YiminZ07/PanCanBench huggingface dataset:
Question: My father has pancreatic cancer and we’re trying to understand the role of the tumor microenvironment. How does this affect treatment?

Grading rubric:
description: The response should describe the tumor microenvironment.
description: The response should mention that the tumor microenvironment in pancreatic cancer critically influences both treatment options and outcomes.
description: The response should include that the pancreatic cancer tumor microenvironment has a dense desmoplastic stroma which can act as a physical barrier.
description: The response should include a description of stromal cells, including fibroblasts.
description: The response should include a description of stromal cells, including pancreatic stellate cells.
description: The response should include a description of immune cells within the tumor microenvironment of pancreatic cancer.
description: The response should include that the tumor microenvironment of pancreatic cancer can be immunosuppressive.
description: The response should mention that the tumor microenvironment architecture creates physical and biochemical barriers that limit drug delivery, promote immune evasion, and drive resistance to chemotherapy, targeted therapy, and immunotherapy.
description: The response should include that the tumor microenvironment of pancreatic cancer is implicated in drug resistance.
description: The response should include that the tumor microenvironment of pancreatic cancer is implicated in metastasis.
description: The response should include that the tumor microenvironment of pancreatic cancer is implicated in relapse.
description: The response should include that drugs targeting the tumor microenvironment in pancreatic cancer have not yet shown benefit to patients.
description: The response should include that many studies are underway evaluating the role of tumor microenvironment-targeted therapies in pancreatic cancer.
description: The response should mention that current and emerging treatment strategies increasingly focus on remodeling the tumor microenvironment to improve therapeutic efficacy.
description: The response should mention that locoregional therapies such as radiation and ablation may also alter the tumor microenvironment, increasing antigen presentation and immune response.
description: The response should recommend that the user discuss this case with an oncologist.
Question: My mother has pancreatic cancer and we’re considering pet therapy visits. Are these beneficial and safe during treatment?

Grading rubric:
description: Pet therapy can offer emotional benefits for patients with cancer.
description: Pet therapy can offer psychological benefits for patients with cancer.
description: Treatment of cancer can cause immune suppression.
description: Pets can carry diseases that can harm immunosuppressed people.
description: Patients should avoid exposing open wounds to pets or animals.
description: Patients should avoid exposing port sites to animals.
description: Patients should discuss the safety of pet therapy with their oncology team.
description: Pet therapy visits are beneficial and generally safe for patients undergoing treatment for pancreatic cancer when conducted with certified therapy animals under appropriate infection control protocols.
description: To reduce exposure to chemotherapy and radiation residues, patients should take precautions to limit the impacts on pets.
description: Immunocompromised patients with pancreatic cancer receiving chemotherapy or radiation therapy should practice good hand hygiene after handling pets, avoid contact with pet waste, and prevent pets from licking open wounds.
description: If patients are severely immunosuppressed, they should avoid contact with young animals, reptiles, or exotic pets.
Question: My loved one has pancreatic cancer and we’re dealing with travel challenges for treatment. What resources can help?

Grading rubric:
description: The response should recommend discussing financial concerns with a social worker associated with their oncology team.
description: The response should include information for the American Cancer Society Road to Recovery program.
description: The response should provide information on travel grants through national patient advocacy organizations, including the Pancreatic Cancer Action Network.
description: The response should recommend discussing financial concerns with the oncology team.
description: The response should recommend discussing financial concerns with a financial counselor associated with their oncology team.
description: The response should recommend discussing lodging assistance programs with their oncology team.
description: The response should provide information on travel grants through national patient advocacy organizations, including Cancer Care.
description: The response should mention that resources include hospital-based transportation programs.
description: The response should mention that resources include philanthropic or grant-funded travel assistance.
description: The response should mention that telemedicine is increasingly used to reduce the need for travel, allowing for virtual visits, remote symptom monitoring, and tele-rehabilitation.
description: The response should mention that telehealth appointments are generally as effective as in-person visits for many aspects of care.
description: The response should mention that telehealth offers benefits, including reduced travel burden, lower costs, decreased infection risk, and improved access to expertise.
description: The response should mention that telehealth may be less suitable for initial diagnosis, physical examinations, or sensitive discussions.
description: The response should mention limitations of telehealth, including challenges with physical examination, technology barriers, and occasional concerns about reduced personal connection.
description: The response should mention that the CDC recommends developing a personal travel health plan, ensuring adequate medication supply, and considering supplemental medical or evacuation insurance.
description: The response should recommend that the user discuss this case with an oncologist.
Question: My loved one has pancreatic cancer and we’re trying to manage treatment schedules with work and family obligations. Any advice?

