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Bridging clinic: The initial medical management of patients with newly diagnosed pancreatic cancer
  1. Loveena Sreedharan1,
  2. Bhaskar Kumar2,
  3. Anna Jewell3,
  4. Paul Banim4,
  5. Andreas Koulouris5,
  6. Andrew R Hart6
  1. 1 ST Upper GI Surgery, East of England Deanery, UK
  2. 2 Upper GI Surgery, Norfolk and Norwich Hospital, Norwich, UK
  3. 3 Pancreatic Cancer UK, London, UK
  4. 4 James Paget University Hospitals, Great Yarmouth, Norfolk, UK
  5. 5 Academic Clinical Fellow in Gastroenterology, Norfolk and Norwich Hospital, Norwich, UK
  6. 6 Gastroenterology, Norfolk and Norwich Hospital, Norwich, UK
  1. Correspondence to Miss Loveena Sreedharan, Speciality Trainee General Surgery, East of England Deanery, Norwich NR9 3AW, UK; loveenasree{at} and Professor Andrew R Hart, University of East Anglia, Norfolk and Norwich Hospital Norwich UK ; a.hart{at}


Pancreatic cancer is the 11th most common cancer in the UK and has the worst prognosis of any tumour with minimal improvements in survival over recent decades. As most patients are either ineligible for surgery or may decline chemotherapy, the emphasis is on control of symptoms and management of complications such as poor nutritional status. The time period between informing the patient of their diagnosis and commencing cancer treatments presents a valuable opportunity to proactively identify and treat symptoms to optimise patients’ overall well-being. The ‘bridging clinic’, delivered by a range of healthcare professionals from gastroenterologists to nurse practitioners, can provide this interface where patients are first informed of their diagnosis and second supportive therapies offered. In this article, we provide a structure for instituting such supportive therapies at the bridging clinic. The components of the clinic are summarised using the mnemonic INDASH (Information/Nutrition/Diabetes and Depression/Analgesia/Stenting/Hereditary) and each is discussed in detail below.

  • pancreatic cancer
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  • Contributors LS wrote the main content of the article and submitted the study. BK as an upper GI surgeon provided clinical input into the manuscript and provided a structure to the article. AJ provided valuable insights into the information and support needs of people with pancreatic cancer from her experience of providing these services at a national patient organisation. PB wrote the section on depression. AK wrote the section on analgesia. ARH provided the concepts behind the paper as well as writing the section on diabetes.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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