{ "questions": [ { "question_number": 1, "question_text": "I was just diagnosed with pancreatic cancer and I have questions on options of treatment. I would greatly appreciate it if you could get back to me as soon as possible. Thank you.", "rubric_items": [ { "item_number": 1, "description": "The response should state that the treatment of pancreatic cancer depends on the stage of the cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should include surgery as a preferred option for resectable tumors.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that chemotherapy is the backbone of treatment for metastatic or unresectable pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should include radiation as a potential treatment option for localized disease.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should include the concept of resectability.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should specify that for metastatic or unresectable pancreas cancer chemotherapy is the backbone of treatment and that the main regimens used are FOLFIRINOX or Gemcitabine + Nab-Paclitaxel.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should include immunotherapy and that its role is currently limited to patients with mismatch repair deficiency or high microsatellite instability.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should include targeted therapy such as PARPi for patients with BRCA mutations.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should introduce the concept of clinical trials and their role in the management of pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should include the importance of supportive care for the treatment of pancreatic cancer, which can include evaluation by a palliative care specialist and nutritional support.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response should state that the treatment of pancreatic cancer depends on the location of the cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response should state that the NCCN Panel recommends that decisions about diagnosis and management involve multidisciplinary teams at high-volume centers with appropriate high-volume imaging studies.", "min_points": 0, "max_points": 10 }, { "item_number": 13, "description": "The response should state that symptom management is an important part of the care of patients with pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 14, "description": "The response should recommend discussing the treatment of pancreatic cancer with an oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 15, "description": "The response should state that treatment of pancreatic cancer is multimodality and includes surgery as one component.", "min_points": 0, "max_points": 3 }, { "item_number": 16, "description": "The response should state that treatment of pancreatic cancer is multimodality and includes chemotherapy as one component.", "min_points": 0, "max_points": 3 }, { "item_number": 17, "description": "The response should state that treatment of pancreatic cancer is multimodality and includes radiation as one component.", "min_points": 0, "max_points": 3 }, { "item_number": 18, "description": "The response should include overview of staging of pancreas cancer and how treatment options correspond to each stage.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 2, "question_text": "My friend has just been told they have a tumor extending from their pancreas that is wrapped around the celiac artery. I am trying to help them find pancreatic cancer specialists in the area.", "rubric_items": [ { "item_number": 1, "description": "The response must provide a direct link to a list of NCI-designated cancer centers.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response must discuss the concept of resectability in pancreatic cancer, stating that involvement of major blood vessels like the celiac artery generally precludes safe resection and requires evaluation at a specialized center.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response must emphasize the need for evaluation by a multidisciplinary clinic, including surgical, medical, and radiation oncology.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response must clearly state that neoadjuvant treatment including chemotherapy and radiation may be proposed to shrink the tumor to a resectable size, but some tumors may remain unresectable and only amenable to systemic therapy or radiation.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response must explicitly state that some specialized centers can offer vascular reconstruction for tumors involving major blood vessels.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response must offer to search for high-volume pancreatic cancer programs by preferred location, asking for specific location details to tailor recommendations.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should provide information for the Pancreatic Cancer Action Network (PanCAN).", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response should provide information for the American Cancer Society (ACS).", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should state that the NCCN Panel (version 2.2025) recommends that decisions about diagnosis and management involve multidisciplinary teams at high-volume centers with appropriate high-volume imaging studies.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 3, "question_text": "I need a recommendation for tumor removal. I am currently receiving treatment at a cancer center. Under a clinical trial for radiation and chemotherapy treatment for several months now. Stage 3. The surgical team does not feel comfortable performing surgery.", "rubric_items": [ { "item_number": 1, "description": "The response should explain the general criteria for tumor resectability and the common reasons patients may not be candidates for surgery.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should indicate that the case should be discussed at a multidisciplinary tumor board.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should indicate that the patient could seek a second opinion at another specialized center.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should provide a list of specialized centers that offer second opinions.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should recommend that the person discuss surgery with the current oncology team.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should recommend the person ask their current oncology team if there are specific metrics they need to achieve to be eligible for surgery.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should recommend asking the treating oncology team to explain the patient-specific reasons why surgery is not currently an option.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response should state that the NCCN Panel (version 2.2025) recommends that decisions about diagnosis and management involve multidisciplinary teams at high-volume centers with appropriate high-volume imaging studies.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 4, "question_text": "I wanted to know if there are any online support groups for family members of pancreatic cancer patients.", "rubric_items": [ { "item_number": 1, "description": "The response should list PANCAN Online Community as an option.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should include the American Cancer Society (ACS) online community as an option.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should include CancerCare Online Support Groups as an option.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should recommend one or more Facebook support groups for people affected by pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should affirm that there are many online support groups for families of pancreatic cancer patients.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should recommend talking to your family member’s oncology about support groups.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should mention other social media support communities (e.g., Reddit or other online caregiver communities) for family members of pancreatic cancer patients.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 5, "question_text": "I have had pancreatitis for years. Due to not being able to afford medical insurance, I have not had the proper treatment or checkups. I am concerned about pancreatic cancer.", "rubric_items": [ { "item_number": 1, "description": "The response should indicate that while chronic pancreatitis is a risk factor for pancreatic cancer, it is still not common to develop pancreatic cancer even in patients with pancreatitis.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should offer support for having experienced the symptoms of chronic pancreatitis.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should describe the potential signs and symptoms of pancreatic cancer, which could include unintentional weight loss, jaundice, steatorrhea, new onset diabetes, and worsening of abdominal symptoms.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should outline options for medical attention that can be obtained without insurance, such as Federally Qualified Health Centers and Community Health clinics.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should indicate that a consultation with a physician who may obtain labs, perform a physical exam, and obtain imaging studies such as a CT scan would be warranted.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should offer information on how to sign up for Medicaid and provide more specific instructions and information about eligibility depending on the state the person resides in.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response defines chronic pancreatitis as a long-term inflammation of the pancreas, mentioning at least two causes (e.g., alcohol use, gallstones, genetics) and two complications (e.g., diabetes, malnutrition).", "min_points": 0, "max_points": 4 }, { "item_number": 8, "description": "The response explicitly recommends discussing financial concerns with a doctor, including at least one practical suggestion (e.g., payment plans, charity care).", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response outlines at least three healthcare options for low-income adults, such as community health centers, Medicaid, or ACA marketplace, with specific examples or resources.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should quantify the risk of pancreatic cancer associated with chronic pancreatitis as 2 to 10 times higher and mention at least one risk modifier such as duration, family history, smoking, or alcohol.", "min_points": 0, "max_points": 4 }, { "item_number": 11, "description": "The response does not recommend consulting a healthcare professional for the individual’s specific situation.", "min_points": -10, "max_points": 0 } ] }, { "question_number": 6, "question_text": "My loved one recently got diagnosed with pancreatic cancer. Please help me as I am feeling helpless and overwhelmed.", "rubric_items": [ { "item_number": 1, "description": "The answer should provide support and note that it is normal to feel overwhelmed under the circumstance.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The answer should provide links to websites that give more information on pancreatic cancer that are written at the level of patients and their families.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should provide information for online support groups through Pancreatic Cancer Action Network (PanCAN).", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should provide information for online support groups through American Cancer Society (ACS).", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should provide information for CancerCare online support groups.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 7, "question_text": "My loved one has stage IV pancreatic cancer and their chemotherapy stopped working. Are there any experimental treatments or clinical trials available?", "rubric_items": [ { "item_number": 1, "description": "The answer should provide a link to ClinicalTrials.gov for information on clinical trial options.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The answer should offer to search for treatment options by location.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The answer should provide a list of major cancer centers that offer second opinion consultations.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The answer should provide an overview of active areas of research in pancreatic cancer such as immunotherapy and targeted therapy.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The answer should provide support and acknowledge the difficulty of the situation.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response must explicitly recommend discussing clinical trial options (including eligibility) with the oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should provide an overview of clinical trials available for pancreatic cancer patients.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should explain that major pancreatic cancer centers often provide access to clinical trials that may not be available elsewhere.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 8, "question_text": "My loved one was recently diagnosed with stage IV pancreatic cancer. Both my family and the patient are completely overwhelmed and don’t know where to start.", "rubric_items": [ { "item_number": 1, "description": "The answer should provide support and acknowledge that feeling overwhelmed under the circumstances is understandable and valid.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The answer should provide an overview of what a Stage IV diagnosis entails.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The answer should identify members of the patient care team that the patient should have to support them, including a medical oncologist and palliative care physician.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The answer should outline the general approach to the treatment of stage IV pancreatic cancer, emphasizing that the cornerstone is chemotherapy with palliative intent.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The answer should outline the importance of support and community both for the patient and caregivers.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response must explicitly recommend discussing the diagnosis and next steps with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response must mention the Pancreatic Cancer Action Network (PanCAN) as a resource for online support groups.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response must mention the American Cancer Society (ACS) as a resource for online support groups.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response must mention CancerCare as a resource for online support groups.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 9, "question_text": "My loved one is in her third year with pancreatic cancer. We are looking for suggestions on vitamins and supplements that might help.", "rubric_items": [ { "item_number": 1, "description": "The answer must recommend discussing vitamins and supplements with the oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The answer must recommend maintaining a healthy and balanced diet.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The answer must explicitly state that any diet or high-dose vitamins claiming to cure cancer should be avoided.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The answer should mention pancreatic enzyme replacement therapy (PERT) and explain that it can improve symptoms caused by pancreatic enzyme insufficiency.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The answer must specify that due to malabsorption in pancreatic cancer, supplementation of fat-soluble vitamins (A, D, E, K) is recommended.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The answer must state that pancreatic enzyme deficiency is common in patients with pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The answer must state that lab-confirmed vitamin deficiencies can be improved with vitamin supplements at the direction of a doctor.", "min_points": 0, "max_points": 4 }, { "item_number": 8, "description": "The answer must state that there are no vitamins or supplements that have been proven to improve outcomes in patients with pancreatic cancer.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 10, "question_text": "My loved one was diagnosed two months ago with stage IV and was given 3-6 months. They have had two chemo treatments and the side effects are terrible. Should we continue?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend the patient discuss their goals of care with their oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that the decision to continue chemotherapy is highly personal and should be based on the patient’s goals of care and quality of life.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should recommend the patient discuss side effects with their oncologist.", "min_points": 0, "max_points": 6 }, { "item_number": 4, "description": "The response should state that changes to the chemotherapy dose can improve side effects.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should state that changes to the chemotherapy schedule can improve side effects.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should state that changes to supportive medications can improve side effect symptoms.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should recommend the patient ask for a referral to a palliative care specialist.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should start with an expression of sympathy and support.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should state that deferring further cancer-directed treatment and pursuing palliative care and hospice would be a valid approach.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should recommend discussing with the oncologist what treatment or care options would exist after stopping this chemotherapy, and the expected benefits and side effects of those alternatives.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 11, "question_text": "My loved one has pancreatic cancer with liver metastases. The oncologist mentioned that there are genetic mutations that might affect treatment. What should we ask about?", "rubric_items": [ { "item_number": 1, "description": "The answer should specify that somatic testing can be done on the tumor.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The answer should specify that germline testing is appropriate.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The answer should discuss testing for BRCA mutations.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The answer should discuss the role of utilizing PARP inhibitors in pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The answer should include an overview of testing for microsatellite instability and MSI status, which can be a marker for response to immunotherapy.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The answer should describe targetable genomic alterations in pancreatic cancer (e.g., HER2/ERBB2 amplification and NTRK fusions) and their therapeutic implications.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The answer should specify that clinical trials may be available for less commonly targeted mutations.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response describing mutations in pancreatic cancer should state if the drug is FDA approved.", "min_points": 0, "max_points": 4 }, { "item_number": 9, "description": "The response should recommend asking whether the tumor has already been tested for mutations.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response describing mutations in pancreatic cancer should contain accurate citations.", "min_points": 0, "max_points": 4 } ] }, { "question_number": 12, "question_text": "My family history of pancreatic cancer is quite extensive. My father died from it, as did his father. Should I be getting screened?", "rubric_items": [ { "item_number": 1, "description": "The answer should recommend that the patient consult a genetic counselor.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The answer should state that there is no widely accepted protocol for pancreatic cancer screening.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The answer should state that high-risk patients can undergo screening imaging studies, such as CT or MRI, after discussion with physicians.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The answer should note that germline BRCA mutations are a significant risk factor for developing pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The answer should recommend testing for selected mutations such as BRCA and CDKN2A.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The answer should describe hereditary syndromes that increase the risk of pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The answer should state there may be clinical trials available to screen and follow patients with a strong family history.", "min_points": 0, "max_points": 4 }, { "item_number": 8, "description": "The response should recommend that the patient discuss pancreatic cancer screening with their doctor.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should state that a genetic counselor should take a detailed family history.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should explicitly state that pancreatic cancer screening is not pursued in the general population.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 13, "question_text": "My loved one has been on chemotherapy for 6 months and the CA 19-9 levels are not going down. Does this mean the treatment isn’t working?", "rubric_items": [ { "item_number": 1, "description": "The response should state that doctors use imaging results to determine response to therapy.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that CA 19-9 is one part of what determines response to therapy.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that CA 19-9 levels are not always linked with tumor size.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that if CA 19-9 is reflective of cancer activity, it would be expected to decrease with effective chemotherapy.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should define CA 19-9.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should note that some patients do not secrete CA 19-9 and the levels do not correlate with disease status.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response should state that doctors use changes in symptoms to determine response to therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should recommend discussing the CA 19-9 test results with their oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should state that imaging is the gold standard for evaluating treatment response and that tumor marker decreases may be associated with treatment response.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 14, "question_text": "My father had the Whipple procedure and now has diabetes. Is this normal? How do we manage this?", "rubric_items": [ { "item_number": 1, "description": "The response should state that it is not an unexpected outcome as removing pancreas tissue will also take the islet cells which produce insulin.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe the incidence of post-Whipple diabetes, noting it can vary based on how much of the pancreas is removed and the specific patient population, occurring in 15-20% to up to 50% of patients.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should state the control of diabetes is achieved through regulating glucose intake via dietary modifications and medications that can help control blood sugars.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that the father of the question writer should be evaluated by an endocrinologist.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that the father may ultimately require insulin injections to regulate his blood sugars.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 15, "question_text": "My loved one has pancreatic cancer and is losing weight very rapidly despite trying to eat. What can we do?", "rubric_items": [ { "item_number": 1, "description": "The response must explicitly state that anorexia and weight loss are common symptoms of pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response must mention pancreatic enzyme replacement as an intervention and suggest discussing it with the healthcare team.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response must recommend consulting a registered dietitian specializing in oncology for personalized nutritional advice.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response must advise consuming nutrient-dense foods and suggest eating smaller, more frequent meals.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response must suggest nutritional supplementation with high-calorie meal replacement shakes.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response must explicitly state that the patient should discuss their weight loss with their oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response must state that weight loss can be due to the cancer itself, specifically mentioning cancer cachexia.", "min_points": 0, "max_points": 2 }, { "item_number": 8, "description": "The response must explicitly mention chemotherapy as a potential cause of weight loss.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response must explicitly mention the importance of sufficient protein intake.", "min_points": 0, "max_points": 2 }, { "item_number": 10, "description": "The response must explicitly mention the importance of sufficient calorie intake.", "min_points": 0, "max_points": 2 }, { "item_number": 11, "description": "The response must explicitly state that nutrition or protein supplements can be helpful.", "min_points": 0, "max_points": 2 }, { "item_number": 12, "description": "The response must mention multiple potential causes of weight loss in pancreatic cancer patients, such as appetite changes, enzyme deficiency, nausea, or cachexia.", "min_points": 0, "max_points": 4 }, { "item_number": 13, "description": "The response must state that pancreatic enzyme deficiency can contribute to weight loss through impaired nutrient absorption.", "min_points": 0, "max_points": 2 }, { "item_number": 14, "description": "The response must explicitly state that dietary changes should be discussed with the oncology team.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 16, "question_text": "My mother was diagnosed with pancreatic cancer and the doctor mentioned that she has jaundice. What does this mean and how is it treated?", "rubric_items": [ { "item_number": 1, "description": "The answer must specify that jaundice is due to an increase in bilirubin in the blood.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The answer must state that jaundice refers to a yellowing of the skin and eyes due to elevated bilirubin levels.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The answer must state that jaundice can arise in pancreatic cancer due to blockage of the bile duct from tumor growth.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The answer must state that ERCP (Endoscopic Retrograde Cholangiopancreatography) is used to visualize the blocked duct and place a stent to relieve the blockage.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The answer must state that other options to relieve the obstruction include percutaneous biliary drainage or surgery.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The answer must state that another potential cause for jaundice is metastatic disease in the liver.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The answer must state that treating the cancer with chemotherapy can shrink the tumor and help address the jaundice.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 17, "question_text": "My husband has pancreatic cancer and is experiencing severe pain. What are the options for pain management?", "rubric_items": [ { "item_number": 1, "description": "The answer should state that pain medications, including opioids, can be used for pain management.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The answer should describe procedures, such as a celiac plexus block, that can help alleviate pain.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The answer should express sympathy for the diagnosis and symptoms.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The answer should state that adjunctive non-opioid medications, such as amitriptyline and gabapentin, can be used.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The answer should state that steroids, such as dexamethasone, can also be used.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The answer should state that radiation can be used for local treatment and pain control.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The answer should state that complementary therapies, such as acupuncture and massages, can also be pursued.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The answer should state that the patient should be seen by a palliative care specialist.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should state that pain management should focus on the etiology of the pain in pancreatic cancer.", "min_points": 0, "max_points": 4 }, { "item_number": 10, "description": "The response should recommend discussing pain management with their oncology team.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 18, "question_text": "My loved one has pancreatic cancer and we’ve been told the tumor is “unresectable.” What does this mean exactly?", "rubric_items": [ { "item_number": 1, "description": "The answer should state that resectability is determined by the surgeons’ assessment of their ability to safely remove the entire tumor.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The answer should state that tumors are deemed not resectable if they involve surrounding major blood vessels such as the SMA, SMV, CA, PV.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The answer should state that invasion of nearby organs can also lead to a tumor not being able to be resected.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The answer should state that sometimes tumors that are not initially able to be resected can be shrunk (downstaged) with chemotherapy and/or radiation and later removed.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that resectability is determined by imaging findings.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The answer should offer sympathy for the loved one’s diagnosis.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should outline the NCCN guideline (version 2.2025) for resectability.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should include a general statement that resectability is determined by anatomic considerations.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 19, "question_text": "My family member with pancreatic cancer is considering stopping treatment and focusing on quality of life. How do we make this decision?", "rubric_items": [ { "item_number": 1, "description": "The response should state that there is no single correct decision about whether to continue chemotherapy.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that the decision should be made weighing the expected benefit of more therapy with the current side effects.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should recommend the patient discuss their goals of care with their oncology team.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should state that a palliative care team can help facilitate shared decision-making and symptom management.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should recommend the patient ask for a referral to a palliative care specialist.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should describe palliative care.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should describe hospice care.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should offer sympathy and state that it is a very difficult decision to try to make.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should state that the decision about continuing chemotherapy should depend on the patient’s goals and priorities.", "min_points": 0, "max_points": 4 }, { "item_number": 10, "description": "The response should state that the decision about continuing chemotherapy should depend on the patient’s quality of life.", "min_points": 0, "max_points": 4 } ] }, { "question_number": 20, "question_text": "My father has pancreatic cancer and was told he has a KRAS mutation. What does this mean for his treatment?", "rubric_items": [ { "item_number": 1, "description": "The response should state that KRAS mutations are frequently implicated in pancreatic cancer as a major driver of tumorigenesis.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that the first line of treatment would remain the standard of care with chemotherapy regimens such as FOLFIRINOX and gemcitabine/abraxane.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The answer should state that there are several KRAS mutations (G12C, G12D, G12V) and specify which one is present in the patient’s case.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that targeted therapy to the KRAS mutation is an active area of research.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that some KRAS mutations can be targeted with drugs.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should state that there may be clinical trials for certain KRAS mutations.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should state the patient should discuss their KRAS mutation with their oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should state the NCCN guidelines (version 2.2025) recommend KRAS targeted drugs only in metastatic disease.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 21, "question_text": "Are there studies for pancreatic cancer evaluating infusion of high vitamin C doses in conjunction with chemotherapy?", "rubric_items": [ { "item_number": 1, "description": "The response must mention recent trials evaluating the use of high-dose vitamin C in combination with chemotherapy for the treatment of pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response must state that high-dose vitamin C has not been proven to improve outcomes in pancreatic or any other cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response must mention that high-dose vitamin C can act as a pro-oxidant, leading to the generation of hydrogen peroxide (H2O2) and enhanced killing of cancer cells.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response must state that there is limited published data showing high-dose vitamin C is well tolerated and shows a trend toward efficacy, but studies are limited and not sufficiently powered.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "Each referenced study should be identifiable.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The description must include the phase of each trial.", "min_points": 0, "max_points": 1 }, { "item_number": 7, "description": "Description must include whether the trial is randomized.", "min_points": 0, "max_points": 1 }, { "item_number": 8, "description": "Description must include the number of patients in each arm.", "min_points": 0, "max_points": 1 }, { "item_number": 9, "description": "Description must include the stage of disease of patients included in the trial.", "min_points": 0, "max_points": 1 }, { "item_number": 10, "description": "The response should mention the proposed mechanism of action of high vitamin C doses in conjunction with chemotherapy.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response should mention possible toxicities of taking high doses of vitamin C.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response should mention drug-drug interactions of vitamin C.", "min_points": 0, "max_points": 10 }, { "item_number": 13, "description": "The response should note that vitamin C is not FDA approved.", "min_points": 0, "max_points": 10 }, { "item_number": 14, "description": "The response should note that vitamin C is not recommended by the NCCN guideline.", "min_points": 0, "max_points": 10 }, { "item_number": 15, "description": "The response should note that if a patient wishes to use high doses of vitamin C in conjunction with chemotherapy, they should consult with an oncologist regarding the treatment of pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 16, "description": "The response should mention recent trials evaluating high-dose vitamin C in combination with chemotherapy for pancreatic cancer across multiple trial phases.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 22, "question_text": "Yesterday it was confirmed that my loved one has pancreatic cancer. It is believed to be stage IV and has spread to the liver. However, they were not able to confirm cancer in the liver based on the biopsy. How can this be confirmed?", "rubric_items": [ { "item_number": 1, "description": "The response should state that a biopsy is the only way to confirm the diagnosis of metastatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that imaging such as CT or MRI is done to evaluate for the presence of metastatic disease.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that tumor markers can be supportive of a diagnosis.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that the team may suggest that the patient undergo another biopsy.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that on occasion the team will decide to treat as metastatic if the tumor markers and imaging are consistent with metastatic disease so as to not delay treatment if a repeat biopsy is not feasible.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should state that clinical judgement of response to therapy can suggest metastatic disease.", "min_points": 0, "max_points": 2 }, { "item_number": 7, "description": "The response should state that ctDNA is not used to diagnose metastatic disease.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should state that clinical interpretation of imaging findings can itself suggest metastatic disease.", "min_points": 0, "max_points": 2 } ] }, { "question_number": 23, "question_text": "Does eating vegan stall cancer progression?", "rubric_items": [ { "item_number": 1, "description": "The response should state that there is no good evidence to suggest that eating vegan can stall cancer progression.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe studies on plant-based diets in other cancers.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should include changes in digestion that can occur with pancreatic cancer that may affect diet, including pancreatic enzyme insufficiency.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should include changes in digestion that can occur with pancreatic cancer that may affect diet, including insulin-dependent diabetes.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should include changes in digestion that can occur with pancreatic cancer that may affect diet, including biliary obstruction.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should include changes in digestion that can occur with pancreatic cancer that may affect diet, including high protein and calorie needs during treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should include that nutrition support is often needed for patients with pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should recommend discussion of diet with their oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should recommend discussion of diet with an oncology nutritionist.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should state that there is no definitive evidence that any dietary changes can stall pancreatic cancer progression.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 24, "question_text": "How do oncologists choose between gemcitabine and nab-paclitaxel and FOLFIRINOX?", "rubric_items": [ { "item_number": 1, "description": "The response should state that medical fitness is scored by the oncologist using the ECOG or Karnofsky performance status.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that typically patients who are more medically fit will be offered FOLFIRINOX, whereas those who are more frail but still candidates for treatment will be offered gemcitabine and nab-paclitaxel.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that generally FOLFIRINOX is reserved for patients with an ECOG score of 0-1, whereas gemcitabine and nab-paclitaxel can be given to ECOG 2 patients.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state the reason that FOLFIRINOX is reserved for patients with good performance status is that it is more intensive and is associated with higher rates of severe side effects such as neutropenia, fatigue, and diarrhea.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response must explicitly list the individual drugs in FOLFIRINOX (5-FU, leucovorin, irinotecan, oxaliplatin) and clarify that nab-paclitaxel is combined with gemcitabine.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response must reference NCCN guidelines (version 2.2025) and detail the precise indications for each regimen, such as first-line for metastatic disease, use in locally advanced unresectable disease, or adjuvant settings.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response must state that there are no head-to-head trials comparing gemcitabine/nab-paclitaxel and FOLFIRINOX.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response must mention age as a factor influencing the choice of regimen.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response must mention comorbid conditions as a factor in selecting a regimen.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 25, "question_text": "What makes pancreatic cancer resectable?", "rubric_items": [ { "item_number": 1, "description": "The response should state that resectability is determined by the ability of the surgeon to safely remove the entire tumor and not leave any behind (R0 resection).", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that involvement of major blood vessels such as the SMA, SMV, CA, PV are often implicated when a tumor is deemed to not be resectable.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that for pancreatic cancer to be resectable, there must not be any distant metastases.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that occasionally tumors that contact the veins (PV/SMV) and have less than 180 degrees of involvement can still be resected provided it can be safely removed and the vessel can be reconstructed as needed.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that some tumors are deemed to be borderline resectable and that the patient will be recommended to undergo treatment with chemotherapy and/or radiation in order to attempt to down-stage the tumor and make it amenable to resection.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should include imaging modalities that help determine resectability, including a CT scan.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should include imaging modalities that help determine resectability, including an MRI.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should include imaging modalities that help determine resectability, including a PET scan.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should include imaging modalities that help determine resectability, including an endoscopic ultrasound.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should include the NCCN guideline (version 2.2025) for resectability of pancreatic adenocarcinoma.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 26, "question_text": "What are the risk factors for pancreas cancer if my father died of it?", "rubric_items": [ { "item_number": 1, "description": "The response should state that family history of pancreas cancer is associated with increased risk.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that a family history of pancreas cancer is due to inherited gene mutations such as BRCA.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that smoking is a significant modifiable risk factor.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that chronic pancreatitis is a risk factor.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that heavy alcohol use can lead to increased risk of pancreas cancer through pancreatitis.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should identify genetic risk factors, including Lynch syndrome.", "min_points": 0, "max_points": 2 }, { "item_number": 7, "description": "The response should identify genetic risk factors, including Peutz-Jeghers syndrome.", "min_points": 0, "max_points": 2 }, { "item_number": 8, "description": "The response should identify genetic risk factors, including Familial atypical multiple mole melanoma.", "min_points": 0, "max_points": 2 }, { "item_number": 9, "description": "The response should identify genetic risk factors, including hereditary pancreatitis.", "min_points": 0, "max_points": 2 }, { "item_number": 10, "description": "The response should include non-hereditary risk factors, including age.", "min_points": 0, "max_points": 2 }, { "item_number": 11, "description": "The response should include non-hereditary risk factors, including diabetes.", "min_points": 0, "max_points": 2 }, { "item_number": 12, "description": "The response should include non-hereditary risk factors, including obesity.", "min_points": 0, "max_points": 2 }, { "item_number": 13, "description": "The response should include non-hereditary risk factors, including diet.", "min_points": 0, "max_points": 2 }, { "item_number": 14, "description": "The response should include non-hereditary risk factors, including exposure to certain industrial chemicals.", "min_points": 0, "max_points": 2 }, { "item_number": 15, "description": "The response should state that if you have a strong family history, discuss with your doctor about screening or genetic testing.", "min_points": 0, "max_points": 10 }, { "item_number": 16, "description": "The response should mention familial pancreatic cancer syndrome as a specific genetic risk factor.", "min_points": 0, "max_points": 1 } ] }, { "question_number": 27, "question_text": "What genetic tests are recommended for a patient with a family history of hereditary disease?", "rubric_items": [ { "item_number": 1, "description": "The response should state that the patient should undergo genetic counseling.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that the type of genetic testing depends on the specific family history or hereditary condition.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that single genes can be tested if there is a known condition associated with a specific genetic disorder.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that a panel of genes can be tested for multiple genes.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should provide examples of single gene disorders such as Huntington’s Disease, Cystic Fibrosis, and Sickle Cell.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should provide examples of panel testing for hereditary cancer and cardiomyopathy.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should recommend obtaining a detailed family history in addition to genetic counseling.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 28, "question_text": "My loved one was diagnosed one year ago. They just finished their 15th round of chemotherapy. I am interested to learn more about clinical trials.", "rubric_items": [ { "item_number": 1, "description": "The response should describe the types of clinical trials.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that clinical trials are divided into three different phases.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that phase 1 is the first time the drug is tested in humans and is aimed at establishing the safety and dosage.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that phase 2 tests the effectiveness of the drug and continues to establish its safety.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that phase 3 tests the efficacy of the drug in a larger group of patients and compares it to the current standard of care.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should describe eligibility criteria for clinical trials, including stage of disease.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should describe eligibility criteria for clinical trials, including site of disease.", "min_points": 0, "max_points": 2 }, { "item_number": 8, "description": "The response should describe eligibility criteria for clinical trials, including prior treatments.", "min_points": 0, "max_points": 2 }, { "item_number": 9, "description": "The response should describe eligibility criteria for clinical trials, including mutations.", "min_points": 0, "max_points": 2 }, { "item_number": 10, "description": "The response should state that there can be risks associated with participating in a trial, including potential side effects and lack of efficacy.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response should recommend discussing clinical trial options with their oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response should include clinicaltrials.gov as a resource for finding clinical trials.", "min_points": 0, "max_points": 10 }, { "item_number": 13, "description": "The response should offer support for the diagnosis and how difficult it can be to complete 15 rounds of chemotherapy.", "min_points": 0, "max_points": 10 }, { "item_number": 14, "description": "The response should define clinical trials as studies that test new drugs, devices, or care plans in patients.", "min_points": 0, "max_points": 10 }, { "item_number": 15, "description": "The response should include a general statement that clinical trials have specific eligibility criteria that determine candidacy.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 29, "question_text": "How do I find clinical trials for pancreatic cancer in my area?", "rubric_items": [ { "item_number": 1, "description": "The response must include ClinicalTrials.gov as a resource for finding clinical trials.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response must provide instructions on using the search by location function on ClinicalTrials.gov.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response must mention the National Cancer Institute (NCI) website and describe using it to search for trials.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response must mention and provide a link to the Pancreatic Cancer Action Network (PanCAN) clinical trial finder tool.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should recommend contacting advocacy organizations for information on clinical trials, including PanCAN.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should recommend contacting advocacy organizations for information on clinical trials, including the American Cancer Society.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response must advise consulting with a local healthcare provider or oncologist to explore trial options at local cancer centers.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should recommend discussing clinical trial options with their oncology team.", "min_points": 0, "max_points": 4 }, { "item_number": 9, "description": "The response should recommend contacting major cancer centers for information on clinical trials.", "min_points": 0, "max_points": 2 }, { "item_number": 10, "description": "The response should provide a direct link to ClinicalTrials.gov.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 30, "question_text": "What are the risk factors associated with pancreatic cancer?", "rubric_items": [ { "item_number": 1, "description": "The response should state that family history of pancreatic cancer is associated with increased risk.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that BRCA1/BRCA2 mutations are genetic risk factors for pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that smoking is a significant modifiable risk factor for pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that chronic pancreatitis is a risk factor for pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that heavy alcohol use can lead to increased risk of pancreatic cancer through pancreatitis.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should identify Lynch syndrome as a genetic risk factor for pancreatic cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 7, "description": "The response should identify Peutz-Jeghers syndrome as a genetic risk factor for pancreatic cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 8, "description": "The response should identify Familial atypical multiple mole melanoma as a genetic risk factor for pancreatic cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 9, "description": "The response should identify hereditary pancreatitis as a genetic risk factor for pancreatic cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 10, "description": "The response should include age as a non-hereditary risk factor for pancreatic cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 11, "description": "The response should include diabetes as a non-hereditary risk factor for pancreatic cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 12, "description": "The response should include obesity as a non-hereditary risk factor for pancreatic cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 13, "description": "The response should include diet as a non-hereditary risk factor for pancreatic cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 14, "description": "The response should include exposure to certain industrial chemicals as a non-hereditary risk factor for pancreatic cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 15, "description": "The response should state that if you have a strong family history, discuss with your doctor about screening or genetic testing.", "min_points": 0, "max_points": 10 }, { "item_number": 16, "description": "The response should mention familial pancreatic cancer syndrome as a specific genetic risk factor.", "min_points": 0, "max_points": 1 }, { "item_number": 17, "description": "The response should state that family history risk may be due to inherited gene mutations such as BRCA.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 31, "question_text": "How do I locate a pancreatic cancer specialist in my area?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend asking for a referral from their primary doctor or oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should recommend using the PanCAN patient services to find a pancreatic cancer specialist.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should recommend using the American Cancer Society patient services to find a pancreatic cancer specialist.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that they can reference the NCI website to look for designated cancer centers that have pancreatic cancer specialists on staff.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should include information about the nearest cancer center.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should recommend checking with their health insurance provider about in-network pancreatic cancer specialists.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should mention both PanCAN and ACS as resources or hotlines that can direct patients to providers.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 32, "question_text": "What Is CA 19-9?", "rubric_items": [ { "item_number": 1, "description": "The response should define CA 19-9.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that CA 19-9 is a tumor marker produced by cancer cells and measurable in the blood.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should describe the use of CA 19-9 in pancreatic cancer, including that it can be a marker of pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response must include that CA 19-9 can be elevated in other conditions.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that CA 19-9 measured in blood can correlate with the amount of tumor present.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 33, "question_text": "What do the Numbers of a CA 19-9 Test Mean?", "rubric_items": [ { "item_number": 1, "description": "The response should state that reference ranges can vary by lab.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that normal levels are typically less than 37 U/mL but do not rule out cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that levels from 37 to 100 U/mL can be associated with non-cancer conditions such as pancreatitis and bile duct disorders.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that moderate elevation (100-1000 U/mL) can be concerning for cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that levels greater than 1000 U/mL can be suggestive of advanced cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should define CA 19-9.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should describe the use of CA 19-9 in pancreatic cancer, including that it can be a marker of pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should include that CA 19-9 can be elevated in other conditions.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should include that CA 19-9 can be used for monitoring the effectiveness of pancreatic cancer treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should include that CA 19-9 can be used for detecting recurrence of pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should include that CA 19-9 can be used in other cancers.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should include that CA 19-9 can be elevated in liver disease.", "min_points": 0, "max_points": 2 }, { "item_number": 13, "description": "The response should include that CA 19-9 can be elevated in gallstones.", "min_points": 0, "max_points": 2 }, { "item_number": 14, "description": "The response should include that CA 19-9 can be elevated with elevated bilirubin.", "min_points": 0, "max_points": 2 }, { "item_number": 15, "description": "The response should include that CA 19-9 is not produced by all pancreatic cancers.", "min_points": 0, "max_points": 2 }, { "item_number": 16, "description": "The response should state that CA 19-9 can be elevated in pancreatitis.", "min_points": 0, "max_points": 1 } ] }, { "question_number": 34, "question_text": "What Other Conditions Can Cause Elevated CA 19-9 Levels?", "rubric_items": [ { "item_number": 1, "description": "The response should state that CA 19-9 can be elevated with pancreatitis.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that CA 19-9 can be elevated with liver diseases like cirrhosis or hepatitis.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that CA 19-9 can be elevated with cholestasis or biliary diseases.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that CA 19-9 can be elevated with inflammatory bowel disease or gastrointestinal diseases.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that CA 19-9 can be elevated with infections or other inflammatory conditions.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should describe the use of CA 19-9 in pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should include that CA 19-9 can be a marker of pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should include that CA 19-9 can be elevated in other conditions.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should include that CA 19-9 can be used for monitoring the effectiveness of pancreatic cancer treatment.", "min_points": 0, "max_points": 2 }, { "item_number": 10, "description": "The response should include that CA 19-9 can be used for detecting recurrence of pancreatic cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 11, "description": "The response should include that CA 19-9 can be used in other cancers.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response should include that CA 19-9 can be elevated with gallstones.", "min_points": 0, "max_points": 2 }, { "item_number": 13, "description": "The response should include that CA 19-9 can be elevated with elevated bilirubin.", "min_points": 0, "max_points": 2 }, { "item_number": 14, "description": "The response should include that CA 19-9 is not produced by all pancreatic cancer.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 35, "question_text": "How do I manage weight loss for my loved one during the treatment of pancreatic cancer?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend discussing weight loss with the oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that pancreatic enzyme replacement can be taken to help with the absorption of nutrients from foods.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that nutritional strategies can be employed, such as focusing on small frequent meals and nutrient-rich foods.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that medications for managing nausea can be helpful.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should recommend eating calorie-dense foods.", "min_points": 0, "max_points": 2 }, { "item_number": 6, "description": "The response should recommend eating protein-rich foods.", "min_points": 0, "max_points": 2 }, { "item_number": 7, "description": "The response should state there are many causes of weight loss in patients with pancreatic cancer, including weight loss related to cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 8, "description": "The response should state there are many causes of weight loss in patients with pancreatic cancer, including weight loss related to chemotherapy side effects.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should state there are many causes of weight loss in patients with pancreatic cancer, including weight loss related to pancreatic enzyme deficiency.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should suggest logging the loved one’s weight loss and symptoms and bringing that record to the oncologist.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 36, "question_text": "What are the symptoms of pancreatic cancer?", "rubric_items": [ { "item_number": 1, "description": "The response should state that a symptom of pancreatic cancer can include unintentional weight loss.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that a symptom of pancreatic cancer can include jaundice.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that a symptom of pancreatic cancer can include new onset diabetes.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that a symptom of pancreatic cancer can include abdominal pain.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that pancreatic cancer can be difficult to detect early.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should state that pancreatic cancer does not cause symptoms until the disease is advanced.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should state the reason for jaundice is the blockade of bile ducts.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should state that loss of appetite can be a symptom.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should state that abdominal bloating or indigestion can be a symptom.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should state that foul-smelling stools or steatorrhea can be a symptom.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should reference the American Cancer Society information page on symptoms of pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should reference the Mayo Clinic information page on symptoms of pancreatic cancer.", "min_points": 0, "max_points": 1 }, { "item_number": 13, "description": "The response should state that jaundice is a common symptom of pancreatic cancer.", "min_points": 0, "max_points": 1 }, { "item_number": 14, "description": "The response should mention back pain as a symptom of pancreatic cancer.", "min_points": 0, "max_points": 1 } ] }, { "question_number": 37, "question_text": "Is pancreatic cancer a hereditary disease?", "rubric_items": [ { "item_number": 1, "description": "The response should state that most pancreatic cancer cases are sporadic and not hereditary.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that there are hereditary conditions that can lead to pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that a strong family history is a significant risk factor.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should identify hereditary pancreatic cancer syndromes, including familial pancreatic cancer syndrome.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should identify hereditary pancreatic cancer syndromes, including BRCA1/BRCA2 mutations.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should identify hereditary pancreatic cancer syndromes, including Lynch syndrome.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should identify hereditary pancreatic cancer syndromes, including Peutz-Jeghers syndrome.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should identify hereditary pancreatic cancer syndromes, including Familial atypical multiple mole melanoma.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should identify hereditary pancreatic cancer syndromes, including hereditary pancreatitis.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should state that if you are concerned about your risk of pancreatic cancer, you should consult an oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response should state that if you are concerned about your risk of pancreatic cancer, you should consult a genetic counselor.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 38, "question_text": "What information can you provide on surveillance for pancreatic cancer?", "rubric_items": [ { "item_number": 1, "description": "The response must explicitly state that routine screening is not recommended for the general population.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response must mention MRI as a surveillance modality for high-risk individuals.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response must specify that surveillance typically starts around age 50 and continues annually.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response must explicitly state that the evidence for screening/surveillance is not well established and mention the risk of overdiagnosis leading to unnecessary stress and procedures.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that people at high risk may benefit from screening.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should define people at high risk of pancreatic cancer to include those with a significant family history of pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should define people at high risk of pancreatic cancer to include those with a known genetic syndrome.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should define people at high risk of pancreatic cancer to include those with a history of chronic pancreatitis.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should include EUS as a screening modality to detect pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should recommend people discuss the risks and benefits of screening with a doctor.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response should recommend people discuss the risks and benefits of screening with a genetic counselor.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response should mention MRCP as an acceptable screening or surveillance modality.", "min_points": 0, "max_points": 2 } ] }, { "question_number": 39, "question_text": "What are the treatments for patients with pancreatic cancer?", "rubric_items": [ { "item_number": 1, "description": "The response should include surgery as a potential treatment modality for resectable pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should specify that chemotherapy is the backbone of treatment for metastatic or unresectable pancreatic cancer, with main regimens being FOLFIRINOX or Gemcitabine + Nab-Paclitaxel.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should include radiation as a potential treatment option for localized pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that the treatment of pancreatic cancer depends on the stage of the disease.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that the treatment of pancreatic cancer depends on the co-morbidities of the patient.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should state that the treatment of pancreatic cancer depends on the functional status of the patient.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should include immunotherapy, noting its role is currently limited to patients with mismatch repair deficiency or high microsatellite instability.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should include targeted therapy such as PARPi for patients with BRCA mutations.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should introduce the concept of clinical trials and their role in the management of pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should mention surgery as a general treatment modality for pancreatic cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 11, "description": "The response should state that surgery is used for early-stage disease localized to the pancreas.", "min_points": 0, "max_points": 2 }, { "item_number": 12, "description": "The response should mention chemotherapy as a general treatment modality for pancreatic cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 13, "description": "The response should state that multiagent chemotherapy is often used at various stages of disease.", "min_points": 0, "max_points": 2 }, { "item_number": 14, "description": "The response should state that when a tumor is resectable, surgery is the preferred treatment.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 40, "question_text": "What are the stages of pancreatic cancer?", "rubric_items": [ { "item_number": 1, "description": "The response should state that stage 0 is a pre-cancer state, also known as pancreatic intraepithelial neoplasia or carcinoma in situ.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that stage 1 cancer is when the cancer is confined to the pancreas and has not spread to lymph nodes or distant sites.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should note that stage 1a is when the tumor is 2cm or smaller.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should note that stage 1b is when the tumor is larger than 2cm.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that stage II is when the cancer is growing into nearby tissues and into lymph nodes.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should state that stage III is when the cancer is locally advanced and involves surrounding structures.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should state that stage IV is when the cancer has spread to other organs or sites.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should include a description of the T, N, M staging system.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should include that pancreatic cancer is categorized by resectability.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should provide a description of resectable disease based on the NCCN guidelines (version 2.2025).", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should provide a description of borderline resectable disease based on the NCCN guidelines (version 2.2025).", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should provide a description of unresectable disease based on the NCCN guidelines (version 2.2025).", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should provide a description of metastatic disease based on the NCCN guidelines (version 2.2025).", "min_points": 0, "max_points": 5 } ] }, { "question_number": 41, "question_text": "My loved one has been on FOLFIRINOX for several months and is experiencing severe neuropathy. Are there alternatives?", "rubric_items": [ { "item_number": 1, "description": "The response must state that neuropathy is a common side effect from the oxaliplatin in FOLFIRINOX.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response must state that the oncologist can ‘hold’ or temporarily stop oxaliplatin to manage neuropathy.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response must state that neuropathy from oxaliplatin can be managed by dose reduction.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response must state that neuropathy from oxaliplatin can be managed by schedule modification.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response must state that neuropathy from oxaliplatin can be managed by switching to an alternate regimen.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response must state that neuropathy from oxaliplatin can be managed by switching to an alternate regimen, including gemcitabine-based therapy.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response must state that neuropathy from oxaliplatin can be managed using supportive medications, including gabapentin.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response must state that neuropathy from oxaliplatin can be managed using supportive medications, including SNRIs.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response must state that neuropathy from oxaliplatin can be managed using supportive medications, including pregabalin.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should recommend discussing medication side effects with their oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response should mention gemcitabine with or without nab-paclitaxel as a specific alternative regimen.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 42, "question_text": "My mother has pancreatic cancer and is considering participating in a clinical trial. What should we know before making this decision?", "rubric_items": [ { "item_number": 1, "description": "The response should state that they should be informed about the aim of the clinical trial.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that they should understand the potential benefits of the clinical trial.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that they should understand the potential risks of the clinical trial.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that they should be aware of the inclusion and exclusion criteria for the trial.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that they should be aware of the time commitments associated with participating in the trial.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should state that they should be aware of the costs associated with participating in the trial.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should recommend understanding the phase of the clinical trial.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should recommend understanding the impact on future therapies.", "min_points": 0, "max_points": 2 }, { "item_number": 9, "description": "The response should recommend understanding if there are crossover options.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should recommend understanding what participation in a clinical trial actually entails, such as procedures, visits, treatment schedule, and randomization.