Grading rubric:
description: The response should recommend understanding the current treatment plan.
description: The response should recommend discussing the treatment schedule with the oncology team.
description: The response should recommend open communication with the care team about work, family, and personal goals.
description: The response should recommend open communication with work.
description: The response should recommend understanding side effects of treatments.
description: The response should recommend understanding the timing of side effects.
description: The response should recommend utilizing a support system, including talking with a social worker.
description: The response should recommend utilizing a support system, including talking with a patient navigator.
description: The response should mention that early referral to palliative care is recommended for symptom management, emotional support, and caregiver assistance, and is not synonymous with hospice.
description: The response should mention that practical strategies for managing treatment schedules include leveraging telehealth, app-based, and telephone support to increase flexibility and reduce travel burden.
Question: My father has pancreatic cancer and is experiencing treatment-related mouth problems. How can these be prevented or managed?

Grading rubric:
description: The response should mention that treatment-related mouth problems, particularly oral mucositis, are common in patients with pancreatic cancer receiving chemotherapy.
description: The response should recommend discussing their mouth problems with their oncology team.
description: The response should recommend maintaining good oral hygiene.
description: The response should include that meeting with an oral medicine provider can be helpful.
description: The response should recommend staying hydrated.
description: The response should recommend getting regular dental care.
description: The response should mention that oral cryotherapy (holding ice chips in the mouth during and after administration of agents such as 5-fluorouracil) is effective for prevention of mucositis for select chemotherapy regimens.
description: The response should mention that benzydamine mouthwash is supported for prevention, especially in patients receiving radiotherapy or chemoradiotherapy.
description: The response should mention that chlorhexidine mouthwash is not recommended for prevention in most adult cancer populations.
description: The response should mention that bland mouth rinses (e.g., sodium bicarbonate or saline) are preferred for routine care and symptom management.
description: The response should mention that topical anesthetics and mixed medication mouthwashes may be used for pain control.
description: The response should mention that gabapentin may be considered for mucositis-related pain.
description: The response should mention that topical and systemic antifungals are indicated for secondary candidiasis.
description: The response should mention that antibiotics are reserved for documented secondary bacterial infections.
description: The response should mention that management often involves over-the-counter pain relief such as acetaminophen or ibuprofen.
description: The response should mention that multidisciplinary and supportive care is essential.
description: The response should mention that management could include dietary adjustments such as soft or liquid diets, small frequent meals, and nutritional support.
Question: My mother has pancreatic cancer and we want to understand more about minimal residual disease testing. What is this?

Grading rubric:
description: The response should define minimal residual disease.
description: The response should mention that minimal residual disease testing in pancreatic cancer is investigational.
description: The response should recommend discussing minimal residual disease testing with an oncologist.
description: The response should include that NCCN guidelines do not recommend minimal residual disease testing in pancreatic cancer.
description: The response should include that insurance may not cover minimal residual disease testing.
description: The response should mention that postoperative ctDNA positivity is associated with a higher risk of early recurrence and worse survival in resected pancreatic cancer.
description: The response should mention that serial minimal residual disease testing can provide dynamic risk stratification.
description: The response should mention that minimal residual disease testing may identify patients who could benefit from intensified surveillance or additional therapy.
Question: My loved one has pancreatic cancer and we’re considering spiritual counseling. How can we find appropriate support?

Grading rubric:
description: The response should recommend asking the oncology team for spiritual care professionals.
description: The response should recommend reaching out to local places of worship.
description: The response should recommend reaching out to community support groups.
description: The response should recommend national cancer support organizations, including the American Cancer Society.
description: The response should recommend national cancer support organizations, including Cancer Care.
description: The response should mention that spiritual counseling and support can be accessed through hospital-based chaplaincy services.
description: The response should mention that spiritual counseling and support can be accessed through interdisciplinary palliative care teams.
description: The response should mention that interventions such as prayer, mindfulness/meditation, and facilitated sessions with trained providers, including both individual and group formats, have demonstrated benefits for spiritual well-being, hope, and meaning in cancer care.
description: The response should mention that cancer.net and the Pancreatic Cancer Action Network (pancan.org) provide high-quality information and support services.
description: The response should recommend that the user discuss this case with an oncologist.
Question: My husband has pancreatic cancer and we’re dealing with significant lifestyle changes. How do we adapt?

