Building patient relationships through early, empathetic engagement and a patient-centered approach is critical to guiding frontline chemotherapy selection in pancreatic cancer, highlighting the role of nurse practitioners as both clinical decision support partners and care navigators within a multidisciplinary team, according to Dallas Gallagher, DNP, FNP-C, AOCNP.
“The day someone is diagnosed with cancer of any sort is potentially one of the worst days of their life. Most often, all they hear in that initial visit is the word ‘cancer’ and nothing else,” Gallagher stated in an interview with OncLive®. “The art of conversation is vital at this stage to understand the acute grief, fear, and anxiety they are bringing to the diagnosis. In my role, I am often the person telling a patient they have pancreatic cancer for the first time; I provide reassurance and let them know I will be navigating them to all the right people to ensure we do everything possible for their care.”
In addition to discussing the critical role of nursing staff and nurse practitioners in identifying and prioritizing patient goals following a pancreatic cancer diagnosis, Gallagher touched on key factors influencing treatment decisions and chemotherapy selection in the frontline setting, provided advice on managing adverse effects (AEs) and ensuring treatment adherence, and expressed optimism about the current state of pancreatic cancer research and future treatment avenues.
Gallagher is a pancreatic cancer nurse practitioner within the University of California, San Diego Health System.
OncLive: As a nurse practitioner, what role do you play in tandem with medical oncologists and other specialists in the overall care of patients with pancreatic cancer?
Gallagher: I have a unique role at my institution. I work with medical oncology and surgical oncology, as well as all supportive care services—including palliative care, interventional radiology, nutrition, pain management, and social work. I am equipped to prescribe, order tests, and review results such as imaging or next-generation sequencing. Additionally, I serve as a navigator, helping patients move through the [health care] system to get to where they need to go.
What factors go into deciding the mainstay of treatment for a patient with newly diagnosed pancreatic adenocarcinoma?
The mainstay of treatment is currently chemotherapy, but decisions are highly individualized. We consider age, mobility, and functional status—essentially, how fit is the person? We also review their baseline labs and comorbidities to see if they can tolerate certain regimens. Next-generation sequencing is also crucial; if a patient has a specific mutation, it potentially opens the door for targeted therapy. Other factors include logistics, such as transportation, distance from the cancer center, and the feasibility of returning home with a pump or a central venous catheter.
How do you select between regimens like NALIRIFOX (irinotecan liposome [Onivyde], oxaliplatin, 5-fluorouracil [5-FU], and leucovorin), FOLFIRINOX (leucovorin, 5-FU, irinotecan, and oxaliplatin), and gemcitabine plus nab-paclitaxel (Abraxane)?
NALIRIFOX and FOLFIRINOX are very similar, differing by only 1 drug. Both require a full day of chemotherapy, followed by being connected to a pump for 46 to 48 hours.1,2 In contrast, gemcitabine plus nab-paclitaxel is a one-day treatment.3 Regimen selection is often provider-specific and based on patient fitness. Historically, FOLFIRINOX or NALIRIFOX is given to younger or fitter patients, while older patients or those with more comorbidities receive gemcitabine/nab-paclitaxel. However, some patients handle FOLFIRINOX well but struggle with the other regimen, and vice versa; sometimes, it requires a bit of trial and error.
How do you help patients manage AEs and maintain treatment adherence?
The most important thing is that a patient knows how to reach their medical team. We don’t want patients sitting at home thinking their symptoms are manageable when they should be reported. If we catch symptoms like nausea, diarrhea, poor appetite, or fever early, we can prevent emergency room admissions and more serious complications. This is essential for a patient to tolerate chemotherapy for the long haul. We also ensure their nutrition is maintained, their mental health is stable, and they remain physically active to maintain their strength.
Optimizing Patient-Centered Pancreatic Cancer Care
- Chemotherapy selection in pancreatic cancer is highly individualized, incorporating performance status, comorbidities, molecular profiling, and logistical considerations such as treatment access and support systems.
- Regimen choice among NALIRIFOX, FOLFIRINOX, and gemcitabine plus nab-paclitaxel is guided by patient fitness and tolerability, with real-world management often requiring iterative adjustment.
- Proactive AE monitoring and strong patient-provider communication are essential to maintaining treatment adherence, minimizing complications, and supporting long-term outcomes.
How do you see the frontline pancreatic space continuing to evolve in the coming years?
We are at a very promising stage in pancreatic cancer research. For the first time in a long time, we have therapies that are showing real potential. Patients now have opportunities for bridging to subsequent treatments, which is something we have seen in other disease states like breast cancer, but not historically in pancreatic cancer. We are also looking at oral medications, which will provide more options for [older] patients or those in rural communities who find the logistics of traveling for chemotherapy too difficult.
What advice would you give to younger women breaking into the oncology field, and how has your personal background guided your career?
I started as an inpatient bedside nurse on a general oncology floor, where I saw the sickest patients—often those with pancreatic cancer. I pursued the nurse practitioner path because I was interested in palliative care and symptom management. This work is a passion project for me because pancreatic cancer is how I lost my father. Now, [all] of my patients have pancreatic cancer. I have been able to launch a nurse practitioner–led diagnostic and survivorship clinic, which is cutting-edge for these patients. My advice is to follow what interests you; in the nursing world, we have a lot of flexibility, and your skills will follow you wherever you go.
References
- Onivyde. Prescribing information. FDA. Updated December 2024. Accessed April 16, 2026. http://www.accessdata.fda.gov/drugsatfda_docs/label/2024/207793s016lbl.pdf
- Fluorouracil injection. Prescribing information. FDA. Updated January 2026. Accessed April 16, 2026. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/040279Orig1s032lbl.pdf
- Abraxane. Prescribing information. Bristol Myers Squibb. Updated October 2022. Accessed April 16, 2026.https://packageinserts.bms.com/pi/pi_abraxane.pdf