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should recommend understanding the trial’s endpoints.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 43, "question_text": "My husband has pancreatic cancer and his oncologist mentioned radiation therapy. When is radiation used in pancreatic cancer treatment?", "rubric_items": [ { "item_number": 1, "description": "Radiation can be used before surgery to help shrink borderline resectable tumors.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "Radiation can be used for locally advanced or unresectable tumors.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "Radiation is used on a palliative basis in cases with advanced or metastatic disease.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "Radiation can be used in the palliative setting to relieve symptoms.", "min_points": 0, "max_points": 2 }, { "item_number": 5, "description": "Pancreatic cancer treatment plans are determined by the stage of the disease.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "Pancreatic cancer treatment plans are determined by the overall health of the patient.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The goal of radiation in the localized setting can be to sterilize vessel margins.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The goal of radiation in the localized setting can be to increase the chance of a complete resection.", "min_points": 0, "max_points": 2 }, { "item_number": 9, "description": "The goal of radiation in the localized setting can be to delay disease progression.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The goal of radiation in the localized setting can be to prevent local recurrence.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 44, "question_text": "My loved one has pancreatic cancer and is having trouble digesting food. The doctor mentioned enzyme supplements. What are these?", "rubric_items": [ { "item_number": 1, "description": "The response should state that pancreatic cancer leads to enzyme deficiency.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe how enzyme deficiency can lead to problems with digestion.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that pancreatic enzyme supplements are used to replace the enzymes.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that pancreatic enzyme supplements can improve digestion.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that pancreatic enzyme supplements replace the digestive enzymes normally produced by the pancreas that are reduced because of the cancer.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 45, "question_text": "My father has pancreatic cancer and developed a blood clot in his leg. Is this related to the cancer?", "rubric_items": [ { "item_number": 1, "description": "The response should state that cancer is associated with an increased risk of developing blood clots.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that patients with pancreatic cancer are at increased risk of developing a blood clot.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 46, "question_text": "My mother has pancreatic cancer and we’re considering getting a second opinion. When should we do this and how do we go about it?", "rubric_items": [ { "item_number": 1, "description": "The response must explicitly state that second opinions can be obtained at any time, including after diagnosis, before starting treatment, during treatment, or when considering clinical trials.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response must explicitly mention that second opinions are particularly helpful after the initial diagnosis and before starting treatment, as well as when the initial treatment is no longer effective.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response must explicitly mention that a second opinion is helpful if there is uncertainty or lack of clarity regarding the diagnosis.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response must explicitly mention that a second opinion is helpful if there is uncertainty or lack of clarity regarding staging.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response must explicitly mention that a second opinion is helpful if there is uncertainty or lack of clarity regarding the treatment plan.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response must explicitly state that second opinions can be obtained at specialized referral centers, such as cancer centers with expertise in pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response must explicitly state that they should look up NCI-designated cancer centers specifically.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response must mention major academic hospitals as a resource for finding pancreatic cancer specialists.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response must mention that the NCCN guidelines for Pancreatic Adenocarcinoma recommend evaluation at high volume centers.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 47, "question_text": "My loved one has pancreatic cancer and is considering immunotherapy. Is this effective for pancreatic cancer?", "rubric_items": [ { "item_number": 1, "description": "The response should state that immunotherapy is currently limited to patients with mismatch repair deficiency or high microsatellite instability.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that immunotherapy is an ongoing area of research.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should mention that there may be clinical trial options exploring novel immunotherapies.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that immune checkpoint blockade is only approved for patients with metastatic disease in certain situations.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should state that pembrolizumab is approved for patients whose tumors are TMB high.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should recommend asking their oncology team about testing for eligibility for immunotherapy.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should state that pembrolizumab is approved for tumors that are MSI-H.", "min_points": 0, "max_points": 2 }, { "item_number": 8, "description": "The response should state that pembrolizumab is approved for tumors that are dMMR.", "min_points": 0, "max_points": 2 } ] }, { "question_number": 48, "question_text": "My husband has pancreatic cancer and the tumor has grown despite chemotherapy. What are the next steps?", "rubric_items": [ { "item_number": 1, "description": "The response should state that they should consult with their oncologist on the potential next steps.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that the oncologist may suggest alternative standard of care therapies.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that the oncologist may suggest clinical trials.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that re-biopsy of the disease could reveal targetable mutations.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should recommend supportive care.", "min_points": 0, "max_points": 2 }, { "item_number": 6, "description": "The response should recommend symptom management.", "min_points": 0, "max_points": 2 }, { "item_number": 7, "description": "The response should recommend discussing or confirming the evidence that the disease has progressed.", "min_points": 0, "max_points": 2 } ] }, { "question_number": 49, "question_text": "My loved one has pancreatic cancer and we’re hearing about CAR-T cell therapy. Is this an option for pancreatic cancer?", "rubric_items": [ { "item_number": 1, "description": "The response should state that there is no approved CAR-T cell therapy for pancreatic cancer at this time.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe CAR-T cells.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that CAR-T cells are being studied in clinical trials for pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that CAR-T cells are approved for the treatment of other types of cancer.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 50, "question_text": "My father has pancreatic cancer and is considering hospice care. What does this involve and when should it be considered?", "rubric_items": [ { "item_number": 1, "description": "The response should state that hospice is considered when the medical team estimates a life expectancy of 6 months or less.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that the aim of hospice is to maximize quality of life and focus on addressing symptoms.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that hospice can take place in the home, a nursing home, or in a dedicated hospice facility.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The answer should start with an expression of sympathy and support.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should define hospice care.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should describe hospice eligibility.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should describe what hospice care covers, including emotional and spiritual support.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should describe what hospice care covers, including bereavement support.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should state that hospice consideration should be linked both to prognosis and to the status of further active treatment.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 51, "question_text": "My mother has pancreatic cancer and is experiencing severe fatigue from chemotherapy. How can we manage this?", "rubric_items": [ { "item_number": 1, "description": "The response must state that fatigue is a common side effect of chemotherapy.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should recommend discussing symptoms with the oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response must mention that optimizing nutrition and hydration can help manage fatigue.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should recommend good sleep hygiene.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should discuss potential causes for fatigue, including the effect of the cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should state that light physical activity can improve fatigue.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should recommend medication review.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should identify poor nutritional intake as a potential cause of fatigue.", "min_points": 0, "max_points": 2 }, { "item_number": 9, "description": "The response should advise the patient to keep a record or log of fatigue symptoms, rate their intensity, and bring that information to the oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should recommend daytime rest with short naps.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 52, "question_text": "My loved one has pancreatic cancer and we’re considering alternative treatments like cannabis oil. What should we know?", "rubric_items": [ { "item_number": 1, "description": "The response should state that alternative treatments like cannabis oil have not been proven to help patients with pancreatic cancer live longer or cure them.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that cannabis oil is sometimes used to manage cancer-related symptoms.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should recommend discussing the use of cannabis oil with their oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should describe cannabis oil.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should state that cannabis oil is not used as an anti-cancer treatment per guidelines.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should describe risks of using cannabis oil, including drug interactions.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should describe risks of using cannabis oil, including side effects.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should describe risks of using cannabis oil, including variation in quality.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should describe risks of using cannabis oil, including legal concerns.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should state that lab and animal studies have been conducted with cannabinoids.", "min_points": 0, "max_points": 2 }, { "item_number": 11, "description": "The response should state that there is no clinical evidence supporting cannabis oil to stop pancreatic cancer growth.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 53, "question_text": "My husband has pancreatic cancer and his appetite has completely disappeared. How can we encourage him to eat?", "rubric_items": [ { "item_number": 1, "description": "The response should state that lack of appetite is a common side effect of pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that the patient should undergo consultation with their oncologist who may refer him to a registered dietitian and/or palliative care physician.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should recommend discussing his symptoms with an oncology nutritionist.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should state that pancreatic enzyme replacement can be pursued.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that the patient can try smaller meals.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should state that the patient can try more frequent meals.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should state that the patient can try nutritional replacement shakes.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should state that appetite stimulants can also be considered.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should include that cancer itself can cause loss of appetite.", "min_points": 0, "max_points": 2 }, { "item_number": 10, "description": "The response should include that chemotherapy can cause nausea and loss of appetite.", "min_points": 0, "max_points": 2 }, { "item_number": 11, "description": "The response should include that bloating can decrease appetite.", "min_points": 0, "max_points": 2 }, { "item_number": 12, "description": "The response should include that pancreatic enzyme deficiency can cause decreased appetite.", "min_points": 0, "max_points": 2 }, { "item_number": 13, "description": "The response should suggest gentle encouragement to increase food intake.", "min_points": 0, "max_points": 2 }, { "item_number": 14, "description": "The response should suggest eating favorite foods to increase food intake.", "min_points": 0, "max_points": 2 }, { "item_number": 15, "description": "The response should recommend including snacks in the dietary plan.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 54, "question_text": "My loved one has pancreatic cancer and we live in a rural area with limited access to specialists. What are our options?", "rubric_items": [ { "item_number": 1, "description": "The response should state that they can start with their primary doctor who can help refer to the most local community hospital with oncology services.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that if they are able to travel, then major cancer centers offer consultations which can also be done as telehealth.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that they can search for NCI-designated cancer centers and find the closest one to them.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response must explicitly recommend reaching out to regional cancer centers, including examples or resources for finding such centers.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response must explicitly state that specialists will often partner with local oncologists to coordinate care.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response must explicitly state that oncologists offer virtual visits, mentioning telemedicine or virtual consultations.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response must explicitly state that palliative care teams offer virtual visits, mentioning telehealth options.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 55, "question_text": "My father has pancreatic cancer and his insurance is denying coverage for certain treatments. What can we do?", "rubric_items": [ { "item_number": 1, "description": "The response should offer sympathy for the stressful situation dealing with insurance coverage.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that they can work with the hospital’s financial counselor or social worker.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state the person should work with their oncology team to help with the denial.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should include contacting the insurance company to understand the reason for denial.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state one option for remedy is filing an appeal.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 56, "question_text": "My mother has pancreatic cancer and is considering surgery at a high-volume center versus locally. What’s the difference?", "rubric_items": [ { "item_number": 1, "description": "The response should define high-volume centers as those performing at least 40 or 50 Whipple procedures per year.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that treatment at a high-volume center is associated with improved survival and lower mortality.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that high-volume centers have significantly lower complication rates.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that at a high-volume center, the surgeon is more likely to be a specialist in pancreas surgery.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that high-volume centers often have access to clinical trials.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should state that high-volume centers have access to the latest treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should state disadvantages of going to a high-volume center, including travel time.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should state disadvantages of going to a high-volume center, including more complicated logistics.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should mention the NCCN guideline recommendation (version 2.2025) to receive care or consultation at a high-volume center.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 57, "question_text": "My loved one has pancreatic cancer and we’re worried about the financial burden of treatment. What resources are available?", "rubric_items": [ { "item_number": 1, "description": "The response should mention the Pancreatic Cancer Action Network as a resource for financial assistance.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should mention CancerCare as a resource for financial assistance.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should mention the American Cancer Society as a resource for financial assistance.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should recommend discussing financial concerns with a social worker.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should offer sympathy for the stressful situation dealing with financial burden during cancer treatment.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should recommend discussing financial concerns with the oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should recommend discussing financial concerns with a financial counselor.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 58, "question_text": "My husband has pancreatic cancer and is experiencing depression. How common is this and what can we do?", "rubric_items": [ { "item_number": 1, "description": "The response should mention specific support organizations such as PanCan (Pancreatic Cancer Action Network) or CancerCare.", "min_points": 0, "max_points": 3 }, { "item_number": 2, "description": "The response recommends discussing the patient’s mood with their oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response mentions support groups as helpful for patients with cancer experiencing depression.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response mentions seeking immediate evaluation by a medical professional if the patient is experiencing thoughts of harming themself or others.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response offers the emergency department and calling 988 if the patient experiences thoughts of harming themself or others.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response points to published scientific studies describing the prevalence of depression in pancreatic cancer patients.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response reviews the signs and symptoms of depression.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response recommends discussing the patient’s mood with a mental health professional.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response states that there are various treatment options for depression.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response states that there are both pharmacologic and non-pharmacologic treatment options for depression.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response mentions lifestyle changes that support improvements in mental health.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should mention that the diagnosis of cancer, especially an aggressive cancer like pancreatic cancer, can frequently lead to psychosocial distress, including depression. (23% PMID: 22666142)", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should mention that based on the ASCO guidelines, optimal care of depression should follow a stepped-care model. ([https://doi.org/10.1200/JCO.23.00293](https://doi.org/10.1200/JCO.23.00293))", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should mention that Cognitive Behavioral Therapy (CBT), behavior therapy (BT), and behavioral activation (BA) are the most effective treatments for managing depressive symptoms. ([https://doi.org/10.1200/JCO.23.00293](https://doi.org/10.1200/JCO.23.00293))", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should mention that exercise both during and after treatment can significantly reduce depression. ([https://doi.org/10.1200/JCO.23.00293](https://doi.org/10.1200/JCO.23.00293))", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should mention that pharmacotherapy is not recommended as a first-line treatment for depression. ([https://doi.org/10.1200/JCO.23.00293](https://doi.org/10.1200/JCO.23.00293))", "min_points": 0, "max_points": 5 }, { "item_number": 17, "description": "The response should mention the patient can be referred for formal support from a social worker or psychiatrist.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 59, "question_text": "My loved one has pancreatic cancer and we want to understand the prognosis better. How do we interpret survival statistics?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response states that many aspects of a patient’s health impact their prognosis.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response defines overall survival as it is used in clinical research.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response defines progression-free survival as it is used in clinical research.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response explains that overall survival and progression-free survival are typically reported as medians.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response explains the above biostatistics terms (overall survival, progression-free survival, and median) in laymen’s terms.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response explains that survival data is best reported in terms of the stage of cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response mentions the limitations of applying reported statistics to patients’ individual cases.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response reports survival data.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response cites the source of the reported survival data.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response mentions the difference between overall survival and progression-free survival.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response mentions that survival is influenced by tumor characteristics such as genetic mutations (BRCA, KRAS), size, and location.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response mentions that survival depends on treatments received (chemotherapy, surgery, targeted therapy, no treatment, etc.) and treatment response.", "min_points": 0, "max_points": 3 }, { "item_number": 14, "description": "The response mentions that new treatments and advancements are being developed all the time, and these could potentially improve outcomes in the future.", "min_points": 0, "max_points": 3 }, { "item_number": 15, "description": "The response mentions that prognosis also depends on patient-level factors beyond the cancer itself, such as age, comorbidities, lifestyle, and social/support circumstances.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should mention that the survival statistics are averages, not predictions.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 60, "question_text": "My father has pancreatic cancer and his doctors are discussing liquid biopsies. What are these?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response explains that a liquid biopsy is a blood test.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response explains that liquid biopsies involve analyzing circulating tumor DNA (ctDNA) from blood samples. ([https://ascopubs.org/doi/full/10.1200/JCO.21.02767](https://ascopubs.org/doi/full/10.1200/JCO.21.02767))", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response explains there are many different tests which evaluate various things including circulating tumor DNA, circulating tumor cells, and proteins in the blood.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response says that liquid biopsies do not replace tissue biopsies in the diagnosis of cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response says the results of liquid biopsies must be interpreted by a medical professional.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response says the results of liquid biopsies may be helpful when combined with imaging and pathology results.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response mentions there are liquid biopsies in various stages of development for different kinds of cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response mentions the limitations of liquid biopsies, including sensitivity, false positives, and cost.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response says there are currently no FDA approved liquid biopsies for pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response says health insurance may not pay for these tests.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response says liquid biopsies may be able to identify genetic mutations present in the cancer which can help to guide treatment.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response should mention that liquid biopsies are noninvasive and can expedite testing because there is no need to retrieve archival blocks or arrange for a new biopsy.", "min_points": 0, "max_points": 3 }, { "item_number": 14, "description": "The response should mention that copy-number changes may be more difficult to assess in cfDNA, and fusion testing may be more limited in common cfDNA tests currently used.", "min_points": 0, "max_points": 3 }, { "item_number": 15, "description": "The response should mention that not all hospitals offer ctDNA testing.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should mention that this is still under active research and not yet standard of care for all cancer patients.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 61, "question_text": "My mother has pancreatic cancer and we’re considering traveling to another country for treatment. What should we consider?", "rubric_items": [ { "item_number": 1, "description": "The response considers the costs of travel.", "min_points": 0, "max_points": 3 }, { "item_number": 2, "description": "The response considers the costs of healthcare abroad.", "min_points": 0, "max_points": 3 }, { "item_number": 3, "description": "The response considers logistics of travel, including the need for passports and/or visas.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response considers language and cultural barriers.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response mentions that patients receiving treatment for pancreatic cancer often require significant support from their family and friends.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response recommends considering if the patient is medically safe for travel.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response recommends researching the quality of healthcare in the intended destination.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response recommends discussing all travel plans with a medical professional prior to leaving.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response says that pancreatic cancer is often an aggressive form of cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response says that delaying the start of treatment for pancreatic cancer can be harmful.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response recommends researching pancreatic cancer outcomes in the intended destination as compared to her home country.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response recommends understanding the patient’s treatment options, including clinical trials, which may be available in her home country before making travel plans.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should mention considerations related to insurance funding.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should mention to consider local accommodations when traveling abroad for treatment.", "min_points": 0, "max_points": 2 }, { "item_number": 15, "description": "The response should mention to consider challenges with follow-up care when traveling abroad for treatment.", "min_points": 0, "max_points": 2 }, { "item_number": 16, "description": "The response should mention that immunizations and infection prevention are important, especially for immunosuppressed patients.", "min_points": 0, "max_points": 5 }, { "item_number": 17, "description": "The response should mention that telemedicine and remote support can be leveraged for follow-up, symptom management, and multidisciplinary care, reducing the need for frequent travel and facilitating access to expertise at high-volume centers.", "min_points": 0, "max_points": 3 }, { "item_number": 18, "description": "The response recommends verifying that the destination has specialized, high-quality pancreatic cancer care, such as experienced pancreatic cancer specialists or high-volume centers.", "min_points": 0, "max_points": 10 }, { "item_number": 19, "description": "The response recommends considering travel-specific social support challenges, such as reduced access to family, friends, and other caregivers while abroad.", "min_points": 0, "max_points": 2 }, { "item_number": 20, "description": "The response recommends discussing the case specifically with an oncologist before deciding on treatment abroad.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 62, "question_text": "My loved one has pancreatic cancer and is experiencing bowel changes. Is this related to the cancer or treatment?", "rubric_items": [ { "item_number": 1, "description": "The response states that bowel changes, including diarrhea, nausea, and constipation, are common among patients undergoing treatment for pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response mentions that chemotherapy, radiation therapy, surgery, and other treatments such as pain medications can impact the bowels.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response explains that bowel changes can also be due to infections.", "min_points": 0, "max_points": 2 }, { "item_number": 4, "description": "The response recommends discussing specific concerns with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response recommends keeping a log of events related to food intake, fluid intake, and bowel symptoms.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response recommends discussing the above log with the patient’s healthcare team.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response recommends if the patient has not had a bowel movement in more than 24 hours and is not passing gas, their bowels may be obstructed, which is a medical emergency and requires immediate evaluation in an emergency department.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response recommends if the patient is nauseous and unable to keep any food or drink down without vomiting, this can quickly lead to severe dehydration, which requires urgent evaluation by a medical professional and potentially intravenous fluids and medicines.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response recommends if the patient is experiencing severe abdominal pain, this may represent a medical emergency which requires immediate evaluation in an emergency department.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response says patients with pancreatic cancer may experience pancreatic insufficiency.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response explains pancreatic insufficiency is related to a deficiency in the pancreatic enzymes which break down food and can cause diarrhea and bloating.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response explains there are supplementary pancreatic enzymes that can be taken to alleviate the symptoms of pancreatic insufficiency.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response explains if the bowel changes are due to chemotherapy, the treating oncologist can often prescribe additional medications to control these side effects.", "min_points": 0, "max_points": 3 }, { "item_number": 14, "description": "The response says proper nutrition is an important part of cancer care outcomes.", "min_points": 0, "max_points": 3 }, { "item_number": 15, "description": "The response says it is important to remain hydrated.", "min_points": 0, "max_points": 3 }, { "item_number": 16, "description": "The response should mention that it is important to determine the cause of the bowel changes to manage them effectively.", "min_points": 0, "max_points": 10 }, { "item_number": 17, "description": "The response should mention that gastric outlet/duodenal obstruction can occur in up to 10% of patients with pancreatic cancer, leading to symptoms like early satiety, nausea, postprandial vomiting, and weight loss.", "min_points": 0, "max_points": 3 }, { "item_number": 18, "description": "The response should mention that patients with malignant ascites from pancreatic cancer may experience abdominal discomfort, nausea, and vomiting.", "min_points": 0, "max_points": 3 }, { "item_number": 19, "description": "The response should mention that diet/nutrition changes can cause bowel changes unrelated to cancer or cancer treatment.", "min_points": 0, "max_points": 2 }, { "item_number": 20, "description": "The response should mention that stress/anxiety can cause bowel changes unrelated to cancer or cancer treatment.", "min_points": 0, "max_points": 2 }, { "item_number": 21, "description": "The response should mention that pre-existing conditions can cause bowel changes unrelated to cancer or cancer treatment.", "min_points": 0, "max_points": 2 }, { "item_number": 22, "description": "The response explains that constipation can be a side effect of pain medications.", "min_points": 0, "max_points": 3 }, { "item_number": 23, "description": "The response mentions that changes in bowel habits in patients with pancreatic cancer may be caused by either the cancer itself or its treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 24, "description": "The response explains that infections can cause bowel changes unrelated to the pancreatic cancer or its treatment.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 63, "question_text": "My husband has pancreatic cancer and we’re concerned about him driving while on chemotherapy. Is this safe?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s healthcare team.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states that pancreatic cancer and its treatments may affect the patient’s ability to drive safely.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response states that pain medications may impair the patient’s ability to drive safely.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states that symptoms such as fatigue, drowsiness, nausea, and vomiting may impair the patient’s ability to drive safely.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states that the patient’s healthcare team may have resources to assist with transportation.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response should mention that there are no official guidelines advising patients to stop driving during or after chemotherapy.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should mention that chemotherapy can cause fatigue that may impair driving abilities.", "min_points": 0, "max_points": 4 }, { "item_number": 8, "description": "The response should mention that chemotherapy can cause vision changes that may impair driving abilities.", "min_points": 0, "max_points": 4 }, { "item_number": 9, "description": "The response should mention that chemotherapy can cause neuropathy that may impair driving abilities.", "min_points": 0, "max_points": 4 }, { "item_number": 10, "description": "The response should mention that chemotherapy can cause pain that may impair driving abilities.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response should mention that chemotherapy can cause cognitive changes that may impair driving abilities.", "min_points": 0, "max_points": 4 }, { "item_number": 12, "description": "The response should mention to avoid driving after the first chemotherapy session to see how your husband tolerates it.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should mention that your husband should listen to his own body; if he feels unwell, it is important to arrange alternative transportation.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should mention to plan for backup transportation, such as a taxi, friends/family, or public transportation.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should mention that the National Highway Traffic Safety Administration (NHTSA) provides information on medical conditions and driving safety.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response states that if dangerous driving habits have been witnessed, the patient’s healthcare team should be contacted urgently.", "min_points": 0, "max_points": 10 }, { "item_number": 17, "description": "The response states that pancreatic cancer and its treatments do not necessarily make the patient unable to drive safely.", "min_points": 0, "max_points": 3 }, { "item_number": 18, "description": "The response specifically recommends discussing the patient’s driving safety with his oncologist.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 64, "question_text": "My loved one has pancreatic cancer and wants to continue working during treatment. Is this possible?", "rubric_items": [ { "item_number": 1, "description": "The response states that the ability to work depends on individual circumstances such as the stage of cancer, overall health, and comorbidities.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response states that the ability to work depends on the type of treatment (chemotherapy, radiation, surgery, targeted therapy) and related side effects.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response states that the ability to work depends on the support available from friends, family, and caregivers.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states that the ability to work depends on job type and flexibility (working from home, reduced hours, workplace accommodations, scheduled breaks).", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states that pancreatic cancer and its treatment can cause symptoms which may make working challenging.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states that some manual labor jobs may be unsafe for patients with pancreatic cancer undergoing treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response recommends discussing this with the patient’s healthcare team.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response recommends workplace accommodations which may make working possible during treatment.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response states the patient’s ability to continue working should be continually reassessed as their medical condition changes.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response states that self-care is important while undergoing cancer treatment.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response states the patient may qualify for paid leave through their employer, the government, or both.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response states many patients with pancreatic cancer take time off of work during treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should mention that it is important for patients with pancreatic cancer to maintain their quality of life, and that work during treatment may be possible.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response specifically recommends discussing the patient’s ability to continue working during treatment with an oncologist.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 65, "question_text": "My father has pancreatic cancer and is asking about medical marijuana. What should we know about this?", "rubric_items": [ { "item_number": 1, "description": "The response explicitly recommends discussing the use of medical marijuana with the patient’s healthcare team.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explicitly states that medical marijuana is not an effective alternative treatment for pancreatic cancer itself.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response explicitly mentions risks and side effects associated with medical marijuana, including psychoactive effects and potential interactions with other medications.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response clearly states that medical marijuana comes in various forms, such as oils, edibles, tinctures, and vaporizers.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response specifically mentions the risk of inhaled medical marijuana exposing patients to infectious organisms like fungi, particularly for those receiving certain chemotherapy treatments.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response explicitly states that medical marijuana may be used to control symptoms associated with pancreatic cancer and its treatments, such as nausea, vomiting, loss of appetite, and pain.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response explicitly states that there is mixed data on the benefit of medical marijuana for managing symptoms.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response discusses potential legal challenges with obtaining and using medical marijuana, noting that these may vary based on the patient’s location.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response explicitly recommends not driving or making important decisions while under the influence of marijuana.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response explicitly recommends obtaining medical marijuana only from professionals licensed to sell it.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response should mention that medical marijuana, refers to products derived from the cannabis plant—or its extracts—that contain active compounds such as THC (tetrahydrocannabinol), CBD (cannabidiol), or combinations thereof. These include synthetic cannabinoids, herbal cannabis derivatives, single purified cannabinoids, blends of cannabis components, and full‑spectrum preparations designed for medical use.", "min_points": 0, "max_points": 7 }, { "item_number": 12, "description": "The response should mention that preliminary data reports poor clinical outcomes in adults receiving immunotherapy while using cannabis and/or cannabinoids.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should mention that CBD presents risks for hepatotoxicity, with a meta-analysis reporting a nearly 6-fold increase in liver enzyme elevation and drug-induced liver injury.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should mention that cannabis and/or cannabinoids are one of several pharmacologic options for adults with cancer experiencing refractory nausea and vomiting despite optimal prophylaxis.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should mention that further research is needed to determine the effectiveness of cannabis to reduce polypharmacy. ([https://ascopubs.org/doi/10.1200/JCO.23.02596](https://ascopubs.org/doi/10.1200/JCO.23.02596))", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should mention that further research is needed to determine the effectiveness of cannabis to reduce opioid requirements for cancer-related pain. ([https://ascopubs.org/doi/10.1200/JCO.23.02596](https://ascopubs.org/doi/10.1200/JCO.23.02596))", "min_points": 0, "max_points": 5 }, { "item_number": 17, "description": "The response should mention that further research is needed to determine the effectiveness of cannabis to reduce chemotherapy-induced peripheral neuropathy. ([https://ascopubs.org/doi/10.1200/JCO.23.02596](https://ascopubs.org/doi/10.1200/JCO.23.02596))", "min_points": 0, "max_points": 5 }, { "item_number": 18, "description": "The response should mention that further research is needed to determine the effects of cannabis on pain. ([https://ascopubs.org/doi/10.1200/JCO.23.02596](https://ascopubs.org/doi/10.1200/JCO.23.02596))", "min_points": 0, "max_points": 5 }, { "item_number": 19, "description": "The response explicitly states that there is a lack of evidence-based data supporting the use of cannabinoids and/or cannabis as anticancer treatments. ([https://ascopubs.org/doi/10.1200/JCO.23.02596](https://ascopubs.org/doi/10.1200/JCO.23.02596))", "min_points": 0, "max_points": 10 }, { "item_number": 20, "description": "The response explicitly mentions common side effects such as dizziness, confusion, dry mouth, and fatigue, as well as serious side effects such as tachycardia, orthostatic hypotension, severe confusion, and paranoia.", "min_points": 0, "max_points": 5 }, { "item_number": 21, "description": "The response explicitly states that data on drug-drug interactions between cannabis and/or cannabinoids and approved anticancer therapeutics are lacking, making it difficult for clinicians to provide informed guidance about such interactions.", "min_points": 0, "max_points": 10 }, { "item_number": 22, "description": "The response explicitly states that the ASCO recommendation for cannabis and/or cannabinoids as antiemetics is weak, is based on moderate evidence for dronabinol and nabilone and low evidence for a 1:1 THC:CBD extract, and that further research is needed to determine antiemetic effectiveness. ([https://ascopubs.org/doi/10.1200/JCO.23.02596](https://ascopubs.org/doi/10.1200/JCO.23.02596))", "min_points": 0, "max_points": 5 }, { "item_number": 23, "description": "The response explicitly recommends discussing this case with an oncologist.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 66, "question_text": "My mother has pancreatic cancer and we’re dealing with difficult family dynamics around treatment decisions. How do we handle this?", "rubric_items": [ { "item_number": 1, "description": "The response explicitly recommends consulting with the patient’s oncologist or healthcare team, including specific roles such as nurse practitioner or palliative care specialist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explicitly states that the healthcare team may have a social worker available to assist with family discussions.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response explicitly recommends involving a neutral third party, such as a social worker, spiritual care worker, counselor, or patient advocate, to facilitate family discussions.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response explicitly provides online resources for cancer patients and their families, including specific organizations like PANCAN, NCI, or ACS.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should recommend scheduling a family meeting to discuss goals of care and important treatment decisions.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should mention that understanding your mother’s specific goals should shape conversations about goals of care and treatment recommendations.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should mention that your mother’s wishes related to treatment, belief systems, and personal ways of coping should be respected by their families, cancer care team, and others who support them through the cancer experience.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response explicitly states that the mother’s oncologist or palliative care provider, together with a social worker, can help guide difficult family conversations about treatment decisions.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response explicitly mentions support networks such as CancerCare or ASCO as resources that can help with family communication and decision making.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 67, "question_text": "My loved one has pancreatic cancer and is worried about being a burden on the family. How do we address this?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response recommends discussing this with a social worker, spiritual care worker, palliative care professional, or counselor.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response recommends support groups and other online resources for cancer patients and their families.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states that depression is highly prevalent in patients with pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response reviews the signs and symptoms of depression.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states that if the patient is experiencing thoughts of harming themselves or others, they should seek immediate evaluation by a healthcare professional.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should mention that it’s important to have open and honest conversations about their concerns, including feeling like a burden to their loved ones.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should encourage the patient to express their fears and anxieties about the impact of their illness on their loved ones, and acknowledge and validate their feelings.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should mention to ask about the patient’s preferences and personal goals of care.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should mention it is important to emphasize working together to manage the challenges.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention support networks such as PanCAN, CancerCare, ASCO.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should mention that professional counseling can help process these emotions.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 68, "question_text": "My husband has pancreatic cancer and his oncologist mentioned targeted therapy. What is this?", "rubric_items": [ { "item_number": 1, "description": "The response states targeted therapies work against cancer with specific genetic mutations.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states that not all pancreatic cancers will have mutations for which targeted therapy can be used.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response provides examples of targetable mutations in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states targeted therapies can be given alone or sometimes in combination with chemotherapy.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should mention that targeted therapy for pancreatic cancer involves using drugs to specifically target proteins, genes, or pathways of cancer cells, potentially causing less damage to normal cells compared to chemotherapy or radiation therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should mention that while targeted therapy is an option, it is important to consider all potential treatment options, outcomes, and adverse events to make an informed decision.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should mention examples of targeted therapies, such as Dabrafenib + trametinib (if BRAF V600E mutation-positive), Entrectinib, Larotrectinib, Repotrectinib (if NTRK gene fusion-positive), Selpercatinib (if RET gene fusion-positive), Rucaparib (for germline or somatic BRCA1/2 or PALB2 mutations), Olaparib (only for germline BRCA1/2 mutations), Adagrasib (if KRAS G12C mutation-positive), Sotorasib (if KRAS G12C mutation-positive), Erdafitinib (if FGFR genetic alterations), Fam-trastuzumab deruxtecan-nxki (if HER2 positive [IHC3+ or IHC2+ with FISH HER2 amplified]) Zenocutuzumab-zbco (if NRG1 gene fusion-positive).", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response discusses targeted therapies that are not approved for pancreatic cancer, such as osimertinib, regorafenib, or mTOR inhibitors.", "min_points": -10, "max_points": 0 }, { "item_number": 10, "description": "The response should mention that NCCN recommends testing pancreatic cancer for actionable findings using comprehensive genomic profiling with an FDA-approved and/or validated NGS-based assay, including fusions (such as ALK, NRG1, NTRK, ROS1, FGFR2, and RET), mutations (such as BRAF, BRCA1/2, KRAS, and PALB2), HER2 amplification, MSI, dMMR, and TMB, as well as HER2 overexpression testing by IHC with or without FISH.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 69, "question_text": "My loved one has pancreatic cancer and we’re considering integrative medicine approaches. What should we know?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing integrative medicine with the patient’s oncologist.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response states integrative medicine is not as effective as standard of care treatments for pancreatic cancer like chemotherapy, radiation, surgery, and targeted therapies.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response states integrative medicine can be a helpful adjunct to standard of care treatments for pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should define integrative oncology (or integrative medicine in cancer care) as an evidence-based approach that combines conventional cancer treatment with mind-body practices, natural products, and lifestyle modifications.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response provides examples of integrative medicine interventions.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response recommends telling the patient’s oncologist if they plan to include integrative medicine interventions into their care plan.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response recommends telling the patient’s oncologist about all supplements they are taking.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response states some supplements may interact with the treatments being prescribed for their pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response states there is data to support some integrative medicine interventions for specific uses.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response should mention that safety concerns and risks related to integrative medicine approaches are heightened with self-prescription or use of non-standardized products.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response provides specific evidence-based examples of integrative approaches such as acupuncture, nutrition or diet, exercise, massage therapy, and mind-body practices.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response states that integrative medicine is used mainly for supportive care rather than as the primary treatment for pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response states that complementary medicines beyond supplements can interfere with cancer treatment and should be discussed with the oncologist before they are started.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 70, "question_text": "My father has pancreatic cancer and is experiencing skin changes from chemotherapy. Is this normal?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing the skin changes with the patient’s oncologist or healthcare team.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states that skin changes are a common side effect of chemotherapy for pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response states that skin changes related to treatment for pancreatic cancer can range from mild to life-threatening.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response provides at least two examples of skin changes, including hand-foot syndrome, allergic reactions, or infections.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response recommends immediate evaluation by a healthcare provider if the patient shows signs of infection.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response provides at least one example of signs and symptoms of infection.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states that skin changes related to treatment for pancreatic cancer should be treated by a healthcare professional experienced in caring for cancer patients.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response states that skin changes related to treatment for pancreatic cancer often require specific interventions or escalation of care.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response mentions that skin changes can be related to specific chemotherapy agents used in pancreatic cancer treatment, such as gemcitabine, FOLFIRINOX, or nab-paclitaxel.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response mentions at least three specific manifestations of skin changes related to chemotherapy, such as new or worsening skin lesions, itch, acne-like symptoms, bullous dermatoses, allergic reactions, hand-foot syndrome, nail changes, or inflammatory dermatitis.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response mentions that skin changes could also be due to other conditions, such as infection, other medications, or unrelated skin disorders.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response states the importance of correctly identifying skin changes to ensure appropriate management and to avoid unnecessary discontinuation of effective cancer therapy.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 71, "question_text": "My mother has pancreatic cancer and we want to make sure we’re asking the right questions at doctor appointments. What should we ask?", "rubric_items": [ { "item_number": 1, "description": "The response suggests asking about the stage of the cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response suggests asking about available treatment options(surgery, radiation, chemotherapy etc).", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response suggests asking about prognosis if the patient wants to know this information.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response suggests asking about potential side effects of treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response suggests asking about when the patient should follow up next.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response recommends writing down questions ahead of time and bringing them to the appointment.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response suggests asking about symptoms affecting the patient’s quality of life.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response suggests asking about clinical trial availability.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response suggests asking about how palliative care can help with the patient’s care.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response suggests asking if genetic testing is available for germline inheritable cancer predisposition syndromes.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response suggests asking about nutrition and if a nutritionist is available to help with dietary recommendations.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response suggests asking about support groups for patients with pancreatic cancer and their families.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response suggests asking about how to contact the oncology team in case of questions.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response suggests asking if lifestyle changes need to be made.", "min_points": 0, "max_points": 3 }, { "item_number": 15, "description": "The response suggests asking about mental health and resources for mental health support.", "min_points": 0, "max_points": 3 }, { "item_number": 16, "description": "The response recommends writing down important information during the appointment.", "min_points": 0, "max_points": 3 }, { "item_number": 17, "description": "The response should mention to ask questions related to goals of treatment (palliative, curative, etc).", "min_points": 0, "max_points": 5 }, { "item_number": 18, "description": "The response should mention bringing a family member or a friend to help listen and take notes.", "min_points": 0, "max_points": 5 }, { "item_number": 19, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 5 }, { "item_number": 20, "description": "The response suggests asking the doctor to explain the diagnosis.", "min_points": 0, "max_points": 5 }, { "item_number": 21, "description": "The response suggests asking how symptoms can be managed.", "min_points": 0, "max_points": 5 }, { "item_number": 22, "description": "The response suggests asking about the next steps in the care plan.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 72, "question_text": "My loved one has pancreatic cancer and is considering stopping treatment to travel. How do we make this decision?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states quality of life is important.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response recommends considering the patient’s goals of care.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states pancreatic cancer is an aggressive cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states stopping treatment without consulting the treating oncologist is dangerous.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response recommends considering access to emergency care at the travel destination.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response recommends refilling all prescription medications prior to travel.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response recommends considering if travel is safe.", "min_points": 0, "max_points": 4 }, { "item_number": 9, "description": "The response recommends considering if the patient is strong enough to travel.", "min_points": 0, "max_points": 4 }, { "item_number": 10, "description": "The response recommends weighing pros and cons of stopping treatment.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response must explicitly clarify what “stopping treatment” means, such as stopping all therapies, only chemotherapy, or supportive care.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response must explicitly discuss the effects of a (temporary) treatment break on the prognosis of the cancer, symptoms, and other risks involved.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response must explicitly state that stopping treatment may affect the patient’s medical stability, ability to travel safely, and access to care and support while away.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response must explicitly state that the decision should be centered on the patient’s own values and preferences.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 73, "question_text": "My husband has pancreatic cancer and his port is causing problems. What are the alternatives for chemotherapy administration?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states that if there are signs or symptoms of infection at the port site, to seek immediate evaluation by a healthcare professional.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response offers examples of signs or symptoms of infection, including fever, chills, redness or pain at the port site, and pus coming from the port site.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states many chemotherapy drugs must be given through central venous catheters.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response offers examples of central venous catheters.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response states different central venous catheters have pros and cons.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response recommends asking the patient’s oncologist about alternative treatment regimens that may not require administration through a central venous catheter.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response recommends avoiding touching, rubbing, and bumping the port site.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should mention that alternatives to chemotherapy administration via a port include peripheral IV lines.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should mention that alternatives to chemotherapy administration via a port include peripherally inserted central catheters (PICC lines).", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that alternatives to chemotherapy administration via a port include a tunneled central venous catheter (Hickman, Broviac, Groshong).", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should mention that alternatives to chemotherapy administration via a port include a non-tunneled central venous catheter (jugular or subclavian line).", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should mention that alternatives to chemotherapy administration via a port include oral chemotherapy such as capecitabine.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response mentions that chemotherapy for pancreatic cancer can be given via subcutaneous injection.", "min_points": -10, "max_points": 0 } ] }, { "question_number": 74, "question_text": "My loved one has pancreatic cancer and we’re worried about infection risk during treatment. What precautions should we take?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response recommends avoiding people who have signs or symptoms of an infectious illness.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response recommends frequent hand washing.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response recommends wearing a face mask while in crowds.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response recommends discussing asking the patient’s healthcare team about which vaccinations are recommended.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response recommends reporting signs and symptoms of infection to the patient’s healthcare team.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response provides examples of signs and symptoms of infection, including fever, chills, cough, runny nose, nausea, and vomiting.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response states the patient’s oncologist may prescribe antibiotics, antivirals, and antifungals to prevent infection.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response instructs the patient to take all medications as prescribed.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response states some treatments for pancreatic cancer can lower white blood cell counts.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response states white blood cells fight off infections.", "min_points": 0, "max_points": 2 }, { "item_number": 12, "description": "The response states a low white blood cell count can increase the risk of infections.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should mention that prevention includes vaccination for COVID-19 and flu for the patient and household members.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should mention that prevention includes avoiding exposure to fungal spores. Patients with neutropenia should avoid prolonged contact with environments that have high concentrations of airborne fungal spores, such as construction and demolition sites, intensive exposure to soil through gardening or digging, and household renovation. ([https://ascopubs.org/doi/full/10.1200/JCO.18.00374](https://ascopubs.org/doi/full/10.1200/JCO.18.00374))", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should mention that there is no need for antimicrobial prophylaxis for most solid tumors if the overall infection risk is low (neutropenia < 7 days). ([https://ascopubs.org/doi/full/10.1200/JCO.18.00374](https://ascopubs.org/doi/full/10.1200/JCO.18.00374))", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should mention that interventions such as footwear exchange, protected environments, neutropenic diet, or nutritional supplements are not recommended due to a lack of evidence of clinical benefit.", "min_points": 0, "max_points": 5 }, { "item_number": 17, "description": "The response recommends practicing good hygiene beyond hand washing, including respiratory hygiene/cough etiquette, and providing this guidance to the patient and caregivers.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 75, "question_text": "My father has pancreatic cancer and his doctors are mentioning precision medicine. What does this mean?", "rubric_items": [ { "item_number": 1, "description": "The response defines precision medicine as tailoring cancer treatment based on a patient’s unique tumor characteristics, such as genetic and molecular profiles, to improve effectiveness and reduce toxicity.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response mentions testing the patient’s tumor for genetic mutations which can be targeted with certain therapies.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response states PARP inhibitors may be used in patients with mutations in the BRCA gene.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states immunotherapy may be used in patients if their tumors have high microsatellite instability (MSI-high).", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response mentions testing the patient’s tumor for expression of certain proteins which can be targeted with certain therapies.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response provides examples of targeted therapies in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response provides examples of therapies targeting protein expression.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response mentions that not every patient will have genetic mutations or protein expression which can be targeted with precision medicine.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response states precision medicine helps the patient’s oncologist identify treatments which will not be helpful.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response mentions that comprehensive genomic profiling using next-generation sequencing (NGS) is now standard for patients with pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response mentions that both germline and somatic testing are recommended for all patients with pancreatic cancer, as actionable alterations may be present even in the absence of family history.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response mentions that TRK inhibitors (larotrectinib, entrectinib) are indicated for NTRK fusion-positive tumors, regardless of histology.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response states that olaparib is an FDA-approved PARP inhibitor for patients with germline BRCA1/2-mutated pancreatic cancer, typically used as maintenance therapy after platinum-based chemotherapy.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response states that immune checkpoint inhibitors such as pembrolizumab, dostarlimab, and ipilimumab/nivolumab are approved for the rare subset of pancreatic cancers that are mismatch repair deficient (dMMR) or MSI-high.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should mention that sotorasib is an emerging agent for KRAS G12C-mutated pancreatic cancer", "min_points": 0, "max_points": 3 }, { "item_number": 17, "description": "The response should mention that BRAF and RET inhibitors are emerging agents for respective fusions in pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 18, "description": "The response should mention that HER2-directed therapies are emerging agents for HER2-amplified pancreatic cancer", "min_points": 0, "max_points": 5 } ] }, { "question_number": 76, "question_text": "My mother has pancreatic cancer and is experiencing mouth sores from chemotherapy. How can we manage this?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states mouth sores are a common side effect of some chemotherapy drugs.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response states drugs like 5-FU and capecitabine can cause mouth sores.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states these are sometimes related to having low white blood cell counts.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states that having low white blood cell counts can increase the likelihood of infection.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states mouth sores in patients on chemotherapy can also be related to infections from viruses or bacteria.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states the patient’s healthcare team may swab the mouth sores to test them for infection.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response states there are medications which can help prevent and improve mouth sores in the form of both topical drugs and specialized mouthwashes.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response states there are medications which can improve symptoms related to mouth sores, like pain.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response instructs the patient to immediately seek evaluation by a healthcare provider if they are experiencing a fever or other signs or symptoms of infection.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response recommends gentle oral hygiene.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response recommends soft and bland foods.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response should mention that treatment-related mouth problems, particularly oral mucositis, are common in patients with pancreatic cancer receiving chemotherapy and/or radiotherapy, with reported incidence rates ranging from 20% to 80% in gastrointestinal malignancies.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should mention that benzydamine mouthwash (0.15%, 15–20 mL rinsed for 30–60 seconds, 3–5 times daily) is supported for prevention, especially in patients receiving radiotherapy or chemoradiotherapy, though its role in chemotherapy alone is less well established.