Grading rubric:
description: The response should recommend learning about pancreatic cancer, including diagnosis.
description: The response should recommend learning about pancreatic cancer, including staging.
description: The response should recommend learning about pancreatic cancer, including treatment options.
description: The response should recommend national patient support resources, including information for the Pancreatic Cancer Action Network.
description: The response should recommend open communication within the couple and with the care team.
description: The response should recommend building a support system.
description: The response should explicitly state that significant lifestyle changes are common for both patients and spouses/partners after a pancreatic cancer diagnosis.
description: The response should explicitly mention at least two of the following: uncertainty about the future, role changes, emotional upheaval, or altered daily routines.
description: The response should explicitly recommend early integration of supportive and/or palliative care for symptom management, psychosocial support, or advance care planning.
description: The response should explicitly state that palliative and/or supportive care should be offered to all patients with pancreatic cancer, regardless of stage or prognosis.
description: The response should explicitly state that both dietary and exercise interventions are important for maintaining quality of life and optimizing outcomes.
description: The response should explicitly state that regular exercise and healthy lifestyle changes are associated with improved physical and psychological outcomes.
description: The response should explicitly recommend discussing the case with an oncologist.
Question: My loved one has pancreatic cancer and we want to understand more about tumor heterogeneity. How does this affect treatment?

Grading rubric:
description: The response should describe tumor heterogeneity, including diverse genetic, epigenetic, transcriptomic, and microenvironmental features both between patients (inter-tumoral) and within a single tumor (intra-tumoral).
description: The response should include that tumor heterogeneity can include differences in genetic mutations within a tumor.
description: The response should include that tumor heterogeneity can include differences in genetic mutations between tumor sites.
description: The response should include that tumor heterogeneity can include differences in cellular growth between cancer sites.
description: The response should include that tumor heterogeneity can include differences in microenvironment between tumor sites.
description: The response should mention that tumor heterogeneity is a major driver of variable treatment response, therapy resistance, and clinical outcomes in pancreatic ductal adenocarcinoma.
description: The response should include that tumor heterogeneity is thought to contribute to drug resistance.
description: The response should include that tumor heterogeneity is thought to contribute to the use of multiple chemotherapy agents.
description: The response should mention that phenotypic plasticity allows tumor cells to shift between subtypes, especially under therapeutic or microenvironmental stress, contributing to acquired resistance and disease progression.
description: The response should mention that tumor heterogeneity limits the effectiveness of one-size-fits-all approaches and underlies the need for molecular profiling and personalized treatment strategies.
description: The response should recommend discussing genetic testing with the oncology team.
description: The response should mention that research efforts focus on integrating genomic, transcriptomic, and single-cell analyses to better classify tumors and guide therapy selection.
description: The response should recommend that the user discuss this case with an oncologist.
Question: My father has pancreatic cancer and is considering volunteering for research studies. What opportunities exist?

Grading rubric:
description: The response should include the definitions of different types of research studies, including randomized clinical trials and observational studies.
description: The response should explain that not all research studies are clinical trials, and some explore ancillary aspects of cancer care such as symptom control or mental health.
description: The response should include links and references to informational websites about clinical trials being held across the United States, such as the National Cancer Institute (NCI).
description: The response should recommend that the patient ask their oncologist about locations where clinical trials are being held and consider a referral to institutions where trial participation is possible.
description: The response should include definitions of phases 1, 2, and 3 clinical trials.
description: The response should include that clinical trials are most commonly done at academic medicine institutions.
description: The response should state that clinical trials may include an experimental treatment or placebo, and the efficacy may not be known as compared to standard of care treatment.
description: The response must explicitly mention clinical trials as a research opportunity.
description: The response must explicitly mention patient registries or biorepositories as opportunities for further studies.
Question: My mother has pancreatic cancer and we’re trying to understand the role of the immune system in her treatment. Can you explain?

