Holland, Sheldon Lewis
  • Things I Wish I'd Known, by Deborah J. Cornwall