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should mention that chlorhexidine mouthwash is not recommended for prevention in most adult cancer populations due to lack of efficacy and potential for adverse effects.", "min_points": 0, "max_points": 3 }, { "item_number": 17, "description": "The response should mention that bland mouth rinses (e.g., sodium bicarbonate or saline) are preferred for routine care and symptom management.", "min_points": 0, "max_points": 5 }, { "item_number": 18, "description": "The response should mention that topical anesthetics (lidocaine viscous, 2% solution) and mixed medication mouthwashes (“magic mouthwash”) may be used for pain control, though evidence for specific formulations is variable.", "min_points": 0, "max_points": 5 }, { "item_number": 19, "description": "The response should mention that Gabapentin may be considered for mucositis-related pain, often in combination with other analgesics.", "min_points": 0, "max_points": 3 }, { "item_number": 20, "description": "The response should mention that topical and systemic antifungals (e.g., clotrimazole troches, systemic fluconazole) are indicated for secondary candidiasis, which is common in the setting of mucositis and xerostomia.", "min_points": 0, "max_points": 3 }, { "item_number": 21, "description": "The response should mention that antibiotics are reserved for documented secondary bacterial infections.", "min_points": 0, "max_points": 5 }, { "item_number": 22, "description": "The response should mention that management often involves over-the-counter pain relief such as acetaminophen or ibuprofen, but that stronger prescription medicines may be indicated.", "min_points": 0, "max_points": 5 }, { "item_number": 23, "description": "The response should mention that multidisciplinary and supportive care is essential.", "min_points": 0, "max_points": 5 }, { "item_number": 24, "description": "The response should mention that management could include dietary adjustments such as soft or liquid diets, small frequent meals, nutritional support.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 77, "question_text": "My loved one has pancreatic cancer and we’re considering a clinical trial but are worried about getting a placebo. How do these work?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response reviews the design of clinical trials.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response reviews the four phases of clinical trials.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response defines placebo.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states that patients in clinical trials for cancer are seldom given a placebo, as this may cause harm.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response reviews informed consent.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response defines the placebo effect.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response states that patients in the control arm of clinical trials often receive the standard of care treatment for pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response states clinical trials are designed to discover new, effective treatments.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response states clinical trials are designed to minimize patient harm.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response states that patients participating in clinical trials are monitored closely for side effects from the disease and the treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response recommends researching clinical trials before participating.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response offers resources for researching clinical trials, including ClinicalTrials.gov.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response states clinical trials are designed to be ethical and are monitored closely.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should mention that clinical trials are essential for optimizing current and future therapies for cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should explain the different phases of clinical trials, including the purpose of each phase. Phase I clinical trials studies the safety and side effects of an investigational drug or treatment approach. Phase 2 trials study how well the drug or approach works against a specific type of cancer. Phase 3 clinical trials test the drug or approach against another standard treatment. If the results are good, it may be approved by the FDA. Phase 4 trials study the safety and benefit of an FDA-approved treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 17, "description": "The response states that clinical trials are research studies in humans that test whether a new medical strategy, treatment, or device is safe and effective.", "min_points": 0, "max_points": 5 }, { "item_number": 18, "description": "The response defines a placebo-controlled clinical trial as one in which some participants receive the treatment being tested and others receive an inactive look-alike placebo.", "min_points": 0, "max_points": 5 }, { "item_number": 19, "description": "The response states that in cancer clinical trials, placebos are usually not given alone but are typically given with standard treatment, such as placebo plus standard care versus new drug plus standard care.", "min_points": 0, "max_points": 5 }, { "item_number": 20, "description": "The response states that if a placebo is part of a clinical trial, this will be disclosed to the patient verbally and in writing before enrollment.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 78, "question_text": "My husband has pancreatic cancer and his oncologist mentioned combination therapy. What does this involve?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response states there are many different types of treatment for pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response includes surgery, chemotherapy, immunotherapy, targeted therapy, and radiation therapy as types of treatment for pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states combination therapy may mean two or more different types of treatment or two or more chemotherapy medications.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response gives the example of FOLFIRINOX.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states that FOLFIRINOX is a combination chemotherapy regimen which contains 5-FU, leucovorin, irinotecan, and oxaliplatin.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states the treatment plan for patients with pancreatic cancer is individualized to their overall health and the cancer’s type, stage, and genetic signature.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response states the decision to use any cancer treatment weighs the likelihood of benefit with the risk of side effects.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response states the goal of combination therapy is to achieve the best anti-cancer effect.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should mention that examples of combination therapy include chemoradiation.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that examples of combination therapy include chemotherapy and surgery, with neoadjuvant chemotherapy given before surgery and adjuvant chemotherapy given after surgery.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should mention that chemotherapy combinations can include CapeOx (capecitabine and oxaliplatin), GTX (gemcitabine, docetaxel, and capecitabine), or Gemcitabine combined with albumin-bound paclitaxel plus cisplatin or combined with an EGFR kinase inhibitor.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 79, "question_text": "My loved one has pancreatic cancer and we’re dealing with insurance pre-authorization issues. What can we do?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s healthcare team.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response states oncology practices often have team members who help patients with insurance issues.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response states pre-authorization issues are not uncommon in oncology care.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states that denials should be appealed.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response recommends contacting the insurance company.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response recommends understanding the patient’s insurance plan.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response recommends understanding the insurance company’s denial.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response recommends contacting patient advocacy programs.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response offers examples of patient advocacy programs.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response recommends clearly documenting all communications.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response recommends obtaining written documentation for all approved pre-authorizations.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response must explicitly state that prior authorization is a process in which payers require clinicians to obtain approval before a medication is covered.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response must specify that the appeal process involves submitting a formal appeal with supporting evidence, such as clinical guidelines, published trial data, and, for targeted or off-label therapies, molecular profiling results.", "min_points": 0, "max_points": 3 }, { "item_number": 14, "description": "The response must mention that if appeals are unsuccessful or delays persist, alternative access strategies should be pursued, including patient assistance programs, manufacturer co-pay cards, and foundation grants, which require application and documentation of financial need.", "min_points": 0, "max_points": 3 }, { "item_number": 15, "description": "The response must specifically mention patient advocacy organizations such as PanCAN and CancerCare as resources.", "min_points": 0, "max_points": 3 }, { "item_number": 16, "description": "The response states that prior-authorization denials or delays affect up to 22% of oncology patients and can cause treatment delays, increased anxiety, and adverse outcomes.", "min_points": 0, "max_points": 10 }, { "item_number": 17, "description": "The response recommends contacting the insurance provider specifically to ask for the reason for the denial.", "min_points": 0, "max_points": 5 }, { "item_number": 18, "description": "The response recommends contacting the oncologist to request a referral to a financial navigator or social worker.", "min_points": 0, "max_points": 5 }, { "item_number": 19, "description": "The response states that prior-authorization delays, not just denials, can be appealed.", "min_points": 0, "max_points": 5 }, { "item_number": 20, "description": "The response recommends discussing the case specifically with an oncologist.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 80, "question_text": "My father has pancreatic cancer and is experiencing cognitive changes. Could this be related to treatment?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states that infections can cause cognitive changes.", "min_points": 0, "max_points": 2 }, { "item_number": 3, "description": "The response states sudden changes in cognition may be a medical emergency and to seek immediate evaluation by a healthcare provider.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response recommends immediate medical evaluation if the patient has stroke symptoms.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states if the patient has a fever or other signs or symptoms of infection, to seek immediate evaluation by a healthcare provider.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states patients commonly experience mental fogginess, or “chemo brain.”", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states that cognitive changes from cancer treatment may improve if the treatment is stopped.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response states that if treatment side effects are severe enough, the patient’s oncologist may choose to decrease the dose of the treatment so it is better tolerated or switch to a different therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response recommends tracking the cognitive changes and sharing this with the patient’s healthcare team.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should mention that cancer treatment (including radiation, chemotherapy, and pain medications such as opioids) can affect a person’s cognitive functions.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that other factors unrelated to treatment could also cause cognitive changes, such as cancer progression.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should mention that stress/anxiety can cause cognitive changes unrelated to cancer or cancer treatment.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response should mention that pre-existing conditions can cause cognitive changes unrelated to cancer or cancer treatment.", "min_points": 0, "max_points": 3 }, { "item_number": 14, "description": "The response should mention that diet/nutrition changes can cause cognitive changes unrelated to cancer or cancer treatment.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 81, "question_text": "My mother has pancreatic cancer and we’re considering a feeding tube. When is this recommended?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states feeding tubes can help patients get the nutrition and hydration they need when they are unable to eat or drink on their own.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response states the most common types of feeding tubes are placed through the skin of the abdomen and into the stomach or small bowel.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states feeding tubes can be helpful in cancer patients if the cancer is obstructing the patient’s bowel.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states that if the patient is not eating or drinking enough because they do not want to, this may be the body’s way of signaling that the patient is nearing the end of life.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states studies have shown that in the absence of a bowel obstruction, feeding tubes do not typically increase survival in patients with cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response recommends considering hospice care.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response states that malnutrition is common in patients with pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response reviews the risks of feeding tubes, including discomfort and infection.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response recommends discussing the patient’s goals of care.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that pancreatic cancer can cause digestive issues due to a blocked bile duct.", "min_points": 0, "max_points": 2 }, { "item_number": 12, "description": "The response should mention that pancreatic cancer can cause digestive issues due to a blocked stomach.", "min_points": 0, "max_points": 2 }, { "item_number": 13, "description": "The response should mention that pancreatic cancer can cause digestive issues due to low levels of digestive enzymes.", "min_points": 0, "max_points": 2 }, { "item_number": 14, "description": "The response should mention that pancreatic cancer can cause digestive issues due to loss of appetite.", "min_points": 0, "max_points": 2 }, { "item_number": 15, "description": "The response should mention that pancreatic cancer can cause digestive issues due to cancer-related pain.", "min_points": 0, "max_points": 2 }, { "item_number": 16, "description": "The response should mention that nutritional counseling is recommended for patients with pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 17, "description": "The response states that whether a feeding tube is needed depends on factors such as the tumor’s location and size, treatment side effects, and the patient’s risk of malnutrition.", "min_points": 0, "max_points": 10 }, { "item_number": 18, "description": "The response states that feeding-tube options include a PEG or G tube placed through the skin into the stomach, a J-tube placed through the skin into the small intestine, and a nasogastric (NG) tube placed through the nose into the stomach for temporary support.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 82, "question_text": "My loved one has pancreatic cancer and is worried about the impact on our children. How do we talk to kids about this?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response recommends involving a professional who can help with these challenging conversations, like a social worker or spiritual counselor.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response recommends online resources for patients with cancer, including cancer.org.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response recommends clear and honest language.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response recommends tailoring the conversation to the children’s ages.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should mention to avoid overwhelming the child with too much information at once; provide information in small doses, stopping frequently to check for comprehension.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should mention to arrange for an appropriate location for the conversation and ensure there is enough time to give the information and answer questions.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should mention to provide information that is relevant to what the child wants to know.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should mention to respond empathically to the child’s emotions and acknowledge their feelings throughout the conversation.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should mention additional support resources for children and families, such as books for kids or support groups.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 83, "question_text": "My husband has pancreatic cancer and his sleep patterns have changed dramatically. Is this normal?", "rubric_items": [ { "item_number": 1, "description": "The response states that sleep patterns can be disturbed by cancer and its treatments.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response states that sleep patterns can be disturbed by symptoms like fatigue, pain, and nausea.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response states that sleep patterns can be a symptom of anxiety and depression.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response recommends tracking the sleep disturbances and sharing this with the patient’s healthcare team.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should mention that sleep hygiene practices can help improve sleep quality, such as maintaining a regular sleep schedule, creating a comfortable sleep environment, limiting caffeine and alcohol, and avoiding screens before bedtime.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states other options for treatment may include supplements like melatonin, cognitive behavioral therapy, or prescribed medications.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response recommends seeking immediate medical evaluation if the changes in sleep patterns are sudden or severe.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should mention that non-pharmacological interventions like relaxation techniques, cognitive behavioral therapy for insomnia, and mindfulness can be beneficial.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should mention that addressing underlying causes of sleep disruption, such as pain management or treatment of anxiety/depression, is important.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response states that sleep disruption is common in patients with pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response states that medication side effects and changes in routine can contribute to sleep disturbances.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 84, "question_text": "My loved one has pancreatic cancer and we’re considering complementary therapies like acupuncture. Are these safe during treatment?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing complementary therapies with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states complementary therapies like acupuncture may improve symptoms related to cancer and its treatments and may improve cancer patients’ quality of life.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response states complementary therapies are not a safe alternative to standard cancer treatments.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response states complementary therapies are not as effective as standard of care cancer treatments.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response defines complementary therapies and provides examples, including acupuncture.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response recommends informing the patient’s oncologist of any supplements the patient starts taking.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states supplements are not regulated by the FDA.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response states some supplements may interact with certain treatments for pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response reviews the risks of acupuncture, including bleeding and infection, which may be increased in patients receiving chemotherapy.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response recommends utilizing a practitioner licensed in acupuncture.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that acupuncture is generally safe for cancer patients, with no increased risk of serious adverse events compared to sham or standard care, though mild side effects such as bruising, soreness, or transient discomfort may occur.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response states that acupuncture is commonly used by people with pancreatic cancer and that current evidence suggests it can be safely integrated alongside conventional cancer treatment.", "min_points": 0, "max_points": 10 }, { "item_number": 13, "description": "The response states that acupuncture may help with cancer-related pain, fatigue, nausea, insomnia, and other treatment side effects when used alongside standard cancer therapy.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 85, "question_text": "My father has pancreatic cancer and is experiencing balance problems. Could this be from the treatment?", "rubric_items": [ { "item_number": 1, "description": "The response explicitly recommends discussing balance problems with the patient’s oncologist or healthcare team immediately.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response clearly states that symptoms from pancreatic cancer and its treatment, such as fatigue, headache, muscle weakness, and peripheral neuropathy, may contribute to sensations of imbalance.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should mention that chemotherapy can cause peripheral neuropathy, fatigue, anemia, and generalized weakness, which can all cause instability.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should mention that pancreatic cancer itself increases the risk of thromboembolic events, including cerebral ischemic strokes, which may present with acute balance disturbances or ataxia.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response explicitly instructs seeking immediate medical evaluation if symptoms are abrupt, severe, or accompanied by other neurologic deficits.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response explicitly states that balance problems can lead to falls.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response explicitly recommends ensuring the patient drinks plenty of fluids.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response explicitly recommends the patient stand and walk with assistance until they can be evaluated by their healthcare team.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 86, "question_text": "My mother has pancreatic cancer and we’re trying to understand her pathology report. What are the key things to look for?", "rubric_items": [ { "item_number": 1, "description": "The response recommends reviewing the pathology report with the patient’s oncologist or healthcare team.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states that pathology reports are written by doctors called pathologists who view tissue under the microscope to diagnose diseases.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response states the pathology report will contain a tumor type.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states the pathology report may contain a stage of the cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states the pathology report may contain a tumor size.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states the pathology report may contain a tumor grade.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states the pathology report may mention vascular invasion.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response states the pathology report may mention perineural invasion.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response states the pathology report may contain special stains which can sometimes be used to determine additional treatment options.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response states the final stage ranges from I to IV and is a sum of a tumor (T) score, a node (N) score, and a metastasis (M) score.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response states the pathology report helps the oncologist determine which treatment may be the most effective.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response states the pathology report may include results from genetic testing of the tumor which may help in identifying targeted therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response must mention margin status, including the presence of the tumor at or within 1 mm of any resection margin (R1), and its impact on prognosis and adjuvant therapy decisions.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response must mention the importance of the number of lymph nodes examined and number positive, and explicitly link perineural and vascular invasion to higher recurrence risk.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should mention that tumor size and location (head, body, tail) are required for accurate pathologic staging (pT), which, along with nodal status (pN) and presence of metastases (pM), determines the AJCC stage", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response must mention immunohistochemical and molecular findings, specifically including SMAD4, KRAS, TP53, and CDKN2A, and their diagnostic and prognostic relevance.", "min_points": 0, "max_points": 5 }, { "item_number": 17, "description": "The response must identify margin status, lymph node involvement, and pathologic stage using TNM/AJCC terminology as key elements of a pancreatic cancer pathology report.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 87, "question_text": "My loved one has pancreatic cancer and is considering participating in a vaccine trial. What should we know?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing the case with an oncologist to review the trial details and discuss the pros and cons.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explains that there are no FDA-approved cancer vaccines for pancreatic cancer and that all vaccines for pancreatic cancer are experimental.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response explains how a cancer vaccine works.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states clinical trials are how treatments are tested for diseases like pancreatic cancer.", "min_points": 0, "max_points": 4 }, { "item_number": 5, "description": "The response should state that clinical trials are conducted in four phases (I–IV).", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response recommends researching clinical trials prior to enrolling.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response recommends ClinicalTrials.gov as a resource.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response states patients should consider all of their treatment options prior to enrolling in a clinical trial.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response states clinical trials are designed to minimize patient harm and closely follow ethical standards.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response reviews potential benefits and risks of clinical trial participation.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response recommends discussing with the clinical trial research team about costs to the patient for participating in the trial.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response must explicitly mention that vaccine clinical trials in pancreatic cancer are designed to address the poor response of this malignancy to standard immunotherapy.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response must explicitly mention that vaccine trials aim to stimulate tumor-specific T cell (immune cell) responses to enhance the immune system’s effectiveness in killing cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response must mention at least two of the following vaccine platforms: peptide-based vaccines targeting defined tumor antigens, dendritic cell vaccines loaded with tumor lysates, or personalized mRNA/neoantigen vaccines that encode patient-specific tumor mutations.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response must mention that safety data from recent trials indicate that most vaccine regimens are well-tolerated, with adverse events generally limited to mild-to-moderate injection site reactions, flu-like symptoms, or transient fever.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response must mention that most data on vaccine trials in pancreatic cancer are derived from early-phase studies with small sample sizes and limited long-term follow-up.", "min_points": 0, "max_points": 5 }, { "item_number": 17, "description": "The response must explicitly define clinical trials as research studies that explore whether a new medical strategy, treatment, or device is safe and effective for humans.", "min_points": 0, "max_points": 5 }, { "item_number": 18, "description": "The response must explicitly state that clinical trials are essential for optimizing current and future therapies for cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 19, "description": "The response must mention that the patient will be informed, verbally and in writing, if a placebo is part of a clinical trial before they enroll.", "min_points": 0, "max_points": 5 }, { "item_number": 20, "description": "The response explains what each clinical trial phase is designed to do: Phase I assesses safety and side effects, Phase II evaluates efficacy in a specific cancer type, Phase III compares the intervention with standard treatment and may support FDA approval, and Phase IV monitors safety and benefit after approval.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 88, "question_text": "My husband has pancreatic cancer and his treatment team includes many specialists. How do we coordinate care?", "rubric_items": [ { "item_number": 1, "description": "The response explicitly recommends discussing care coordination concerns directly with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response clearly states that the medical oncologist typically serves as the coordinating physician among the different specialists on the healthcare team.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response explicitly recommends discussing care coordination with a patient navigator or social worker.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states that most oncology clinics have nurses who specialize in helping patients coordinate care.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response explicitly recommends trying to schedule multiple appointments on one day to limit life interruptions.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response states that the different specialists will communicate with one another and document their assessments in the electronic medical record.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response explicitly recommends asking about a multidisciplinary meeting with the involved specialists, sometimes called a “Tumor Board.”", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response must explicitly mention a structured multidisciplinary approach for coordinating care among multiple specialists for pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response must list all required specialists: surgical oncology, medical oncology, radiation oncology, gastroenterology, genetics, nutrition, and palliative care, and mention their distinct roles in diagnosis, staging, treatment, and supportive care.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response must define the specific roles of each specialist: surgical oncologists assess resectability and operative planning; medical oncologists direct systemic therapy; radiation oncologists evaluate indications for radiotherapy; gastroenterologists manage biliary and gastrointestinal complications; geneticists perform germline and somatic testing; nutritionists address malnutrition and enzyme replacement; and palliative care teams optimize symptom management and psychosocial support.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response must emphasize the necessity of clear patient-centered communication.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response states that multidisciplinary tumor board meetings review imaging, pathology, and the patient’s clinical status to reach consensus on the care plan.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response explicitly recommends identifying a primary point of contact for care coordination, such as a lead physician, nurse navigator, or case manager.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 89, "question_text": "My loved one has pancreatic cancer and we’re concerned about emergency situations. What should we be prepared for?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response reviews common medical emergencies experienced by patients with pancreatic cancer, including biliary obstruction and bowel obstruction.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response recommends having an Advance Directive or Living Will in place to guide the patient’s care if they are unable to speak for themselves.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response recommends seeking help from a professional in talking about these challenging questions, like a social worker, spiritual worker, or palliative care professional.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response recommends ensuring supportive care medications are refilled for symptoms like pain and nausea.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response reviews common medical emergencies experienced by patients with pancreatic cancer, including acute cholangitis, acute pancreatitis, acute hepatitis, infections, and blood clots.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response must state that pancreatic cancer patients are at high risk for acute emergencies due to tumor progression, treatment effects, or comorbidities.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response must mention that biliary obstruction presents with jaundice, dark urine, and pruritus.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response must describe gastric outlet obstruction as persistent vomiting, inability to tolerate oral intake, and abdominal distension.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response must mention VTE and include symptoms like sudden leg swelling, pain, shortness of breath, or chest pain, and state that pulmonary embolism is a leading cause of death after cancer itself.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response must mention febrile neutropenia as a life-threatening complication of chemotherapy, characterized by fever and signs of infection in the context of neutropenia.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response must mention metabolic derangements such as hypercalcemia (confusion, weakness, constipation) or hyponatremia (confusion, seizures).", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response must describe bowel obstruction as presenting with abdominal pain, vomiting, and constipation.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response must mention spinal cord compression and its symptoms, such as new-onset weakness, sensory changes, or loss of bowel/bladder control.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response must identify at least four distinct emergency situations that may occur in patients with pancreatic cancer.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 90, "question_text": "My father has pancreatic cancer and is experiencing hearing changes. Is this related to treatment?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing the hearing changes with his oncologist or healthcare team immediately.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states some chemotherapy treatments, like oxaliplatin, which is frequently used in treating pancreatic cancer as part of combination chemotherapy, can cause hearing changes.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response states that platinum-based chemotherapy, such as cisplatin, is well-known to cause hearing loss (ototoxicity).", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states the hearing changes may be related to other conditions like fatigue, infection, dehydration, malnutrition, or metabolic abnormalities from the cancer or its treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states it is important for the patient’s oncologist to know about new symptoms because they may need to adjust the dose of the chemotherapy or consider a different treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states that treatment-related side effects may become worse or permanent if changes are not made to the treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states hearing changes may be related to cancer spreading to the brain if there are other neurologic symptoms.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response states the hearing changes may be related to normal age-related hearing loss.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should mention that the risk of hearing loss increases with cumulative doses and patient age.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should mention that other therapies, including aminoglycoside antibiotics, loop diuretics, and radiation to the head/neck, can also contribute to hearing loss.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that hearing changes may result from direct cancer involvement, such as metastases affecting cranial nerves or brain, but this is uncommon in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should mention that referral for audiologic evaluation is advised.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response recommends seeking urgent medical evaluation if the hearing changes began suddenly or are severe, or if they are accompanied by fever, dizziness, or other neurologic symptoms.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 91, "question_text": "My mother has pancreatic cancer and we’re considering proton therapy. What is this and when is it used?", "rubric_items": [ { "item_number": 1, "description": "The response states proton therapy is a type of radiation therapy.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states proton therapy uses protons rather than photons to deliver highly conformal radiation doses to tumors.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response states proton therapy may be more precise in its target field compared to traditional radiation therapy techniques, which may reduce treatment-related side effects.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states proton therapy is a safe and feasible option for select patients with locally advanced or recurrent pancreatic cancer, especially when minimizing toxicity to surrounding organs is critical.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states the decision to use proton therapy is influenced by the cancer’s stage, location, size, proximity to other organs, among others.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response recommends discussing this with a Radiation Oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response states proton therapy has proven benefit in some cancers, like head and neck cancer, though has unclear benefit over traditional radiation therapy and is considered experimental in most types of cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response states not all cancer centers have the capability to provide proton therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response states proton therapy still carries the risk of side effects.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response states proton therapy is often used in combination with chemotherapy (such as gemcitabine) as part of concurrent chemoradiation protocols.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response states proton therapy can be used for locally advanced, unresectable, or recurrent disease.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response states proton therapy is a form of external beam radiation therapy.", "min_points": 0, "max_points": 10 }, { "item_number": 14, "description": "The response states the physical properties of protons allow precise dose deposition with minimal exit dose, which can reduce radiation exposure to adjacent organs such as the stomach, duodenum, and bowel.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response states the use of proton therapy should be individualized based on patient anatomy and multidisciplinary evaluation.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 92, "question_text": "My loved one has pancreatic cancer and is worried about the cost of medications. What assistance programs are available?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s healthcare team or oncologist, as they likely have financial experts who are knowledgeable in this area.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response recommends learning about the patient’s insurance plan, including out-of-pocket costs.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response states pharmaceutical companies have programs to help patients cover the cost of medications and provides examples.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states large hospital systems and cancer centers may have assistance programs.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states patient assistance programs may cover all or most of the cost of medications for cancer patients.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states government programs may offer assistance with the cost of medications and provides examples.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response offers examples of non-profit organizations with patient assistance programs.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response offers examples of pancreatic cancer-specific patient assistance programs.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response recommends applying for assistance early as the process may take time and delay treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response must mention federal, state, manufacturer, and independent charity options for medication cost assistance for pancreatic cancer patients.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response must explicitly state that Medicaid offers comprehensive prescription drug coverage with minimal co-payments and is the most effective public program for low-income patients.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response must mention that manufacturer-sponsored assistance programs provide free or discounted medications to eligible uninsured or underinsured patients, requiring proof of financial hardship and doctor certification.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response must specify that independent nonprofits like HealthWell and PAN Foundation offer co-pay and premium assistance to insured patients with incomes below 400-500% of the federal poverty level.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response must mention the complexity of accessing assistance programs and disparities among non-English speakers and some ethnic groups.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response must mention financial navigators and online tools such as NeedyMeds or RxAssist.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response explicitly recommends discussing the case with the patient’s oncologist.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 93, "question_text": "My husband has pancreatic cancer and his oncologist mentioned maintenance therapy. What does this mean?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states maintenance therapy is typically used in pancreatic cancer after the initial induction therapy.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response states maintenance therapy typically involves fewer anti-cancer drugs with the goal of limiting side effects.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response states the oncologist will continue to monitor the cancer closely while the patient is on maintenance therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states that if the cancer grows while on maintenance therapy, combination therapy may be reintroduced to get the cancer back under control.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states chemotherapy side effects are typically cumulative, so using maintenance therapy may help the patient tolerate treatment for a longer period of time.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states maintenance therapy may involve chemotherapy, targeted therapy, or immunotherapy depending upon the characteristics of the patient’s tumor.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should mention that the decision to initiate maintenance therapy should be individualized, considering disease response, cumulative toxicities, patient preference, and goals of care.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response states maintenance therapy is started once the cancer has been controlled by the initial treatment, with the goals of prolonging survival and maintaining quality of life.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 94, "question_text": "My loved one has pancreatic cancer and we’re dealing with treatment-related anxiety. What resources are available?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response recommends discussing this with a licensed mental health care provider.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response instructs the patient to seek immediate medical evaluation if they are experiencing thoughts of harming themselves or others.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response states anxiety is a common occurrence in patients with cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states treatments like cognitive behavioral therapy may help to control anxiety.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states medications may help to control anxiety.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response must explicitly mention psychotherapy, psychoeducation, supportive therapy, and integrative modalities as available resources for treatment-related anxiety.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response must explicitly mention mindfulness-based interventions or mindfulness-based stress reduction.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response recommends mindfulness and relaxation techniques.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response must explicitly mention pharmacologic therapy as a secondary option for severe anxiety or for those not responding to first-line psychological interventions.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response offers pancreatic cancer-specific resources.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response offers mental health-specific resources.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response recommends participation in cancer support groups.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response explicitly identifies cognitive-behavioral therapy(CBT) as the first-line intervention for treatment-related anxiety in patients with pancreatic cancer and attributes this recommendation to the American Society of Clinical Oncology.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response attributes the recommendation for mindfulness-based interventions or mindfulness-based stress reduction to the American Society of Clinical Oncology or the Society for Integrative Oncology.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response states that, per the American Society of Clinical Oncology, pharmacologic therapy for treatment-related anxiety has a weaker evidence base than first-line psychological interventions.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 95, "question_text": "My father has pancreatic cancer and is considering cryotherapy. What is this treatment?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response offers an explanation of cryotherapy.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response states cryotherapy is a procedure that uses metal instruments cooled to subzero temperatures in order to kill tumors.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should mention that cryotherapy (also called cryoablation) is a minimally invasive locoregional treatment that destroys tumor tissue by freezing it, typically using probes inserted through the skin (percutaneously) or intraoperatively under imaging guidance.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response states the decision to use cryotherapy involves the cancer’s size, location, proximity to other organs, among other things.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response recommends discussing the benefits and risks of this procedure with the patient’s healthcare team.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states cryotherapy may be used in conjunction with other treatment modalities like chemotherapy.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response states cryotherapy is not typically used to cure cancer but may be used to debulk tumors that are not operable.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response states not all patients benefit from cryotherapy.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should mention that in pancreatic cancer, cryotherapy is not a standard first-line therapy but is considered for patients with unresectable, locally advanced, or metastatic disease who are not candidates for surgical resection or have failed systemic therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that its primary role is palliative, aiming to reduce tumor burden, alleviate pain, and potentially improve quality of life and local disease control.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 96, "question_text": "My mother has pancreatic cancer and we want to understand more about tumor markers beyond CA 19-9. What others are there?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states CA 19-9 is the tumor marker most commonly used to track disease status in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response states other tumor markers, like CEA and CA 125, are less reliable than CA 19-9 for disease monitoring in pancreatic cancer and are used more frequently in other gastrointestinal or genitourinary cancers.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states tumor markers may be used to monitor the course of disease in patients with pancreatic cancer, along with imaging studies.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states tumor markers are not reliable markers of disease in all patients with pancreatic cancer, as not all tumors secrete the markers.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states circulating tumor DNA (ctDNA) is an emerging technology aimed at detecting early cancer progression and recurrence.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states circulating tumor DNA (ctDNA) is not FDA approved for disease monitoring in pancreatic cancer and remains experimental.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response states CA 19-9, in conjunction with imaging and a history and physical examination, is currently the most reliable method of disease monitoring in pancreatic cancer.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response should mention that CEA is elevated in 30-60% of pancreatic cancer cases and is particularly useful in Lewis-negative patients who do not secrete CA19-9.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should mention that both CEA and CA125 have demonstrated value for diagnosis, prognosis, and monitoring, especially when CA19-9 is not informative. CA125, when combined with CA19-9, improves diagnostic accuracy and is associated with tumor burden and metastatic disease.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that DUPAN-2 and CA242 are carbohydrate antigens that can complement CA19-9, especially in patients with genetic variants affecting CA19-9 synthesis.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should mention that emerging markers such as LAMC2, POSTN are not yet standard in routine clinical practice.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response states that, in pancreatic cancer, CA 19-9 together with other tumor markers such as CEA and CA 125 may be used for diagnosis, prognosis, or monitoring.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response states that CEA and CA 125 are the most widely used supplementary tumor markers beyond CA 19-9 in pancreatic cancer.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 97, "question_text": "My loved one has pancreatic cancer and is experiencing hand-foot syndrome from chemotherapy. How is this managed?", "rubric_items": [ { "item_number": 1, "description": "The response states that hand-foot syndrome is a common side effect of some chemotherapy drugs used to treat pancreatic cancer, including capecitabine， 5-FU, and other fluoropyrimidines.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response recommends discussing this with the patient’s oncologist and healthcare team immediately.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response states that the patient’s oncologist may recommend reducing the chemotherapy dose.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response instructs the patient to seek immediate medical evaluation if the patient experiences fever, chills, blisters, or pus draining from the affected area.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states the patient’s oncology team will grade the severity of the hand-foot syndrome, which will determine the recommended treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response recommends hand hygiene with a gentle soap.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states pain may be controlled with over-the-counter medications like Tylenol or ibuprofen, though the patient should check with their healthcare team first.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response states oral or topical prescription pain medications may be needed if pain is severe.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response recommends utilizing topical moisturizers.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response recommends skin protection with loose clothing and soft shoe soles.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response recommends cooling the skin with cold compresses.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response recommends avoiding hot showers and activities that cause rubbing on the skin.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should mention that HFS presents with redness (erythema), changes in sensation (dysesthesia), pain, cracking, and peeling (desquamation) of the palms and soles, and can significantly impair daily function, especially in elderly patients.", "min_points": 0, "max_points": 10 }, { "item_number": 14, "description": "The response should mention that prevention strategies include celecoxib and urea cream.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should mention that cooling procedures, such as frozen gloves or socks applied during taxane infusions, may prevent or reduce HFS severity and are recommended by the Oncology Nursing Society for taxane-based regimens.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should mention that prevention strategies such as Pyridoxine (vitamin B6) and lactic acid have not shown consistent benefit for prevention or treatment of HFS in randomized trials.", "min_points": 0, "max_points": 5 }, { "item_number": 17, "description": "The response should mention that omeprazole (a proton pump inhibitor) and tipiracil (a thymidine phosphorylase inhibitor) may have prophylactic effects, but these are not yet standard practice.", "min_points": 0, "max_points": 3 }, { "item_number": 18, "description": "The response should mention that management of established HFS includes topical urea and corticosteroids.", "min_points": 0, "max_points": 5 }, { "item_number": 19, "description": "The response should mention that Photobiomodulation (low-level laser therapy) has shown promise as an adjunct for pain and symptom control.", "min_points": 0, "max_points": 3 }, { "item_number": 20, "description": "The response states that hand-foot syndrome is typically non-life-threatening but can substantially impair quality of life as a cutaneous toxicity.", "min_points": 0, "max_points": 5 }, { "item_number": 21, "description": "The response states that for grade 2 or higher hand-foot syndrome, interrupting or holding chemotherapy is a mainstay of management because continued exposure can worsen symptoms and may necessitate treatment discontinuation.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 98, "question_text": "My husband has pancreatic cancer and we’re considering treatment at a cancer center versus community oncology. What’s the difference?", "rubric_items": [ { "item_number": 1, "description": "The decision between a cancer center and community oncology is often based on the type and stage of cancer, the patient’s insurance, location, and preference.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "Cancer centers may have access to more advanced therapies and clinical trials than community oncology programs.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "Pancreatic cancer requires multidisciplinary care involving medical oncology, radiation oncology, and surgical oncology, which may be more readily available at a large cancer center.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "Cancer centers may be more equipped to handle complex care for advanced disease.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "Community oncology programs may be more convenient and closer to home.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "There may be differences in cost between cancer centers and community oncology programs based on the patient’s insurance.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "Cancer centers may offer more support services to patients.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "Most standard cancer care can be delivered at community oncology programs.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "Cancer centers include NCI-designated comprehensive cancer centers and academic medical centers.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "Cancer centers are often located in major cities, which can mean longer travel times, more complex scheduling, and larger, busier environments.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "In some cases, initial treatment planning can be done at a cancer center, and follow-up care can be done at a community center closer to home.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The best choice also depends on the specific treatment needed, the patient’s overall health, and the support systems available.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "For pancreatic cancer, treatment at a specialized cancer center is associated with greater use of modern combination therapies and better survival outcomes than treatment in community oncology settings.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 99, "question_text": "My loved one has pancreatic cancer and is worried about intimacy during treatment. How do we address this?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s healthcare team.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states patients undergoing treatment for pancreatic cancer may experience a decrease in libido related to symptoms from treatment or the cancer itself, like fatigue, nausea, pain, malnutrition, anxiety, and depression.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response specifically mentions at least one of the following changes in intimacy: decreased desire, arousal disorders, pain, erectile dysfunction, altered body image, or emotional distress.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response recommends open communication.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response recommends seeking input from a professional trained in intimacy problems.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response recommends cancer support groups.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response explicitly mentions at least one of the following interventions: psychosocial therapy, psychosexual therapy, or couples-based therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response explicitly mentions at least one of the following referral options: medical sexologist, psycho-sexologist, social worker, or psychologist.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response explicitly states that concerns about intimacy during treatment for a loved one with pancreatic cancer are common.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response explicitly recommends discussing the case with an oncologist.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 100, "question_text": "My father has pancreatic cancer and his doctors mentioned radiofrequency ablation. What is this?", "rubric_items": [ { "item_number": 1, "description": "The response defines radiofrequency ablation.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states radiofrequency ablation is minimally invasive and typically does not require surgery.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response recommends discussing this with the patient’s healthcare team.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states not all patients with pancreatic cancer benefit from radiofrequency ablation.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response considers the potential risks and benefits of radiofrequency ablation for the treatment of pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states radiofrequency ablation is typically used in a multidisciplinary treatment plan along with chemotherapy for the treatment of pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states radiofrequency ablation is a procedure performed by specially trained Interventional Radiologists.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response states this is typically an outpatient procedure.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should mention that in pancreatic cancer, RFA is most commonly delivered via endoscopic ultrasound guidance (EUS-RFA), allowing precise targeting of the tumor while minimizing injury to surrounding structures.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should mention that radiofrequency ablation is used in pancreatic cancer primarily for unresectable or inoperable tumors as a palliative or adjunctive therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that RFA is not a substitute for surgery or systemic therapy in resectable disease.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response states that radiofrequency ablation is a locoregional thermal therapy that uses heat to cause coagulative necrosis and cell death in tumor tissue.", "min_points": 0, "max_points": 10 }, { "item_number": 13, "description": "The response states that the side effects of radiofrequency ablation are usually mild and self-limited, such as transient abdominal pain or mild pancreatitis.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 101, "question_text": "My mother has pancreatic cancer and we’re trying to manage her medications. She’s on so many pills - is this normal?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s healthcare team or oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states it is normal for patients with pancreatic cancer to be on multiple medications.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response states patients undergoing treatment for pancreatic cancer may need medications for symptom control, including acid reflux, nausea, pain, diarrhea, and enzyme replacement.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response recommends utilizing a pill organizer.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response recommends keeping an updated medication list with administration times.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response recommends reviewing the patient’s medication list with the healthcare team to identify strategies to make handling the medications easier.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states that pancreatic cancer treatment may involve several new medications, including the cancer treatment itself.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response states that the multiple medications are used to manage both the cancer itself and treatment-related side effects.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response explicitly recommends discussing the medication regimen with the patient’s oncologist or cancer specialist.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 102, "question_text": "My loved one has pancreatic cancer and is considering yoga during treatment. Is this safe and beneficial?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing yoga with the patient’s healthcare team.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response states yoga may improve a cancer patient’s quality of life.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response recommends gentle and slow yoga practice to avoid injury.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states patients undergoing treatment for pancreatic cancer may be more prone to injury due to fatigue, malnutrition, dehydration, and pain.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response recommends cancer support groups.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response cites any studies it mentions.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states there are yoga classes specifically for cancer patients and provides resources.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should mention that yoga is generally safe for people with cancer, including those undergoing treatment for pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should mention that yoga may help reduce cancer-related fatigue, anxiety, and depression, and improve emotional well-being during and after treatment, though effects are typically small to moderate and the certainty of evidence is low to moderate.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response supports any claim that yoga may improve a cancer patient’s quality of life with published research evidence.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that yoga may improve quality of life during and after treatment, though effects are typically small to moderate and the certainty of evidence is low to moderate.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 103, "question_text": "My husband has pancreatic cancer and we’re worried about long-term side effects of treatment. What should we expect?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states many side effects from cancer treatment improve and disappear once treatment stops.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response states some side effects like peripheral neuropathy may become permanent.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states some side effects from treatment may take time to improve or disappear, as long as many months.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states many side effects from treatment can be controlled with medications, for example pancreatic enzyme supplementation for pancreatic insufficiency or vitamins for malabsorption after surgery.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response reviews potential side effects of surgery for pancreatic cancer (e.g., Whipple procedure).", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response reviews potential side effects of chemotherapy for pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response mentions the potential for long-term heart or kidney damage and fertility issues.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response states the treating team will work within the patient’s goals of care to maximize treatment efficacy while limiting side effects.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response reviews potential side effects of radiation therapy for pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response states some cancer treatments can increase the likelihood of developing second cancers in the future.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response recommends open communication with the patient’s healthcare team about symptoms and symptom control to limit the long-term effects of treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response must explicitly state that long-term side effects are common in patients treated for pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response must mention the cumulative impact of surgery, chemotherapy, radiation, and the underlying disease as sources of long-term side effects.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response must mention at least four of the following chronic effects: fatigue, chemotherapy-induced peripheral neuropathy, chronic pain, sexual dysfunction, cognitive changes, metabolic derangements, or nutritional deficiencies due to pancreatic exocrine insufficiency.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 104, "question_text": "My loved one has pancreatic cancer and wants to donate to pancreatic cancer research. What organizations should we consider?", "rubric_items": [ { "item_number": 1, "description": "The response offers recommendations for organizations and includes key initiatives of the organizations.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response includes Charity Navigator ratings for the mentioned organizations.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response must explicitly state that nonprofit organizations are vital for supporting innovative research in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response must mention that donations to nonprofit organizations can support research, clinical trials, and patient support initiatives.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response mentions at least three of the following organizations: Pancreatic Cancer Action Network (PanCAN), American Association for Cancer Research (AACR), National Cancer Institute (NCI), and National Pancreas Foundation (NPF).", "min_points": 0, "max_points": 5 } ] }, { "question_number": 105, "question_text": "My father has pancreatic cancer and is experiencing vision changes. Could this be treatment-related?", "rubric_items": [ { "item_number": 1, "description": "The response recommends contacting the patient’s oncologist immediately.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response instructs the patient to seek immediate medical evaluation if the vision changes are abrupt in onset, severe, or accompanied by other symptoms including dizziness, pain, confusion, fever, or other neurologic symptoms.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response states vision changes related to treatment are not typical, though can be related to dry eyes or peripheral neuropathy from chemotherapy.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should mention that chemotherapy can cause vision changes (ocular toxicity). For example, gemcitabine and 5-fluorouracil have been associated with retinal findings including cotton-wool spots and other visual disturbances.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response states the oncologist may recommend dose reducing treatment or changing to a different treatment if the vision changes are felt to be treatment-related.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states vision changes may be related to metastasis to the brain.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should mention that ocular metastases may cause vision changes.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response states vision changes may be related to paraneoplastic processes and explains what this is.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should mention that paraneoplastic syndromes may cause vision changes.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response states the patient’s oncologist may prescribe medications to improve the vision changes, including eye drops, steroids, or antibiotics.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response states the patient’s vision changes may be due to infection.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response states the patient’s vision changes may be due to age-related vision changes.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response should mention that an eye evaluation is recommended for new vision changes during cancer therapy to distinguish between treatment-related toxicity, disease progression, and other causes.", "min_points": 0, "max_points": 10 }, { "item_number": 14, "description": "The response should mention that vision changes in a patient with pancreatic cancer can be related to cancer treatment.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 106, "question_text": "My mother has pancreatic cancer and we’re considering telehealth appointments. Are these as effective as in-person visits?", "rubric_items": [ { "item_number": 1, "description": "The response states that telehealth appointments are generally as effective as in-person visits for many aspects of care for patients with pancreatic cancer.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response reviews the potential benefits of telehealth appointments, including reduced travel burden, lower costs, decreased infection risk, and improved access to expertise.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response reviews the potential downsides of telehealth appointments, including potential differences in insurance reimbursement and challenges with physical examination.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states it can be challenging for a doctor to fully evaluate a patient via telehealth.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states telehealth can be a convenient alternative to in-office visits and may be helpful if the patient has mobility or transportation issues.