Grading rubric:
description: The response should describe how cells that acquire mutations that can go on to form a cancer in our bodies can evade the immune system.
description: The response should describe the immune system’s role in protecting the body from mutated cells that have oncogenic potential.
description: The response should include a definition of immunotherapy.
description: The response should describe the mechanism of action of immunotherapies in cancer.
description: The response should describe features of pancreatic cancer that make this malignancy difficult to treat with immunotherapy.
description: The response should mention that there is research being done on the role of the immune system in pancreatic cancer treatment.
description: The response should recommend that the patient speak with his/her oncologist about clinical trials that might utilize immunotherapy for pancreatic cancer, or consider a referral to a center that does clinical trials.
description: The response should state that a limited number of pancreatic cancer cases have features that do make it respond to immunotherapy, such as MSI-H or mismatch repair deficiency.
description: The response should state that they should ask the oncologist if her mother’s tumor has MSI-H or mismatch repair deficiency.
Question: My loved one has pancreatic cancer and we’re dealing with caregiver burnout. What support is available?

Grading rubric:
description: The response must define caregiver burnout as physical, emotional, and mental exhaustion, and normalize it as a common experience among caregivers.
description: The response must link to no-cost support services for caregivers, such as support groups or online groups of people with similar experiences.
description: The response must explicitly mention insurance-covered caregiver assistance and advise inquiring with the insurance carrier about coverage.
description: The response must provide resources for mental wellbeing, specifically mentioning therapists through Psychology Today’s website.
description: The response must describe the use of family members and friends to help with caretaking responsibilities.
description: The response must recommend reaching out to the oncology team to inquire if social work resources are available to assist in determining if any in-home support or respite services are financially covered by the patient’s insurance.
description: The response must mention that Hospice services offer varying degrees of in-home support and caregiver support, if/when appropriate for their loved one.
description: The response should state that there are options for professional caregiver support to give a break to family members/loved ones.
description: The response should state that palliative care involvement can help with optimizing symptom management which may help reduce caregiver burden.
description: The response should state they should make sure to take time for self-care.
Question: My husband has pancreatic cancer and his doctors mentioned liquid biopsy monitoring. What does this involve?

Grading rubric:
description: The response should explain what liquid biopsies are and how they are different from traditional biopsies.
description: The response should state that “liquid biopsy” involves taking a sample of blood to analyze either circulating tumor DNA or circulating tumor cells.
description: The response should explain the different uses of liquid biopsies in cancer care.
description: The response should mention if liquid biopsy is FDA approved for any uses in pancreatic adenocarcinoma.
description: The response should describe that liquid biopsies are used as an adjunct to traditional cancer monitoring techniques.
description: The response should state that this is not sufficient to establish whether or not the cancer is responding to treatment and that it has to be used in addition to imaging tests.
description: The response should describe advantages of liquid biopsy over traditional biopsy, but should state that liquid biopsy cannot be used to diagnose cancer at this time.
description: The response should describe that liquid biopsies can provide information about the genetic mutations in a cancer which can impact treatment options.
description: The response should mention that the role of liquid biopsy in cancer care is being heavily studied.
description: The response should state that liquid biopsy meaningfulness is different across cancer types and sometimes among patients with the same cancers, as some tumors do not shed material as much as others.
description: The response should also state that the approach is not established as standard of care and would likely be offered in the context of a research study.
Question: My loved one has pancreatic cancer and we’re trying to maintain their independence during treatment. What strategies work?

Grading rubric:
description: The response should emphasize the importance of managing treatment and disease-related side effects to preserve independence and quality of life.
description: The response should describe the expected side effects of pancreatic cancer treatment.
description: The response should describe common symptoms that patients experience from pancreatic cancer.
description: The response should suggest ways to use technology to help with everyday tasks in the home.
description: The response should suggest ways to make modifications in the home to allow the patient to traverse and use their home independently.
description: The response should emphasize the importance of maintaining autonomy and some control for the patient regarding their everyday tasks and life.
description: The response should make recommendations for how to assist an individual suffering from pancreatic cancer treatment or disease-related side effects on their activities of daily living.
description: The response should emphasize the importance of maintaining good mental health by the patient and caregivers.
description: The response should mention resources for in-home assistance such as paid caregivers or Hospice services.
description: The response should suggest asking the oncology team if there is social work support available, and/or if anyone can assist in determining if the patient’s insurance will cover the cost of an in-home paid caregiver.
description: The response should state that physical independence can be promoted by maintaining strength with rehab and exercises.
description: The response should state that assistance devices and equipment such as shower chairs and grabbing bars can be used to help maintain independence.
description: The response should state that emotional support including participating in patient groups is another good way of maintaining independence.
Question: My father has pancreatic cancer and we’re considering family genetic testing. Who should be tested and when?

