Management of pain and cachexia in pancreatic cancer: Study protocol for systematic reviews, network meta-analysis, surveys and focus groups (Preprint)

UNSTRUCTURED Introduction: Approximately 75% of people with pancreatic cancer suffer with pain and more than half of patients have cachexia (weakness and wasting of the body). However, there is considerable uncertainty regarding the management of these distressing symptoms. Primary objectives: To compare the relative benefits and harms of different interventions for pain in people with unresectable pancreatic cancer and for the prevention and treatment of cachexia due to pancreatic cancer, through systematic reviews and network meta-analysis. Secondary objectives: To develop an evidence-based clinical care pathway for management of pain and for prevention and treatment of cachexia in people with pancreatic cancer through surveys and focus group discussions involving patients, carers and healthcare professionals. Methods and analysis: We will perform two systematic reviews of the literature related to pain and cachexia in people with pancreatic cancer using searches from Cochrane Library, MEDLINE, EMBASE, Science Citation Index and trial registries. Two researchers will independently screen against the eligibility criteria and identify randomised controlled trials (no language restriction) comparing interventions for pain or cachexia for inclusion based on full-texts for articles shortlisted during screening. We will assess risk of bias in the trials and obtain data related to baseline prognostic characteristics, potential effect modifiers, details of interventions, and outcome data related to overall survival, health-related quality of life, treatment-related complications and resource utilisation. We aim to conduct network meta-analysis on outcomes with multiple treatment comparisons where possible. Alternatively, we will perform standard meta-analysis with direct comparisons, or a narrative synthesis. We will perform various subgroup analyses, meta-regression and sensitivity analyses. Using information obtained from the two systematic reviews, we will conduct surveys and focus groups to assess the acceptability and feasibility of delivering interventions in the NHS. Ethics and dissemination: This project was approved by the UCL Research Ethics Committee (Ethics number: 23563/001). We aim to present the findings through patient group websites, conferences and publish the review, irrespective of the findings, in a peer-reviewed journal. PROSPERO registration numbers: CRD42022333239 and CRD42022333241