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states in-office visits may be more appropriate in certain situations, including for initial visits or when there are big changes to the patient’s health or treatment plan.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response recommends discussing telehealth options with the patient’s oncologist.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response states not all oncologists offer telehealth appointments.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response offers tips for making the most out of a telehealth appointment.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response states medical emergencies are not appropriate for telehealth evaluations.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response mentions that telehealth may be less suitable for sensitive discussions, such as new diagnosis or end-of-life care.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response mentions that limitations of telehealth include technology barriers and occasional concerns about reduced personal connection or quality of interaction.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response cites research studies or other evidence supporting the claim that, in certain situations, telehealth visits may be as effective as in-office visits.", "min_points": 0, "max_points": 7 }, { "item_number": 14, "description": "The response states that telehealth’s improved access to expertise is especially valuable for patients who live far from high-volume centers.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 107, "question_text": "My loved one has pancreatic cancer and is worried about hair loss from chemotherapy. What can we expect?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states some chemotherapy treatments for pancreatic cancer can cause hair loss, for example, FOLFIRINOX or gemcitabine.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response provides reported estimates of hair loss with FOLFIRINOX and gemcitabine and cites its sources.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states hair typically grows back once the causative treatment is stopped.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states cold caps are sometimes used to reduce hair loss but they can be expensive.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states hair loss from chemotherapy is a common and distressing side effect in patients undergoing treatment for pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states other chemotherapy regimens or immunotherapy or targeted therapy cause hair loss at lower rates or not at all.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response states many cancer patients wear hats or wigs to help with appearances and self-esteem.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response recommends cancer support groups.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response reports expected timelines for hair loss after starting chemotherapy.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response mentions that the severity and risk of hair loss is higher with multi-agent and taxane-containing protocols, and female patients are at increased risk.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response mentions that most cases of hair loss are reversible, with regrowth expected within 3-6 months after cessation of chemotherapy, but persistent or permanent alopecia can occur, especially after repeated or high-dose regimens.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response mentions that eyebrow and eyelash loss may also be seen.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response mentions that topical minoxidil may aid regrowth post-chemotherapy, though evidence for prevention is limited.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response mentions that the overall incidence of chemotherapy-related hair loss can be up to 65%, depending on the regimen used.", "min_points": 0, "max_points": 10 }, { "item_number": 16, "description": "The response describes chemotherapy-related hair loss as typically diffuse, nonscarring alopecia (anagen effluvium).", "min_points": 0, "max_points": 5 }, { "item_number": 17, "description": "The response mentions that scalp cooling devices can reduce the risk or severity of hair loss, with success rates of about 50–80% in clinical studies.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 108, "question_text": "My husband has pancreatic cancer and his oncologist mentioned oligometastatic disease. What does this mean?", "rubric_items": [ { "item_number": 1, "description": "The response defines oligometastatic disease in pancreatic cancer as a state where the cancer has spread to a limited number of sites, typically involving a single organ (e.g., liver or lung) and a small number of lesions, commonly defined as ≤3 to ≤5 metastases.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response recommends discussing this with the patient’s healthcare team or oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response discusses the potential impact oligometastatic disease may have on treatment options, including the possibility of aggressive multimodal therapy such as systemic chemotherapy followed by local treatments like surgery, ablation, or stereotactic radiotherapy, if there is a good response to initial therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response contrasts oligometastatic disease to localized disease and widespread metastatic disease.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response mentions that patients with oligometastatic disease have the potential for an improved prognosis compared to widespread metastatic disease.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 109, "question_text": "My loved one has pancreatic cancer and we’re dealing with treatment delays due to low blood counts. Is this common?", "rubric_items": [ { "item_number": 1, "description": "The response states it is common for patients to have low blood counts due to chemotherapy used in the treatment of pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states treatment delays due to low blood counts are enacted to ensure the patient’s safety.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response states the oncologist may recommend dose reducing the chemotherapy or changing to a different treatment if the blood counts remain low.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response gives examples of chemotherapy known to cause low blood counts.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response lists the different types of low blood counts that may impact treatment, including anemia, neutropenia, thrombocytopenia, and low total white blood cell count, and explains why these cells are important in layman’s terms.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response states the oncologist may prescribe an injection medication (e.g., G-CSF) to help increase the neutrophil count.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states if the red blood cell or platelet counts get too low, the oncologist may order a transfusion of red blood cells or platelets to keep these at safe levels.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response instructs the patient to seek immediate medical evaluation if they have low blood counts and experience fever, chest pain, shortness of breath, leg swelling, blood in the urine, blood in the stool, or other uncontrollable bleeding.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response recommends ensuring good nutrition to ensure the bone marrow can produce the required blood cells.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response must strongly recommend consulting with an oncologist or care team, providing specific questions or topics to discuss.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response explains that treatment delays are necessary, essential, or required to prevent serious complications from low blood counts, specifically including infections.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response states that schedule modifications may be used to prevent severe neutropenia and explains that the care team balances reducing side effects with maintaining treatment efficacy.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 110, "question_text": "My father has pancreatic cancer and is considering hyperthermia treatment. What is this?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explains hyperthermia treatment for cancer in layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response specifies that hyperthermia treatment involves heating tumor tissue to a temperature range of 39-43°C to enhance the cytotoxic effects of chemotherapy and/or radiotherapy.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response mentions all three delivery methods: regional (including ‘deep regional’), intraoperative, and whole-body hyperthermia.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response reviews potential benefits and risks of hyperthermia treatment.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response states hyperthermia is not an effective alternative to standard of care treatment for pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response states hyperthermia is not a standard first-line therapy for pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response states there is not robust evidence for the use of hyperthermia treatment in pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response must mention that hyperthermia is used in pancreatic cancer as an adjunct to standard chemoradiotherapy for patients with locally advanced, unresectable, or metastatic disease, especially when conventional therapies have limited efficacy or are refractory.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response must state that adding hyperthermia to chemoradiotherapy may improve overall response rates and median survival compared to standard therapy alone, with acceptable safety profiles.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response must explicitly state that the quality of evidence for hyperthermia is limited, it remains investigational, and there are ongoing trials evaluating its efficacy and optimal integration into multimodal treatment regimens.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 111, "question_text": "My mother has pancreatic cancer and we want to understand more about her genetic testing results. Who can help interpret these?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response recommends discussing this with a genetic counselor.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response mentions that board-certified genetic counselors, medical geneticists, and oncologists with expertise in hereditary cancer syndromes can help interpret genetic testing results for a patient with pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response explains genetic testing and why it is done in cancer treatment, using layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response includes in its explanation that certain genetic mutations like BRCA2 may be targets for targeted cancer therapies.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states that certain genetic mutations are associated with inherited cancer predisposition syndromes which may affect the patient’s relatives.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response mentions that board-certified genetic counselors, medical geneticists, and oncologists can help determine the clinical significance of identified variants, discuss implications for surveillance, prevention, and treatment, and provide guidance for at-risk family members.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response mentions that pathogenic variants in genes such as BRCA1, BRCA2, PALB2, ATM, CDKN2A, and others may influence both therapeutic decisions and recommendations for family screening.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 112, "question_text": "My loved one has pancreatic cancer and is experiencing taste changes. How can we manage this?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist or a nutritionist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response states changes in taste are a common side effect of some chemotherapies used in the treatment of pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response recommends trying different foods and drinks to identify flavor profiles that are appealing.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response states cold intolerance is a common side effect of oxaliplatin, so patients should avoid cold foods and drinks.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response states changes in taste typically improve or disappear entirely when the causative medication is stopped.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response emphasizes the importance of maintaining proper nutrition and hydration while undergoing treatment for pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response recommends nutritional supplements to ensure the patient is achieving their needs.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response should mention that improved oral hygiene and active swallowing exercises may also promote taste recovery.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should mention that a referral to a registered dietitian is recommended for tailored nutritional strategies, as taste changes often lead to reduced appetite, altered food preferences, and risk of malnutrition.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response should mention that dietitians can assist with food texture modification, flavor enhancement, and strategies to maintain adequate caloric and protein intake.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response should mention that pharmacological and supplement-based interventions have been explored with mixed results. Further research is needed to establish standardized, effective interventions.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response states that taste changes affect approximately 56–76% of patients with pancreatic cancer undergoing chemotherapy, depending on treatment modality, and can significantly impair nutritional intake, food enjoyment, and quality of life.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 113, "question_text": "My husband has pancreatic cancer and we’re considering exercise during treatment. What’s safe and beneficial?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing the exercise plan with the patient’s oncologist or healthcare provider.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response recommends gentle and slow exercise to avoid injury.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response states patients undergoing treatment for pancreatic cancer may be more prone to injury due to fatigue, malnutrition, dehydration, and pain.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response recommends cancer support groups.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response states gentle exercise participation may improve a cancer patient’s quality of life and offers published research studies as evidence.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response cites any studies it mentions.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response states there are exercise classes specifically for cancer patients and provides resources.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response must explicitly mention that The American Society of Clinical Oncology recommends both aerobic and resistance exercise as safe and beneficial for patients with pancreatic cancer during chemotherapy, chemoradiotherapy, or neoadjuvant therapy.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response must clearly state that physical activity should be tailored to individual capacity and comorbidities.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response must explicitly state that aerobic exercise (e.g., walking, cycling, swimming) and resistance training (e.g., weights, resistance bands) improve cardiorespiratory fitness, physical function, and reduce symptoms like fatigue and mood disturbances.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 114, "question_text": "My loved one has pancreatic cancer and we’re worried about the progression of the disease. What signs should we watch for?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s healthcare team.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response recommends reporting any new symptoms to the patient’s healthcare team.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response states it is important to separate side effects of treatment from progression of disease.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response gives examples of new or worsening pain, jaundice, unintentional weight loss, and appetite changes as symptoms that may signify progression of disease.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response states metastases to other sites in the body can have various symptoms and provides examples.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response instructs the patient to seek immediate medical evaluation if they experience severe pain, jaundice, severe constipation, confusion, or neurologic changes.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response must mention at least 10 of the following signs and symptoms indicating disease progression in pancreatic cancer: jaundice, dark urine, pale stools, pruritus, abdominal pain, back pain, weight loss, anorexia, fatigue, nausea/vomiting, constipation, diarrhea, new or worsening diabetes, bloating, belching, cachexia, or blood clots.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should mention that alarm symptoms such as gastrointestinal bleeding or rapidly declining performance status should also be recognized as potential indicators of advanced disease or complications.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response must explicitly state the importance of close monitoring of symptoms for timely intervention and supportive care.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response must explicitly mention early integration of supportive care to optimize quality of life and address complications.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 115, "question_text": "My father has pancreatic cancer and his doctors mentioned neoadjuvant therapy. What does this mean?", "rubric_items": [ { "item_number": 1, "description": "The response should define neoadjuvant therapy.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response should include that neoadjuvant treatment is given before the definitive treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should include that neoadjuvant therapy usually occurs before surgery.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should include that neoadjuvant therapy is usually chemotherapy.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should include that radiation therapy can sometimes be used for neoadjuvant therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should include that oncologists often evaluate the response of a person’s cancer after neoadjuvant therapy to determine the next steps.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should mention that the main goals of neoadjuvant therapy are to treat micrometastases early, improve chances of margin-negative (R0) resection, downstage advanced tumors, and ensure patients receive systemic therapy, as many can’t complete adjuvant treatment after surgery.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response should mention that patient selection, multidisciplinary coordination, and management of therapy-related toxicities are critical, as attrition during neoadjuvant therapy can preclude surgery.", "min_points": 0, "max_points": 6 }, { "item_number": 9, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 116, "question_text": "My mother has pancreatic cancer and we’re considering music therapy. Are there benefits to this during treatment?", "rubric_items": [ { "item_number": 1, "description": "The response should state that music therapy can help with symptoms associated with pancreatic cancer.", "min_points": 0, "max_points": 8 }, { "item_number": 2, "description": "The response should state that music therapy can help with anxiety.", "min_points": 0, "max_points": 4 }, { "item_number": 3, "description": "The response should state that music therapy can improve quality of life.", "min_points": 0, "max_points": 4 }, { "item_number": 4, "description": "The response should state that music therapy can help with depression.", "min_points": 0, "max_points": 4 }, { "item_number": 5, "description": "The response should state that music therapy can help with pain.", "min_points": 0, "max_points": 4 }, { "item_number": 6, "description": "The response should state that music therapy can help with fatigue.", "min_points": 0, "max_points": 4 }, { "item_number": 7, "description": "The response states that music therapy is anti-cancer therapy.", "min_points": -10, "max_points": 0 }, { "item_number": 8, "description": "The response should cite peer-reviewed publications with links.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should mention that the American Society of Clinical Oncology and the Society for Integrative Oncology recommend music therapy as a safe, non-invasive adjunct for managing anxiety and depression in adults with cancer, including those undergoing active treatment.", "min_points": 0, "max_points": 8 }, { "item_number": 10, "description": "The response should mention that emerging evidence suggests music therapy may also modulate immune responses and support overall treatment outcomes, but further research is needed to clarify its biological effects and optimal use in pancreatic cancer.", "min_points": 0, "max_points": 8 }, { "item_number": 11, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 117, "question_text": "My loved one has pancreatic cancer and is worried about the impact on our pets. Should we be concerned about anything?", "rubric_items": [ { "item_number": 1, "description": "The response must state that pancreatic cancer is not contagious.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response should state that chemotherapy can weaken the immune system and make someone at increased risk of infection.", "min_points": 0, "max_points": 8 }, { "item_number": 3, "description": "The response should state that pets can carry infections that could be harmful to immunocompromised persons.", "min_points": 0, "max_points": 8 }, { "item_number": 4, "description": "The response should recommend the patient discuss precautions related to chemotherapy excretion with a pharmacist.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should state that some chemotherapy drugs are excreted in urine.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response should state that some chemotherapy drugs are excreted in stool.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should state that some chemotherapy drugs are excreted in saliva.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response should state that some chemotherapy drugs are excreted in vomit.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should state that pets should avoid contact with excreted medications.", "min_points": 0, "max_points": 4 }, { "item_number": 10, "description": "The response should state that pets should avoid contact with chemotherapy medications.", "min_points": 0, "max_points": 8 }, { "item_number": 11, "description": "The response should state that pets should avoid contact with all medications.", "min_points": 0, "max_points": 1 }, { "item_number": 12, "description": "The response should mention that pets provide significant emotional and psychological benefits to cancer patients.", "min_points": 0, "max_points": 8 }, { "item_number": 13, "description": "The response should mention that to reduce exposure to chemotherapy and radiation residues, patients should take precautions to limit the impacts on their pets.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "After chemotherapy, surfaces—especially in bathrooms—can remain contaminated for at least 48 hours, so thorough cleaning is advised. Hand hygiene is essential after contact with patient waste or contaminated areas.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "Immunocompromised patients should practice good hand hygiene after handling pets.", "min_points": 0, "max_points": 8 }, { "item_number": 16, "description": "Immunocompromised patients should avoid contact with pet waste.", "min_points": 0, "max_points": 8 }, { "item_number": 17, "description": "Immunocompromised patients should prevent pets from licking open wounds.", "min_points": 0, "max_points": 8 }, { "item_number": 18, "description": "There is no strong evidence that pet ownership increases cancer risk or that pets need to be removed from the home during treatment.", "min_points": 0, "max_points": 7 }, { "item_number": 19, "description": "If patients are severely immunosuppressed, they should avoid contact with young animals, reptiles, or exotic pets, and seek assistance with pet care.", "min_points": 0, "max_points": 8 }, { "item_number": 20, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 1 } ] }, { "question_number": 118, "question_text": "My husband has pancreatic cancer and his oncologist mentioned adjuvant therapy. What is this?", "rubric_items": [ { "item_number": 1, "description": "The response should define adjuvant therapy.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state the goal of adjuvant therapy is to prevent cancer recurrence.", "min_points": 0, "max_points": 6 }, { "item_number": 3, "description": "The response should include that adjuvant therapy usually occurs after surgery.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should include adjuvant therapy can be chemotherapy.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should include adjuvant therapy can be radiation therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states that guidelines recommend all patients with resected pancreatic adenocarcinoma who did not receive preoperative therapy should be offered 6 months of adjuvant chemotherapy, unless there are medical or surgical contraindications.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response states that adjuvant systemic therapy significantly improves survival compared to surgery alone.", "min_points": 0, "max_points": 4 }, { "item_number": 8, "description": "The response states that the choice of adjuvant regimen should be individualized based on patient fitness and risk of toxicity.", "min_points": 0, "max_points": 6 }, { "item_number": 9, "description": "The response recommends that the user discuss this case with an oncologist or cancer specialist.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response states that in pancreatic cancer, adjuvant therapy is used to eliminate remaining microscopic cancer cells that may persist after surgical resection.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 119, "question_text": "My loved one has pancreatic cancer and we’re dealing with constipation from pain medications. How can we manage this?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend discussing constipation with their oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should recommend discussing pain medications with the oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should include that constipation is a side effect of opioid pain medications.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should recommend the use of a bowel regimen to help with constipation associated with pain medications, including the use of stimulant laxatives.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should recommend the use of a bowel regimen to help with constipation associated with pain medications, including the use of osmotic laxatives.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should recommend the use of a bowel regimen to help with constipation associated with pain medications, including the use of stool softeners.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should state that a combination of these treatments is sometimes needed.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should state that there are prescription medications that can directly target opioid-associated constipation.", "min_points": 0, "max_points": 4 }, { "item_number": 9, "description": "The response should recommend hydration to improve constipation.", "min_points": 0, "max_points": 6 }, { "item_number": 10, "description": "The response should recommend physical activity to improve constipation.", "min_points": 0, "max_points": 6 }, { "item_number": 11, "description": "The response should mention that opioid-induced constipation is primarily due to reduced gut motility, and agents that increase water content or stimulate peristalsis directly address the underlying pathophysiology.", "min_points": 0, "max_points": 7 }, { "item_number": 12, "description": "The response should mention that the American Gastroenterological Association recommends polyethylene glycol (PEG) and lactulose as effective osmotic agents, both of which significantly improve stool consistency and frequency compared to placebo.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should mention that soluble fiber may be considered only for patients with fiber-deficient diets, as it has limited efficacy in opioid-induced constipation due to its lack of effect on colonic motility.", "min_points": 0, "max_points": 7 }, { "item_number": 14, "description": "The response should mention that enemas are reserved for rescue therapy and not for regular use.", "min_points": 0, "max_points": 4 } ] }, { "question_number": 120, "question_text": "My father has pancreatic cancer and is considering meditation and mindfulness. Are these helpful during treatment?", "rubric_items": [ { "item_number": 1, "description": "The response should state that meditation and mindfulness can improve quality of life.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response should state that meditation and mindfulness are not anti-cancer treatments.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should state that meditation and mindfulness can help emotional well-being.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should mention that meditation and mindfulness demonstrate moderate improvements in anxiety, depression, cancer-related fatigue, and overall quality of life in oncology populations, with effects maintained for at least several months post-intervention.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response should mention that meditation and mindfulness are safe, feasible, and can be integrated alongside standard cancer care to help manage both physical and psychological symptoms.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 2 }, { "item_number": 7, "description": "The response should cite peer-reviewed studies and provide links to the articles when stating that meditation and mindfulness can help emotional well-being.", "min_points": 0, "max_points": 2 }, { "item_number": 8, "description": "The response should cite peer-reviewed studies and provide links to the articles when stating that meditation and mindfulness can improve quality of life.", "min_points": 0, "max_points": 2 }, { "item_number": 9, "description": "The response should mention that the American Society of Clinical Oncology and the Society for Integrative Oncology strongly recommend meditation and mindfulness during active cancer treatment, including for pancreatic cancer, for symptom management and quality-of-life support.", "min_points": 0, "max_points": 2 } ] }, { "question_number": 121, "question_text": "My mother has pancreatic cancer and we’re trying to understand the role of nutrition during treatment. What should we focus on?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend discussing their concerns with an oncology nutritionist or dietitian.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that pancreatic enzyme supplements can help with digesting food when there is pancreatic enzyme deficiency.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should state that nutrition is important for maintaining strength or energy.", "min_points": 0, "max_points": 4 }, { "item_number": 4, "description": "The response should state that nutrition is important for supporting the immune system.", "min_points": 0, "max_points": 4 }, { "item_number": 5, "description": "The response should state that nutrition is important for maintaining weight.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should state the reasons for challenges with nutrition in patients with pancreatic cancer, including poor appetite.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should state the reasons for challenges with nutrition in patients with pancreatic cancer, including digestion difficulties.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response should state the reasons for challenges with nutrition in patients with pancreatic cancer, including side effects of treatment like nausea.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should state they should focus on protein intake.", "min_points": 0, "max_points": 2 }, { "item_number": 10, "description": "The response should state they should focus on calorie intake.", "min_points": 0, "max_points": 2 }, { "item_number": 11, "description": "The response should recommend trying to manage nausea.", "min_points": 0, "max_points": 6 }, { "item_number": 12, "description": "The response should recommend hydration.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response should mention that patients with pancreatic cancer undergoing treatment are at high risk of malnutrition, cachexia, and weight loss, necessitating early and ongoing nutritional assessment and intervention.", "min_points": 0, "max_points": 9 }, { "item_number": 14, "description": "The response should mention that dietary strategies should prioritize enteral nutrition over parenteral nutrition when oral intake is inadequate.", "min_points": 0, "max_points": 7 }, { "item_number": 15, "description": "The response should mention that oral nutritional supplements, especially those enriched with omega-3 fatty acids, are beneficial for supporting body weight and lean body mass.", "min_points": 0, "max_points": 3 }, { "item_number": 16, "description": "The response should mention that diet composition should emphasize a plant-enriched diet for overall health and cancer risk reduction.", "min_points": 0, "max_points": 3 }, { "item_number": 17, "description": "The response should mention that current evidence does not support ketogenic diets for treatment.", "min_points": 0, "max_points": 8 }, { "item_number": 18, "description": "The response should mention that nutritional support is a cornerstone of care that can improve outcomes and quality of life, and that prompt referral to a registered dietitian or nutritionist for individualized evaluation and counseling is recommended.", "min_points": 0, "max_points": 10 }, { "item_number": 19, "description": "The response should mention that pancreatic exocrine insufficiency is common in pancreatic cancer and can cause weight loss and deficiencies of fat-soluble vitamins (A, D, E, K) and other micronutrients, and that pancreatic enzyme replacement is essential.", "min_points": 0, "max_points": 10 }, { "item_number": 20, "description": "The response should explain that enteral nutrition is associated with fewer complications, shorter hospital stays, and better outcomes than parenteral nutrition.", "min_points": 0, "max_points": 10 }, { "item_number": 21, "description": "The response should recommend discussing the case with an oncologist.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 122, "question_text": "My loved one has pancreatic cancer and is experiencing memory issues. Could this be related to treatment?", "rubric_items": [ { "item_number": 1, "description": "The response should mention that chemotherapy is known to cause cancer-related cognitive impairment affecting memory, attention, and executive function.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should recommend discussing memory concerns with their oncology team.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should state that memory issues can be associated with pain medications.", "min_points": 0, "max_points": 2 }, { "item_number": 4, "description": "The response should state that memory issues can be associated with poor nutrition.", "min_points": 0, "max_points": 2 }, { "item_number": 5, "description": "The response should state that memory issues can be associated with dehydration.", "min_points": 0, "max_points": 2 }, { "item_number": 6, "description": "The response should state that memory issues can be associated with anxiety.", "min_points": 0, "max_points": 2 }, { "item_number": 7, "description": "The response should state that memory issues can be associated with depression.", "min_points": 0, "max_points": 2 }, { "item_number": 8, "description": "The response should state that memory issues can be associated with fatigue.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should state that memory issues can be associated with stress.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should cite peer-reviewed articles with links.", "min_points": 0, "max_points": 2 }, { "item_number": 11, "description": "The response should mention that memory issues in pancreatic cancer patients are frequently related to cancer treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should mention that biological mechanisms underlying chemotherapy-induced cognitive changes include direct neurotoxic effects of chemotherapy, neuroinflammation, changes in brain structure and connectivity, and involvement of specific biomarkers and genetic predispositions.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should mention that cognitive impairment may also be influenced by the cancer itself, paraneoplastic effects, and other factors such as age, comorbidities, and emotional distress.", "min_points": 0, "max_points": 6 } ] }, { "question_number": 123, "question_text": "My husband has pancreatic cancer and his doctors are discussing ablative techniques. What are these?", "rubric_items": [ { "item_number": 1, "description": "The response should mention that ablative techniques in the treatment of pancreatic cancer refer to a group of minimally invasive procedures designed to locally destroy tumor tissue.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should mention that ablative techniques are typically used for locally advanced pancreatic cancer patients who are not candidates for surgical resection.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should describe types of ablative techniques used in pancreatic cancer, including radiofrequency ablation (RFA).", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should describe types of ablative techniques used in pancreatic cancer, including microwave ablation (MWA).", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should state that ablative techniques are not curative.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should state that ablative techniques in pancreatic cancer are used to manage symptoms.", "min_points": 0, "max_points": 4 }, { "item_number": 7, "description": "The response should describe types of ablative techniques used in pancreatic cancer, including cryoablation.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should mention that these techniques are typically considered after or in conjunction with systemic chemotherapy, which remains the first-line treatment for locally advanced pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should describe types of ablative techniques used in pancreatic cancer, including irreversible electroporation (IRE).", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should describe types of ablative techniques used in pancreatic cancer, including high-intensity focused ultrasound (HIFU).", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that RFA delivers thermal energy via a probe to induce coagulative necrosis of tumor cells. RFA can be performed percutaneously, surgically, or via endoscopic ultrasound (EUS) guidance.", "min_points": 0, "max_points": 2 }, { "item_number": 12, "description": "The response should mention that RFA is the most studied thermal technique and has demonstrated feasibility and safety, with some evidence of improved survival and immune modulation.", "min_points": 0, "max_points": 6 }, { "item_number": 13, "description": "The response should mention that MWA uses electromagnetic waves to generate heat and destroy tumor tissue.", "min_points": 0, "max_points": 4 }, { "item_number": 14, "description": "The response should mention that MWA is emerging as an alternative to RFA, with potential advantages in speed and ablation volume, but clinical data remain limited.", "min_points": 0, "max_points": 4 }, { "item_number": 15, "description": "The response should mention that IRE is a non-thermal technique that uses high-voltage electrical pulses to create permanent nanopores in cell membranes, leading to apoptosis.", "min_points": 0, "max_points": 4 }, { "item_number": 16, "description": "The response should mention that IRE is particularly attractive for tumors near critical structures, as it spares connective tissue and vessels. It is increasingly used in locally advanced pancreatic cancer and is under investigation in randomized trials.", "min_points": 0, "max_points": 4 }, { "item_number": 17, "description": "The response should mention that HIFU delivers focused ultrasound waves to induce thermal and mechanical destruction of tumor cells.", "min_points": 0, "max_points": 4 }, { "item_number": 18, "description": "The response should mention that HIFU is less commonly used but has shown feasibility in clinical studies.", "min_points": 0, "max_points": 4 }, { "item_number": 19, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 124, "question_text": "My loved one has pancreatic cancer and we’re concerned about the quality of life during treatment. How do we maintain this?", "rubric_items": [ { "item_number": 1, "description": "The response explicitly recommends that the patient or family discuss goals of care (e.g., treatment goals, quality of life preferences, advanced care planning) with their oncologist or oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explicitly recommends discussing symptom management (e.g., pain, nausea, fatigue) with the oncology team or oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should mention that early integration of supportive and palliative care is strongly supported by the medical literature as a means to improve quality of life (QOL) and reduce symptom burden in pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response explicitly states or clearly implies that mental health professionals (e.g., counselor, psychologist, psychiatrist, mental health provider) can help patients deal with the emotional or psychological burden of cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response explicitly recommends discussing side effect management (e.g., side effects of treatment, managing adverse effects) with the oncology team or oncologist.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should mention that pancreatic cancer is an aggressive malignancy associated with a high symptom burden, including pain, gastrointestinal symptoms, fatigue, and significant psychological distress.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should mention that palliative care is not synonymous with hospice; rather, it is an active, multidisciplinary approach to symptom management and psychosocial support that can be provided at any stage of disease, including during active cancer-directed therapy.", "min_points": 0, "max_points": 4 }, { "item_number": 8, "description": "The response should mention that multidisciplinary collaboration can impact quality of life during treatment of pancreatic cancer.", "min_points": 0, "max_points": 4 }, { "item_number": 9, "description": "The response should mention that advance care planning can impact quality of life during treatment of pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response should mention that early integration of supportive or palliative care is supported by the medical literature as a way to improve quality of life and reduce symptom burden in pancreatic cancer.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response should mention that proactive symptom management can improve quality of life during pancreatic cancer treatment.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response should mention that psychosocial support for both the patient and caregivers can improve quality of life during pancreatic cancer treatment.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 125, "question_text": "My father has pancreatic cancer and is considering participating in advocacy work. What organizations can he connect with?", "rubric_items": [ { "item_number": 1, "description": "The response should include the Pancreatic Cancer Action Network (PanCAN) as a major pancreatic cancer advocacy organization.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should recommend discussing advocacy options with their oncology team.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should mention that PanCAN is a leading national organization dedicated to patient advocacy, support, research funding, and public policy initiatives for pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should mention that PanCAN offers structured opportunities for patients and families to engage in advocacy, including legislative outreach, awareness campaigns, and peer support programs such as the Patient and Liaison Services (PALS) program.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should mention that the American Society of Clinical Oncology’s patient-facing website, Cancer.Net, provides information on advocacy opportunities and connects patients to broader cancer advocacy networks.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should mention that both PanCAN and Cancer.Net are specifically recommended by the American Society of Clinical Oncology in its clinical practice guidelines as key resources for patients with pancreatic cancer.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 126, "question_text": "My loved one has pancreatic cancer and we want to know what options are out there. They think she can have surgery but we aren’t sure what to do.", "rubric_items": [ { "item_number": 1, "description": "The response should state that the treatment of pancreatic cancer depends on the stage of the cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that treatment of pancreatic cancer is multimodality and include surgery.", "min_points": 0, "max_points": 3 }, { "item_number": 3, "description": "The response should state that treatment of pancreatic cancer is multimodality and include chemotherapy.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should state that treatment of pancreatic cancer is multimodality and include radiation.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should state that chemotherapy can be used before or after surgery.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should state that pancreatic cancer management should involve a multidisciplinary team.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response should state types of surgical procedures used in pancreatic cancer and describe the Whipple procedure.", "min_points": 0, "max_points": 4 }, { "item_number": 8, "description": "The response should state types of surgical procedures used in pancreatic cancer and describe distal pancreatectomy.", "min_points": 0, "max_points": 4 }, { "item_number": 9, "description": "The response should state types of surgical procedures used in pancreatic cancer and describe total pancreatectomy.", "min_points": 0, "max_points": 2 }, { "item_number": 10, "description": "The response should state that surgical resection is the only potentially curative option for pancreatic cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 11, "description": "The response should mention that deciding whether surgery is appropriate requires careful multidisciplinary evaluation, considering anatomical (vascular involvement, distant metastases), biological (tumor markers such as CA19-9), and patient factors (performance status, comorbidities).", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response should recommend discussing the case with an oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 13, "description": "The response should state that treatment of pancreatic cancer depends on the location of the cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should state that the NCCN recommends management decisions be made at high-volume centers with appropriate high-volume imaging studies.", "min_points": 0, "max_points": 4 }, { "item_number": 15, "description": "The response should explicitly mention that treatment decisions are guided by precise disease staging and list at least two of the following categories: resectable, borderline resectable, locally advanced/unresectable, or metastatic.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 127, "question_text": "There is a strong possibility that my loved one has pancreatic cancer. While we will know more early next week, I am doing as much preliminary research as possible to understand how I can be the most effective advocate for her. Please help.", "rubric_items": [ { "item_number": 1, "description": "The response should state that the treatment of pancreatic cancer depends on the stage of the cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response should state that the treatment of pancreatic cancer depends on the location of the cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 3, "description": "The response should state that treatment of pancreatic cancer is multimodality and includes surgery.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should state that treatment of pancreatic cancer is multimodality and includes chemotherapy.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should state that treatment of pancreatic cancer is multimodality and includes radiation.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response should mention that early, multidisciplinary management is essential to optimize outcomes.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should mention that care is best coordinated at high-volume centers with expertise in pancreatic malignancies.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should state that symptom management is an important part of the care of patients with pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should describe the basics of pancreatic cancer, including that the most common type is pancreatic adenocarcinoma.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should describe how pancreatic cancer is staged based on the NCCN guidelines (version 2.2025).", "min_points": 0, "max_points": 2 }, { "item_number": 11, "description": "The response should mention that pancreatic cancer is an aggressive malignancy with a poor prognosis, often presenting at an advanced stage.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response should recommend writing down questions in advance to ensure that all concerns are addressed during consultations.", "min_points": 0, "max_points": 10 }, { "item_number": 13, "description": "The response should mention that advocacy for comprehensive testing is important, including somatic and germline genetic testing.", "min_points": 0, "max_points": 10 }, { "item_number": 14, "description": "The response should mention to inquire about clinical trial opportunities, as participation may provide access to novel therapies.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should mention that cancer.net and the Pancreatic Cancer Action Network (pancan.org) provide high-quality information, support services, and advocacy opportunities.", "min_points": 0, "max_points": 7 }, { "item_number": 16, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 17, "description": "The response should state that the NCCN Panel (version 2.2025) recommends appropriate high-volume imaging studies as part of diagnostic and management decision-making for pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 18, "description": "The response should mention that pancreatic cancer is categorized as resectable, borderline resectable, locally advanced, or metastatic, and that this classification determines surgical eligibility and guides treatment planning.", "min_points": 0, "max_points": 5 }, { "item_number": 19, "description": "The response should mention that somatic and germline genetic testing should be discussed early because actionable mutations may influence therapy and have implications for family members.", "min_points": 0, "max_points": 5 }, { "item_number": 20, "description": "The response should mention that quality-of-life concerns, including pain, fatigue, dietary issues, and psychosocial distress, should be proactively addressed.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 128, "question_text": "My loved one died with pancreatic cancer. She had a less common type called Pancreatic Neuroendocrine Tumor. I’d like to know if that type tends to have a genetic component and if genetic testing is available.", "rubric_items": [ { "item_number": 1, "description": "The response should state that pancreatic neuroendocrine tumors (pNETs) are usually sporadic.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response should mention that pancreatic neuroendocrine tumors (pNETs) do tend to have a genetic component in a significant minority of cases.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should mention that approximately 10–17% of pNETs are associated with inherited syndromes, most commonly multiple endocrine neoplasia type 1 (MEN1), but also MEN4, von Hippel-Lindau disease (VHL), neurofibromatosis type 1 (NF1), and tuberous sclerosis complex (TSC).", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that genetic testing is available for pancreatic neuroendocrine tumors.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should recommend that they have concerns about the risk of cancer, they should talk with a genetic counselor.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should mention that these inherited syndromes often present at a younger age.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should mention that germline mutations are also found in sporadic-appearing pancreatic neuroendocrine tumors (pNETs), including mutations in DNA repair genes such as MUTYH, CHEK2, and BRCA2, as well as MEN1 and VHL.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should mention that multigene panel testing is recommended, as it can identify both syndromic and non-syndromic germline variants relevant for familial risk assessment.", "min_points": 0, "max_points": 6 }, { "item_number": 9, "description": "The response should recommend that the user discuss this case with a medical professional.", "min_points": 0, "max_points": 8 }, { "item_number": 10, "description": "The response should state that genetic testing is available for the hereditary syndromes associated with pancreatic neuroendocrine tumors (pNETs).", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response should state that genetic testing can be especially helpful for people with a strong family history of similar tumors.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 129, "question_text": "Where can I find stories of hope? I have been diagnosed with pancreatic cancer, stage IV and I am feeling hopeless. I want to remain positive so that I can keep fighting.", "rubric_items": [ { "item_number": 1, "description": "The response mentions the Pancreatic Cancer Action Network(www.pancan.org) (PanCAN) as a source for survivor stories.", "min_points": 0, "max_points": 3 }, { "item_number": 2, "description": "The response recommends asking the oncology team for additional support group recommendations.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response mentions Cancer Support Community (CSC) as a resource for support or survivor stories.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response mentions Let’s Win! Pancreatic Cancer survivor stories.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response mentions the American Society of Clinical Oncology’s patient-facing website (www.cancer.net) as a source for stories of hope.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response mentions that organizations provide patient and survivor stories, peer support networks, and opportunities to connect with others who have faced similar diagnoses.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response mentions that peer support and shared experiences are recognized as powerful tools for maintaining motivation and a sense of hope during the cancer journey.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response recommends that the user discuss their case with an oncologist.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 130, "question_text": "Trying to gather information for my mother with stage IV pancreatic cancer. We are looking for everything we can do to improve her chance of survival and quality of life.", "rubric_items": [ { "item_number": 1, "description": "The response should define stage IV pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should include that the disease is not curable.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should include the goal of treatment is to control the cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should include the goal of treatment to improve symptoms.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should mention that the cornerstone of treatment for stage IV pancreatic cancer is systemic chemotherapy.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should include chemotherapy regimens listed in NCCN guidelines (version 2.2025) for treatment of metastatic pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should discuss that clinical trials are another option.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response should state that there may be targeted treatments based on genetic mutations.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should recommend the tumor have genetic testing.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response should recommend focusing on symptom management.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that early palliative care referral is recommended at diagnosis to optimize symptom management, psychological support, and advance care planning.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should mention that aggressive symptom management, such as management of pain, fatigue, nausea, and gastrointestinal symptoms is essential.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should mention that pancreatic enzyme replacement therapy should be considered for exocrine insufficiency, and nutritional support is important for maintaining weight and strength.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should mention that psychosocial support, including counseling and peer support, is critical for both patients and families.", "min_points": 0, "max_points": 3 }, { "item_number": 15, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 131, "question_text": "My father has pancreatic cancer and we’re looking for the best specialists in our region. How do we identify top doctors?", "rubric_items": [ { "item_number": 1, "description": "The response should state that management of pancreatic tumors involves a multidisciplinary team of surgeons, medical oncologists, and radiation oncologists.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response should mention that outcomes are significantly improved when care is delivered by a multidisciplinary team at high-volume centers.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response should provide information for the Pancreatic Cancer Action Network (PanCAN).", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should provide information for the American Cancer Society (ACS).", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The recommendation should provide a link to the NCI website for finding an NCI-designated cancer center.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response should mention that multidisciplinary management should include surgical oncology, medical oncology, gastroenterology, radiology, and palliative care.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should mention that high-volume centers—defined as institutions performing at least 15 pancreatic resections annually—demonstrate superior survival rates, lower postoperative morbidity, improved lymphadenectomy, shorter hospital stays, and better access to adjuvant therapies.", "min_points": 0, "max_points": 8 }, { "item_number": 8, "description": "The response should mention that high-volume centers are typically academic medical centers, National Cancer Institute-designated cancer centers, or hospitals with established pancreatic cancer programs.", "min_points": 0, "max_points": 8 }, { "item_number": 9, "description": "The response should mention to request referrals from local oncologists or primary care providers, who can direct patients to high-volume centers and experienced teams.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response should mention that the NCCN Panel (version 2.2025) recommends that diagnosis and management decisions be made by multidisciplinary teams at high-volume centers with appropriate high-volume imaging studies.", "min_points": 0, "max_points": 4 } ] }, { "question_number": 132, "question_text": "My mother has pancreatic cancer and we’re concerned about the side effects of treatment on her heart. What should we monitor?", "rubric_items": [ { "item_number": 1, "description": "The response explicitly states that some chemotherapy can have negative effects on the heart.", "min_points": 0, "max_points": 3 }, { "item_number": 2, "description": "The response specifically mentions that 5-fluorouracil (or “5-FU”) can harm the heart.", "min_points": 0, "max_points": 1 }, { "item_number": 3, "description": "The response recommends monitoring for shortness of breath.", "min_points": 0, "max_points": 2 }, { "item_number": 4, "description": "The response recommends monitoring for chest pain.", "min_points": 0, "max_points": 2 }, { "item_number": 5, "description": "The response recommends monitoring for fast heart rate.", "min_points": 0, "max_points": 2 }, { "item_number": 6, "description": "The response recommends monitoring for dizziness.", "min_points": 0, "max_points": 2 }, { "item_number": 7, "description": "The response recommends monitoring for unusual fatigue.", "min_points": 0, "max_points": 2 }, { "item_number": 8, "description": "The response explicitly recommends discussing any new symptom with the oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response explicitly recommends discussing any concerning symptom with the oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response states that electrocardiograms can be used to monitor the heart.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response states that echocardiogram can be used to monitor heart function.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response states that blood pressure can be used to monitor the heart.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response specifically mentions that capecitabine can harm the heart.", "min_points": 0, "max_points": 1 }, { "item_number": 14, "description": "The response specifically mentions that some targeted therapies can harm the heart.", "min_points": 0, "max_points": 1 }, { "item_number": 15, "description": "The response explicitly states that pancreatic cancer treatments can cause at least three cardiac issues: heart failure, arrhythmias, hypertension, ischemia, or cardiomyopathy.", "min_points": 0, "max_points": 3 }, { "item_number": 16, "description": "The response explicitly states that the risk of cardiac side effects is higher in patients with preexisting cardiovascular conditions or those receiving specific agents such as anthracyclines or fluoropyrimidines.", "min_points": 0, "max_points": 3 }, { "item_number": 17, "description": "The response explicitly recommends baseline cardiac risk assessment and regular monitoring with echocardiography, cardiac biomarkers, and clinical evaluation for early/asymptomatic cardiac dysfunction.", "min_points": 0, "max_points": 4 }, { "item_number": 18, "description": "The response explicitly references recommendations from the American College of Cardiology and/or the American Society of Clinical Oncology, stating that pretherapy evaluation and ongoing surveillance are recommended for patients with cardiovascular risk factors or those receiving cardiotoxic agents.", "min_points": 0, "max_points": 10 }, { "item_number": 19, "description": "The response explicitly recommends that the user discuss the case with an oncologist.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 133, "question_text": "My loved one has pancreatic cancer and is considering stopping all treatment. How do we support this decision?", "rubric_items": [ { "item_number": 1, "description": "The response should include that treatment decisions are personal decisions.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should recommend listening to their feelings.", "min_points": 0, "max_points": 3 }, { "item_number": 3, "description": "The response should recommend validating their feelings.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should recommend respecting their autonomy.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should recommend supporting their quality of life.", "min_points": 0, "max_points": 6 }, { "item_number": 6, "description": "The response should recommend offering reassurance.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should mention that clear, compassionate communication about prognosis, treatment options, and goals of care is important.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should mention that transitioning to hospice care may be appropriate when the focus shifts entirely to comfort and dignity.", "min_points": 0, "max_points": 6 }, { "item_number": 9, "description": "The response should mention that hospice provides intensive symptom management, psychosocial and spiritual support, and home-based care, while avoiding non-beneficial interventions such as hospitalization or aggressive procedures.", "min_points": 0, "max_points": 6 }, { "item_number": 10, "description": "The response should mention addressing practical issues related to end-of-life decision-making, such as managing costs and accessing resources.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response should mention that it is essential to explore the patient’s hopes, worries, and values to clarify what matters most in this phase of life.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 134, "question_text": "My husband has pancreatic cancer and we’re trying to plan for the future. What legal documents should we have in place?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend discussing legal planning with a qualified professional.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should include that laws can vary state to state.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should include a description of an advance healthcare directive or living will.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should include a description of a medical power of attorney.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should include a description of a durable power of attorney for finances.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response should include a description of a last will and testament.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should mention that POLST forms translate preferences into actionable medical orders for emergency settings.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should mention that these documents ensure that care aligns with the patient’s values and preferences, especially if the patient loses decision-making capacity due to disease progression or treatment effects.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response should mention that it is essential to have ongoing, structured conversations about goals of care, as patient preferences may change over time.", "min_points": 0, "max_points": 8 }, { "item_number": 10, "description": "The response should mention that the American Society of Clinical Oncology recommends having an advance directive, a designated surrogate decision-maker, and POLST forms in place for future planning.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that advance directives can specify preferences for life-sustaining treatments, such as resuscitation, mechanical ventilation, and artificial nutrition and hydration, and may include a living will.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should recommend discussing this situation with the husband’s oncologist.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should mention that the health care proxy or power of attorney for health care legally appoints someone to make medical decisions if the patient is unable.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 135, "question_text": "My loved one has pancreatic cancer and we’re dealing with significant medical bills. What financial assistance is available?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend discussing their concerns with the oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should recommend discussing their concerns with a social worker.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should recommend discussing their concerns with a financial counselor.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that patient advocacy organizations can help and include information on the Pancreatic Cancer Action Network (PanCAN).", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should state that patient advocacy organizations can help and include information on CancerCare.org.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response should state that patient advocacy organizations can help and include information for the American Cancer Society.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should mention that patients with pancreatic cancer who are facing significant medical bills have access to several financial assistance options.", "min_points": 0, "max_points": 2 }, { "item_number": 8, "description": "The response should mention that financial assistance options include patient assistance programs (PAPs) from independent charity foundations, pharmaceutical company programs, and direct grants from nonprofit organizations.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should mention that these programs may provide co-payment assistance, help with insurance premiums, and sometimes support for non-medical expenses such as transportation or housing.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response should mention that eligibility is generally based on annual household income (often up to 400–500% of the federal poverty level), insurance status, and physician endorsement.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 136, "question_text": "My father has pancreatic cancer and his doctors mentioned PARP inhibitors. What are these and when are they used?", "rubric_items": [ { "item_number": 1, "description": "The response should describe PARP inhibitors as a class of targeted agents that block the PARP enzyme, which is involved in repairing single-strand DNA breaks.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response should mention that PARP inhibitors can be used in advanced pancreatic cancer when there is a germline mutation in a BRCA gene.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should mention that PARP inhibitors are used as maintenance therapy in patients with metastatic pancreatic cancer who have a germline BRCA1 or BRCA2 mutation and whose cancer has not progressed after at least 16 weeks of first-line platinum-based chemotherapy.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should mention that comprehensive germline testing for BRCA mutations is recommended for all patients with pancreatic cancer to identify those eligible for this targeted approach.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should mention that the American Society of Clinical Oncology specifically recommends olaparib, based on the POLO trial, which demonstrated a significant improvement in progression-free survival compared to placebo, without compromising quality of life.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should mention that other PARP inhibitors and combination strategies are under investigation, but their use remains investigational at this time.", "min_points": 0, "max_points": 4 }, { "item_number": 7, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should explain that the rationale for PARP inhibitors in pancreatic cancer is synthetic lethality, in which tumors with homologous recombination repair deficiency such as germline BRCA1 or BRCA2 mutations are especially sensitive to PARP blockade, causing accumulation of DNA damage and tumor cell death.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should describe PARP inhibitor per Cancer Research UK website.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 137, "question_text": "My mother has pancreatic cancer and we’re considering relocating to be closer to a major cancer center. What should we consider?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend considering proximity to the treatment center.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response should recommend considering housing options near the cancer center.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should recommend considering transportation to and from the cancer center.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should recommend considering financial considerations as relocation may affect network status, out-of-pocket costs, and eligibility for financial assistance programs.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response should include insurance coverage as relocation may affect network status, out-of-pocket costs, and eligibility for financial assistance programs.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response should recommend considering the social support system near the cancer center.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should provide information for the Pancreatic Cancer Action Network (PanCAN) Patient services.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response should provide information for the American Cancer Society (ACS) page on finding a doctor.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The recommendation should provide a link to the NCI website for finding an NCI-designated cancer center.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response should state that the NCCN Panel (version 2.2025) recommends that decisions about diagnosis and management involve multidisciplinary teams at high-volume centers with appropriate high-volume imaging studies.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response explicitly mentions patient preferences, goals of care, or quality of life as central to the decision.