Grading rubric:
description: The response should include a definition of genetic testing for heritable cancer syndromes.
description: The response should state that genetic testing for inherited mutations is recommended for all patients with pancreatic adenocarcinoma at diagnosis.
description: The response should recommend that the patient discuss genetic testing for inherited cancer syndromes and molecular testing of tumor tissue with their oncologist and oncology team.
description: The response should describe why family members at risk of inheriting a genetic mutation should be aware if they have it.
description: The response should list cancer syndromes and mutated genes that are associated with an increased risk of pancreatic cancer.
description: The response must explicitly mention that BRCA1 and BRCA2 testing can be considered, particularly if there are other first-degree relatives with malignancies such as breast or prostate cancer.
description: If a patient’s genetic testing for inherited mutations returns positive for a pathogenic mutation or they have a strong family history for cancer (regardless of mutation status), they should be referred to a genetic counselor.
description: The response should mention that some family members of a patient with a positive pathogenic mutation may be at increased risk for certain cancers and should consider genetic testing.
Question: My mother has pancreatic cancer and we’re dealing with treatment-related cognitive changes. Is this reversible?

Grading rubric:
description: The response should describe the phenomenon known as “chemo-brain,” or cognitive issues experienced by individuals undergoing chemotherapy treatment.
description: The response should state that treatment-related cognitive changes are a known side effect of treatment.
description: The response should include information about impaired cognition related to chemotherapy treatment and how long it is expected to last once treatment is completed.
description: The response should state that the cognitive changes can be from the chemotherapy drugs or from the cancer itself.
description: The response should mention that some medications, such as opioids, used for symptom management can cause depressed cognition.
description: The response should state that other etiologies of impaired cognition may also be present, such as organ dysfunction, age-related cognitive decline, poor nutritional status, or medication side effects.
description: The response should mention that depression is related to cognitive impairment, especially in the elderly population.
description: The response should state that some causes of cognitive impairment are reversible, while others are not.
description: The response should recommend that the patient or family member discuss cognitive impairment with the patient’s oncology team.
description: The response should state that symptoms can be managed with “cognitive rehabilitation,” which can include exercises such as puzzles and word games.
description: The response should state that optimizing lifestyle changes, such as good sleep and exercise, can help manage symptoms.
description: The response should state that in some cases, the treatment team may consider prescribing a stimulant such as methylphenidate.
Question: My loved one has pancreatic cancer and we want to understand more about cancer stem cells. How do these affect treatment?

Grading rubric:
description: The response should describe what cancer stem cells are.
description: The response should explain the role that cancer stem cells play in tumorigenesis and metastasis.
description: The response should describe what is known about cancer stem cells in pancreatic cancer.
description: The response should reference research on pancreatic cancer stem cells and include real citations.
description: The response should clearly state what is known about how pancreatic cancer stem cells affect treatment efficacy.
description: The response must explicitly state that cancer stem cells are a subpopulation of cancer cells within a tumor that possess the ability to self-renew and differentiate into various cell types, and the concept of persistence must be clearly mentioned.
description: The response must explicitly state that cancer stem cells are more resistant to conventional therapies like chemotherapy and radiation, and mention at least two mechanisms such as quiescence, efflux pumps, DNA repair, or microenvironment.
description: The response must explicitly state that there are currently no standard of care treatments that directly target cancer stem cells, but it is an active area of research.
Question: My husband has pancreatic cancer and we’re considering joining support groups. What types are available?

Grading rubric:
description: The response should describe different types of support groups such as in-person, virtual, and telephone.
description: The response should list resources with website links that provide free or insurance-covered pancreatic cancer support group information such as PanCAN, NCI, and NCCN.
description: The response should recommend that the patient and/or family inquire with the oncology team about support group resources.
description: The response should describe the importance of maintaining mental health support for patients and caregivers affected by pancreatic cancer.
description: The response should mention websites for people to find support groups local to their home.
description: The response should mention ways in which support groups for people affected by cancer can be helpful.
description: The response should normalize the use of support groups for people affected by cancer.
description: The response should state that people can use support groups for different stages of cancer, and that mental health challenges can be faced even during the survivorship period.
description: The response should emphasize that support groups can help people affected by cancer feel less isolated or alone.
description: The response should mention that faith-based support groups exist.
description: The response should state that support groups are not a substitute for seeking mental health services if you are suffering from depression, and should describe what depression is.
description: The response should mention other avenues for support including palliative medicine and Hospice.
description: The response should state that virtual options include Facebook groups and PanCAN virtual support groups.
Question: My loved one has pancreatic cancer and we’re trying to understand treatment resistance. Why do treatments stop working?