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response explicitly addresses open communication about expectations, prognosis, or the impact of relocation on daily life.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response explicitly mentions continuity of care, transferring medical records, coordinating with the current care team, or ensuring uninterrupted access to medications/supportive services.", "min_points": 0, "max_points": 4 }, { "item_number": 14, "description": "The response explicitly mentions access to multidisciplinary care and/or clinical trials as important factors.", "min_points": 0, "max_points": 10 }, { "item_number": 15, "description": "The response explicitly recommends discussing the case with an oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 16, "description": "The response explicitly states that receiving care at a high-volume or certified pancreatic cancer center is especially important because such centers are associated with better outcomes, such as improved survival, lower perioperative mortality, or better adherence to standard-of-care therapies.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 138, "question_text": "My loved one has pancreatic cancer and is experiencing severe anxiety about upcoming scans. How can we help manage this?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend discussing the anxiety with their oncology team.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response should include considering relaxation techniques prior to the scan.", "min_points": 0, "max_points": 3 }, { "item_number": 3, "description": "The response should recommend asking the oncology team about what will happen during the scan.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should include talking to a mental health professional.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response should include talking to a social worker.", "min_points": 0, "max_points": 1 }, { "item_number": 6, "description": "The response should discuss medical interventions to help with anxiety.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response explicitly states that severe anxiety related to upcoming scans is highly prevalent or very common among patients with pancreatic cancer or cancer in general.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response explicitly mentions at least two of the following resource types for managing treatment-related anxiety: psychotherapy, psychoeducation, supportive therapy, or integrative modalities.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response explicitly identifies Cognitive Behavioral Therapy (CBT) as the first-line or primary intervention for treatment-related anxiety in pancreatic cancer or cancer patients, and attributes this recommendation to a major oncology guideline.", "min_points": 0, "max_points": 6 }, { "item_number": 10, "description": "The response explicitly mentions mindfulness-based interventions (MBIs) or mindfulness-based stress reduction (MBSR) as recommended for anxiety in cancer patients, and attributes this recommendation to a major oncology guideline.", "min_points": 0, "max_points": 4 }, { "item_number": 11, "description": "The response explicitly states that pharmacologic therapy may be considered for severe anxiety or when first-line psychological interventions are insufficient, and that this is a secondary option with weaker evidence, as per a major oncology guideline.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 139, "question_text": "My husband has pancreatic cancer and we’re trying to maintain normalcy for our family. What strategies work best?", "rubric_items": [ { "item_number": 1, "description": "The response should mention that open, constructive communication within the couple and family is essential for reducing distress and maintaining relationship satisfaction.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response should include maintaining daily routines.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should include continuing to do activities that bring enjoyment.", "min_points": 0, "max_points": 6 }, { "item_number": 4, "description": "The response should include letting the support system help.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response should include ensuring self-care for the patient.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response should include ensuring self-care for the support system.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should mention that pancreatic cancer imposes profound emotional, social, and practical upheaval on both the patient and family, disrupting established routines, roles, and relationships.", "min_points": 0, "max_points": 8 }, { "item_number": 8, "description": "The response should mention that early integration of supportive and palliative care is recommended by the American Society of Clinical Oncology and other expert groups.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should mention that referrals to registered dietitians and symptom management specialists can help minimize disruptions to family life.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should mention that caregiver and family support resources can provide education, emotional support, and practical assistance.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that the literature notes persistent gaps in support for caregivers and families affected by pancreatic cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 12, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 140, "question_text": "My loved one has pancreatic cancer and we’re considering getting genetic counseling. What does this involve?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend discussing genetic counseling with the oncology team or healthcare provider in the context of pancreatic cancer care.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should accurately describe the role of a genetic counselor as a trained professional who helps individuals and families understand the genetic aspects of disease, provides information, guidance, and support for informed decision-making, and assists with risk assessment and testing.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should mention that genetic counseling involves a structured evaluation of personal and family cancer history.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should mention that genetic counseling involves education about hereditary cancer syndromes.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should mention that genetic counseling involves a discussion of the risks, benefits, and limitations of genetic testing.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should mention that genetic counseling addresses the psychological and ethical aspects of genetic information, including communication of results to family members and consideration of reproductive implications.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should mention that the American Society of Clinical Oncology recommends that this process be conducted with providers experienced in hereditary cancer syndromes.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should mention that the American Society of Clinical Oncology recommends that germline genetic testing be offered early in the disease course, ideally using a multigene panel that includes genes linked to pancreatic cancer risk such as BRCA1, BRCA2, and others.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 141, "question_text": "My father has pancreatic cancer and is experiencing peripheral neuropathy. What treatments are available for this?", "rubric_items": [ { "item_number": 1, "description": "The response should state that neuropathy is a common side effect from certain chemotherapy drugs.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should recommend discussing medication side effects with their oncology team.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should state that neuropathy from chemotherapy can be managed by dose reduction.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should state that neuropathy from chemotherapy can be managed by schedule modification.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should state that neuropathy from chemotherapy can be managed by switching to an alternate regimen.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should state that neuropathy from chemotherapy can be managed by switching to an alternate regimen, including gemcitabine-based therapy.", "min_points": 0, "max_points": 1 }, { "item_number": 7, "description": "The response should state that neuropathy from chemotherapy can be managed using supportive medications, including gabapentin.", "min_points": 0, "max_points": 1 }, { "item_number": 8, "description": "The response should state that neuropathy from oxaliplatin can be managed using supportive medications, including SNRIs.", "min_points": 0, "max_points": 1 }, { "item_number": 9, "description": "The response should state that neuropathy from oxaliplatin can be managed using supportive medications, including pregabalin.", "min_points": 0, "max_points": 1 }, { "item_number": 10, "description": "The response should include physical therapy.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response should include occupational therapy.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response should mention that peripheral neuropathy could arise from chemotherapy (notably platinum agents), direct tumor involvement, or paraneoplastic syndromes.", "min_points": 0, "max_points": 2 }, { "item_number": 13, "description": "The response should mention that peripheral neuropathy significantly impairs quality of life and functional status.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should mention that management should be individualized, balancing efficacy, side effects, and patient-specific factors.", "min_points": 0, "max_points": 3 }, { "item_number": 15, "description": "The response should mention that Duloxetine is the only agent with moderate evidence-based recommendation for the treatment of chemotherapy-induced peripheral neuropathy (CIPN) in cancer patients.", "min_points": 0, "max_points": 7 }, { "item_number": 16, "description": "The response should mention that the typical starting dose of duloxetine is 30 mg daily, titrated to 60 mg daily as tolerated, with slow tapering recommended to avoid withdrawal symptoms.", "min_points": 0, "max_points": 7 }, { "item_number": 17, "description": "The response should mention that other pharmacologic options include tricyclic antidepressants (nortriptyline, amitriptyline), gabapentin, and pregabalin, which are supported by guidelines for cancer-related neuropathic pain but have inconclusive evidence.", "min_points": 0, "max_points": 2 }, { "item_number": 18, "description": "The response should mention that topical agents such as lidocaine and capsaicin patches may be considered for localized neuropathic pain, though evidence is limited.", "min_points": 0, "max_points": 3 }, { "item_number": 19, "description": "The response should mention that opioids are not preferred for chronic neuropathic pain due to risk of tolerance, dependence, and adverse effects.", "min_points": 0, "max_points": 7 }, { "item_number": 20, "description": "The response should mention that interventional approaches, notably neurolytic celiac plexus block, are effective for refractory pain in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 21, "description": "The response should mention that peripheral neuropathy is common in patients with pancreatic cancer.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 142, "question_text": "My mother has pancreatic cancer and we’re trying to understand the difference between curative and palliative treatment. Can you explain?", "rubric_items": [ { "item_number": 1, "description": "The response should define curative treatment as interventions with the intent to eradicate the disease and achieve long-term survival.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should mention that curative treatment is only possible in a minority of patients, typically those with resectable or borderline resectable tumors, where surgery (pancreaticoduodenectomy or distal pancreatectomy) is feasible.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should mention that in curative treatment, surgery is often followed by adjuvant chemotherapy to reduce recurrence risk.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should define palliative treatment as focusing on improving quality of life when cure is not possible.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should mention that palliative treatment is the case for the majority of patients with locally advanced unresectable or metastatic disease.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should include that the primary goal of palliative treatment is to prolong survival, control symptoms, and maintain quality of life.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should include that palliative treatment can include chemotherapy.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response should include that palliative treatment can include radiation for local control or pain.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should include that palliative treatment can include pain management.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response should mention that palliative approaches include endoscopic or surgical procedures to relieve biliary or gastric outlet obstruction, and comprehensive supportive care for pain, nutrition, and psychosocial needs.", "min_points": 0, "max_points": 4 }, { "item_number": 11, "description": "The response should mention that the American Society of Clinical Oncology emphasizes early integration of palliative care for all patients with advanced disease to address symptom burden and support patient and family well-being.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should include that curative treatment can include radiation.", "min_points": 0, "max_points": 1 } ] }, { "question_number": 143, "question_text": "My loved one has pancreatic cancer and is considering experimental treatments abroad. What should we research?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend understanding the costs.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response should recommend discussing treatment decisions with your oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should recommend understanding the stage of pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should recommend understanding the type of cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 5, "description": "The response should recommend understanding the reputation of the clinic.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should recommend understanding the qualifications of the providers.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should recommend understanding the details of the experimental treatments, including types of drugs.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response should recommend understanding the evidence supporting the treatment.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should recommend understanding the potential side effects of the experimental treatments.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should recommend understanding the safety of the drugs.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response should recommend understanding the legal protections of the country.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should recommend understanding the availability of medical records.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response should recommend understanding the logistics of traveling abroad for treatment.", "min_points": 0, "max_points": 1 }, { "item_number": 14, "description": "The response should mention considering your loved one’s health and travel suitability, as long travel can be taxing.", "min_points": 0, "max_points": 3 }, { "item_number": 15, "description": "The response should mention considering if the other country has specialized high-quality pancreatic cancer care.", "min_points": 0, "max_points": 3 }, { "item_number": 16, "description": "The response should mention considering visa barriers when traveling abroad for treatment.", "min_points": 0, "max_points": 2 }, { "item_number": 17, "description": "The response should mention considering local accommodations when traveling abroad for treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 18, "description": "The response should mention considering cultural barriers when traveling abroad for treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 19, "description": "The response should mention considering challenges with follow-up care when traveling abroad for treatment.", "min_points": 0, "max_points": 6 }, { "item_number": 20, "description": "The response should mention considering social support challenges when traveling abroad for treatment.", "min_points": 0, "max_points": 6 }, { "item_number": 21, "description": "The response should mention considering whether insurance will cover the treatment abroad or what other funding sources are available.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 144, "question_text": "My husband has pancreatic cancer and we’re dealing with treatment-related infections. How can we prevent these?", "rubric_items": [ { "item_number": 1, "description": "The response should describe why treatments for pancreatic cancer can increase the risk of infections, including immunosuppression due to chemotherapy.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should recommend hand hygiene.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should mention to limit contact with sick people who are contagious (colds, flu, or other infections).", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should recommend being up to date on age-appropriate vaccinations.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should recommend discussing the infections with the oncology team.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response should recommend food safety.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should recommend adherence with prophylactic medications if prescribed.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should mention avoiding exposure to fungal spores, especially for patients with neutropenia, by avoiding environments with high concentrations of airborne fungal spores. ([https://ascopubs.org/doi/abs/10.1200/JCO.18.00374](https://ascopubs.org/doi/abs/10.1200/JCO.18.00374))", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should mention that there is no need for antimicrobial prophylaxis for most solid tumors if the overall infection risk is low (neutropenia < 7 days). ([https://ascopubs.org/doi/abs/10.1200/JCO.18.00374](https://ascopubs.org/doi/abs/10.1200/JCO.18.00374))", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should mention that interventions such as footwear exchange, protected environments, neutropenic diet, or nutritional supplements are not recommended due to a lack of evidence of clinical benefit.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response should specifically recommend COVID-19 and influenza vaccination for the patient and household members.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should recommend respiratory hygiene/cough etiquette and providing the patient and caregivers with education on hand hygiene and respiratory hygiene practices.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 145, "question_text": "My loved one has pancreatic cancer and we want to understand more about immunotherapy combinations. What research is being done?", "rubric_items": [ { "item_number": 1, "description": "The response describes the combination of immune checkpoint blockade with chemotherapy as a current research strategy in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response describes the combination of immune checkpoint blockade with radiation as a current research strategy in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response describes the combination of immune checkpoint blockade with other novel agents (e.g., targeted therapies, immune modulators, or agents targeting the tumor microenvironment) as a current research strategy in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response explicitly defines immunotherapy as a treatment that uses the body’s immune system to attack cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response states that pembrolizumab is approved for pancreatic cancer with MSI-high tumors.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response states that pembrolizumab is approved for pancreatic cancer with dMMR (deficient mismatch repair) tumors.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response states that pembrolizumab is approved for pancreatic cancer with TMB-high (tumor mutational burden-high) tumors.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response specifically mentions clinicaltrials.gov as a resource for finding immunotherapy clinical trials.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response specifically mentions the PanCan clinical trial finder as a resource for finding immunotherapy clinical trials.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response describes immune checkpoint blockade as a current strategy for studying immunotherapy in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response describes adoptive cellular therapy (e.g., CAR-T cell therapy or modified T-cells) as a current research strategy in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should mention that current research on immunotherapy combinations for patients with pancreatic cancer is focused on overcoming the immunosuppressive tumor microenvironment (TME) and enhancing antitumor immune responses.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response should mention that neoadjuvant immunotherapy combinations are being tested to prime the immune system before surgery, with early results suggesting potential improvements in disease-free and overall survival.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should mention that cancer vaccines are under investigation as an immunotherapy approach for pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 15, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 16, "description": "The response describes the combination of immune checkpoint blockade with PARP inhibitors as a current research strategy in pancreatic cancer.", "min_points": 0, "max_points": 1 }, { "item_number": 17, "description": "The response states that monotherapy with immune checkpoint inhibitors has shown limited efficacy in pancreatic cancer, which is motivating investigation of combination approaches.", "min_points": 0, "max_points": 10 }, { "item_number": 18, "description": "The response gives specific examples of promising combinations, such as anti-PD-1/PD-L1 or anti-CTLA-4 antibodies combined with gemcitabine/nab-paclitaxel or with tumor-microenvironment-modifying or immune-stimulating agents such as CD40 agonists or IL-1β inhibitors.", "min_points": 0, "max_points": 5 }, { "item_number": 19, "description": "The response should mention that agents targeting stromal or myeloid compartments are under investigation as immunotherapy approaches for pancreatic cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 20, "description": "The response should mention that oncolytic viruses are under investigation as an immunotherapy approach for pancreatic cancer.", "min_points": 0, "max_points": 2 } ] }, { "question_number": 146, "question_text": "My father has pancreatic cancer and is considering participating in a research study. What questions should we ask?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend understanding the goal of the study.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should recommend understanding the phase of the trial.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should recommend understanding the eligibility requirements of the trial.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should recommend understanding the potential side effects of the treatments.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should recommend understanding if there are additional tests required to participate in the trial.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response should recommend understanding if there are travel costs associated with the trial.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should recommend understanding the evidence supporting the trial.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should recommend understanding the kind of treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should recommend understanding the visit schedule of the trial.", "min_points": 0, "max_points": 4 }, { "item_number": 10, "description": "The response explicitly states that research studies are designed to determine if a new medical strategy, treatment, or device is safe and/or effective for humans.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response explicitly states that clinical trials are essential for improving, optimizing, or advancing current and/or future cancer therapies.", "min_points": 0, "max_points": 6 }, { "item_number": 12, "description": "The response includes the question: “How will participation impact current treatment and care?”", "min_points": 0, "max_points": 6 }, { "item_number": 13, "description": "The response includes the question: “What are the implications for family members, especially if genetic testing is involved?”", "min_points": 0, "max_points": 7 }, { "item_number": 14, "description": "The response recommends discussing the case with an oncologist or relevant healthcare professional to review trial details and discuss pros and cons.", "min_points": 0, "max_points": 10 }, { "item_number": 15, "description": "The response includes a question about the potential benefits of participating and the overall risks of the trial beyond side effects alone.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response includes the question: “What will participation involve overall, including required procedures, treatments, tests, and participant responsibilities?”", "min_points": 0, "max_points": 8 }, { "item_number": 17, "description": "The response includes a question about how side effects or adverse effects will be monitored and managed during the trial.", "min_points": 0, "max_points": 7 }, { "item_number": 18, "description": "The response includes a question about other financial or logistical considerations, such as insurance coverage, non-travel costs, compensation, or support services.", "min_points": 0, "max_points": 10 }, { "item_number": 19, "description": "The response should mention that trials are divided into phases (phase I - phase IV).", "min_points": 0, "max_points": 7 }, { "item_number": 20, "description": "The results should explain the different phases. Phase I clinical trials studies the safety and side effects of an investigational drug or treatment approach. Phase 2 trials study how well the drug or approach works against a specific type of cancer. Phase 3 clinical trials test the drug or approach against another standard treatment. If the results are good, it may be approved by the FDA. Phase 4 trials study the safety and benefit of an FDA-approved treatment.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 147, "question_text": "My mother has pancreatic cancer and we’re trying to manage her pain without becoming dependent on opioids. What alternatives exist?", "rubric_items": [ { "item_number": 1, "description": "The response should describe non-opioid medications for pain control, including acetaminophen.", "min_points": 0, "max_points": 4 }, { "item_number": 2, "description": "The response should describe non-opioid medications for pain control, including NSAIDs.", "min_points": 0, "max_points": 4 }, { "item_number": 3, "description": "The response should mention that neuropathic pain may be treated with adjuvant/non-opioid analgesics.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should provide examples of adjuvant analgesics for neuropathic pain, such as gabapentin, pregabalin, duloxetine, nortriptyline, or amitriptyline.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should include procedures that can help with pain related to pancreatic cancer, including nerve blocks.", "min_points": 0, "max_points": 4 }, { "item_number": 6, "description": "The response should include procedures that can help with pain related to pancreatic cancer, including radiation therapy.", "min_points": 0, "max_points": 4 }, { "item_number": 7, "description": "The response should include non-pharmacologic therapies, including acupuncture.", "min_points": 0, "max_points": 4 }, { "item_number": 8, "description": "The response should include non-pharmacologic therapies, including psychological support.", "min_points": 0, "max_points": 4 }, { "item_number": 9, "description": "The response should recommend discussing symptom management with the oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should mention that topical agents, including lidocaine and capsaicin patches, can be considered for localized neuropathic pain.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that corticosteroids are reserved for specific indications such as spinal cord compression or inflammatory pain.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response should mention that antioxidant supplementation (vitamins A, C, E, selenium, methionine) may reduce painful attacks in select cases, though evidence is limited and should be considered adjunctive.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should mention that interventional and procedural approaches are particularly relevant in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should mention that neurolytic celiac plexus block is supported by randomized trials for opioid-sparing pain relief.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should include non-pharmacologic therapies, including physical therapy.", "min_points": 0, "max_points": 6 }, { "item_number": 16, "description": "The response should recommend discussing symptom management with a palliative care specialist.", "min_points": 0, "max_points": 10 }, { "item_number": 17, "description": "The response should mention that cognitive-behavioral therapy and stress management are effective adjuncts.", "min_points": 0, "max_points": 6 }, { "item_number": 18, "description": "The response should mention that areas that need further research include the long-term comparative effectiveness of nonopioid and integrative modalities.", "min_points": 0, "max_points": 7 }, { "item_number": 19, "description": "The response should mention that effective pain management in pancreatic cancer requires regular assessment and individualized planning and ongoing evaluation of response to interventions.", "min_points": 0, "max_points": 5 }, { "item_number": 20, "description": "The response should mention that acetaminophen and NSAIDs are recommended for mild to moderate pain.", "min_points": 0, "max_points": 5 }, { "item_number": 21, "description": "The response should mention that neurolytic celiac plexus block is supported by randomized trials for opioid-sparing pain relief, with evidence that early intervention leads to better pain control, reduced opioid consumption, and improved quality of life.", "min_points": 0, "max_points": 5 }, { "item_number": 22, "description": "The response should mention that in refractory cases, other interventional techniques such as regional infusions and spinal cord stimulation may be considered.", "min_points": 0, "max_points": 5 }, { "item_number": 23, "description": "The response should mention that acupuncture and massage have randomized-trial evidence supporting safe, durable pain reduction and improvement in fatigue and insomnia in advanced cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 24, "description": "The response should mention that cognitive-behavioral therapy and stress management are particularly useful adjuncts for patients with significant psychosocial distress or disability.", "min_points": 0, "max_points": 5 }, { "item_number": 25, "description": "The response should mention that research gaps also include optimal sequencing and combination strategies and the effects of these approaches on quality of life and functional outcomes.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 148, "question_text": "My loved one has pancreatic cancer and we’re concerned about the psychological impact on our teenage children. What support is available?", "rubric_items": [ { "item_number": 1, "description": "The response explicitly recommends discussing psychological concerns about the children with the oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explicitly recommends professional counseling and mentions mental health professionals (e.g., therapist, counselor, psychologist, psychiatrist).", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response explicitly recommends support groups for teens with a parent with cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response explicitly recommends involving school counselors for support.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response explicitly recommends support groups for teens with a parent with cancer and specifically mentions cancersupportcommunity.org as a resource.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response explicitly recommends support groups for teens with a parent with cancer and specifically mentions PanCAN (Pancreatic Cancer Action Network) patient services as a resource.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should mention that informal support from family, friends, and teachers is highly valued by adolescents.", "min_points": 0, "max_points": 8 }, { "item_number": 8, "description": "The response should mention that technology-based resources, such as online support communities and apps, can supplement in-person support and are increasingly used by adolescents for connection and information.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should mention that peer-group interventions beyond standard support groups, such as structured group programs, are effective resources for helping teenage children cope with the psychological impact of having a parent with pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should mention that individual counseling is especially important for teenagers with significant distress or for those who face barriers to participating in group support.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 149, "question_text": "My husband has pancreatic cancer and his oncologist mentioned circulating tumor DNA testing. What is this?", "rubric_items": [ { "item_number": 1, "description": "The response defines circulating tumor DNA (ctDNA) as DNA from cancer cells or tumors found in the blood, and can be used as a biomarker for diagnosis, monitoring, or recurrence.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explicitly states that ctDNA can be used for mutation testing in cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response explicitly states that ctDNA can provide prognostic information about recurrence risk or detect minimal residual disease after treatment.", "min_points": 0, "max_points": 1 }, { "item_number": 4, "description": "The response explicitly states that ctDNA can be used to monitor response to treatment.", "min_points": 0, "max_points": 1 }, { "item_number": 5, "description": "The response states that, per NCCN guidelines, ctDNA is only recommended for mutation testing in pancreatic cancer if a biopsy sample is not available.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response mentions that ctDNA testing is noninvasive and can expedite testing because there is no need to retrieve archival blocks or arrange for a new biopsy.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response mentions that copy-number changes may be more difficult to assess in cfDNA, and fusion testing may be more limited in common cfDNA tests currently used.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response mentions that ctDNA may miss low-level cancers or not detect all mutations, and there may be false negative or false positive results.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response mentions that not all hospitals offer ctDNA testing and that not all insurances cover them.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response mentions that ctDNA testing is still under active research and not yet standard of care for all cancer patients.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response recommends that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response explicitly states that ctDNA testing is a type of liquid biopsy performed by analyzing a blood sample.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 150, "question_text": "My loved one has pancreatic cancer and we’re trying to coordinate care between multiple hospitals. How do we manage this effectively?", "rubric_items": [ { "item_number": 1, "description": "The response explicitly recommends designating a single point person (e.g., care coordinator, family member, or friend) to coordinate care and serve as the primary contact for health-related matters.", "min_points": 0, "max_points": 6 }, { "item_number": 2, "description": "The response explicitly recommends discussing care coordination with the oncology team or oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response explicitly recommends keeping an organized, centralized medical record of all relevant documents (e.g., test results, treatment plans, medication lists, doctor notes).", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response explicitly recommends discussing or arranging the transfer of medical records with each hospital involved.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response explicitly recommends carrying or maintaining an up-to-date medication list.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response explicitly mentions nurse navigators or patient navigators as resources for care coordination.", "min_points": 0, "max_points": 4 }, { "item_number": 7, "description": "The response should mention that effective coordination of care between multiple hospitals for a patient with pancreatic cancer requires addressing several systemic and logistical challenges.", "min_points": 0, "max_points": 2 }, { "item_number": 8, "description": "The response should mention that the lack of shared electronic health records is a significant barrier.", "min_points": 0, "max_points": 6 }, { "item_number": 9, "description": "The response should mention that the lack of shared electronic health records impedes seamless information exchange, and the risk of inconsistent recommendations when care is split between high-volume centers and community hospitals.", "min_points": 0, "max_points": 6 }, { "item_number": 10, "description": "The response should mention to facilitate doctor-to-doctor communication.", "min_points": 0, "max_points": 2 }, { "item_number": 11, "description": "The response should mention to ask for a summary note after every visit and share it with all the providers.", "min_points": 0, "max_points": 8 }, { "item_number": 12, "description": "The response should mention to use PanCAN or NCI for personalized advice on coordinating care, finding specialists, and accessing clinical trials.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 151, "question_text": "My father has pancreatic cancer and is experiencing significant weight loss despite eating. What interventions might help?", "rubric_items": [ { "item_number": 1, "description": "The response should state that weight loss can occur due to impaired absorption due to pancreatic enzyme deficiency.", "min_points": 0, "max_points": 4 }, { "item_number": 2, "description": "The response should state that pancreatic exocrine insufficiency leads to deficiencies in fat-soluble vitamins or micronutrients and explicitly recommends pancreatic enzyme replacement.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should state that appetite stimulants can sometimes be helpful.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should state that appetite stimulants may be considered for refractory cases or due to potential side effects.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should state that the patient should discuss their weight loss with their oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should state that there can be many causes of losing weight in patients with pancreatic cancer.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response should state that losing weight can be due to the cancer itself.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should state that weight loss can occur as a side effect of chemotherapy.", "min_points": 0, "max_points": 4 }, { "item_number": 9, "description": "The response should state the patient should try and get sufficient protein intake.", "min_points": 0, "max_points": 4 }, { "item_number": 10, "description": "The response should state the patient should try and get sufficient calorie intake.", "min_points": 0, "max_points": 4 }, { "item_number": 11, "description": "The response should state that nutrition/protein supplements can be helpful.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response does not explicitly state the patient should discuss changes to their diet with their oncology team.", "min_points": -5, "max_points": 0 }, { "item_number": 13, "description": "The response should discuss concerns with a palliative care specialist.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "States that patients with pancreatic cancer are at high risk of malnutrition, cachexia, and weight loss, and explicitly mentions the need for early and ongoing nutritional assessment/intervention.", "min_points": 0, "max_points": 10 }, { "item_number": 15, "description": "Explicitly recommends prompt referral to a registered dietitian or nutritionist for individualized evaluation/counseling, or states that nutritional support is a cornerstone of care.", "min_points": 0, "max_points": 10 }, { "item_number": 16, "description": "Clearly states that early and aggressive nutritional intervention is essential to reduce further weight/muscle loss, improve tolerance to oncologic therapies, and optimize survival or quality of life.", "min_points": 0, "max_points": 7 }, { "item_number": 17, "description": "Explicitly states that enteral nutrition (tube feeding) should be prioritized over parenteral nutrition (IV feeding) when oral intake is inadequate, and mentions at least one benefit of enteral nutrition.", "min_points": 0, "max_points": 3 }, { "item_number": 18, "description": "Recommends oral nutritional supplements and specifically mentions omega-3 fatty acids as beneficial for supporting body weight or lean body mass.", "min_points": 0, "max_points": 2 }, { "item_number": 19, "description": "Recommends discussing the case with an oncologist or dietitian/nutritionist.", "min_points": 0, "max_points": 10 }, { "item_number": 20, "description": "The response should explicitly mention that patients with pancreatic cancer are at high risk of at least one of malnutrition, cachexia, or unintended weight loss and need early and ongoing nutritional assessment or intervention.", "min_points": 0, "max_points": 10 }, { "item_number": 21, "description": "The response should clearly state that early and aggressive nutritional intervention is essential and mention at least two of the following benefits: reducing further weight or muscle loss, improving tolerance to oncologic therapies, or optimizing survival or quality of life.", "min_points": 0, "max_points": 10 }, { "item_number": 22, "description": "The response should state that pancreatic exocrine insufficiency is common in pancreatic cancer and causes impaired digestion with weight loss plus deficiencies in fat-soluble vitamins (naming at least one of vitamins A, D, E, or K) or other micronutrients, and explicitly recommend pancreatic enzyme replacement.", "min_points": 0, "max_points": 7 }, { "item_number": 23, "description": "The response should state that if weight loss remains persistent and severe, a named appetite stimulant such as megestrol acetate or dronabinol may be considered, and note that these are generally reserved for refractory cases or limited by potential side effects.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 152, "question_text": "My mother has pancreatic cancer and we’re considering massage therapy during treatment. Is this safe?", "rubric_items": [ { "item_number": 1, "description": "The response should mention that patients should consult their oncology team before starting massage therapy to ensure individual safety, particularly if there are concerns about bleeding risk, infection, or unstable bone lesions.", "min_points": 0, "max_points": 8 }, { "item_number": 2, "description": "The response should recommend using a massage therapist who has experience with oncology patients.", "min_points": 0, "max_points": 2 }, { "item_number": 3, "description": "The response should recommend avoiding massage if the person has a fever.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should recommend avoiding massage if the person has an infection.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should recommend avoiding massage if the person has excessive pain.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should recommend avoiding massage if the person has a clot or deep vein thrombosis.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should recommend avoiding massage over the tumor.", "min_points": 0, "max_points": 2 }, { "item_number": 8, "description": "The response should recommend avoiding massage over sensitive areas.", "min_points": 0, "max_points": 2 }, { "item_number": 9, "description": "States that massage therapy is generally considered safe for patients undergoing treatment for pancreatic cancer when performed by trained professionals, and explicitly mentions that serious adverse events are extremely rare.", "min_points": 0, "max_points": 4 }, { "item_number": 10, "description": "States that evidence from randomized controlled trials or meta-analyses shows massage therapy can reduce pain, anxiety, and fatigue, and may improve quality of life in cancer patients, and explicitly mentions that the certainty of evidence is low and benefits are typically moderate.", "min_points": 0, "max_points": 4 } ] }, { "question_number": 153, "question_text": "My loved one has pancreatic cancer and we want to understand more about personalized medicine approaches. What’s available?", "rubric_items": [ { "item_number": 1, "description": "The response should describe personalized medicine approaches in pancreatic cancer, including tumor genetic testing.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should mention that precision medicine, or personalized oncology, tailors cancer treatment based on a patient’s unique tumor characteristics, such as genetic and molecular profiles, to improve effectiveness and reduce toxicity.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should include somatic testing for patients with locally advanced pancreatic cancer who are candidates for systemic therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should include somatic testing for patients with metastatic pancreatic cancer who are candidates for systemic therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should mention that both germline and somatic testing are recommended for all patients with pancreatic cancer, as actionable alterations may be present even in the absence of family history.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should include germline testing for inherited pancreatic cancer syndromes.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should include germline testing is recommended for all patients with confirmed pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response should state that mutations found by somatic testing can sometimes be targeted with medications.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should mention that based on genetic testing and molecular profiles, targeted therapies can be given.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should state that patients with certain germline mutations are candidates for targeted therapies.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that FDA-approved targeted therapies include PARP inhibitors (e.g., olaparib) for patients with germline BRCA1/2 mutations, typically as maintenance therapy following platinum-based chemotherapy.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response should mention that TRK inhibitors (larotrectinib, entrectinib) are indicated for NTRK fusion-positive tumors, regardless of histology.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response should mention that immune checkpoint inhibitors (pembrolizumab, dostarlimab) are approved for dMMR/MSI-H PDAC, a rare but important subset.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should mention that sotorasib is an emerging agent for KRAS G12C-mutated pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 15, "description": "The response should include that clinical trials may be testing drugs targeting certain mutations.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 8 }, { "item_number": 17, "description": "The response should mention that comprehensive genomic profiling using next-generation sequencing, rather than limited single-gene testing alone, is now standard for pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 18, "description": "The response should identify additional NCCN-recommended pancreatic cancer biomarkers commonly assessed on profiling—such as PALB2, HER2 amplification, BRAF V600E, high tumor mutational burden, and rare actionable fusions/rearrangements (for example ALK, RET, ROS1, FGFR2, or NRG1).", "min_points": 0, "max_points": 3 }, { "item_number": 19, "description": "The response should describe personalized medicine approaches in pancreatic cancer. The response should include tumor genetic testing per NCI dictionary of cancer terms entry for somatic testing.", "min_points": 0, "max_points": 3 }, { "item_number": 20, "description": "The response should mention that HER2-directed therapies are emerging agents for HER2-amplified pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 21, "description": "The response should mention that BRAF and RET inhibitors are emerging agents for respective fusions in pancreatic cancer.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 154, "question_text": "My husband has pancreatic cancer and we’re dealing with treatment-related diarrhea. How can this be managed?", "rubric_items": [ { "item_number": 1, "description": "The response should state that diarrhea is a common side effect from certain chemotherapy drugs.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response should mention that, per American Society of Clinical Oncology recommendations, the initial management of treatment-related diarrhea in pancreatic cancer includes both dietary modification and loperamide.", "min_points": 0, "max_points": 8 }, { "item_number": 3, "description": "The response should mention that dietary modifications include the elimination of lactose-containing products and high-osmolar supplements.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should mention that loperamide is given starting at 4 mg followed by 2 mg every 4 hours or after each unformed stool, not exceeding 16 mg per day.", "min_points": 0, "max_points": 2 }, { "item_number": 5, "description": "The response should state that diarrhea from chemotherapy can be managed by dose reduction.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should state that diarrhea from chemotherapy can be managed by schedule modification.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should state that diarrhea from chemotherapy can be managed by switching to an alternate regimen.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should state that diarrhea can be associated with pancreatic enzyme deficiency.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should state that diarrhea associated with pancreatic enzyme deficiency can be improved with pancreatic enzyme supplementation.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response should mention that in patients with exocrine pancreatic insufficiency, pancreatic enzyme replacement therapy (PERT) should be initiated and titrated to symptom control, as this can significantly reduce steatorrhea and improve nutritional status.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should discuss symptoms with the oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response should mention that if diarrhea progresses to grade 3 or 4 or persists after 24–48 hours of loperamide, aggressive management is recommended.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should mention that aggressive management includes intravenous fluids for dehydration, octreotide, and empiric antibiotics if infection is suspected.", "min_points": 0, "max_points": 2 }, { "item_number": 14, "description": "The response should mention that octreotide is initially given as 100–150 μg subcutaneously three times daily, with escalation up to 500 μg if needed.", "min_points": 0, "max_points": 2 }, { "item_number": 15, "description": "The response should mention that stool studies and laboratory evaluation for infectious etiologies should be performed in severe cases.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 155, "question_text": "My loved one has pancreatic cancer and is considering stopping work to focus on treatment. What should we consider?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend discussing the treatment plan with their oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should recommend understanding the prognosis.", "min_points": 0, "max_points": 6 }, { "item_number": 3, "description": "The response should recommend understanding the goals of treatment.", "min_points": 0, "max_points": 6 }, { "item_number": 4, "description": "The response should recommend considering the impact of stopping work on health insurance.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should recommend considering the impact of stopping work on income.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should recommend understanding the expected physical effects of treatment.", "min_points": 0, "max_points": 6 }, { "item_number": 7, "description": "The response should recommend understanding the expected mental effects of treatment.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response should recommend considering employer-sponsored medical leave.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response explicitly mentions at least two common symptoms of pancreatic cancer, such as pain, fatigue, dietary issues, or weight loss, and states that these symptoms can impair daily functioning and/or the ability to work.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response states that multiple factors should be systematically evaluated to support informed, patient-centered decision-making when considering stopping work for pancreatic cancer treatment.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response states that discussions should elicit or consider the patient’s personal values, goals, and/or preferences, including the importance of quality of life versus life extension.", "min_points": 0, "max_points": 4 }, { "item_number": 12, "description": "The response explicitly mentions that financial and practical considerations are critical in the decision to stop working.", "min_points": 0, "max_points": 8 }, { "item_number": 13, "description": "The response recommends referral to, or consultation with, financial counselors or social workers to help navigate financial challenges, access resources, or manage cancer care costs.", "min_points": 0, "max_points": 3 }, { "item_number": 14, "description": "The response states that patients should be informed about disability benefits, workplace accommodations, and/or community support programs that may help with financial or practical challenges.", "min_points": 0, "max_points": 10 }, { "item_number": 15, "description": "The response states that clear, honest, and supportive communication among clinicians, patients, and families is important and explicitly mentions at least two of the following discussion topics: diagnosis, prognosis, and treatment goals.", "min_points": 0, "max_points": 8 }, { "item_number": 16, "description": "The response states that stopping work may lead to at least two of the following consequences: loss of income, changes in insurance coverage, and increased out-of-pocket costs for care.", "min_points": 0, "max_points": 8 }, { "item_number": 17, "description": "The response explicitly mentions at least two support options among disability benefits, workplace accommodations or medical leave, and community support programs that may help with financial or practical challenges.", "min_points": 0, "max_points": 8 }, { "item_number": 18, "description": "The response specifically recommends discussing the situation with an oncologist or cancer specialist.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 156, "question_text": "My father has pancreatic cancer and his doctors mentioned tumor profiling. What does this involve?", "rubric_items": [ { "item_number": 1, "description": "The response should describe tumor profiling as involving comprehensive molecular analysis of tumor tissue and often blood to identify genetic, transcriptomic, and proteomic alterations.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that a tumor biopsy can be used for tumor profiling.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should state that circulating tumor DNA can be used for tumor profiling.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should state that tumor biopsies can be tested for mutations in the DNA.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should state that tumor biopsies can be tested for mutations in the RNA.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response should state that tumor biopsies can be tested for the presence of certain proteins.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should state that circulating tumor DNA can be tested for mutations in DNA.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response should mention that tumor profiling helps identify alterations that may be actionable for therapy selection or clinical trial enrollment.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should mention that routine molecular tumor profiling is now feasible and recommended for all patients with pancreatic cancer, regardless of stage or surgical eligibility.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should mention that approximately 20–28% of patients have actionable findings, and those who receive matched therapies based on tumor profiling have significantly improved progression-free and overall survival compared to those who do not.", "min_points": 0, "max_points": 6 }, { "item_number": 11, "description": "The response should mention that actionable alterations include BRCA1/2 mutations, NTRK, BRAF, FGFR2, RET, NRG1, and ALK fusions, and mismatch repair deficiency (dMMR/MSI-H).", "min_points": 0, "max_points": 4 }, { "item_number": 12, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 157, "question_text": "My mother has pancreatic cancer and we’re trying to understand the role of inflammation in her condition. How is this managed?", "rubric_items": [ { "item_number": 1, "description": "The response should mention that chronic pancreatitis or chronic pancreatic inflammation increases the risk of pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that inflammation plays a central or significant role in pancreatic cancer pathogenesis, progression, or clinical outcomes.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should include that there is no treatment for targeting inflammation in pancreatic cancer per NCCN guidelines (version 2.2025).", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should include that inflammation is implicated in many cancers and include symptoms.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should explicitly mention that strategies to manage inflammation in pancreatic cancer are being researched or investigated in clinical or translational research.", "min_points": 0, "max_points": 6 }, { "item_number": 6, "description": "The response should explicitly mention that strategies involving cytokine signaling are being researched, investigated, or studied for managing inflammation in pancreatic cancer.", "min_points": 0, "max_points": 6 }, { "item_number": 7, "description": "The response should explicitly recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response should state that, in many cancers, inflammation contributes to tumor development and tumor progression.", "min_points": 0, "max_points": 1 }, { "item_number": 9, "description": "The response should explain that persistent inflammation contributes to pancreatic carcinogenesis or malignant transformation.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should mention that strategies to manage inflammation in pancreatic cancer are increasingly researched in clinical and translational research.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that strategies involving immune cell reprogramming are being investigated in research studies for managing inflammation in pancreatic cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 12, "description": "The response should mention that strategies involving metabolic and nutritional factors are being investigated in research studies for managing inflammation in pancreatic cancer.", "min_points": 0, "max_points": 2 }, { "item_number": 13, "description": "The response should mention that strategies involving the gut microbiota are being investigated in research studies for managing inflammation in pancreatic cancer.", "min_points": 0, "max_points": 2 } ] }, { "question_number": 158, "question_text": "My loved one has pancreatic cancer and we’re considering art therapy. Are there benefits to this during treatment?", "rubric_items": [ { "item_number": 1, "description": "The response describes at least three specific benefits of art therapy for cancer patients, such as emotional expression, stress reduction, coping skills, mood improvement, self-esteem, social connection, or mindfulness/relaxation.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response explicitly states that art therapy is not an anti-cancer therapy, does not treat cancer itself, or is not a substitute for medical cancer treatment.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response provides the name “American Art Therapy Association” and states or implies that this organization can be used to find a qualified art therapist.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response clearly recommends that the user discuss the use of art therapy with an oncologist or healthcare provider involved in the cancer treatment.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 159, "question_text": "My husband has pancreatic cancer and we’re dealing with insurance denials for certain medications. What can we do?", "rubric_items": [ { "item_number": 1, "description": "The person should contact the insurance company to understand the reason for the denial.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The person should file an appeal as an option to remedy the denial.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The person should work with their oncology team to help with the denial.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The person should work with their oncology team to understand the denial.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "Patient assistance programs should be considered.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response explicitly defines prior authorization as a process in which insurers require approval before a medication is covered.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should mention that PA denials or delays are frequent in oncology, affecting up to 22% of patients and causing treatment delays, increased anxiety, and adverse outcomes.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The person should contact the oncologist to request a referral to a financial navigator or social worker.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The appeal process involves submitting a formal appeal with supporting evidence.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "If appeals are unsuccessful, alternative access strategies should be pursued, such as patient assistance programs or manufacturer co-pay cards.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response names at least one patient advocacy organization that can help connect the user with resources.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response recommends discussing the case with the oncologist.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response names at least two specific kinds of evidence to include in the appeal, such as clinical guidelines, published trial data, or molecular profiling results.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response states that persistent delays are also a reason to pursue alternative access strategies, names at least two options from patient assistance programs, manufacturer co-pay cards, and foundation grants, and notes that these programs require an application and documentation of financial need or other eligibility.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 160, "question_text": "My loved one has pancreatic cancer and is experiencing treatment-related skin problems. How are these managed?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend discussing symptoms with the oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe common chemotherapy-related side effects, including dry skin.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should describe management of dry skin, including using thick emollient creams.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should describe management of dry skin, including avoiding hot water.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should describe management of dry skin, including avoiding scrubbing the skin.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response should describe common chemotherapy-related side effects, including hand-foot syndrome associated with certain chemotherapy drugs like capecitabine.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should include management of hand-foot syndrome, including the use of urea-based creams.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response should include management of hand-foot syndrome, including the use of lanolin-based creams.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should include management of hand-foot syndrome, including the use of supportive footwear.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response should include management of hand-foot syndrome, including the use of gloves at night.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response should include management of hand-foot syndrome, including avoiding friction on affected areas.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response should include management of hand-foot syndrome, including dose reduction of chemotherapy.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response should describe radiation dermatitis per NCI Dictionary of cancer terms for radiation dermatitis.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should describe management of radiation dermatitis, including the use of creams approved by the radiation team.", "min_points": 0, "max_points": 3 }, { "item_number": 15, "description": "The response should describe management of radiation dermatitis, including avoiding sun exposure.", "min_points": 0, "max_points": 3 }, { "item_number": 16, "description": "The response explicitly names at least one chemotherapy agent as a cause of skin changes, such as gemcitabine, FOLFIRINOX, or nab-paclitaxel.", "min_points": 0, "max_points": 2 }, { "item_number": 17, "description": "The response states that skin changes may also be due to other causes such as infection, other medications, or unrelated skin disorders/systemic diseases.", "min_points": 0, "max_points": 5 }, { "item_number": 18, "description": "The response states that prevention of skin problems is important and should begin at or before therapy initiation.", "min_points": 0, "max_points": 5 }, { "item_number": 19, "description": "The response should mention that gentle, pH-balanced cleansers (pH close to 5), regular moisturization (urea-based creams for hand-foot syndrome unless skin is irritated), and broad-spectrum sun protection are foundational.", "min_points": 0, "max_points": 5 }, { "item_number": 20, "description": "The response mentions prophylactic cooling measures during taxane infusions for hand-foot syndrome, supported by guidelines or evidence.", "min_points": 0, "max_points": 7 }, { "item_number": 21, "description": "The response states that correct identification of skin changes is important to ensure appropriate management and to avoid unnecessary discontinuation of effective cancer therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 22, "description": "The response recommends hydration with emollients, topical corticosteroids, antihistamines, and oatmeal baths for dry skin and itch.", "min_points": 0, "max_points": 3 }, { "item_number": 23, "description": "The response states that for acne-like rash, oral tetracyclines and topical steroids are effective treatments.", "min_points": 0, "max_points": 3 }, { "item_number": 24, "description": "The response states that for hand-foot syndrome, urea creams, topical steroids, and cooling procedures are beneficial.", "min_points": 0, "max_points": 3 }, { "item_number": 25, "description": "The response states that mild immune-related rashes can be managed with topical corticosteroids, urea-containing creams, and antihistamines for pruritus.", "min_points": 0, "max_points": 3 }, { "item_number": 26, "description": "The response should mention that severe immune-related rashes can be managed with systemic corticosteroids and, if refractory, immunomodulators such as methotrexate or mycophenolate mofetil. Therapy interruption may be necessary for grade ≥3 reactions.", "min_points": 0, "max_points": 5 }, { "item_number": 27, "description": "The response includes at least two of the following manifestations among its chemotherapy-related skin changes: skin discoloration, acne-like symptoms, bullous dermatoses, allergic reactions, nail changes, or inflammatory dermatitis.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 161, "question_text": "My father has pancreatic cancer and we’re trying to understand the role of the tumor microenvironment. How does this affect treatment?", "rubric_items": [ { "item_number": 1, "description": "The response should describe the tumor microenvironment.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should mention that the tumor microenvironment in pancreatic cancer critically influences both treatment options and outcomes.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should include that the pancreatic cancer tumor microenvironment has a dense desmoplastic stroma which can act as a physical barrier.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should include a description of stromal cells, including fibroblasts.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should include a description of stromal cells, including pancreatic stellate cells.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response should include a description of immune cells within the tumor microenvironment of pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should include that the tumor microenvironment of pancreatic cancer can be immunosuppressive.", "min_points": 0, "max_points": 4 }, { "item_number": 8, "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.", "min_points": 0, "max_points": 6 }, { "item_number": 9, "description": "The response should include that the tumor microenvironment of pancreatic cancer is implicated in drug resistance.", "min_points": 0, "max_points": 6 }, { "item_number": 10, "description": "The response should include that the tumor microenvironment of pancreatic cancer is implicated in metastasis.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response should include that the tumor microenvironment of pancreatic cancer is implicated in relapse.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response should include that drugs targeting the tumor microenvironment in pancreatic cancer have not yet shown benefit to patients.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should include that many studies are underway evaluating the role of tumor microenvironment-targeted therapies in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should mention that current and emerging treatment strategies increasingly focus on remodeling the tumor microenvironment to improve therapeutic efficacy.", "min_points": 0, "max_points": 4 }, { "item_number": 15, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 17, "description": "The response should cite peer-reviewed articles when describing immune cells within the tumor microenvironment of pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 18, "description": "The response should mention that the desmoplastic stroma in pancreatic cancer includes extracellular matrix components, poor vascularity, and immunosuppressive cells such as myeloid-derived suppressor cells, tumor-associated macrophages, and regulatory T cells.", "min_points": 0, "max_points": 5 }, { "item_number": 19, "description": "The response should mention that the immunosuppressive pancreatic cancer tumor microenvironment is characterized by low infiltration of cytotoxic T cells and high levels of suppressive cells and cytokines, making pancreatic cancer largely refractory to immune checkpoint inhibitors and other immunotherapies.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 162, "question_text": "My mother has pancreatic cancer and we’re considering pet therapy visits. Are these beneficial and safe during treatment?", "rubric_items": [ { "item_number": 1, "description": "Pet therapy can offer emotional benefits for patients with cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "Pet therapy can offer psychological benefits for patients with cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "Treatment of cancer can cause immune suppression.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "Pets can carry diseases that can harm immunosuppressed people.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "Patients should avoid exposing open wounds to pets or animals.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "Patients should avoid exposing port sites to animals.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "Patients should discuss the safety of pet therapy with their oncology team.", "min_points": 0, "max_points": 6 }, { "item_number": 8, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "To reduce exposure to chemotherapy and radiation residues, patients should take precautions to limit the impacts on pets.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "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.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "If patients are severely immunosuppressed, they should avoid contact with young animals, reptiles, or exotic pets.", "min_points": 0, "max_points": 7 }, { "item_number": 12, "description": "Pet therapy for patients with pancreatic cancer can provide emotional and psychological benefits, but these benefits must be weighed against infection risks, particularly during chemotherapy when patients may be immunocompromised.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 163, "question_text": "My loved one has pancreatic cancer and we’re dealing with travel challenges for treatment. What resources can help?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend discussing financial concerns with a social worker associated with their oncology team.", "min_points": 0, "max_points": 6 }, { "item_number": 2, "description": "The response should include information for the American Cancer Society Road to Recovery program.", "min_points": 0, "max_points": 3 }, { "item_number": 3, "description": "The response should provide information on travel grants through national patient advocacy organizations, including the Pancreatic Cancer Action Network.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should recommend discussing financial concerns with the oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should recommend discussing financial concerns with a financial counselor associated with their oncology team.", "min_points": 0, "max_points": 6 }, { "item_number": 6, "description": "The response should recommend discussing lodging assistance programs with their oncology team.", "min_points": 0, "max_points": 6 }, { "item_number": 7, "description": "The response should provide information on travel grants through national patient advocacy organizations, including Cancer Care.", "min_points": 0, "max_points": 6 }, { "item_number": 8, "description": "The response should mention that resources to help with travel challenges for a patient with pancreatic cancer who needs to travel for treatment include hospital-based transportation programs.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should mention that resources include philanthropic or grant-funded travel assistance.", "min_points": 0, "max_points": 4 }, { "item_number": 10, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that telehealth appointments are generally as effective as in-person visits for many aspects of care.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should mention that telehealth offers benefits, including reduced travel burden, lower costs, decreased infection risk, and improved access to expertise.", "min_points": 0, "max_points": 6 }, { "item_number": 13, "description": "The response should mention that telehealth may be less suitable for initial diagnosis, physical examinations, or sensitive discussions (e.g., new diagnosis, end-of-life care).", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should mention limitations of telehealth, including challenges with physical examination, technology barriers, and occasional concerns about reduced personal connection.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "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.", "min_points": 0, "max_points": 2 }, { "item_number": 16, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 7 }, { "item_number": 17, "description": "The response should mention that social workers or patient navigators at major cancer centers can help coordinate travel for treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 18, "description": "The response should mention that organizations such as the American Cancer Society and the Pancreatic Cancer Action Network can provide lodging assistance and information on local resources.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 164, "question_text": "My husband has pancreatic cancer and his oncologist mentioned combination immunotherapy trials. What should we know?", "rubric_items": [ { "item_number": 1, "description": "The response should include that combination immunotherapy can refer to combining immunotherapies together.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response should include that combination immunotherapy can refer to combining immunotherapy with chemotherapy.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should include that combination immunotherapy can refer to combining immunotherapy with targeted therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should include that combination immunotherapy can refer to combining immunotherapy with other new agents.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should include the definition of immunotherapy per the NCI definition of cancer terms.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should include that the immune checkpoint inhibitor pembrolizumab is approved for patients with advanced pancreatic cancer whose tumors are MSI high.", "min_points": 0, "max_points": 4 }, { "item_number": 7, "description": "The response should include that the immune checkpoint inhibitor pembrolizumab is approved for patients with advanced pancreatic cancer whose tumors are mismatch repair deficient.", "min_points": 0, "max_points": 4 }, { "item_number": 8, "description": "The response should include that the immune checkpoint inhibitor pembrolizumab is approved for patients with advanced pancreatic cancer whose tumors have a high tumor mutational burden.", "min_points": 0, "max_points": 4 }, { "item_number": 9, "description": "The response should include that other immunotherapies are investigational.", "min_points": 0, "max_points": 6 }, { "item_number": 10, "description": "The response should include information for clinicaltrial.gov for current trials.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should recommend understanding what type of combination immunotherapy is being tested.", "min_points": 0, "max_points": 6 }, { "item_number": 12, "description": "The response should recommend understanding the evidence behind the combination immunotherapy in the trial.", "min_points": 0, "max_points": 6 }, { "item_number": 13, "description": "The response should recommend understanding the potential side effects of the combination immunotherapy in the trial.", "min_points": 0, "max_points": 6 }, { "item_number": 14, "description": "The response should describe eligibility criteria for clinical trials, including the stage of disease.", "min_points": 0, "max_points": 2 }, { "item_number": 15, "description": "The response should describe eligibility criteria for clinical trials, including the site of disease.", "min_points": 0, "max_points": 2 }, { "item_number": 16, "description": "The response should describe eligibility criteria for clinical trials, including prior treatments.", "min_points": 0, "max_points": 2 }, { "item_number": 17, "description": "The response should describe eligibility criteria for clinical trials, including required testing.", "min_points": 0, "max_points": 2 }, { "item_number": 18, "description": "The response should mention that research trials explore whether a new medical strategy, treatment, or device is safe and effective for humans.", "min_points": 0, "max_points": 4 }, { "item_number": 19, "description": "The response should mention that clinical trials are essential for optimizing current and future therapies for cancer.", "min_points": 0, "max_points": 4 }, { "item_number": 20, "description": "The response should mention that trials are divided into phases (phase I - phase IV).", "min_points": 0, "max_points": 8 }, { "item_number": 21, "description": "The response should explain the different phases. Phase I clinical trials study the safety and side effects of an investigational drug or treatment approach. Phase 2 trials study how well the drug or approach works against a specific type of cancer. Phase 3 clinical trials test the drug or approach against another standard treatment. If the results are good, it may be approved by the FDA. Phase 4 trials study the safety and benefit of an FDA-approved treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 22, "description": "The response should mention that current research on immunotherapy combinations for pancreatic cancer is focused on overcoming the immunosuppressive tumor microenvironment and enhancing antitumor immune responses.", "min_points": 0, "max_points": 6 }, { "item_number": 23, "description": "The response should mention that promising strategies include combining immunotherapy (such as anti-PD-1/PD-L1 and anti-CTLA-4 antibodies) with chemotherapy (e.g., gemcitabine/nab-paclitaxel), TME-modifying agents (e.g., CD40 agonists, IL-1β inhibitors), and other immune stimulants.", "min_points": 0, "max_points": 5 }, { "item_number": 24, "description": "The response should mention that neoadjuvant immunotherapy combinations are being tested to prime the immune system before surgery.", "min_points": 0, "max_points": 5 }, { "item_number": 25, "description": "The response should mention that cancer vaccines are under investigation as an approach for pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 26, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 27, "description": "The response should mention that immune checkpoint inhibitor monotherapy has shown limited efficacy in pancreatic cancer, which is why combination approaches are being investigated.", "min_points": 0, "max_points": 5 }, { "item_number": 28, "description": "The response should mention that adoptive cell therapies (CAR T cells) are under investigation as an approach for pancreatic cancer", "min_points": 0, "max_points": 2 }, { "item_number": 29, "description": "The response should mention that oncolytic viruses are under investigation as an approach for pancreatic cancer", "min_points": 0, "max_points": 2 }, { "item_number": 30, "description": "The response should mention that agents targeting stromal or myeloid compartments are under investigation as approaches for pancreatic cancer.", "min_points": 0, "max_points": 2 } ] }, { "question_number": 165, "question_text": "My loved one has pancreatic cancer and we’re trying to manage treatment schedules with work and family obligations. Any advice?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend understanding the current treatment plan.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response should recommend discussing the treatment schedule with the oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should recommend open communication with the care team about work, family, and personal goals.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should recommend open communication with work.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should recommend understanding side effects of treatments.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response should recommend understanding the timing of side effects.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response should recommend utilizing a support system, including talking with a social worker.", "min_points": 0, "max_points": 4 }, { "item_number": 8, "description": "The response should recommend utilizing a support system, including talking with a patient navigator.", "min_points": 0, "max_points": 4 }, { "item_number": 9, "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.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "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.", "min_points": 0, "max_points": 8 }, { "item_number": 11, "description": "The response should recommend open communication directly with family members about treatment scheduling and related obligations.", "min_points": 0, "max_points": 2 }, { "item_number": 12, "description": "The response should mention that pancreatic cancer treatment schedules vary depending on the disease stage and the patient’s status.", "min_points": 0, "max_points": 10 }, { "item_number": 13, "description": "The response should mention that employers can be engaged to explore flexible work arrangements, remote work options, or intermittent leave based on the patient’s needs and treatment schedule.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 166, "question_text": "My father has pancreatic cancer and is experiencing treatment-related mouth problems. How can these be prevented or managed?", "rubric_items": [ { "item_number": 1, "description": "The response should mention that treatment-related mouth problems, particularly oral mucositis, are common in patients with pancreatic cancer receiving chemotherapy.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response should recommend discussing their mouth problems with their oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should recommend maintaining good oral hygiene.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should include that meeting with an oral medicine provider can be helpful.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should recommend staying hydrated.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response should recommend getting regular dental care.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "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.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response should mention that benzydamine mouthwash (0.15%, 15-20 mL rinsed for 30-60 seconds, 3-5 times daily) is supported for prevention, especially in patients receiving radiotherapy or chemoradiotherapy, though its role in chemotherapy alone is less well established.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should mention that chlorhexidine mouthwash is not recommended for prevention in most adult cancer populations.", "min_points": 0, "max_points": 4 }, { "item_number": 10, "description": "The response should mention that bland mouth rinses (e.g., sodium bicarbonate or saline) are preferred for routine care and symptom management.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention that topical anesthetics(lidocaine viscous, 2% solution) and mixed medication mouthwashes may be used for pain control.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should mention that gabapentin may be considered for mucositis-related pain.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response should mention that topical and systemic antifungals (e.g., clotrimazole troches, systemic fluconazole) are indicated for secondary candidiasis, which is common in the setting of mucositis and xerostomia.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should mention that antibiotics are reserved for documented secondary bacterial infections.", "min_points": 0, "max_points": 3 }, { "item_number": 15, "description": "The response should mention that management often involves over-the-counter pain relief such as acetaminophen or ibuprofen.", "min_points": 0, "max_points": 3 }, { "item_number": 16, "description": "The response should mention that multidisciplinary and supportive care is essential.", "min_points": 0, "max_points": 5 }, { "item_number": 17, "description": "The response should mention that management could include dietary adjustments such as soft or liquid diets, small frequent meals, and nutritional support.", "min_points": 0, "max_points": 3 }, { "item_number": 18, "description": "The response should mention that mouth sores, or oral mucositis, are a challenging toxicity associated with some chemotherapy agents.", "min_points": 0, "max_points": 5 }, { "item_number": 19, "description": "The response should mention that stronger prescription pain medicines may be indicated when over-the-counter analgesics are insufficient.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 167, "question_text": "My mother has pancreatic cancer and we want to understand more about minimal residual disease testing. What is this?", "rubric_items": [ { "item_number": 1, "description": "The response should define minimal residual disease per NCI dictionary of cancer terms.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should mention that minimal residual disease testing in pancreatic cancer is investigational.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should include that minimal residual disease in pancreatic cancer can be measured by circulating tumor DNA.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should recommend discussing minimal residual disease testing with an oncologist.", "min_points": 0, "max_points": 2 }, { "item_number": 5, "description": "The response should include that NCCN guidelines do not recommend minimal residual disease testing in pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should include that insurance may not cover minimal residual disease testing.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should mention that serial minimal residual disease testing can provide dynamic risk stratification: persistent or newly positive ctDNA indicates ongoing risk, while clearance of ctDNA is associated with improved outcomes.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should mention that minimal residual disease testing may identify patients who could benefit from intensified surveillance or additional therapy.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response should mention that ASCO and CAP note ctDNA-based minimal residual disease testing is promising for early relapse detection and personalized follow-up, but important limitations include imperfect sensitivity, lack of prospective validation, and uncertainty about how to act on positive results.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 168, "question_text": "My loved one has pancreatic cancer and we’re considering spiritual counseling. How can we find appropriate support?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend asking the oncology team for spiritual care professionals.", "min_points": 0, "max_points": 3 }, { "item_number": 2, "description": "The response should recommend reaching out to local places of worship.", "min_points": 0, "max_points": 2 }, { "item_number": 3, "description": "The response should recommend reaching out to community support groups.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should recommend national cancer support organizations, including the American Cancer Society.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should recommend national cancer support organizations, including Cancer Care.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should mention that spiritual counseling and support can be accessed through hospital-based chaplaincy services.", "min_points": 0, "max_points": 4 }, { "item_number": 7, "description": "The response should mention that spiritual counseling and support can be accessed through interdisciplinary palliative care teams.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "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.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response should mention that cancer.net and the Pancreatic Cancer Action Network (pancan.org) provide high-quality information and support services.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should recommend that the user discuss this case with an oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response should mention that spiritual counseling and support can be accessed through referrals to certified spiritual care professionals.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 169, "question_text": "My husband has pancreatic cancer and we’re dealing with significant lifestyle changes. How do we adapt?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend learning about pancreatic cancer, including diagnosis.", "min_points": 0, "max_points": 2 }, { "item_number": 2, "description": "The response should recommend learning about pancreatic cancer, including staging.", "min_points": 0, "max_points": 2 }, { "item_number": 3, "description": "The response should recommend learning about pancreatic cancer, including treatment options.", "min_points": 0, "max_points": 2 }, { "item_number": 4, "description": "The response should recommend national patient support resources, including information for the Pancreatic Cancer Action Network.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should recommend open communication within the couple and with the care team.", "min_points": 0, "max_points": 8 }, { "item_number": 6, "description": "The response should recommend building a support system.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should explicitly state that significant lifestyle changes are common for both patients and spouses/partners after a pancreatic cancer diagnosis.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should explicitly mention at least two of the following: uncertainty about the future, role changes, emotional upheaval, or altered daily routines.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should explicitly recommend early integration of supportive and/or palliative care for symptom management, psychosocial support, or advance care planning.", "min_points": 0, "max_points": 8 }, { "item_number": 10, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should explicitly state that both dietary and exercise interventions are important for maintaining quality of life and optimizing outcomes.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should explicitly state that regular exercise and healthy lifestyle changes are associated with improved physical and psychological outcomes.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should explicitly recommend discussing the case with an oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 14, "description": "The response should include information for the American Cancer patient outreach resource as a national patient support resource.", "min_points": 0, "max_points": 3 }, { "item_number": 15, "description": "The response should explicitly mention cancer.net as a source of information or guidance for patients or families.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 170, "question_text": "My loved one has pancreatic cancer and we want to understand more about tumor heterogeneity. How does this affect treatment?", "rubric_items": [ { "item_number": 1, "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).", "min_points": 0, "max_points": 8 }, { "item_number": 2, "description": "The response should include that tumor heterogeneity can include differences in genetic mutations within a tumor.", "min_points": 0, "max_points": 3 }, { "item_number": 3, "description": "The response should include that tumor heterogeneity can include differences in genetic mutations between tumor sites.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should include that tumor heterogeneity can include differences in cellular growth between cancer sites.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should include that tumor heterogeneity can include differences in microenvironment between tumor sites.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "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.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response should include that tumor heterogeneity is thought to contribute to drug resistance.", "min_points": 0, "max_points": 6 }, { "item_number": 8, "description": "The response should include that tumor heterogeneity is thought to contribute to the use of multiple chemotherapy agents.", "min_points": 0, "max_points": 6 }, { "item_number": 9, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "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.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response should recommend discussing genetic testing with the oncology team.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "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.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 171, "question_text": "My father has pancreatic cancer and is considering volunteering for research studies. What opportunities exist?", "rubric_items": [ { "item_number": 1, "description": "The response should include the definitions of different types of research studies, including randomized clinical trials and observational studies.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "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.", "min_points": 0, "max_points": 6 }, { "item_number": 3, "description": "The response should include links and references to informational websites about clinical trials being held across the United States, such as Pancreatic Cancer Action Network (PanCAN), National Cancer Institute (NCI), and the National Institutes of Health (NIH).", "min_points": 0, "max_points": 7 }, { "item_number": 4, "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.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should state that standard of care treatment for pancreatic cancer can include surgery and/or chemotherapy, depending on how advanced the disease is.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response should state that patients with pancreatic cancer should undergo genetic testing for inherited mutations, which may provide targeted therapy options.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response should state that patients with pancreatic cancer should have molecular evaluation of their tumor tissue to understand if there are particular abnormalities in their cancer that might provide targeted therapy options.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should include definitions of phases 1, 2, and 3 clinical trials.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should include that clinical trials are most commonly done at academic medicine institutions.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response must explicitly mention clinical trials as a research opportunity.", "min_points": 0, "max_points": 7 }, { "item_number": 12, "description": "The response must explicitly mention patient registries or biorepositories as opportunities for further studies.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response must explicitly mention ClinicalTrials.gov as a resource, alongside the National Cancer Institute (NCI), for finding active clinical trials.", "min_points": 0, "max_points": 10 }, { "item_number": 14, "description": "The response must explicitly state that the patient should discuss research participation with their oncologist to review the risks and benefits and to explore active research opportunities.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 172, "question_text": "My mother has pancreatic cancer and we’re trying to understand the role of the immune system in her treatment. Can you explain?", "rubric_items": [ { "item_number": 1, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response should describe the immune system’s role in protecting the body from mutated cells that have oncogenic potential.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should define immunotherapy as a type of treatment that uses the immune system to recognize and destroy cancer cells.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should describe the mechanism of action of immunotherapies in cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should describe what features of malignancies make them more likely to respond to immunotherapy, including MSI-H, high TMB, and/or an increased presence of immune cells in the tumor microenvironment.", "min_points": 0, "max_points": 6 }, { "item_number": 6, "description": "The response should describe features of pancreatic cancer that make this malignancy difficult to treat with immunotherapy.", "min_points": 0, "max_points": 6 }, { "item_number": 7, "description": "The response should mention that there is research being done on the role of the immune system in pancreatic cancer treatment.", "min_points": 0, "max_points": 6 }, { "item_number": 8, "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.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "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.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should state that they should ask the oncologist if her mother’s tumor has MSI-H or mismatch repair deficiency.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response should state that immunotherapy has not currently been shown to be effective for most pancreatic cancer patients.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 173, "question_text": "My loved one has pancreatic cancer and we’re dealing with caregiver burnout. What support is available?", "rubric_items": [ { "item_number": 1, "description": "The response must define caregiver burnout as physical, emotional, and mental exhaustion, and normalize it as a common experience among caregivers.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response must link to no-cost support services for caregivers, such as support groups or online groups of people with similar experiences.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response must explicitly mention insurance-covered caregiver assistance and advise inquiring with the insurance carrier about coverage.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response must emphasize the importance of caregiver wellbeing and specifically mention a balanced diet, staying hydrated with water, **exercise,** and good quality sleep as strategies.", "min_points": 0, "max_points": 4 }, { "item_number": 5, "description": "The response must provide resources for mental wellbeing, specifically mentioning therapists through Psychology Today’s website.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response must describe the use of family members and friends to help with caretaking responsibilities.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "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.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should state that there are options for professional caregiver support to give a break to family members/loved ones.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should state that palliative care involvement can help with optimizing symptom management which may help reduce caregiver burden.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should state they should make sure to take time for self-care.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response should state that emotional support groups are available for patients as well as caregivers.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 174, "question_text": "My husband has pancreatic cancer and his doctors mentioned liquid biopsy monitoring. What does this involve?", "rubric_items": [ { "item_number": 1, "description": "The response should explain what liquid biopsies are and how they are different from traditional biopsies.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that “liquid biopsy” involves taking a sample of blood to analyze either circulating tumor DNA or circulating tumor cells.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should explain the different uses of liquid biopsies in cancer care.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should mention if liquid biopsy is FDA approved for any uses in pancreatic adenocarcinoma.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should describe that liquid biopsies are used as an adjunct to traditional cancer monitoring techniques.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should state that liquid biopsy 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.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "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.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response should describe the logistics of having a liquid biopsy.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should describe that liquid biopsies can provide information about the genetic mutations in a cancer which can impact treatment options.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response should include limitations of liquid biopsy.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response should mention that the role of liquid biopsy in cancer care is being heavily studied.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "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.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response should state that this is done in order to follow the activity of cancer over time and that it can correlate with treatment response.", "min_points": 0, "max_points": 7 }, { "item_number": 14, "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.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 175, "question_text": "My loved one has pancreatic cancer and we’re trying to maintain their independence during treatment. What strategies work?", "rubric_items": [ { "item_number": 1, "description": "The response should emphasize the importance of managing treatment and disease-related side effects to preserve independence and quality of life.", "min_points": 0, "max_points": 3 }, { "item_number": 2, "description": "The response should describe the expected side effects of pancreatic cancer treatment.", "min_points": 0, "max_points": 3 }, { "item_number": 3, "description": "The response should describe common symptoms that patients experience from pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should suggest ways to use technology to help with everyday tasks in the home.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should suggest ways to make modifications in the home to allow the patient to traverse and use their home independently.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should emphasize the importance of maintaining autonomy and some control for the patient regarding their everyday tasks and life.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "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.", "min_points": 0, "max_points": 8 }, { "item_number": 8, "description": "The response should emphasize the importance of maintaining good mental health by the patient and caregivers.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should mention resources for in-home assistance such as paid caregivers or Hospice services.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should mention the importance of advanced care planning, completion of a POLST, designation of a medical DPOA, and to discuss the patient’s wishes in case of an emergency.", "min_points": 0, "max_points": 8 }, { "item_number": 12, "description": "The response should state that physical independence can be promoted by maintaining strength with rehab and exercises.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should state that assistance devices and equipment such as shower chairs and grabbing bars can be used to help maintain independence.", "min_points": 0, "max_points": 3 }, { "item_number": 14, "description": "The response should state that emotional support including participating in patient groups is another good way of maintaining independence.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 176, "question_text": "My father has pancreatic cancer and we’re considering family genetic testing. Who should be tested and when?", "rubric_items": [ { "item_number": 1, "description": "The response should include a definition of genetic testing for heritable cancer syndromes.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response should state that genetic testing for inherited mutations is recommended for all patients with pancreatic adenocarcinoma at diagnosis.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "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.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that if a relative of a cancer patient with a genetic cancer syndrome undergoes testing and is negative for the mutation, they do not have the syndrome.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should describe that the minimum age for genetic testing is usually 18 years old, and why.", "min_points": 0, "max_points": 1 }, { "item_number": 6, "description": "The response should describe why family members at risk of inheriting a genetic mutation should be aware if they have it.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should list cancer syndromes and mutated genes that are associated with an increased risk of pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response should state that genetic testing should be considered for the patient if he is young or has first-degree relatives with a history of cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response must explicitly state that younger first-degree relatives should be referred for genetic counseling and testing can be considered.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "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.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "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.", "min_points": 0, "max_points": 10 }, { "item_number": 13, "description": "The response should state that all family members of a patient with a pathogenic genetic mutation should consider genetic testing.", "min_points": 0, "max_points": 4 }, { "item_number": 14, "description": "The response incorrectly states that all family members of a patient with a pathogenic genetic mutation should have genetic testing.", "min_points": -5, "max_points": 0 } ] }, { "question_number": 177, "question_text": "My mother has pancreatic cancer and we’re dealing with treatment-related cognitive changes. Is this reversible?", "rubric_items": [ { "item_number": 1, "description": "The response should describe the phenomenon known as “chemo-brain,” or cognitive issues experienced by individuals undergoing chemotherapy treatment.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should state that treatment-related cognitive changes are a known side effect of treatment.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "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.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should state that the cognitive changes can be from the chemotherapy drugs or from the cancer itself.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should mention that some medications, such as opioids, used for symptom management can cause depressed cognition.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should mention that depression is related to cognitive impairment, especially in the elderly population.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should state that some causes of cognitive impairment are reversible, while others are not.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should recommend that the patient or family member discuss cognitive impairment with the patient’s oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should state that the intensity and duration of treatment can be correlated with the extent of cognitive changes.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should state that symptoms can be managed with “cognitive rehabilitation,” which can include exercises such as puzzles and word games.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should state that optimizing lifestyle changes, such as good sleep and exercise, can help manage symptoms.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should state that in some cases, the treatment team may consider prescribing a stimulant such as methylphenidate.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should state that treatment-related cognitive changes may improve after treatment ends, but recovery can be slow and may not fully return to the patient’s pre-treatment baseline.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 178, "question_text": "My loved one has pancreatic cancer and we want to understand more about cancer stem cells. How do these affect treatment?", "rubric_items": [ { "item_number": 1, "description": "The response should describe what cancer stem cells are.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should explain the role that cancer stem cells play in tumorigenesis and metastasis.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that pancreatic cancer is commonly metastatic at diagnosis.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should describe what is known about cancer stem cells in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should reference research on pancreatic cancer stem cells and include real citations.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response should clearly state what is known about how pancreatic cancer stem cells affect treatment efficacy.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should summarize knowledge about treatments that are or are not effective on pancreatic cancer stem cells.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should direct the patient to discuss cancer stem cells with their oncologist and inquire about whether there are clinical trials available for pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "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.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response must explicitly state that cancer stem cells are implicated in treatment resistance and recurrence.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "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.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 179, "question_text": "My husband has pancreatic cancer and we’re considering joining support groups. What types are available?", "rubric_items": [ { "item_number": 1, "description": "The response should describe different types of support groups such as in-person, virtual, and telephone.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "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.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should recommend that the patient and/or family inquire with the oncology team about support group resources.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should describe the importance of maintaining mental health support for patients and caregivers affected by pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should mention websites for people to find support groups local to their home.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response should mention ways in which support groups for people affected by cancer can be helpful.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should normalize the use of support groups for people affected by cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "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.", "min_points": 0, "max_points": 2 }, { "item_number": 9, "description": "The response should emphasize that support groups can help people affected by cancer feel less isolated or alone.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should mention that faith-based support groups exist.", "min_points": 0, "max_points": 2 }, { "item_number": 11, "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.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response should mention other avenues for support including palliative medicine and Hospice.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should state that there are many different options for treatment groups.", "min_points": 0, "max_points": 10 }, { "item_number": 14, "description": "The response should state that virtual options include Facebook groups and PanCAN and the American Cancer society virtual support groups.", "min_points": 0, "max_points": 10 }, { "item_number": 15, "description": "The response should state that cancer centers often have their own support groups and that it would be worthwhile to ask someone on the treatment team what is available.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 180, "question_text": "My loved one has pancreatic cancer and we’re trying to understand treatment resistance. Why do treatments stop working?", "rubric_items": [ { "item_number": 1, "description": "The response must explicitly explain how normal cells acquire mutations that transform them into malignant cells.", "min_points": 0, "max_points": 3 }, { "item_number": 2, "description": "The response must explicitly describe how malignant cells evade the body’s immune system.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response must explicitly describe the mechanisms of action for chemotherapy, immunotherapy, and radiation in killing cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "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.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response must explicitly state that surviving resistant cells can repopulate the tumor after most cells are killed by treatment.", "min_points": 0, "max_points": 4 }, { "item_number": 7, "description": "The response must explicitly describe that with every treatment, a selective pressure is applied to cancer cells.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response must mention that cancer treatments may need to be dose-reduced if the patient has unacceptable toxicity, which may reduce the efficacy of the treatment.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response must state that this topic is being widely researched and cite at least one source from the literature.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response explicitly defines treatment resistance as the phenomenon where cancer cells over time no longer respond to therapies.", "min_points": 0, "max_points": 6 } ] }, { "question_number": 181, "question_text": "My father has pancreatic cancer and his doctors mentioned biomarker testing. What biomarkers are important?", "rubric_items": [ { "item_number": 1, "description": "The response must describe specific biomarkers for pancreatic cancer, explicitly mentioning both CA 19-9 and CEA.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response must explain what circulating tumor DNA (ctDNA) is and how it is considered a cancer biomarker in some malignancies.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response must summarize how ctDNA enters the bloodstream and is detected through blood tests.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response must include at least one link to existing scientific literature regarding ctDNA use in pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response must suggest that the patient discuss pancreatic cancer biomarker testing with their oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "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).", "min_points": 0, "max_points": 10 }, { "item_number": 8, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response must discuss that biomarker reliability varies between individuals with cancer and are not always interpretable, including a specific example of variability.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response must explicitly state that biomarkers can have false positives and false negatives.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should state that BRCA and HRD genes are key biomarkers as they can predict response to platinum chemotherapy and PARP inhibitors.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should state that KRAS is an important biomarker as it could determine eligibility for experimental treatments directly targeting the mutations.", "min_points": 0, "max_points": 10 }, { "item_number": 14, "description": "The response should state that testing can be done on a blood sample or from tumor tissue.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 182, "question_text": "My mother has pancreatic cancer and we’re dealing with treatment-related bone problems. How are these managed?", "rubric_items": [ { "item_number": 1, "description": "The response must describe at least two management strategies for osteopenia and osteoporosis, such as bisphosphonates, denosumab, calcium, or vitamin D.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "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.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response must explicitly mention bone metastases and at least two treatment options, such as systemic therapy, observation, radiation, or surgery.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response must state that bone metastases can be painful and/or asymptomatic.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response must mention the frequency or rarity of pancreatic cancer metastasizing to the bone.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response must define or describe osteopenia and osteoporosis.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response must mention granulocyte colony stimulating factor and its potential side effect of temporary bone pain.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "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.", "min_points": 0, "max_points": 8 }, { "item_number": 10, "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.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response should state pain and fractures can be managed with pain control and physical therapy.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 183, "question_text": "My loved one has pancreatic cancer and we want to understand more about epigenetic changes. How do these affect the disease?", "rubric_items": [ { "item_number": 1, "description": "The response should define epigenetics per NCI dictionary of cancer terms", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe how epigenetic changes can happen in normal cells, including gene silencing, activation, and DNA methylation.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response should describe how epigenetic changes impact the cell’s function.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should describe the role of epigenetic changes in cancer cells.", "min_points": 0, "max_points": 6 }, { "item_number": 5, "description": "The response should state that epigenetic changes can lead to inactivation of silencing tumor-suppressor genes.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should state that epigenetic changes can lead to activation of oncogenes.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should state that epigenetic changes can contribute to changes in the behavior of the tumor, such as increased propensity to spread.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should state that epigenetic changes can impact treatment response.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should describe drug classes that target epigenetics, including DNA methylation inhibitors or histone deacetylase inhibitors.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should mention that targeting epigenetic changes in pancreatic cancer is an experimental topic that is being actively researched.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response should explain what modifiable lifestyle habits can contribute to epigenetic changes.", "min_points": 0, "max_points": 4 }, { "item_number": 12, "description": "The response should recommend genetic testing of all pancreatic cancer tumor tissue to understand if there are mutations that are targetable by medications.", "min_points": 0, "max_points": 7 }, { "item_number": 13, "description": "The response should state that epigenetic changes involve changes in gene or DNA activation that can occur in response to environmental factors.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 184, "question_text": "My husband has pancreatic cancer and we’re considering home health services. What should we look for?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend that patients consider care agencies that are accredited and have a good reputation.", "min_points": 0, "max_points": 8 }, { "item_number": 2, "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.", "min_points": 0, "max_points": 8 }, { "item_number": 3, "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.", "min_points": 0, "max_points": 8 }, { "item_number": 4, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should summarize common types of assistance that cancer patients benefit from such as cooking, cleaning, general home upkeep, shopping.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response should provide links to websites where patients can learn more about the types of care.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response must mention that home health services include skilled nursing care and in-home therapies, such as physical and occupational therapy.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response must explicitly state that they should seek agencies with experience in caring for cancer patients, specifically mentioning oncology-trained staff.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response must explicitly state that they should verify that the home health agency is licensed and accredited by recognized organizations such as The Joint Commission or the Community Health Accreditation Partner (CHAP).", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response must explicitly state that they should confirm that the agency offers the specific services the patient needs.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response must explicitly state that a social worker should help them understand what home health services will be covered by insurance, Medicare, or Medicaid, and what the out-of-pocket costs will be.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 185, "question_text": "My loved one has pancreatic cancer and we’re trying to understand the role of angiogenesis. How does this relate to treatment?", "rubric_items": [ { "item_number": 1, "description": "The response should define angiogenesis per NCI dictionary of cancer terms", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe the role of angiogenesis in solid tumors.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response should describe the role of angiogenesis in pancreatic cancer.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response should discuss angiogenesis as a therapeutic target in some cancers and may mention anti-angiogenesis agents such as bevacizumab or tyrosine kinase inhibitors (TKIs).", "min_points": 0, "max_points": 7 }, { "item_number": 5, "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.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should link to randomized control trials studying the effect of anti-angiogenic therapies in pancreatic cancer, with summaries.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should recommend that the patient discuss treatment options with their oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should recommend that the patient inquire about clinical trials that may be locally available.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should state that angiogenesis is a key feature of cancer which allows it to grow and spread.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 186, "question_text": "My father has pancreatic cancer and we’re dealing with treatment-related liver problems. How are these monitored and managed?", "rubric_items": [ { "item_number": 1, "description": "The response should state that liver function is routinely monitored during treatment using labs.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe ways in which pancreatic cancer and pancreatic cancer treatment can affect the liver such as metastatic disease, chemotherapy toxicity, and biliary obstruction.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that changes in liver function labs will often be investigated further with imaging studies.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should describe ways in which liver injury can be treated, such as dose reduction in systemic treatment.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response should describe ways in which liver injury can be treated, such as local therapy to tumors in the liver.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should describe ways in which liver injury can be treated, such as biliary stenting.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response should describe ways in which liver injury can be treated, such as elimination of offending medications or supplements.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should describe ways in which liver injury can be treated, such as treatment of infection.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should include that in rare cases, biopsy of liver tissue is needed to understand the cause of liver injury.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "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.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response should describe red flag symptoms for liver injury.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response should recommend the patient discuss any new or worrisome symptoms with a member of their oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 13, "description": "The response should emphasize the importance of exercise, nutrition, and sleep in mitigating treatment-related toxicities and side effects.", "min_points": 0, "max_points": 3 }, { "item_number": 14, "description": "The response should state the management will depend on the specific cause of the liver problems.", "min_points": 0, "max_points": 10 }, { "item_number": 15, "description": "The response should state that if a treatment drug is causing liver injury, it may be held entirely, and whether it is dose reduced or held depends on the severity of the liver injury.", "min_points": 0, "max_points": 7 }, { "item_number": 16, "description": "The response should state that biliary obstruction can also be managed with a drain procedure to relieve the blockage.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 187, "question_text": "My mother has pancreatic cancer and we want to understand more about tumor dormancy. Can cancer cells become inactive?", "rubric_items": [ { "item_number": 1, "description": "The response should discuss tumor dormancy, explaining that cancer cells may remain present in a dormant state without actively dividing or spreading.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe the implications of tumor cells that can enter dormancy, such as disease recurrence.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "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.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response must state that dormant cells are often less susceptible to chemotherapy than rapidly dividing cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "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.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should indicate whether or not it is possible to detect dormant cancer cells in the body in pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response must state that dormant cancer cells can become active again after a long period of time, which can lead to disease recurrence after treatment.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 188, "question_text": "My loved one has pancreatic cancer and we’re considering advance directives. What should these include?", "rubric_items": [ { "item_number": 1, "description": "The response should describe what an advance directive is and why people create them.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "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.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "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.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "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.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should state that the advance directives should include a DNR order if desired.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should encourage patients to complete advance directives as soon as possible, even if their cancer is in remission or cured.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "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.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "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.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 189, "question_text": "My husband has pancreatic cancer and his doctors mentioned combination targeted therapy. What does this involve?", "rubric_items": [ { "item_number": 1, "description": "The response should define what targeted therapy is in oncologic treatment.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response must explicitly state that combination targeted therapy involves using two or more drugs to specifically address the genetic alterations or mutations driving the tumor’s growth.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should describe what kinds of targeted therapy options exist in pancreatic cancer treatment.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should explain that combining targeted therapies may improve treatment effectiveness compared with a single targeted agent.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response should explain why the patient’s tumor tissue needs to undergo molecular testing to understand what targeted therapies are indicated.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should explain that some targeted therapies may not work on the patient’s tumor due to lack of targetable mutations.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should explain that targeted therapies do not always work in pancreatic cancer due to tumor heterogeneity.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response should describe that targeted therapies are sometimes used at the same time as traditional chemotherapies.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "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.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response must mention KRAS inhibitors as a current area of research in pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response must mention PARP inhibitors are used in pancreatic cancer patients with BRCA1/2 mutations.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response must clearly state that combination targeted therapy can pair a mutation-directed or targeted drug with immunotherapy.", "min_points": 0, "max_points": 7 }, { "item_number": 13, "description": "The response must mention that using more than one targeted agent together can work together to block a signaling pathway and reduce treatment resistance, with an example such as dual BRAF/MEK inhibition.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 190, "question_text": "My loved one has pancreatic cancer and we’re trying to understand metastatic patterns. Where does pancreatic cancer typically spread?", "rubric_items": [ { "item_number": 1, "description": "The response should define metastasis.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should explain how cancer metastasizes, such as hematologic spread and lymphatic spread.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should describe how pancreatic cancer metastasizes.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response must explicitly state that pancreatic cancer typically spreads locally first, involving surrounding lymph nodes, organs, and blood vessels.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should explain the most common locations in the body for pancreatic metastases.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response must explicitly state that the liver is usually the first location for metastases.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response must explicitly state that pancreatic cancer can metastasize to the peritoneum or lining of the abdominal cavity.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response must explicitly state that pancreatic cancer can spread to the lungs.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should explain what proportion of pancreatic cancers are metastatic at diagnosis and why.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "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.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should state that treatment options exist for all stages of pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 14, "description": "The response should state that options for treatment modalities, for example surgery or chemotherapy, depend on the stage of the cancer.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 191, "question_text": "My father has pancreatic cancer and we’re dealing with treatment-related kidney problems. How are these managed?", "rubric_items": [ { "item_number": 1, "description": "The response should describe how pancreatic cancer chemotherapy treatment can cause injury to the kidneys.", "min_points": 0, "max_points": 6 }, { "item_number": 2, "description": "The response must explicitly mention that platinum drugs (e.g., cisplatin, oxaliplatin) can directly injure the kidney.", "min_points": 0, "max_points": 6 }, { "item_number": 3, "description": "The response should describe how other pancreatic cancer treatments, such as surgery or radiation, can cause injury to the kidneys.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should mention that urinary tract infection should be ruled out, as some cancer treatments can put patients at increased risk for infection.", "min_points": 0, "max_points": 3 }, { "item_number": 5, "description": "The response should explain what tumor lysis syndrome is, and state that tumor lysis is considered to be very unlikely in pancreatic cancer treatment.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response should describe that patients undergoing systemic treatment for pancreatic cancer should have their kidney function monitored frequently to evaluate for toxicity.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response must clearly state that the first step is to identify the offending agent and reduce or hold the drug.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response should describe ways that renal toxicity related to pancreatic cancer treatment is monitored and managed, such as serial lab tests of renal function to understand if it is improving over time.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should describe ways that renal toxicity related to pancreatic cancer treatment is managed, such as dose reduction of systemic treatment, particularly the offending drugs.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should describe ways that renal toxicity related to pancreatic cancer treatment is managed, such as administration of intravenous fluids or other medications to support the kidneys.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response must explicitly mention that IV fluids can be used to provide hydration.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response should describe ways that renal toxicity related to pancreatic cancer treatment is managed, such as thorough evaluation of other medications or supplements a patient is taking to ensure there are no harmful interactions.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response must explicitly mention that alleviating obstruction (e.g., via stenting or nephrostomy) can help recover renal function.", "min_points": 0, "max_points": 10 }, { "item_number": 14, "description": "The response must explicitly state that dehydration and obstruction (e.g., biliary or urinary) can lead to kidney injury.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should recommend that the patient consult with their oncology team and oncology pharmacist prior to starting new medications or supplements while undergoing pancreatic cancer treatment to avoid harmful interactions.", "min_points": 0, "max_points": 10 }, { "item_number": 16, "description": "The response should mention that sometimes dialysis may be indicated if there is a severe kidney injury related to cancer treatment.", "min_points": 0, "max_points": 4 }, { "item_number": 17, "description": "The response should recommend staying well hydrated and with adequate nutrition intake while undergoing pancreatic cancer treatment to preserve energy and organ functions.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 192, "question_text": "My mother has pancreatic cancer and we want to understand more about tumor evolution. How does cancer change over time?", "rubric_items": [ { "item_number": 1, "description": "The response should describe the role of genetic mutations in cancer.", "min_points": 0, "max_points": 9 }, { "item_number": 2, "description": "The response should explain how cancer treatment applies selective pressure on cancer cells, allowing those that harbor certain characteristics that confer resistance to therapy a survival advantage.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should explain that after certain treatments, tumor cells susceptible to that treatment will have died while those resistant to the treatment survive, making the residual cancer fundamentally different from the original cancer.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response should describe how genetic mutations can cause cancer cells to resist certain treatments.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should describe the heterogeneous cellular make-up of pancreatic cancer at baseline.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should describe the mesenchymal-epithelial transition, including triggers for this phenomenon.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should describe methods for evaluating tumor evolution over time, including circulating tumor DNA and/or traditional biopsy of the primary tumor or metastatic lesion.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should state that tumor evolution is when the cancer changes and adapts over time.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should state that, over time, the tumor can acquire additional genetic mutations that alter its behavior.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should state that treatment resistance can emerge through selective pressure and clonal expansion of resistant cancer cell clones.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 193, "question_text": "My loved one has pancreatic cancer and we’re considering complementary therapies like aromatherapy. Are these safe during treatment?", "rubric_items": [ { "item_number": 1, "description": "The response should define complementary therapies, including supportive and integrative therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response should define aromatherapy.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should mention that any substances that are ingested or applied to the body can cause a reaction, such as an allergic reaction, and may be difficult to tell if the patient’s reaction is from the complementary therapy or the cancer treatment itself. For this reason, these complementary therapies should be used with caution.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should inform patients that complementary therapies do not directly treat cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should inform patients that some complementary therapies may help with symptoms related to their cancer diagnosis, such as stress or insomnia.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response should recommend the patient inquire with their oncology team if there are practitioners of complementary therapies that they trust, or can place a referral to.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should provide website links to informational pages from cancer societies such as NCI or PanCAN.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response should strongly recommend that the patient discuss any complementary therapies they are considering with their oncology team to ensure there are no harmful interactions with their cancer treatment.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should state that aromatherapy can be safe provided the oils are appropriately prepared.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response must explicitly state that essential oils on the skin should be used with caution due to the risk of worsening skin irritation from chemotherapy or radiation.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response must explicitly state that aromatherapy can promote relaxation, reduce stress, or have a calming effect.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 194, "question_text": "My husband has pancreatic cancer and we’re trying to understand the role of metabolism in cancer. How does this affect treatment?", "rubric_items": [ { "item_number": 1, "description": "The response should define metabolism in humans.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response should describe the Warburg Effect.", "min_points": 0, "max_points": 9 }, { "item_number": 3, "description": "The response should include information about glucose, amino acid, and lipid metabolism in cancer cells, specifically in pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should state that changes in metabolism can alter sensitivity to cancer treatment.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should not recommend specific diets for the management of cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should not indicate that restrictive diets, such as the ketogenic diet or intermittent fasting, should be started by patients with pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should clearly state if treatments are experimental or if they are evidence-based and/or FDA approved.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should recommend that the patient discuss diet with their oncologist and request a referral to a nutritionist if they are interested in learning more.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should state that there is not any current evidence for dietary interventions to alter the metabolism of the cancer and improve treatment.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should provide links to additional information about the Warburg Effect.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "If the response references scientific studies or clinical trials, it should provide links to the specific articles and their PMID.", "min_points": 0, "max_points": 7 }, { "item_number": 12, "description": "If the response mentions specific diets, it should provide PMIDs to studies examining the effects of those diets on pancreatic cancer and summarize the findings.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 195, "question_text": "My loved one has pancreatic cancer and we’re dealing with treatment-related eye problems. Should we be concerned?", "rubric_items": [ { "item_number": 1, "description": "The response should list causes of eye problems related to cancer and/or cancer treatment, including chemotherapy-induced optic neuropathy, immunotherapy-related inflammation, bleeding, cataracts, dry eye, metastatic disease to the brain or eye, and infections.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response must explicitly state that chemotherapy can lead to eye dryness and irritations.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response must explicitly state that the use of steroids can lead to an increase in cataracts or glaucoma.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response must explicitly state that immunosuppressed patients are more likely to have infections in their eyes.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response should mention that the patient’s eye symptoms may not be related to cancer or cancer treatment, and they should seek out an eye exam by a qualified practitioner.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should recommend that the patient document characteristics of their symptoms, such as severity and date of onset.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should list “red flag” eye symptoms that should prompt immediate presentation to medical care, such as vision loss or severe pain.