Grading rubric:
description: The response must explicitly describe how malignant cells evade the body’s immune system.
description: The response must explicitly describe the mechanisms of action for chemotherapy, immunotherapy, and radiation in killing cancer cells.
description: The response must thoroughly cover multiple mechanisms of treatment resistance, including genetic mutations, tumor heterogeneity, drug efflux, alterations in drug targets, epigenetic changes, adaptive responses, and the tumor microenvironment.
description: The response must explicitly mention cancer stem cells and connect them to specific resistance mechanisms such as drug efflux pumps, enhanced DNA repair, or immune evasion.
description: The response must explicitly state that surviving resistant cells can repopulate the tumor after most cells are killed by treatment.
description: The response must explicitly describe that with every treatment, a selective pressure is applied to cancer cells.
description: The response must state that this topic is being widely researched and cite at least one source from the literature.
description: The response explicitly defines treatment resistance as the phenomenon where cancer cells over time no longer respond to therapies.
Question: My father has pancreatic cancer and his doctors mentioned biomarker testing. What biomarkers are important?

Grading rubric:
description: The response must describe specific biomarkers for pancreatic cancer, explicitly mentioning both CA 19-9 and CEA.
description: The response must explain what circulating tumor DNA (ctDNA) is and how it is considered a cancer biomarker in some malignancies.
description: The response must summarize how ctDNA enters the bloodstream and is detected through blood tests.
description: The response must include ways that ctDNA detection can enhance existing modalities for cancer monitoring, including detection of new and potentially targetable mutations in cancer cells.
description: The response must include at least one link to existing scientific literature regarding ctDNA use in pancreatic cancer.
description: The response must suggest that the patient discuss pancreatic cancer biomarker testing with their oncology team.
description: The response must define biomarkers for cancer in general terms, including at least one example of a measurable indicator (e.g., proteins, genes, or mutations).
description: The response must describe how biomarkers are used in pancreatic cancer care and explicitly state that they are an adjunct to traditional imaging and biopsy interventions.
description: The response must discuss that biomarker reliability varies between individuals with cancer and are not always interpretable, including a specific example of variability.
description: The response must explicitly state that biomarkers can have false positives and false negatives.
description: The response should state that BRCA and HRD genes are key biomarkers as they can predict response to platinum chemotherapy and PARP inhibitors.
description: The response should state that MSI/MMR is an important biomarker as it can identify the small percentage of patients that may respond to immunotherapy.
description: The response should state that testing can be done on a blood sample or from tumor tissue.
Question: My mother has pancreatic cancer and we’re dealing with treatment-related bone problems. How are these managed?

Grading rubric:
description: The response must describe at least two management strategies for osteopenia and osteoporosis, such as bisphosphonates, denosumab, calcium, or vitamin D.
description: The response must explicitly describe at least two types of bone and bone density problems that can arise during cancer treatment, such as osteopenia, osteoporosis, or bone metastases.
description: The response must explicitly mention bone metastases and at least two treatment options, such as systemic therapy, observation, radiation, or surgery.
description: The response must state that bone metastases can be painful and/or asymptomatic.
description: The response must mention the frequency or rarity of pancreatic cancer metastasizing to the bone.
description: The response must define or describe osteopenia and osteoporosis.
description: The response must identify at least one risk factor for osteopenia and osteoporosis and explain how these conditions are tested, such as with a DEXA scan.
description: The response must mention granulocyte colony stimulating factor and its potential side effect of temporary bone pain.
description: The response must emphasize that pain related to cancer or cancer-treatment is taken seriously and should be discussed with the patient’s oncology team.
description: The response must mention that palliative medicine is a specialty for managing symptoms related to medical diagnoses and treatments, and that the patient can request a referral to this specialty if available.
Question: My loved one has pancreatic cancer and we want to understand more about epigenetic changes. How do these affect the disease?