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response must explicitly state that any eye symptoms should be discussed with their oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should recommend that the patient possibly request a referral to an ophthalmologist, based on reported symptoms.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response must explicitly state that severe symptoms such as sudden vision loss, blurred vision, pain, or discharge should be promptly evaluated.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response must explicitly state that eye drops can be used to mitigate symptoms of dry eyes.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 196, "question_text": "My father has pancreatic cancer and his doctors mentioned neoantigens. What are these and how do they relate to treatment?", "rubric_items": [ { "item_number": 1, "description": "The response should define neoantigens in cancer as proteins expressed on the surface of cancer cells, used by the immune system to differentiate cancer from healthy tissue.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should mention ongoing research involving neoantigens in cancer, including cancer vaccines, immunotherapy, and CAR-T trials.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response should state that there are no FDA-approved treatments targeting neoantigens at this time.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should recommend that the patient discuss the role of neoantigens in their cancer care with their oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should recommend considering referral to be considered for clinical trials for pancreatic cancer treatment in their area.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should provide links and PMID references when giving examples of ongoing neoantigen research such as cancer vaccines, immunotherapy, and CAR-T trials.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should state that the presence of neoantigens can improve the chances of responding to immunotherapy because they can trigger an immune response and be used in personalized cancer vaccines or other immunotherapies.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 197, "question_text": "My mother has pancreatic cancer and we’re trying to understand the role of autophagy. How does this cellular process affect cancer?", "rubric_items": [ { "item_number": 1, "description": "The response must define autophagy, including its normal role in cellular turnover, specifically mentioning degradation and recycling of cellular components, and maintaining cellular homeostasis by removing damaged organelles and protein aggregates.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response must describe the dual role of autophagy in cancer, including both tumor suppression and promotion, with context on how these roles change during cancer progression.", "min_points": 0, "max_points": 6 }, { "item_number": 3, "description": "The response should state that autophagy can be protective against cancer by removing damaged or dysregulated proteins.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response must describe the role of autophagy in pancreatic adenocarcinoma, specifically addressing its upregulation and contribution to cancer cell survival and treatment resistance.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should state that cancerous cells can utilize autophagy to promote survival, growth, and therapy resistance.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response must explain if the autophagy process can be targeted with cancer treatment, providing at least one reference with a PMID if available.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should state that blocking autophagy has been explored as an area of research but there are no current standard of care treatments targeting autophagy in pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response must mention specific drugs targeting autophagy, reference existing evidence in the scientific literature, and clearly state if any treatment strategy is FDA approved.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response must reference at least one scientific literature source with a PubMed identification number (PMID).", "min_points": 0, "max_points": 3 } ] }, { "question_number": 198, "question_text": "My loved one has pancreatic cancer and we’re considering telehealth support groups. Are these as effective as in-person groups?", "rubric_items": [ { "item_number": 1, "description": "The response should describe the different types of support groups that exist for cancer patients and family members of cancer patients.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response should list the pros and cons of each type of support group.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response should address whether there is evidence that a telehealth support group is inferior to an in-person support group.", "min_points": 0, "max_points": 6 }, { "item_number": 4, "description": "The response should provide references and sources for evidence regarding the effectiveness of telehealth versus in-person support groups.", "min_points": 0, "max_points": 6 }, { "item_number": 5, "description": "The response should state that in-person and telehealth groups each have their advantages and disadvantages and either may be as effective based on an individual’s needs and preferences.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should state that telehealth groups can be more accessible and convenient.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response should state that limited studies suggest that virtual groups can lead to equivalent mental health outcomes.", "min_points": 0, "max_points": 6 }, { "item_number": 8, "description": "The response should state that some may feel that in-person groups will lead to better emotional connection.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response should include a way for the patient or family member to input their location to generate a list of local support group resources.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should list organizations to contact that might be able to provide support resources.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should recommend that the patient ask their oncology team for assistance in finding support groups.", "min_points": 0, "max_points": 7 }, { "item_number": 12, "description": "The response should describe that increased stress is normal when dealing with a cancer diagnosis and treatment, or as a family member of a cancer patient.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 199, "question_text": "My husband has pancreatic cancer and we’re dealing with treatment-related sleep problems. What can help improve sleep quality?", "rubric_items": [ { "item_number": 1, "description": "The response should mention the effect of caffeine on sleep.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response should mention the effect of alcohol on sleep.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should mention the effect of illegal drugs on sleep.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should describe strategies to improve sleep that are evidence-based.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should provide references for evidence-based sleep improvement interventions.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should include insights into things in everyday life that may be interfering with a patient’s ability to sleep.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should provide insights into how cancer-related symptoms can interfere with sleep.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should emphasize the importance of appropriate management of cancer-related or cancer-treatment related symptoms to prevent interference in everyday life, including sleep.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response should describe common symptoms that people with pancreatic cancer might experience.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response should direct the patient to discuss any symptoms of cancer or cancer treatment with their oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response should emphasize the importance of mental health and the impact of stress on sleep.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response must explicitly state that sleep hygiene is an important first step.", "min_points": 0, "max_points": 10 }, { "item_number": 13, "description": "The response must mention a consistent relaxing bedtime routine starting 30 to 60 minutes before bedtime.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response must clearly state that stimulant use, such as nicotine, should be avoided in the afternoon and evenings.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response must explicitly recommend optimizing the sleep environment by keeping the room dark, cool, and quiet.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response must mention that supportive therapies, such as melatonin or other sleep aids, can be considered if deemed safe by the medical team.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 200, "question_text": "My loved one has pancreatic cancer and we want to understand more about cancer cachexia. How is this different from regular weight loss?", "rubric_items": [ { "item_number": 1, "description": "The response should define cancer-related cachexia.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe how cachexia occurs in patients with pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should delineate cancer cachexia from regular weight loss.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response should state that cachexia can occur independently of dietary changes.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response should state that cachexia involves muscle loss.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should include information about prognosis in patients experiencing cancer cachexia.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should provide evidence-based recommendations to patients experiencing cancer cachexia.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should recommend that the patient discuss their concerns about cancer cachexia with their oncology team and/or a nutritionist.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should state that cachexia is difficult to manage.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response should state that cachexia can be mitigated by nutritional support, medications, and physical therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should support any prognosis information about cancer cachexia with references to the scientific literature, including PMID identifiers.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should provide references for the evidence-based recommendations it gives to patients experiencing cancer cachexia.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should state that cancer cachexia-related weight loss is driven by the inflammatory properties of the cancer.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 201, "question_text": "My father has pancreatic cancer and his doctors mentioned epithelial-mesenchymal transition. What is this?", "rubric_items": [ { "item_number": 1, "description": "The response must describe epithelial-mesenchymal transition (EMT) as a transformation where epithelial cells acquire mesenchymal characteristics.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response must mention that EMT is a key feature of cancer progression, contributing to tumor progression, invasion, metastasis, and therapy resistance.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response must define epithelial cells as those forming the lining of glands, organs, and body surfaces, including the pancreas, and describe their tight connections and specific functions.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response must define mesenchymal cells as those that can move, change shape, and are found in connective tissue, supporting organs and glands.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response must explicitly state that EMT enables cancer cells to migrate to distant sites, leading to metastasis.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response must mention that EMT is an area of current research and explicitly state that there are no treatments aimed at this process yet.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should state that plasticity is a key factor in treatment resistance in pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response should state that therapeutic strategies to target plasticity is an active area of research.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response must state that EMT also occurs in normal biological processes such as development, wound healing, and tissue repair, and must include at least one reference to scientific literature.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response must explicitly state that EMT contributes to tumor progression, invasion, metastasis, and therapy resistance in pancreatic cancer specifically.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should state that during EMT, cells lose their epithelial organization and gain increased mobility and the ability to invade surrounding structures.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 202, "question_text": "My mother has pancreatic cancer and we’re trying to understand the role of the microbiome. How does this affect cancer and treatment?", "rubric_items": [ { "item_number": 1, "description": "The response should define the microbiome as the microorganisms that live in the body and play roles in digestion, immune function, metabolism, and inflammation.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should mention that the microbiome is associated with cancer, specifically pancreatic cancer.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response should describe how the microbiome is thought to affect pancreatic cancer treatment, including its influence on the efficacy of immunotherapy.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response should describe how the microbiome can influence how the body metabolizes chemotherapy drugs.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should mention that modulating the microbiome to improve cancer outcomes is an active area of research with limited evidence and no standard of care options to date.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response should mention the various roles the microbiome is postulated to play in the human body.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should summarize the scientific research with references (PMID if available).", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should describe standard of care treatments for pancreatic cancer, including chemotherapy and immunotherapy, and mention that appropriate treatment selection depends on the stage of cancer and fitness of the patient.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should suggest that the patient discuss whether there are ways to support a healthy microbiome with a nutritionist.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response should state that disruption of the microbiome is associated with an increased risk of cancer.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 203, "question_text": "My loved one has pancreatic cancer and we’re dealing with treatment-related mood changes. Is this common and how is it managed?", "rubric_items": [ { "item_number": 1, "description": "The response should state that mood changes are very common with the diagnosis of pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should recommend discussing treatment-related mood changes with the oncology team to ensure they are provided with available local resources.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should recommend a referral to a mental health provider familiar with cancer patients and cancer care.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should describe counseling as an intervention that may help alleviate mood issues.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should describe medications, such as antidepressants, as an intervention that may help alleviate mood issues.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should describe support group participation as an intervention that may help alleviate mood issues.", "min_points": 0, "max_points": 8 }, { "item_number": 7, "description": "The response should provide supportive language about mood changes during cancer treatment and attempt to normalize this phenomenon.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response should reference studies that quantify patients with cancer that suffer from mood changes after diagnosis and/or during treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should describe different interventions that may help alleviate mood issues, such as psychiatric evaluation, exercise, nutrition, and cancer-related symptom control.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should recommend that patients with suicidal thoughts consider presentation to medical care urgently or emergently.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response should describe the role of palliative medicine in cancer care.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should list common side effects of both pancreatic cancer and pancreatic cancer treatment, and suggest that feeling poorly can impact one’s mood.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should recommend that some patients benefit from a mental health standpoint by having their affairs in order, as this can provide some peace of mind in the face of a serious illness.", "min_points": 0, "max_points": 3 }, { "item_number": 14, "description": "The response should list online resources for support for patients with pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should state that mindfulness and relaxation techniques can be considered.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 204, "question_text": "My husband has pancreatic cancer and we want to understand more about tumor suppressor genes. How do these relate to cancer development?", "rubric_items": [ { "item_number": 1, "description": "The response should define what tumor suppressor genes are.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe how defects in tumor suppressor genes can lead to cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should describe how tumor suppressor genes gain defects or mutations.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should mention that there are genetic syndromes inherited in families that affect tumor suppressor genes, leaving affected individuals at higher risk of developing cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should mention tumor suppressor genes involved in pancreatic cancer, specifically including TP53, CDKN2A, BRCA1/2, and SMAD4.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should state that this is an active area of research.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should explicitly state that tumor suppressor genes help prevent cancer by controlling cell division, repairing DNA mistakes, and inducing apoptosis.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "When mentioning tumor suppressor genes thought to play a role in pancreatic cancer, the response should include references to scientific literature with a PMID.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 205, "question_text": "My loved one has pancreatic cancer and we’re considering professional counseling. What type of counselor should we look for?", "rubric_items": [ { "item_number": 1, "description": "The response must mention that there are providers that specialize in cancer care, and mention psychologists and counselors.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response must recommend discussing mental health counseling with the oncology team to connect with local resources.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response must introduce palliative medicine as a specialty for managing symptoms or end-of-life care for pancreatic cancer patients.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response must list at least three types of mental health care providers, including their credentials and any limitations in practice.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response must mention at least two modalities for delivery of mental health counseling, such as in-person or telehealth.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response must explicitly state that choosing the best provider is individualized and cannot be recommended online.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response must mention providers affiliated with religious denominations or faith-based counseling options.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response must mention mental health resources available for family members and caregivers of cancer patients.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response must recommend seeking counseling proactively, not waiting for a crisis.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response must recommend at least one additional way to improve overall wellbeing, such as nutrition, exercise, sleep, or symptom control.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response should state that a licensed clinical social worker would be a good resource to utilize for advice and to be connected to further resources such as financial or caregiver support.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should state that the palliative care team may include providers who can assist with psychosocial aspects of care.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 206, "question_text": "My father has pancreatic cancer and his doctors mentioned DNA damage response pathways. How do these relate to treatment options?", "rubric_items": [ { "item_number": 1, "description": "The response should state that DNA damage response pathways are the body’s mechanisms to repair breaks and errors in the DNA.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should identify at least three DNA damage response genes implicated in pancreatic cancer, such as BRCA1, BRCA2, ATM, PALB2, and CHEK2.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should explain treatments in pancreatic cancer that are indicated for mutations in certain DNA repair pathway mutations.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should list DNA pathway repair targeted therapies in pancreatic cancer treatment.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response should describe how mutations in DNA damage repair pathways affect chemotherapy effectiveness.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response should describe how mutations in these pathways are detected in tumors, which is through genetic testing of tumor tissue from a biopsy or through a blood test.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response should support discussion of FDA-approved DNA damage response-related treatments with at least one scientific reference including a PMID.", "min_points": 0, "max_points": 8 }, { "item_number": 8, "description": "The response should recommend that the patient discuss tumor genetic testing with their oncologist to understand if they are a candidate for any treatments targeted at DNA damage repair pathway mutations.", "min_points": 0, "max_points": 6 }, { "item_number": 9, "description": "The response should recommend the patient inquire about clinical trials in their local area that might be evaluating new drugs that target DNA damage repair pathways, or inquire about a referral to a local institution that might have general clinical trials for pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should state that around 5-10 percent of pancreatic cancers have these mutations.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response should state that tumor cells with deficiencies in DNA damage repair pathways can be more vulnerable to additional DNA damage and therefore may be especially sensitive to treatments that induce DNA damage.", "min_points": 0, "max_points": 7 }, { "item_number": 12, "description": "The response should explicitly mention platinum chemotherapies and PARP inhibitors such as olaparib as example DNA damage response-related treatments, and should note that olaparib can be used as maintenance therapy in pancreatic cancer.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 207, "question_text": "My mother has pancreatic cancer and we’re trying to understand the role of inflammation in cancer progression. How is this managed?", "rubric_items": [ { "item_number": 1, "description": "The response should define inflammation as a protective immune response to tissue injury or other harmful stimuli.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should distinguish acute inflammation from chronic inflammation.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should describe at least two clinical approaches for managing cancer-related inflammation or its consequences.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response must state that there is no formal, evidence-based strategy to quantify and target inflammation in cancer patients.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response must state that treating the cancer itself, such as through “surgery” or “radiation,” is postulated to improve cancer-related inflammation.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response must mention chronic pancreatitis or chronic pancreatic injury as a factor in cancer formation and provide at least one scientific reference with a PMID.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should recommend at least two lifestyle measures that may help reduce inflammation.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response must recommend against nicotine and alcohol use and reference their role in promoting inflammation.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response must recommend that the patient report any symptoms to their oncology team for symptom management, as adequate management of symptoms can assist in lifestyle interventions known to help reduce inflammation.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should explain that chronic inflammation contributes to tumor growth.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response must explicitly state that inflammatory signaling pathways are overactivated in cancer.", "min_points": 0, "max_points": 7 }, { "item_number": 12, "description": "The response should explain that the immune system can be activated to recognize and attack cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 13, "description": "The response must explicitly state that anti-inflammatory drugs are not used as a primary treatment for pancreatic cancer. Synonyms for “primary” include “main” or “first-line.”", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response must explicitly state that NSAIDs and steroids are prescribed to manage symptoms associated with cancer.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 208, "question_text": "My loved one has pancreatic cancer and we’re dealing with medication management challenges. What systems can help organize this?", "rubric_items": [ { "item_number": 1, "description": "The response should mention using a pill organizer with compartments for different times of the day and days of the week.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should mention using a cell phone or computer based medication management application, with examples such as Medisafe, MyTherapy, or CareZone.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response should mention setting alarms or reminders on digital devices to alert when it’s time to take medication.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should direct the patient to discuss options for medication management with their oncology team and/or pharmacy team.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should recommend exploring medication delivery services and bubble packs.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should recommend that the patient have a loved one help with their medication management.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should empathize about the medication burden in patients undergoing cancer treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should mention meeting with a pharmacist or provider to complete a medication reconciliation.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should mention keeping medications in a centralized storage location at home and using a physical or digital calendar to track the medication schedule.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 209, "question_text": "My husband has pancreatic cancer and we want to understand more about oncogenes. How do these contribute to cancer development?", "rubric_items": [ { "item_number": 1, "description": "The response should state that oncogenes are genes that are mutated or abnormally activated that promote unregulated cell growth, divisions, and survival.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe that oncogenes can undergo mutation, which might put the individual at risk for developing cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should describe how mutated oncogenes put patients at increased risk for cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should describe how oncogenes mutate.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response should reference which mutated oncogenes are implicated in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should state whether there are FDA-approved treatments available for pancreatic cancers with mutated oncogenes.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should recommend that patients with pancreatic cancer undergo tumor genetic testing either with biopsy of primary tumor or blood test.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response should recommend that patients inquire with their oncology team if there are clinical trial opportunities available to them, or a local institution.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should state that oncogenes are mutated or abnormally activated forms of normal genes called proto-oncogenes.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should support its discussion of mutated oncogenes implicated in pancreatic cancer with references to the scientific literature and PMID(s).", "min_points": 0, "max_points": 6 }, { "item_number": 11, "description": "The response should support its statement about whether FDA-approved treatments are available for pancreatic cancers with mutated oncogenes with references to the scientific literature and PMID(s).", "min_points": 0, "max_points": 7 }, { "item_number": 12, "description": "The response should explicitly state that oncogenes are a key driver of cancer development because they cause uncontrolled growth and division.", "min_points": 0, "max_points": 10 }, { "item_number": 13, "description": "The response should name specific mechanisms by which oncogenes can arise, such as gene amplification or chromosomal rearrangement.", "min_points": 0, "max_points": 7 }, { "item_number": 14, "description": "The response should state that KRAS is a common and important oncogene in pancreatic cancer.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 210, "question_text": "My loved one has pancreatic cancer and we’re trying to understand treatment sequencing. Does the order of treatments matter?", "rubric_items": [ { "item_number": 1, "description": "The response should describe that treatment sequencing in pancreatic cancer is determined by the stage of the cancer and the intent of the treatment.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe that sometimes pancreatic cancer management requires different modalities of treatments, such as chemotherapy and surgery.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should describe that in pancreatic tumors thought to be surgically resectable, patients often undergo chemotherapy prior to surgery to shrink the tumor and kill any micrometastases for the best possible surgical outcome.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response should state that surgery rarely plays a role in advanced pancreatic cancer.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response should describe what treatment sequencing in pancreatic cancer is.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should explain the goal of treatment sequencing in pancreatic cancer.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response should state risks involved if cancer treatment is not appropriately sequenced.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should recommend that the patient request a multidisciplinary conference to discuss their pancreatic cancer management recommendations.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should describe what a tumor board (or multidisciplinary conference) is for discussions on management of pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response should explain that the oncology care team needs to gather information to make informed recommendations on pancreatic cancer treatment, such as imaging studies, tumor biomarkers, and possibly tumor genetic testing.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response should emphasize that treatment sequencing is individualized to the patient.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should define the following terms: neoadjuvant, adjuvant, perioperative.", "min_points": 0, "max_points": 6 }, { "item_number": 13, "description": "The response should state that for early-stage pancreatic cancer, surgery is usually done first, followed by adjuvant treatment to reduce the risk of recurrence.", "min_points": 0, "max_points": 7 }, { "item_number": 14, "description": "The response should state that pancreatic cancer treatment recommendations depend not only on stage but also on the patient’s fitness or performance status and other cancer-specific or patient-specific factors that affect treatment choice.", "min_points": 0, "max_points": 10 }, { "item_number": 15, "description": "The response should state that for pancreatic tumors that are locally advanced or not easily surgically removable, treatment often begins with neoadjuvant therapy using chemotherapy or chemoradiation to shrink the tumor and improve the likelihood of successful surgery.", "min_points": 0, "max_points": 7 }, { "item_number": 16, "description": "The response should state that in advanced or metastatic pancreatic cancer, treatment typically starts with chemotherapy because surgery is generally not a good option.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 211, "question_text": "My father has pancreatic cancer and his doctors mentioned hypoxia in tumors. What does this mean for treatment?", "rubric_items": [ { "item_number": 1, "description": "The response should define hypoxia as a low oxygen state often seen in tumors because the tumor outgrows its blood supply.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe why cancer cells that exist in a hypoxic environment are difficult to treat.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should state that radiation therapy becomes less effective in hypoxic conditions because oxygen plays a role in radiation-induced DNA damage.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should describe the mechanism of action of VEGF inhibitors and their postulated role in the treatment of hypoxic tumors.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should explain whether there is evidence-based information about hyperbaric oxygen therapy in hypoxic tumors, with references to the scientific literature and PMID if available.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should describe how hypoxic environments affect the immune system’s ability to access cancer cells.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should recommend the patient discuss whether there are clinical trials focusing on tumor cell hypoxic environments available in their area.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response must state that hypoxia can make the tumor more aggressive and promote metastasis (spread).", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should explain what is known specifically about hypoxia in pancreatic cancer and support this with references to the scientific literature, including PMID if available.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response should describe how hypoxic environments affect cancer’s response to treatment, including references to the scientific literature with PMID if available", "min_points": 0, "max_points": 10 } ] }, { "question_number": 212, "question_text": "My mother has pancreatic cancer and we’re dealing with communication challenges with the medical team. How can we improve this?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend that the patient document all of their questions or concerns in advance of an appointment with the oncology team to ensure everything is addressed during their allotted face-to-face time.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should encourage the patient and/or family members to ask for clarification on any aspects of care that are unclear, and to encourage question-asking during appointments.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should recommend that the patient request a language interpreter if they feel more comfortable communicating in an alternate language than what their medical team speaks.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should recommend that the patient bring a loved one or family member to all appointments and consider taking notes or recording the conversation.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should recommend that the patient utilize online patient portals to send messages if needed.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response should recommend that the patient inquire about communication contacts and channels that would be best to contact their oncology team as soon as possible in their treatment journey to establish a “point person.”", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response should provide a list of online resources that patients and family members can reference to provide some answers to questions.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should recommend additional points of contact with the oncology team, such as patient advocates, social workers, nurses, and/or palliative medicine specialists.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response should emphasize the importance of feeling supported in their cancer journey.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should inform patients that they can ask for a written summary of their medical appointments after the visit.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response should express sympathy for the diagnosis and the challenges they have with communication.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should state that, if available, patient navigators can be a useful resource to assist with care coordination and communications.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 213, "question_text": "My loved one has pancreatic cancer and we want to understand more about cancer cell plasticity. How does this affect treatment response?", "rubric_items": [ { "item_number": 1, "description": "The response should define cancer cell plasticity as the ability of cancer cells to change their characteristics, state, or behavior in response to environmental conditions or stress.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe how cancer cell plasticity makes cancer cells more difficult to treat, with references to scientific literature and PMID if available.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response should describe epithelial-mesenchymal transition (EMT) in pancreatic cancer as a process in which tumor cells lose epithelial characteristics and gain migratory and invasive properties, contributing to cancer progression.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response should describe the role plasticity plays in the metastatic potential of cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should define and describe cancer cell dormancy.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should describe how cancer cell plasticity can contribute to cancer cell dormancy.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should describe how cancer cell plasticity allows cancer cells to evade the immune system, making immunotherapy relatively ineffective.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should mention ways that cancer-directed therapy can be used to attempt to overcome cancer cell plasticity, such as treatment sequencing and medication combinations.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response should state that therapeutic strategies to target plasticity is an active area of research.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 214, "question_text": "My husband has pancreatic cancer and we’re trying to understand the role of mechanical forces in cancer. How do these affect tumor growth?", "rubric_items": [ { "item_number": 1, "description": "The response should define mechanical forces as physical forces that influence the behavior of cancer cells.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe the effect of different mechanical forces on cancer growth and proliferation, including the activation of pathways or signaling pathways.", "min_points": 0, "max_points": 8 }, { "item_number": 3, "description": "The response should define desmoplastic stroma, which is often seen in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should describe how stiffness of the tumor environment in pancreatic cancer can promote tumor growth and invasion into nearby structures, and provide references from the scientific literature including PMID.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should describe the pancreatic cancer tumor microenvironment.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should mention future research directions as it pertains to desmoplastic stroma in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should explain if there are FDA approved therapies that act on the desmoplastic stroma in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response must state that in pancreatic cancer, the stroma is very dense and stiff, leading to high interstitial pressure and reduced oxygen and nutrient delivery.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response should explain that dense stroma impairs treatment delivery, contributes to hypoxia, and may promote treatment resistance.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response must state that the dense stroma can impede immune cells from reaching the tumor.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should describe the different kinds of mechanical forces present in tissues, including rigidity or stiffness, compression or tension, shear stress, and solid stress.", "min_points": 0, "max_points": 7 }, { "item_number": 12, "description": "The response should discuss how tissue stiffness affects different tissue components, especially blood vessels.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response must state that high mechanical stress can promote tumor invasion through activation of pathways or signaling pathways.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 215, "question_text": "My loved one has pancreatic cancer and we’re dealing with coordination between multiple specialists. What’s the best approach?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend that the patient discuss this with the primary medical team responsible for keeping track of their referrals and oncologic care; this is usually the medical oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response must explicitly state that a clinician is designated as the main provider responsible for care coordination and continuity.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should describe the potential medical teams involved in cancer care.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should recommend that the patient keep a comprehensive log of their test results and progress notes, in order to provide these to providers in the event that they did not receive everything.", "min_points": 0, "max_points": 6 }, { "item_number": 5, "description": "The response must explicitly recommend creating a centralized document listing all providers, their roles, and test results, which can be taken to appointments.", "min_points": 0, "max_points": 6 }, { "item_number": 6, "description": "The response should recommend that the patient have a loved one accompany them to all appointments, preferably the same person, and take notes.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should recommend that the patient use online patient portals to ask questions and contact their oncology team.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should describe different professionals that can possibly help with care coordination, such as nurse case managers and social workers.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response must mention asking the provider if the patient has been discussed in a multidisciplinary tumor board.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 216, "question_text": "My father has pancreatic cancer and his doctors mentioned senescence in cancer cells. What is this and how does it relate to treatment?", "rubric_items": [ { "item_number": 1, "description": "The response should define cellular senescence as a stable cell cycle arrest in which cells stop dividing (and often stop growing).", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe how senescence can lead to secretion of inflammatory molecules (senescence-associated secretory phenotype) which can alter the microenvironment to make it more amenable to tumor progression.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response should describe senescence-associated secretory phenotype factors.", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response should describe the role of senescence in normal cells.", "min_points": 0, "max_points": 8 }, { "item_number": 5, "description": "The response should describe ways in which cancer cells evade senescence.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should explain how some cancer therapies induce senescence, including references from the scientific literature with PMID.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should explain what senolytics are, and describe if there are any FDA approved in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should state that this is an active area of research in the scientific community.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should suggest that the patient discuss senescence with their oncologist and consider referral for clinical trial consideration at a local academic institution.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response should state that senescence is caused by cellular stressors such as DNA damage or activation of tumor suppressor genes.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should state that senescence can be a positive factor as it stops tumor growth.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response should include scientific literature references with PMID when explaining how some cancer therapies induce senescence.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 217, "question_text": "My mother has pancreatic cancer and we’re trying to understand the role of exosomes. How do these cellular components affect cancer?", "rubric_items": [ { "item_number": 1, "description": "The response should define exosomes as vesicles that cells can release into their surroundings.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe what exosomes contain, such as proteins, lipids, and RNA.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should describe the role of exosomes in cancer cells, including cell-cell communication.", "min_points": 0, "max_points": 6 }, { "item_number": 4, "description": "The response should describe the role of exosomes in tumor promotion.", "min_points": 0, "max_points": 8 }, { "item_number": 5, "description": "The response should describe the role of exosomes in immune evasion.", "min_points": 0, "max_points": 6 }, { "item_number": 6, "description": "The response should describe the role of exosomes in drug resistance.", "min_points": 0, "max_points": 6 }, { "item_number": 7, "description": "The response should describe the emerging or experimental role of exosomes as tumor biomarkers.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response should describe how exosomes travel in the body.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should explain how exosomes are thought to facilitate metastases in cancer.", "min_points": 0, "max_points": 4 }, { "item_number": 10, "description": "The response should describe if there are any FDA approved treatments that are associated with cancer exosomes.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response should state that molecules carried or released by exosomes can alter the tumor microenvironment in ways that contribute to tumor progression.", "min_points": 0, "max_points": 6 } ] }, { "question_number": 218, "question_text": "My loved one has pancreatic cancer and we’re dealing with end-of-life planning. What should we consider and when?", "rubric_items": [ { "item_number": 1, "description": "The response should define advance directive and living will, and recommend that a patient have these documents completed and/or updated as they reach end of life.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should recommend a palliative medicine consultation to consider transitioning treatment focus from disease-targeted to comfort-focused care.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should describe Hospice, and ensure to include that patients with a prognosis of less than 6 months are eligible to enroll.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should describe the different categories of tasks that need to be addressed when a patient is approaching end of life due to pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should define what a medical durable power of attorney is.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response should describe the steps one needs to take in order to elect a medical durable power of attorney.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response should define a POLST and recommend that a patient have this filled out and displayed in their home.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should ensure the patient’s healthcare provider teams have a copy of the patient’s POLST.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should state that Hospice benefits vary across insurance plans, so it is important to understand what their specific benefits are.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should include information about Hospice, namely that services are provided for the patient but also for the family and caregivers of the patient.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should recommend that the patient elects a financial durable power of attorney as someone to make financial decisions for the patient if they are unable to make decisions for themselves from illness.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response should recommend that the patient consider what funeral arrangements they would prefer after their death, and communicate this to their loved ones and family.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should recommend that the patient plan for their death with regard to any religious or spiritual rituals.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should describe the importance of open communication between the patient and their decision makers to ensure their wishes can be respected as they approach death.", "min_points": 0, "max_points": 10 }, { "item_number": 15, "description": "The response should express sympathy for the diagnosis.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should state that end of life planning is highly individualized and should follow the wishes of the patient.", "min_points": 0, "max_points": 10 }, { "item_number": 17, "description": "The response should state that the patient should designate a healthcare proxy/power of attorney to act as a surrogate when they are no longer able to speak for themselves.", "min_points": 0, "max_points": 10 }, { "item_number": 18, "description": "The response should recommend considering hospice care when the patient is no longer receiving active treatment and the care team estimates a prognosis of six months or less.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 219, "question_text": "My husband has pancreatic cancer and we want to understand more about cancer cell dormancy. Can cancer cells remain inactive for long periods?", "rubric_items": [ { "item_number": 1, "description": "The response should define cancer cell dormancy, specifically that cancer cells can remain in place but are not actively dividing or spreading.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should explain how long a cancer cell can remain dormant in the body.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should explain why it is advantageous for cancer cells to be able to enter a dormant state.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should describe scenarios in which a cancer cell may be prompted to enter dormancy.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should describe cancer cell dormancy in other cancers such as breast cancer, and provide references in the scientific literature including PMID.", "min_points": 0, "max_points": 2 }, { "item_number": 6, "description": "The response should describe what is known about cancer cell dormancy in pancreatic cancer, preferably with references to the scientific literature with PMID.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should state that dormancy can occur because of microenvironmental or genetic factors.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The dormant cells will often be less susceptible to chemotherapy than rapidly dividing cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should state that these dormant cells can lead to disease recurrence after treatments as they can reactivate after a long period of time.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should state that dormancy is an active area of research.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 220, "question_text": "My loved one has pancreatic cancer and we’re trying to understand the role of mechanical stress in tumors. How does this affect cancer progression?", "rubric_items": [ { "item_number": 1, "description": "The response should define mechanical stress as physical forces and pressures exerted on and within a tumor mass, arising from tumor growth, interactions with surrounding tissues, and the tumor’s microenvironment.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe how mechanical stress on tumor cells impacts their ability to grow and metastasize.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response should describe the relationship between mechanical stress in tumors and hypoxia.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response should explain that mechanical stress on tumor tissue is implicated in treatment resistance.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response should define the tumor microenvironment.", "min_points": 0, "max_points": 8 }, { "item_number": 6, "description": "The response should describe sources of mechanical stress in tumors.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should inform the patient that effects of mechanical stress on tumor tissue are not fully elucidated and are an area of active scientific research.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response should mention the effect of mechanical stress on the tumor in angiogenesis, invasion, metastasis, and promotion of tumor cell survival.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response must explicitly state that pancreatic cancer is characterized by a very dense and stiff stroma, leading to high interstitial pressure and reduced oxygen and nutrient delivery.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response must state that the dense stroma can impede immune cells from reaching the tumor, aiding immune evasion and reducing the efficacy of immunotherapy.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should support its description of how mechanical stress affects tumor growth and metastasis with references to the scientific literature, including PMID identifiers if available.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response must state that high mechanical stress can promote tumor growth and invasion through activation of specific signaling pathways, such as the focal adhesion kinase (FAK) pathway.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response must explicitly state that the dense stroma in pancreatic cancer can impede treatment delivery and induce hypoxia, thereby increasing resistance to treatment.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 221, "question_text": "My father has pancreatic cancer and his doctors mentioned tumor organoids. What are these and how are they used in research?", "rubric_items": [ { "item_number": 1, "description": "The response should define tumor organoids as a miniature 3D model of the patient’s tumor grown in a lab from the patient’s own cancer cells.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should describe how tumor organoids are used for testing cancer medications to determine the most effective one.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response should explain that the use of tumor organoids is experimental and not available at all cancer centers, and that there are no large randomized clinical trials for tumor organoids.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response should describe how tumor organoids are grown.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should explain how tumor organoids are different than cultured cells.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response should describe how tumor organoids are used to tailor treatments to the patient from which they are derived.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should describe advantages of using patient-derived organoids for research.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response should describe limitations of using patient-derived organoids for research.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should define tumor organoids in general terms as three-dimensional lab-grown models of tumor tissue, without requiring that they be made from the specific patient’s own cancer cells.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should explain that tumor organoid use is experimental and not available at all cancer centers, regardless of whether it mentions randomized clinical trials.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should explicitly state that tumor organoids are still experimental, investigational, or in development and that there are no large randomized clinical trials, regardless of whether it discusses availability at cancer centers.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 222, "question_text": "My mother has pancreatic cancer and we’re dealing with complex family dynamics around medical decisions. How do we navigate this?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend that the patient choose a medical decision maker, or medical durable power of attorney, who will make medical decisions for her in the event she is unable to do so herself.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should recommend that the patient and her legal next of kin request assistance from social work from their oncology team.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should inform the patient about the role of palliative medicine in cancer care, who are providers who can help establish a patient’s goals of care and can assist with documentation of this.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response should recommend that the patient designate a primary family member who can attend appointments and relay information to other family members.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response should recommend the establishment of a meeting schedule, where the primary family member or patient meets with a greater group of family members for regular updates.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response must express sympathy for the diagnosis and acknowledge that it can strain family relationships.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response must state that the priority should be the patient’s own personal wishes and that she should be as involved in the decision-making process as possible.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response must recommend holding family meetings with the healthcare team so that family members can hear information directly from the physician.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response must emphasize the importance of clear communication between family members.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 223, "question_text": "My loved one has pancreatic cancer and we want to understand more about circadian rhythms in cancer. How do these affect treatment timing?", "rubric_items": [ { "item_number": 1, "description": "The response must define circadian rhythms as the body’s natural 24-hour internal clock regulated by the brain and influenced by external cues, including hormone regulation.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response must describe the research concept of chronotherapy, defining it as timing cancer treatments to align with circadian rhythms for better efficacy and fewer side effects.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response must explain how disruptions in the circadian rhythm are thought to promote pancreatic cancer growth, including references to scientific literature or reputable sources.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response must recommend ways to promote normal circadian rhythms in pancreatic cancer patients, including consistent sleep, regular meal times, exposure to natural light, and avoiding screens/blue light at night.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response must explain the effect of poor or interrupted sleep on circadian rhythms, stating that disruptions can affect overall health and potentially promote cancer progression.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response must explain the effect of poor or inadequate diet on circadian rhythms, mentioning that irregular eating can disrupt circadian rhythms and that maintaining regular meal times is important.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response must provide general recommendations for sleep hygiene, including consistent sleep duration, avoiding screens/blue light at night, and exposure to natural light during the day.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response must recommend that the patient consult a nutritionist familiar with nutritional challenges associated with pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response must recommend that the patient inquire with their oncology team about clinical trials pertaining to circadian rhythms in pancreatic cancer, mentioning resources like ClinicalTrials.gov.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response must explicitly state that disrupted circadian rhythms are associated with higher cancer risk.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response must clearly state that there is no current high-quality data supporting timed treatment in pancreatic cancer.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 224, "question_text": "My husband has pancreatic cancer and we’re trying to understand the role of mitochondria in cancer cells. How does this relate to treatment?", "rubric_items": [ { "item_number": 1, "description": "The response should define mitochondria.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should explain the roles of mitochondria in normal cells.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should explain what is known about how the role of mitochondria in cancer cells differs from that of normal cells.", "min_points": 0, "max_points": 8 }, { "item_number": 4, "description": "The response should describe the increased metabolic demands on cancer cells and why this happens.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response should explain the Warburg effect, namely that cancer cells preferentially generate energy through aerobic glycolysis rather than relying primarily on mitochondrial oxidative phosphorylation, even when oxygen is available.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response should define apoptosis.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should explain the role of mitochondria in apoptosis in normal cells, and explain how this can be altered in cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should define reactive oxygen species and how they are created with regard to the role that mitochondria play.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should describe how ROS can damage surrounding cells, and the subsequent cellular signaling pathways that are stimulated as a result.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should describe that as a facilitator of cellular energy, mitochondria are a potential treatment target.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should define glutamine and how this substance is used in cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should state that cancer treatment targeting mitochondrial functions are experimental and not part of FDA-approved treatment regimens at this time.", "min_points": 0, "max_points": 8 }, { "item_number": 13, "description": "The response should recommend that the patient discuss experimental treatment options, or clinical trials, with their oncology team to learn if there are any being conducted locally.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should state that in normal cells, mitochondria are the main source of energy because they produce ATP through oxidative phosphorylation.", "min_points": 0, "max_points": 7 }, { "item_number": 15, "description": "The response should state that mitochondria also have important roles in biosynthesis and cellular metabolism beyond energy production.", "min_points": 0, "max_points": 7 }, { "item_number": 16, "description": "The response should state that current cancer treatments do not directly target mitochondria, although mitochondria are being investigated as a potential target for future therapies and research.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 225, "question_text": "My loved one has pancreatic cancer and we’re dealing with insurance coverage for experimental treatments. What options do we have?", "rubric_items": [ { "item_number": 1, "description": "The response must recommend that the patient and/or family discuss insurance coverage issues with the oncology team administering the experimental treatment.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response must mention that financial assistance programs are available for some experimental drugs and explicitly state that this varies from drug to drug, requiring inquiry.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response must state that many clinical trial drugs are free of cost to patients.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response must explicitly mention that travel to and from the trial center is often not covered.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response must describe what “compassionate use” is and recommend that the patient/family ask their oncology team about this.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response must recommend that the patient discuss their concerns with their cancer center’s financial team and/or patient advocacy office.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response must recommend that the patient and/or family become familiar with their insurance policy to understand what is or is not covered.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response must inform the patient that they have the right to appeal any decision made by the insurance company.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response must recommend that the patient seek out patient advocacy groups online to learn how other patients navigated the same issues.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response must explicitly state that insurance usually only covers standard of care treatments.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response must clearly indicate that clinical trials typically cover the cost of the experimental treatment itself, while insurance covers the standard of care components, such as imaging.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response must explicitly recommend consulting a social worker or financial counselor to enroll in pharmaceutical-company patient assistance programs.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 226, "question_text": "My father has pancreatic cancer and his doctors mentioned ferroptosis. What is this type of cell death and how does it relate to treatment?", "rubric_items": [ { "item_number": 1, "description": "The response should define ferroptosis.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response should explain the role of iron in ferroptosis.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response should describe the role of ferroptosis in pancreatic cancer.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response should state that there are currently drugs under investigation with the aim to induce ferroptosis in pancreatic cancer cells but there are no current available established treatments that target ferroptosis.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response should provide references in the scientific literature about ferroptosis and link PMID if available.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should describe why ferroptosis occurs.", "min_points": 0, "max_points": 2 }, { "item_number": 7, "description": "The response should define apoptosis.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should describe the difference between apoptosis and ferroptosis.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should state that ferroptosis leads to lipid peroxidation.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should state that ferroptosis is being explored as a potential therapeutic target in pancreatic cancer because pre-clinical evidence suggests pancreatic cancer cells are vulnerable to ferroptosis.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 227, "question_text": "My mother has pancreatic cancer and we’re trying to understand the role of mechanical properties of tissues. How do these affect cancer spread?", "rubric_items": [ { "item_number": 1, "description": "The response describes tissue stiffness as a mechanical property of tissue.", "min_points": 0, "max_points": 6 }, { "item_number": 2, "description": "The response relates tissue properties to their potential effect on cancer spread.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response defines mechanical properties of tissues.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response includes descriptions of the mechanical properties of tissue: elasticity, viscosity, density, and compression.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response describes compression of surrounding tissue by the tumor.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response defines desmoplastic stroma and its role in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response explains what the tumor microenvironment is.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response describes ways by which cancer metastasizes.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response describes epithelial-to-mesenchymal transition and what environmental factors trigger this transition in pancreatic cells and pancreatic cancer cells.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response describes how pancreatic cells interact with desmoplastic stroma.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response describes how pancreatic cancer cells interact with the tumor microenvironment, and how different elements encourage cell travel, such as inflammation and hypoxia.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response describes the effect of DNA mutations, such as KRAS, on a pancreatic cancer cell’s potential to travel outside of the primary site.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response explains other methods for the spread of pancreatic cancer besides invasion into solid tissue, such as hematologic spread, lymphatic spread, and perineural invasion.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response relates tissue properties to their potential effect on treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response offers published scientific journal articles as evidence of its claims and provides citations.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 228, "question_text": "My loved one has pancreatic cancer and we’re considering participating in patient advocacy. What opportunities are available?", "rubric_items": [ { "item_number": 1, "description": "The response recommends contacting the patient’s healthcare team or oncology team about patient advocacy opportunities within their organization.", "min_points": 0, "max_points": 6 }, { "item_number": 2, "description": "The response identifies one or more patient advocacy organizations relevant to cancer patients.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response defines patient advocacy.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response provides examples of patient advocacy work.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response offers examples of patient advocacy opportunities specific to pancreatic cancer and provides contact information or a website for each.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response recommends joining pancreatic cancer support groups, either online or in-person, to learn about advocacy opportunities.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response mentions at least three different areas of advocacy for pancreatic cancer patients, such as direct patient support, support groups, funding for cancer research, awareness of clinical trials, or political lobbying.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response recommends contacting government representatives regarding patient advocacy opportunities.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response suggests participating in fundraising campaigns for cancer research as an advocacy avenue.