Grading rubric:
description: The response should define epigenetics.
description: The response should describe how epigenetic changes can happen in normal cells, including gene silencing, activation, and DNA methylation.
description: The response should describe how epigenetic changes impact the cell’s function.
description: The response should describe the role of epigenetic changes in cancer cells.
description: The response should state that epigenetic changes can lead to inactivation of silencing tumor-suppressor genes.
description: The response should state that epigenetic changes can lead to activation of oncogenes.
description: The response should state that epigenetic changes can contribute to changes in the behavior of the tumor, such as increased propensity to spread.
description: The response should state that epigenetic changes can impact treatment response.
description: The response should mention that targeting epigenetic changes in pancreatic cancer is an experimental topic that is being actively researched.
Question: My husband has pancreatic cancer and we’re considering home health services. What should we look for?

Grading rubric:
description: The response should recommend that patients consider care agencies that are accredited and have a good reputation.
description: The response should recommend that patients consider care agencies that provide a broad range of services, as the patient may have evolving needs as their treatment progresses.
description: The response should recommend that the patient inquire with his oncology team if there is social work support available to assist in seeking home health care that is covered by the patient’s insurance carrier.
description: The response should state that there is a broad range of types of in-home care and that the patient and family should consider what tasks they need assistance with.
description: The response should summarize common types of assistance that cancer patients benefit from such as cooking, cleaning, general home upkeep, shopping.
description: The response should provide links to websites where patients can learn more about the types of care.
description: The response should mention Hospice as a service that provides care in the home for patients with a prognosis of 6 months or less.
description: The response must mention that home health services include skilled nursing care and in-home therapies, such as physical and occupational therapy.
description: The response must explicitly state that they should seek agencies with experience in caring for cancer patients, specifically mentioning oncology-trained staff.
Question: My loved one has pancreatic cancer and we’re trying to understand the role of angiogenesis. How does this relate to treatment?

Grading rubric:
description: The response should define angiogenesis.
description: The response should describe the role of angiogenesis in solid tumors.
description: The response should describe the role of angiogenesis in pancreatic cancer.
description: The response should discuss how angiogenesis is a target for cancer treatment in some cancers.
description: The response should state that anti-angiogenesis drugs are not used routinely in pancreatic cancer as they have not been shown to significantly improve outcomes.
description: The response should link to randomized control trials studying the effect of anti-angiogenic therapies in pancreatic cancer, with summaries.
description: The response should recommend that the patient discuss treatment options with their oncology team.
Question: My father has pancreatic cancer and we’re dealing with treatment-related liver problems. How are these monitored and managed?

Grading rubric:
description: The response should state that liver function is routinely monitored during treatment using labs.
description: The response should describe ways in which pancreatic cancer and pancreatic cancer treatment can affect the liver.
description: The response should state that changes in liver function labs will often be investigated further with imaging studies.
description: The response should describe ways in which liver injury can be treated, such as dose reduction in systemic treatment.
description: The response should describe ways in which liver injury can be treated, such as local therapy to tumors in the liver.
description: The response should describe ways in which liver injury can be treated, such as biliary stenting.
description: The response should describe ways in which liver injury can be treated, such as elimination of offending medications or supplements.
description: The response should describe ways in which liver injury can be treated, such as treatment of infection.
description: The response should include that in rare cases, biopsy of liver tissue is needed to understand the cause of liver injury.
description: The response should state that many different medications and supplements can cause liver toxicity, and the patient should discuss all medications and supplements they take while undergoing cancer treatment to ensure no interactions.
description: The response should describe red flag symptoms for liver injury.
description: The response should recommend the patient discuss any new or worrisome symptoms with a member of their oncology team.
description: The response should emphasize the importance of exercise, nutrition, and sleep in mitigating treatment-related toxicities and side effects.
Question: My mother has pancreatic cancer and we want to understand more about tumor dormancy. Can cancer cells become inactive?

Grading rubric:
description: The response should discuss what tumor dormancy is.
description: The response should describe the implications of tumor cells that can enter dormancy, such as disease recurrence.
description: The response should outline that there is ongoing study on the subject of tumor dormancy, though it is not fully understood at this time.
description: The response must mention that dormancy can occur due to microenvironmental factors such as changes in the tumor microenvironment, lack of nutrients, or the presence of certain immune cells.
description: The response must state that dormant cells are often less susceptible to chemotherapy than rapidly dividing cancer cells.
description: The response should reference evidence from the scientific literature that discusses tumor dormancy in pancreatic cancer, and only references with a PubMed identification number (PMID) should be included.
description: The response should indicate whether or not it is possible to detect dormant cancer cells in the body in pancreatic cancer.
Question: My loved one has pancreatic cancer and we’re considering advance directives. What should these include?

Grading rubric:
description: The response should describe what an advance directive is and why people create them.
description: The response should recommend that the patient and family ask their oncology team if there are resources available to assist in the creation of advance directives, such as social work.
description: The response should direct the patient to consider what medical treatments they would accept in the event of an emergency or if they became too sick to make decisions on their own, including wishes surrounding CPR, invasive medical procedures such as dialysis, artificial nutrition, and noninvasive medical treatments such as intravenous fluids or antibiotics. This is also referred to as a living will.
description: The response should recommend that the patient elect a specific person to be their durable power of attorney for healthcare, or a person who would make medical decisions for them if they were too sick to make their own decisions.
description: The response should state that the patient should also complete a POLST, or a physician order for life-sustaining treatment, with their oncologist or other health practitioner, and should have this in their home in an easy-to-see location.
description: The response should state that the advance directives should include a DNR order if desired.
description: The response should encourage patients to complete advance directives as soon as possible, even if their cancer is in remission or cured.
description: The response should explain the logistics of completing an advance directive and recommend that the patient turn in a completed copy of the form to their oncology team.
description: The response should emphasize to patients with pancreatic cancer the importance of future planning, as this disease is difficult to cure and can be aggressive.
Question: My husband has pancreatic cancer and his doctors mentioned combination targeted therapy. What does this involve?

Grading rubric:
description: The response should define what targeted therapy is in oncologic treatment.
description: The response should explain what combination targeted therapy is.
description: The response should describe what kinds of targeted therapy options exist in pancreatic cancer treatment.
description: The response should illustrate why more than one targeted medication might be used at the same time to treat cancer.
description: The response should explain why the patient’s tumor tissue needs to undergo molecular testing to understand what targeted therapies are indicated.
description: The response should explain that some targeted therapies may not work on the patient’s tumor due to lack of targetable mutations.
description: The response should explain that targeted therapies do not always work in pancreatic cancer due to tumor heterogeneity.
description: The response should describe that targeted therapies are sometimes used at the same time as traditional chemotherapies.
description: The response should recommend that the patient discuss this further with their oncologist as targeted therapies are individualized to each patient’s cancer, and not all targeted therapies are treatment options for all patients with pancreatic cancer.
description: The response must mention KRAS inhibitors as a current area of research in pancreatic cancer.
description: The response must mention PARP inhibitors are used in pancreatic cancer patients with BRCA1/2 mutations.
Question: My loved one has pancreatic cancer and we’re trying to understand metastatic patterns. Where does pancreatic cancer typically spread?

Grading rubric:
description: The response should define metastasis.
description: The response should explain how cancer metastasizes, such as hematologic spread and lymphatic spread.
description: The response should describe how pancreatic cancer metastasizes.
description: The response must explicitly state that pancreatic cancer typically spreads locally first, involving surrounding lymph nodes, organs, and blood vessels.
description: The response should state that metastatic spread of the pancreatic cancer can be influenced by the location of the primary tumor, for example whether it is located at the pancreatic head or the tail.
description: The response must explicitly state that the liver is usually the first location for metastases.
description: The response must explicitly state that pancreatic cancer can metastasize to the peritoneum or lining of the abdominal cavity.
description: The response must explicitly state that pancreatic cancer can spread to the lungs.
description: The response must explicitly state that pancreatic cancer can spread to at least one of the following less common sites: bones, brain, or adrenal gland.
description: The response should explain what proportion of pancreatic cancers are metastatic at diagnosis and why.
description: The response should discuss that pancreatic cancer commonly has already metastasized at the time of diagnosis because it often is asymptomatic at an early stage and only becomes symptomatic, prompting diagnostic investigation, once it has spread beyond its original site.
description: The response should state that treatment options exist for all stages of pancreatic cancer.
description: The response should state that options for treatment modalities, for example surgery or chemotherapy, depend on the stage of the cancer.