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response provides direct contact information or URLs for the identified organizations.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 229, "question_text": "My husband has pancreatic cancer and we want to understand more about cancer metabolism. How do cancer cells obtain energy differently?", "rubric_items": [ { "item_number": 1, "description": "The response explains normal cellular metabolism in layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response outlines the differences between normal cellular metabolism and cancer cell metabolism.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should describe the Warburg Effect and provide links to additional information about this phenomenon.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response provides examples of how cancer cell metabolism affects its clinical behavior.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response gives examples of targeting the differences in cancer cell metabolism as a means of treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response provides published scientific journal articles as evidence for its claims and cites its sources.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response should define glycolysis.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should describe how cancer cells use glutamine, and how this is different than normal cells.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should define lactic acid and describe how excess lactic acid can be produced by cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should describe how cancer cells are required to obtain fuel in a hypoxic environment.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should discuss how cancer cells utilize glucose inefficiently.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response should not recommend specific diets for management of cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 13, "description": "The response should not reference specific diets unless it provides PMID to studies that examine the effect of diet on pancreatic cancer, and the response should provide a summary of the findings.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should not indicate that restrictive diets, such as ketogenic diet or intermittent fasting, should be started by patients with pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should clearly state if treatments are experimental or if they are evidence-based and/or FDA approved.", "min_points": 0, "max_points": 7 }, { "item_number": 16, "description": "The response should recommend that the patient discuss diet with their oncologist and request a referral to a nutritionist if they are interested in learning more.", "min_points": 0, "max_points": 10 }, { "item_number": 17, "description": "The response should summarize what is known specifically in pancreatic cancer about glucose, amino acid, and lipid metabolism, including the role of lipid metabolism in cancer cells.", "min_points": 0, "max_points": 3 }, { "item_number": 18, "description": "If the response references scientific studies or clinical trials, it should provide direct links to the specific articles and include the PMID for each.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 230, "question_text": "My loved one has pancreatic cancer and we’re dealing with treatment-related peripheral neuropathy. What rehabilitation options exist?", "rubric_items": [ { "item_number": 1, "description": "The response states peripheral neuropathy is a common side effect of certain chemotherapy agents used to treat pancreatic cancer, including oxaliplatin.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response should define chemotherapy-induced peripheral neuropathy.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response provides examples of symptoms of peripheral neuropathy such as numbness or paresthesia.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response provides examples of how peripheral neuropathy symptoms may affect a patient’s function.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states some patients may see an improvement in symptoms when the causative medication is stopped.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should describe that some patients have diminishment of chemotherapy-induced peripheral neuropathy over time, but sometimes it is permanent.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response recommends physical therapy.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response recommends occupational therapy.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response states medication may help with some symptoms of peripheral neuropathy and provides examples like gabapentin, pregabalin, and duloxetine.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response should describe the grading system oncologists use to quantify the severity of chemotherapy-induced peripheral neuropathy.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response should describe ways that patients with peripheral neuropathy can adapt to their environment to prevent adverse events.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should inform patients of the importance of protecting body parts that are experiencing neuropathy, such as appropriately sized and firm shoes.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should encourage patients to participate in activities that promote general wellness such as exercise, balanced nutrition with an emphasis on plant-based foods, good sleep hygiene, and adequate hydration.", "min_points": 0, "max_points": 7 }, { "item_number": 14, "description": "The response recommends discussing adjunct therapies and interventions for severe treatment side effects such as peripheral neuropathy, including cognitive behavioral therapy, with the oncology team.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 231, "question_text": "My father has pancreatic cancer and his doctors mentioned liquid-liquid phase separation in cells. How does this relate to cancer?", "rubric_items": [ { "item_number": 1, "description": "The response explains what liquid-liquid phase separation is in layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explains how liquid-liquid phase separation relates to cancer cell biology.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response describes the role of liquid-liquid phase separation in pancreatic cancer and specific ways it can be affected.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response describes the link between common mutations seen in pancreatic cancer and dysregulated liquid-liquid phase separation, including references to the scientific literature.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response explains that this is an active area of scientific research.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response mentions that there are no FDA-approved treatments that target liquid-liquid phase separation at this time.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response recommends that the patient consider inquiring about liquid-liquid phase separation in pancreatic cancer with their oncology team and ask about local clinical trial availability.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response provides published scientific journal articles as evidence for its statements and cites its sources.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response describes specific ways that liquid-liquid phase separation itself is altered or dysregulated in cancer cells, such as abnormal condensate formation, persistence, composition, or material properties.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 232, "question_text": "My mother has pancreatic cancer and we’re trying to understand the role of mechanical forces in drug delivery. How does this affect treatment effectiveness?", "rubric_items": [ { "item_number": 1, "description": "The response mentions tissue stiffness.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response relates tissue properties to their potential consequences for treatment effectiveness and resistance.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response mentions blood flow and hypoxia as potentially having effects on treatment effectiveness.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response cites one or more published scientific journal articles as evidence and includes a PMID for at least one cited article.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response defines mechanical properties of tissues, including at least two of the following: interstitial fluid pressure, solid stress, or fibrotic structure.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response describes at least three of the following mechanical properties of tissue: stiffness, elasticity, viscosity, density, or compression.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response describes compression of surrounding tissue by the tumor, specifically mentioning blood vessels or lymphatics.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response defines desmoplastic stroma and describes its role in pancreatic cancer, including its composition.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response describes how pancreatic cancer remodels the extracellular matrix to promote a tumor-friendly environment.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response states that research on the effects of mechanical properties of tissue on treatment delivery is active and ongoing.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response recommends that the patient inquire about experimental treatments or clinical trials with their oncology team.", "min_points": 0, "max_points": 7 }, { "item_number": 12, "description": "The response explicitly explains that tissue mechanical properties can influence cancer spread or metastasis.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response explicitly explains the tumor microenvironment, including its components and how it affects drug delivery.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 233, "question_text": "My loved one has pancreatic cancer and we’re dealing with long-distance caregiving challenges. What strategies work best?", "rubric_items": [ { "item_number": 1, "description": "The response recommends that the patient establish an emergency plan with local family members, friends, caregivers, or other support persons.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response recommends discussing this with a social worker or patient care navigator.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response recommends utilizing telemedicine for patient-provider medical care when available and appropriate.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response recommends engaging family and friends for assistance.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response recommends discussing this with the patient’s healthcare team.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response states the patient’s healthcare team may have resources to help patients at home and lighten caregivers’ load.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response provides data on caregiver burnout and cites its sources from published scientific literature.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response offers examples of signs and symptoms of caregiver burnout.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response mentions assisted living, home health aides, and respite homes.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response offers resources for cancer patients and their caregivers and provides contact information or websites.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response should emphasize the importance of regular and comprehensive communication with the patient to ensure they feel well supported.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should recommend shared apps or other technological tools to share information between the patient and distant caregivers.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should recommend ways that caregivers can provide support from afar.", "min_points": 0, "max_points": 7 }, { "item_number": 14, "description": "The response should recommend that the patient look into their insurance to understand if they have a benefit for paid caregiving.", "min_points": 0, "max_points": 7 }, { "item_number": 15, "description": "The response should provide online resources for patients with pancreatic cancer to learn more about local caregiving opportunities.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response recommends building a local support network near the patient in addition to the long-distance caregiving network.", "min_points": 0, "max_points": 5 }, { "item_number": 17, "description": "The response recommends that family members, caregivers, or other support persons participate remotely in medical appointments when they cannot attend in person.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 234, "question_text": "My husband has pancreatic cancer and we want to understand more about cancer cell competition. How do different cancer cells interact?", "rubric_items": [ { "item_number": 1, "description": "The response describes how cancer cells compete for resources within a tumor (e.g., oxygen and nutrients), and provides supporting scientific literature or citations when available.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response discusses how cell competition may lead to clonal evolution of cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response should describe how different stressors on the tumor, such as chemotherapy, select for certain characteristics in the cancer cell populations, such as chemotherapy resistance.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response describes cancer cell competition.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response describes the origin of cancer, from a single mutated cell that proliferates over time.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response describes that sometimes the interests of different subpopulations of cancer cells oppose each other, and how.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response describes that sometimes the interests of different subpopulations of cancer cells are aligned and their effect benefits all of the cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response explains ways pancreatic cancer cells differ and how they compete with each other.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response explains that, over time, some tumor cells acquire additional mutations that create genetically distinct subpopulations within the same cancer.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 235, "question_text": "My loved one has pancreatic cancer and we’re trying to understand the role of mechanical stress in drug resistance. How does this affect treatment?", "rubric_items": [ { "item_number": 1, "description": "The response relates tissue properties to their potential consequences for treatment effectiveness and resistance.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response mentions blood flow and hypoxia as potentially having effects on treatment effectiveness.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response offers published scientific journal articles as evidence of its claims and provides citations.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response relates tissue properties to their potential effect on cancer spread.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response defines the mechanical properties of tissues.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response includes descriptions of the mechanical properties of tissue: stiffness, elasticity, viscosity, density, and compression.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response describes compression of surrounding tissue by the tumor.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response defines desmoplastic stroma and its role in pancreatic cancer.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response explains what the tumor microenvironment is.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response describes how pancreatic cancer is able to remodel its surrounding extracellular matrix to promote a tumor-friendly environment.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response explains that research on the effects of mechanical properties of tissue on treatment delivery is active and ongoing.", "min_points": 0, "max_points": 7 }, { "item_number": 12, "description": "The response recommends that the patient inquire about experimental treatments or clinical trials in their area with their oncology team.", "min_points": 0, "max_points": 7 }, { "item_number": 13, "description": "The response explains that mechanical changes in the tumor tissue or stroma can compress, collapse, or otherwise alter nearby blood vessels.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 236, "question_text": "My father has pancreatic cancer and his doctors mentioned proteostasis in cancer cells. What is this and how does it relate to treatment?", "rubric_items": [ { "item_number": 1, "description": "The response explains proteostasis in layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explains how proteostasis may be altered in cancer cells.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response provides examples of cancer treatments that target proteostasis in cancer cells and explains their mechanism of action in layman’s terms.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response defines proteostasis.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response explains the role of proteostasis in normal cells, including protein synthesis, protein folding, protein trafficking, and protein degradation.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response explains different steps and phases of proteostasis, which could be potential targets for cancer treatments.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response mentions whether there are any FDA-approved therapies for pancreatic cancer that target proteostasis.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response explains the role of proteostasis specifically in pancreatic cancer cells, rather than only in cancer cells generally.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response recommends asking the oncology team specifically about proteostasis-targeting therapies and whether clinical trials are available that target this pathway.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 237, "question_text": "My mother has pancreatic cancer and we’re dealing with treatment decision fatigue. How do we manage this overwhelming feeling?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s healthcare team.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response recommends discussing this with a Palliative Care team.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response recommends cancer support groups and online resources for cancer patients and their families.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response recommends breaking up decisions into smaller portions and creating pros and cons lists to organize thoughts.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response recommends discussing goals of care with the patient to help with decision making.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response recommends discussing this with a patient care navigator or social worker.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response provides data on caregiver burnout and cites its sources from published scientific literature.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response offers examples of signs and symptoms of caregiver burnout.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should attempt to normalize treatment decision fatigue for patients undergoing cancer care.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should emphasize the importance of maintaining mental health while undergoing cancer treatments, for both the patient and their loved ones.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should recommend that patients lean on their support network for assistance in making medical decisions.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response should suggest that the patient request more frequent appointments with their oncology team for ongoing conversations and to answer questions that arise.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should mention that documentation of thoughts can be helpful to reflect upon when it comes time to make a medical decision.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response explains that palliative medicine can help patients clarify their goals of care and treatment priorities during a serious cancer diagnosis.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 238, "question_text": "My loved one has pancreatic cancer and we want to understand more about cancer cell migration. How do cancer cells spread through the body?", "rubric_items": [ { "item_number": 1, "description": "The response explains cancer metastasis in layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response gives examples of how cancer spreads in the body, including direct invasion by the tumor.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response describes lymphatic spread.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response describes hematologic spread.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response mentions epithelial to mesenchymal transition.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response mentions how different treatment modalities are or are not helpful once cancer has metastasized.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response recommends discussing this with the patient’s healthcare team.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response discusses some of the cellular mechanisms by which cancer spreads in the body.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response mentions cancer metastasis as a response to cell stress.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response mentions the healthcare team uses advanced imaging like CT, MRI, and PET/CT to identify places the cancer has spread to.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response should describe perineural invasion and describe how cancer can spread this way.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should describe how cancer cells lodge in tissues distant from their original site.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should describe that pancreatic cancer is often diagnosed at advanced stages, when it has already spread outside of the original site.", "min_points": 0, "max_points": 7 }, { "item_number": 14, "description": "The response should explain the most common sites that cancer cells spread.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should describe patterns of spread in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should describe characteristics of cancers that have higher predilection for spreading.", "min_points": 0, "max_points": 5 }, { "item_number": 17, "description": "The response explains, specifically in pancreatic cancer, how epithelial-to-mesenchymal transition makes tumor cells more mobile and invasive, thereby promoting cancer cell spread.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 239, "question_text": "My husband has pancreatic cancer and we’re trying to understand the role of mechanical cues in cancer stem cells. How does this affect cancer recurrence?", "rubric_items": [ { "item_number": 1, "description": "The response defines cancer stem cells.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response discusses the role of cancer stem cells in cancer biology using layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response mentions the role cancer stem cells may play in cancer recurrence.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response mentions tissue stiffness.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response relates tissue properties to their potential effect on cancer spread.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response relates tissue properties to their potential consequences for treatment effectiveness and resistance.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response offers published scientific journal articles as evidence of its claims and provides citations.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response defines tumor microenvironment.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response describes mechanical cues as they pertain to solid tumors.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response delineates between other types of environmental inputs that cells experience and mechanical forces, such as chemical or hormonal cues.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response describes that pancreatic cancer promotes desmoplasia in its microenvironment.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response explains how mechanical forces in the tumor microenvironment influence the behavior of cancer stem cells.", "min_points": 0, "max_points": 7 }, { "item_number": 13, "description": "The response links scientific literature with PMID on the subject, if available.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response describes how mechanical forces in the tumor microenvironment affect disease recurrence and metastatic potential.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response mentions how mechanical cues affect tumor cell dormancy.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response mentions that the desmoplastic tumor microenvironment in pancreatic cancer is actively being researched.", "min_points": 0, "max_points": 7 }, { "item_number": 17, "description": "The response describes specific properties of cancer stem cells, such as self-renewal, differentiation, or tumor-initiating capacity.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 240, "question_text": "My loved one has pancreatic cancer and we’re dealing with the emotional toll of uncertainty. What coping strategies are most effective?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s healthcare team.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response recommends discussing this with a social worker, counselor, or Palliative Care professional.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response recommends cancer support groups as a resource.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response emphasizes the importance of establishing a strong support system.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response offers examples of stress relief strategies.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response offers examples of organizations that offer support for cancer patients and their families and provides contact information or a website.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response recommends prioritizing self-care.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should normalize the range of emotions felt after a loved one receives a serious cancer diagnosis.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should emphasize the importance of maintaining mental health during times of strife.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response should emphasize the importance of maintaining healthy lifestyle habits to support wellbeing during times of stress, such as a cancer diagnosis.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should recommend organization of thoughts and questions to discuss with the oncology team.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should emphasize the importance of understanding the diagnosis to the patient and suggest ways to educate themselves.", "min_points": 0, "max_points": 7 }, { "item_number": 13, "description": "The response should mention the importance of getting one’s affairs in order upon receiving a cancer diagnosis, as this can provide some peace of mind about the future.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should emphasize the importance of avoiding isolation.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should recommend that both the cancer patient and their family members seek out available support resources.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 241, "question_text": "My father has pancreatic cancer and his doctors mentioned phase separation in cancer cells. How does this cellular organization affect cancer behavior?", "rubric_items": [ { "item_number": 1, "description": "The response explains what phase separation is using layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explains how phase separation relates to cancer cell biology.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response defines biomolecular condensates.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response describes how phase separation affects drug resistance in cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response describes how phase separation affects gene manipulation.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response describes the role that phase separation plays in the tumor microenvironment.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response describes the effect that phase separation has on cellular metabolism and survival.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response mentions that phase separation is the topic of ongoing research at this time.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response describes the role of phase separation in the facilitation of invasion and metastasis of cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response provides published scientific journal articles as evidence for its statements and cites its sources.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 242, "question_text": "My mother has pancreatic cancer and we’re trying to understand the role of mechanotransduction. How do cells sense and respond to mechanical forces?", "rubric_items": [ { "item_number": 1, "description": "The response explains the biology of how cells sense mechanical stress using layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response discusses the biology of how cells respond to mechanical stress using layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response outlines how these processes may be altered in pancreatic cancer cells.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response provides published scientific journal articles as evidence for its statements and cites its sources.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "Define mechanotransduction as the process by which cells convert mechanical stimuli into biochemical signals.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "Include the relevance of mechanotransduction in normal physiology and disease.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "Describe at least two types of mechanical forces acting on tissues, such as stretch, pressure, stiffness, compression, tension, shear stress, or hydrostatic pressure.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "Explain how mechanical forces in tumors and/or the surrounding tissues differ from normal tissue, specifically mentioning the creation of a stiff and dense extracellular matrix (ECM).", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "Describe at least two ways cells detect mechanical forces, including structures like ion channels, integrins, cell surface receptors, or the cytoskeleton.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "Describe how pancreatic cancer cells respond to mechanical forces in their environment, particularly focusing on stiffness or desmoplastic stroma.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "Define desmoplastic stroma as a key feature of pancreatic cancer characterized by excessive fibrous tissue formation around the tumor.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 243, "question_text": "My loved one has pancreatic cancer and we’re considering legacy planning. What should we focus on during treatment?", "rubric_items": [ { "item_number": 1, "description": "The response recommends meeting with a Palliative Care specialist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explains Advanced Care Planning and how it impacts a patient’s clinical course.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response mentions code status.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response mentions an advanced directive or living will.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response mentions financial planning and recommends discussing this with a professional with experience in this.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response recommends discussing this with a social worker or counselor.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response mentions the importance of a strong support system during cancer treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response provides examples of organizations with resources for cancer patients and their families and includes contact information or websites.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should instruct patients to create a POLST with their healthcare provider, and post this in a visible place in their home.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should recommend that the patient elect a healthcare durable power of attorney.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response should recommend that the patient ensure their financial affairs are in order.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should recommend that the patient elect a financial durable power of attorney.", "min_points": 0, "max_points": 7 }, { "item_number": 13, "description": "The response should recommend that the patient complete a will and designate beneficiaries on life insurance.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should recommend that the patient consider reaching out to friends and loved ones in order to connect and spend time together.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should recommend that the patient consider how to reconcile their affairs in the financial, legal, and social realms.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should provide online references and links to resources regarding legacy planning.", "min_points": 0, "max_points": 7 }, { "item_number": 17, "description": "The response should suggest the patient inquire about assistance with some of these aspects of legacy planning with their oncology team, to understand if there are resources available.", "min_points": 0, "max_points": 10 }, { "item_number": 18, "description": "The response recommends that the patient complete advance care planning to document their preferences for medical care in the event of an emergency or if they become unable to communicate.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 244, "question_text": "My husband has pancreatic cancer and we want to understand more about cancer cell adhesion. How do cancer cells attach and detach from tissues?", "rubric_items": [ { "item_number": 1, "description": "The response explains the biology of cell adhesion in layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response describes how cell adhesion processes are changed in cancer cells.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response mentions integrins and cadherins.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response mentions changes to cell adhesion in pancreatic cancer specifically.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response provides published scientific journal articles as evidence for its statements and cites its sources.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response describes the extracellular matrix.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response explains epithelial-mesenchymal transition (EMT).", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response explains how EMT facilitates cancer cell spread.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response describes the components of cell adhesion.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response describes the components of cell detachment.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response includes different enzymes implicated in cell adhesion and detachment.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response describes factors in the tumor microenvironment that promote or facilitate tumor cell detachment and migration.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response mentions if there are any FDA-approved treatments that target cancer cell detachment.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response defines the adhesion proteins it lists by explaining their roles in mediating cell-to-cell or cell-to-matrix attachment.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 245, "question_text": "My loved one has pancreatic cancer and we’re dealing with the challenge of hope versus realism. How do we balance these perspectives?", "rubric_items": [ { "item_number": 1, "description": "The response should suggest asking the oncology team for prognostic information, including the expected outcomes of treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response recommends open communication between patient and caregivers.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response recommends discussing this with a social worker, spiritual worker, counselor, or Palliative Care specialist.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response recommends establishing the patient’s goals of care.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response recommends cancer support groups as helpful resources.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response provides examples of organizations with resources for cancer patients and their families and includes contact information or a website.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should emphasize the importance of maintaining mental health throughout the cancer diagnosis and treatment process.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should state that it is normal to feel this conflict in the face of a pancreatic cancer diagnosis.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should explain quality of life, and describe factors of cancer treatment that can impact the patient’s quality of life.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should provide online resources for pancreatic cancer information and support groups for the patient to consider reaching out to a community about their struggles.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should emphasize the importance of supporting the patient’s autonomy in decisions about their care.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 246, "question_text": "My father has pancreatic cancer and his doctors mentioned condensates in cancer cells. What are these structures and how do they affect cancer?", "rubric_items": [ { "item_number": 1, "description": "The response explains what condensates are using layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response defines biomolecular condensates as membrane-less organelles containing proteins, RNA, and other molecules.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response explains how condensates relate to cancer cell biology.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response describes how biomolecular condensates become deregulated in cancer cells, including at least one mechanism of deregulation.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response provides published scientific journal articles as evidence for its statements and cites its sources.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response references at least one scientific literature source regarding biomolecular condensates, including a PMID.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response defines liquid-liquid phase separation (LLPS) as the process by which condensates form.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response explains the role of biomolecular condensates in normal cells, including at least one function such as gene regulation or stress response.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response mentions the protein YAP/TAZ and its role in biomolecular condensates in cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response lists at least two ways that biomolecular condensates encourage cancer cell growth, proliferation, or migration.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response mentions that the study of biomolecular condensates and their role in cancer is an area of active scientific research.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response states whether there are FDA-approved therapies that target biomolecular condensates in cancer.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 247, "question_text": "My mother has pancreatic cancer and we’re trying to understand the role of tissue stiffness. How does this physical property affect cancer progression?", "rubric_items": [ { "item_number": 1, "description": "The response defines tissue stiffness.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response relates tissue properties to their potential effect on cancer spread.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response relates tissue properties to their potential effect on treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response offers published scientific journal articles as evidence of its claims and provides citations.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response defines desmoplastic stroma.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response explains how and why pancreatic cancer promotes the formation of desmoplastic stroma around itself.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response describes the process of cell adhesion in normal tissue.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response describes how increased stiffness in tumors and the tumor microenvironment influences cell adhesion.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response mentions the effect of tissue stiffness on angiogenesis and drug resistance.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response describes how the development of desmoplastic stroma around pancreatic cancer tumors is a protective factor.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response explains whether there are FDA-approved treatments that target tissue stiffness in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response defines mechanotransduction.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response suggests that the patient discuss the role of clinical trials in their cancer care with their oncology team.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 248, "question_text": "My loved one has pancreatic cancer and we’re dealing with the complexity of multi-generational family support. How do we coordinate care across generations?", "rubric_items": [ { "item_number": 1, "description": "The response emphasizes the importance of open, organized, and proactive communication among family members.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explicitly recommends discussing care coordination with the patient’s healthcare team or medical providers.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response explicitly recommends discussing care coordination with a social worker, spiritual counselor, or Palliative Care specialist.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response explicitly emphasizes the importance of a strong support system, such as building a caregiver network or ensuring emotional support.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response provides specific examples of organizations that support cancer patients and their families, including contact information or websites.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response explicitly recommends participating in a support group for cancer patients and their families.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response explicitly recommends educating the family on the patient’s diagnosis and treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should recommend that one family member is designated as a communication person, and perhaps accompany the patient to their medical appointments and take notes.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response should encourage the communication person to develop a strategy to deliver information to the multi-generational family members.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should reinforce the importance of boundaries for the pancreatic cancer patient while they undergo treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should suggest that the patient inquire with their oncology team if there are resources available for group support or for cultural mediation.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should recommend that the patient or loved ones identify care needs, such as cleaning or food prep, and assign roles to family members according to their strengths.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should encourage the patient to focus on their own wellbeing and mental health.", "min_points": 0, "max_points": 3 }, { "item_number": 14, "description": "The response should recommend online resources for pancreatic cancer information as well as support services that the patient and family members can access to answer questions, etc.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response recommends a structured communication strategy, such as regular family meetings or communication tools.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 249, "question_text": "My husband has pancreatic cancer and we want to understand more about cancer cell invasion. What makes cancer cells able to invade healthy tissue?", "rubric_items": [ { "item_number": 1, "description": "The response explains epithelial-mesenchymal transition and how this affects a cell’s ability to migrate.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response describes major mechanisms of cancer spread, including direct invasion, lymphatic spread, hematogenous spread, and perineural invasion, and explains the unique role of perineural invasion.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response discusses some of the cellular mechanisms by which cancer spreads in the body.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response mentions cancer metastasis as a response to cell stress.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response mentions the healthcare team uses advanced imaging like CT, MRI, and PET/CT to identify places the cancer has spread to.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response mentions how different treatment modalities are or are not helpful once cancer has metastasized.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response recommends discussing this with the patient’s healthcare team.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response explains cancer metastasis in layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should describe how a cancer cell develops, including DNA mutations.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response should describe tumor suppressor genes.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response should describe oncogenes.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response should describe cell adhesion, and how this process can be altered in cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should explain the phenomenon of loss of cell-cell adhesion in cancer cells.", "min_points": 0, "max_points": 3 }, { "item_number": 14, "description": "The response should define tumor microenvironment.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should explain how cancer cells can use enzymes to change the tumor microenvironment to their advantage.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should describe other ways cancer cells can interact with the tumor microenvironment to promote migration.", "min_points": 0, "max_points": 5 }, { "item_number": 17, "description": "The response should describe any unique ways pancreatic cancer cells are thought to metastasize.", "min_points": 0, "max_points": 5 }, { "item_number": 18, "description": "The response should recommend websites that help explain different aspects of pancreatic cancer and provide resources for pancreatic cancer patients.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 250, "question_text": "My loved one has pancreatic cancer and we’re trying to understand the role of fluid flow in tumors. How does this affect drug delivery and cancer behavior?", "rubric_items": [ { "item_number": 1, "description": "The response discusses the normal flow of fluid from blood vessels to the extracellular space to the lymphatic system and blood vessels using layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explains how fluids move in normal tissue to perform tasks such as nutrient and oxygen delivery, and to manage waste products.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response discusses changes to fluid flow that may occur in pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response describes abnormalities seen in tumors with fluid management.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response discusses the implications of altered fluid flow on cancer treatment, including reduced drug delivery or immune cell penetration into the tumor.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response describes how fluid flow affects cancer behavior.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response describes how low flow to tumor tissue stimulates further cancer cell growth and development.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response mentions how altered cellular biology and extracellular structures can impact cancer behavior.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response provides published scientific journal articles as evidence of its claims and cites its sources.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response describes different fluids that exist in a tumor and its environment.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response describes the tumor microenvironment.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response describes attributes of tumors and the surrounding tissue that disrupt the normal function of fluids.", "min_points": 0, "max_points": 7 }, { "item_number": 13, "description": "The response defines desmoplastic stroma and how pancreatic cancer encourages the development of this.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response defines interstitial fluid pressure.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response explains how increased interstitial fluid pressure impacts drug delivery, including uneven distribution of exposure in the tumor.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response explains that poor fluid flow in tumor tissue is an active area of scientific research at this time.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 251, "question_text": "My father has pancreatic cancer and we’re dealing with the challenge of maintaining dignity during treatment. What approaches help preserve this?", "rubric_items": [ { "item_number": 1, "description": "The response explains that palliative care can help manage symptoms, maintain quality of life, and provide support during serious illness.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response recommends discussing dignity-preserving or comfort-focused care options with the oncology or palliative care team.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response explicitly mentions Advance Care Planning and includes either Advance Directives or Living Wills.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response explicitly recommends establishing the patient’s goals of care, including understanding and documenting the patient’s preferences and involving them in decision-making.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response explicitly recommends support groups for cancer patients.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response provides specific examples of organizations that support cancer patients and their families, including contact information or websites for each.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should attempt to normalize feelings of loss of control for cancer patients at the time of diagnosis and/or during cancer treatment.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response should describe components of personal dignity.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should encourage the patient, family, and friends of the patient, and oncology care team to respect the patient’s bodily autonomy.", "min_points": 0, "max_points": 4 }, { "item_number": 10, "description": "The response should encourage the patient to prioritize management of side effects and symptoms of cancer or cancer treatment.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response should encourage the patient to communicate any side effects or symptoms of cancer or cancer treatment to their oncology care team to ensure they are being offered management solutions.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should encourage the patient and family to have open and ongoing communication about the patient’s wishes for medical care.", "min_points": 0, "max_points": 10 }, { "item_number": 13, "description": "The response should recommend that the patient and loved ones promote independence and normalcy in the patient’s life as much as possible.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should encourage the patient to always remember that anything that happens to their body with regard to cancer treatment is their choice.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should recommend that the patient disclose any feelings of overwhelm or loss of autonomy with their oncology team and inquire about resources for support.", "min_points": 0, "max_points": 10 }, { "item_number": 16, "description": "The response should emphasize the importance of prevention of caregiver burnout.", "min_points": 0, "max_points": 7 }, { "item_number": 17, "description": "The response explicitly recommends putting the patient’s wishes for medical care in writing as a POLST, alongside an advance directive.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 252, "question_text": "My mother has pancreatic cancer and we want to understand more about cancer cell contractility. How do mechanical forces generated by cells affect cancer?", "rubric_items": [ { "item_number": 1, "description": "The response explains how cells respond to mechanical stress, including processes like ECM remodeling, increased contractility, and effects on proliferation, invasion, metastasis, and drug resistance.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explicitly relates tissue properties, such as stiffness and fibrous stroma, to their potential effect on cancer spread, including invasiveness and metastasis.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response explains how tissue or ECM properties affect treatment delivery, effectiveness, or resistance (e.g., impaired drug penetration).", "min_points": 0, "max_points": 3 }, { "item_number": 4, "description": "The response explains how cells sense mechanical stress, including mechanosensing mechanisms like mechanoreceptors, integrins, or mechanotransduction pathways.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response provides specific citations from published scientific journal articles as evidence for its statements.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response must explain normal cell contractility, including the role of the actomyosin complex in generating mechanical forces for movement.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response must define actin, including its role in cellular structure and function.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response must define myosin, including its function in cell contractility.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response must explicitly describe the tumor microenvironment, including its components and characteristics.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response must define the extracellular matrix, including its composition and function.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response must define mechanobiology, including its relevance to cancer progression.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response must explain epithelial-mesenchymal transition (EMT), including its occurrence in pancreatic cancer cells and its impact on cancer spread.", "min_points": 0, "max_points": 7 }, { "item_number": 13, "description": "The response explicitly distinguishes cancer-cell contractility from normal-cell contractility, including how altered contractility in cancer cells promotes migration.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response explicitly explains how changes in the tumor microenvironment alter the mechanical forces experienced by cancer cells, including through changes in extracellular matrix composition or stiffness.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response explains how tumor microenvironment changes promote cancer invasion, metastasis, or drug resistance through specific biological mechanisms.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 253, "question_text": "My loved one has pancreatic cancer and we’re trying to understand the role of extracellular matrix. How does this tissue scaffolding affect cancer?", "rubric_items": [ { "item_number": 1, "description": "The response defines the extracellular matrix and explains its role in normal cellular biology.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response contrasts the role of the extracellular matrix in cancer cell biology with normal cell biology.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response discusses the potential consequences of an altered extracellular matrix for cancer treatment effectiveness and resistance, including examples like decreased drug and immune cell penetration.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response discusses the potential consequences of an altered extracellular matrix on cancer cell biology, including examples like angiogenesis and metastasis.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response provides published scientific journal articles as evidence for its statements and cites its sources.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response describes the different components of the extracellular matrix in normal tissue.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response describes how the extracellular matrix changes in pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response explains how the changes in the extracellular matrix in pancreatic cancer promote cancer growth and facilitate movement of cancer cells.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response defines desmoplastic stroma.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response defines tumor microenvironment.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response describes how desmoplastic stroma causes hypoxia in the tumor microenvironment.", "min_points": 0, "max_points": 7 }, { "item_number": 12, "description": "The response describes how hypoxia in the tumor microenvironment causes inflammation, and how this promotes cancer growth.", "min_points": 0, "max_points": 7 }, { "item_number": 13, "description": "The response describes how the desmoplastic stroma in the pancreatic cancer microenvironment contributes to treatment resistance.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response describes how the desmoplastic stroma in the pancreatic cancer microenvironment can cause symptoms and complications due to mechanical forces on the surrounding structures, specifically mentioning the effect on blood vessels.", "min_points": 0, "max_points": 7 }, { "item_number": 15, "description": "The response presents the definition of the extracellular matrix and its role in normal cellular biology in layman’s terms that a non-specialist can understand.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response contrasts the role of the extracellular matrix in cancer cell biology with its role in normal cell biology in layman’s terms that a non-specialist can understand.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 254, "question_text": "My husband has pancreatic cancer and we’re dealing with the challenge of maintaining relationships during this difficult time. What strategies work?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend that the patient consider professional counseling or therapy support.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response explicitly recommends discussing relationship challenges with a social worker, spiritual counselor, or Palliative Care specialist.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response explicitly recommends joining a support group for cancer patients or their families.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response explicitly emphasizes the importance of self-care.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response explicitly emphasizes the importance of having a support system during cancer treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response provides specific examples of organizations that support cancer patients and their families, including contact information or websites.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should recommend that loved ones of a patient with pancreatic cancer seek education about the disease and common symptoms.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should encourage open communication between the patients and their loved ones.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response should encourage the patient to seek support from their loved ones.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response should attempt to normalize the stress that patients feel after receiving a pancreatic cancer diagnosis.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response should recommend against behaviors that might isolate the patient after a serious medical diagnosis.", "min_points": 0, "max_points": 7 }, { "item_number": 12, "description": "The response should recommend that the patient prioritize symptom control to feel as normal as possible.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should indicate that some people may not feel comfortable discussing a serious cancer diagnosis with a friend or loved one, and that this can be a normal response.", "min_points": 0, "max_points": 3 }, { "item_number": 14, "description": "The response should recommend that the patient observe which people in their social circle want to be supportive, and to lean on these people.", "min_points": 0, "max_points": 3 }, { "item_number": 15, "description": "The response should recommend that the patient continue to reach out to friends and loved ones, and try to participate in the same activities they previously did, to maintain relationships.", "min_points": 0, "max_points": 3 }, { "item_number": 16, "description": "The response should suggest that the patient consider creating boundaries with people, including how to handle unsolicited advice.", "min_points": 0, "max_points": 5 }, { "item_number": 17, "description": "The response should recommend that the patient consider activities where they can be fully present with the people they are with, for the best quality interactions.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 255, "question_text": "My loved one has pancreatic cancer and we want to understand more about cancer cell mechanosensing. How do cancer cells detect and respond to their mechanical environment?", "rubric_items": [ { "item_number": 1, "description": "The response explains how cancer cells detect mechanical characteristics of their environment.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explains how cancer cells respond to mechanical characteristics of their environment.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response outlines how mechanosensing processes may be altered in pancreatic cancer cells.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response defines mechanosensing.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response describes mechanosensing in normal cells.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response defines desmoplastic stroma and describes its development in pancreatic cancer.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response describes integrins, cytoskeleton, ion channels, and membrane sensors.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response explains the YAP/TAZ pathway and its role in the development of desmoplastic stroma in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response mentions if there are FDA-approved therapies that target the cancer cells’ ability to mechanosense.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response describes how cancer cells migrate in response to cues from mechanical forces in their environment.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response defines epithelial-mesenchymal transition.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response provides published scientific journal articles as evidence for its statements and cites its sources.", "min_points": 0, "max_points": 10 }, { "item_number": 13, "description": "The response explains in layman’s terms how cells sense mechanical stress.", "min_points": 0, "max_points": 10 }, { "item_number": 14, "description": "The response explains in layman’s terms how cells respond to mechanical stress.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 256, "question_text": "My father has pancreatic cancer and we’re trying to understand the role of pressure in tumors. How does elevated pressure affect treatment delivery?", "rubric_items": [ { "item_number": 1, "description": "The response explains the normal flow of fluid from blood vessels to the extracellular space to the lymphatic system, including nutrient and oxygen delivery and waste management.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response describes how fluid flow becomes compromised in tumors, including increased intratumoral pressure due to abnormal blood vessels, poor lymphatic drainage, and dense stroma.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response discusses the implications of altered fluid flow on cancer treatment, specifically mentioning reduced drug delivery and immune cell penetration.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response explains how increased interstitial fluid pressure impacts drug delivery, including uneven distribution of exposure in the tumor.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response discusses the potential impact of altered fluid flow on treatment efficacy.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response mentions the impact of altered cellular biology and extracellular structures on cancer behavior, including tumor growth, metastasis, and resistance to therapy.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response describes how low flow to tumor tissue stimulates further cancer cell growth and development.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response defines desmoplastic stroma and how pancreatic cancer encourages its development.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response defines interstitial fluid pressure.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response describes ways that increased pressure from interrupted fluid dynamics and desmoplastic stroma can cause compression on surrounding structures, leading to blockages and symptoms.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response provides specific published scientific journal articles as evidence of its claims, with proper citations.", "min_points": 0, "max_points": 7 }, { "item_number": 12, "description": "The response explains that poor fluid flow in tumor tissue is an active area of scientific research at this time.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response identifies and describes the major fluid compartments in and around tumors, including blood, interstitial fluid, and lymph.", "min_points": 0, "max_points": 7 }, { "item_number": 14, "description": "The response defines the tumor microenvironment as the cancer cells together with surrounding stromal cells, immune cells, blood vessels, extracellular matrix, signaling molecules, and local fluids.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 257, "question_text": "My mother has pancreatic cancer and we’re dealing with the emotional impact on our extended family. How do we support everyone affected?", "rubric_items": [ { "item_number": 1, "description": "The response recommends clear communication with the family regarding how everyone is dealing with the patient’s cancer diagnosis.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response recommends discussing this with the patient’s healthcare team.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response recommends discussing this with a social worker, spiritual counselor, or Palliative Care specialist.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response emphasizes the importance of self-care and healthy boundaries.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response emphasizes the importance of a strong support system for patients with cancer.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response provides examples of organizations that support cancer patients and their families and includes contact information or websites.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response recommends participating in a support group for cancer patients and their families.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response recommends educating the family on the patient’s diagnosis and treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should encourage that family members provide emotional support to each other.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should recommend pursuit of professional mental health counseling for family members of a patient with pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response should recommend resources that patients and families of patients with pancreatic cancer can access for information about the disease.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should list sources and/or websites for support groups for patients with pancreatic cancer and their family members.", "min_points": 0, "max_points": 7 }, { "item_number": 13, "description": "The response should encourage family members to provide assistance and support to their loved ones affected by pancreatic cancer.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 258, "question_text": "My loved one has pancreatic cancer and we want to understand more about cancer cell deformability. How does the ability of cells to change shape affect cancer spread?", "rubric_items": [ { "item_number": 1, "description": "The response explains cancer metastasis in layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explains the major routes by which cancer spreads from the primary tumor, including direct invasion, lymphatic spread, and hematogenous (bloodstream) spread.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response discusses some of the cellular mechanisms by which cancer spreads in the body.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response mentions epithelial to mesenchymal transition.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response mentions cancer metastasis as a response to cell stress.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response explains cancer cell deformability.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response defines extracellular matrix and cytoskeleton.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response explains cell adhesion processes.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response describes how cell deformity changes in cancer cells as compared to normal cells.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response describes the impact of enhanced deformability of cancer cells on their ability to metastasize.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response describes how cancer cells with increased ability to deform survive stresses that normal cells would not.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response describes desmoplastic stroma in the pancreatic cancer tumor microenvironment.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response explains how increased deformability capabilities are necessary for cells to travel within the desmoplastic stroma of pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 14, "description": "The response mentions perineural invasion as an additional route by which cancer cells can spread from the primary tumor.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 259, "question_text": "My husband has pancreatic cancer and we’re trying to understand the role of shear stress in cancer. How do fluid forces affect cancer cells?", "rubric_items": [ { "item_number": 1, "description": "The response explains the normal physiological flow of fluid from blood vessels to the extracellular space and lymphatic system in layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response discusses changes to fluid flow in pancreatic cancer, such as increased intratumoral pressure, and how these changes differ from normal tissue.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response addresses how altered fluid flow impacts cancer treatment, including drug delivery and immune cell penetration into tumors.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response discusses the potential impacts of altered fluid flow on cancer behavior, including metastasis, proliferation, migration, and invasion.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response provides at least one citation from a published scientific journal article as evidence for its claims.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response defines shear stress.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response describes what sources of shear stress exist in cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response defines mechanobiology.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response explains that cancer cells can encounter shear stress forces in the tumor, in the bloodstream, and in lymph channels.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response describes desmoplastic stroma and how this forms in pancreatic cancer’s tumor microenvironment.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response explains the effect that the desmoplastic stroma has on fluid flow in and around a pancreatic cancer tumor.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response explains how increased shear stress encourages cancer cells to proliferate and metastasize.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response describes how shear stresses on cancer cells impact drug resistance.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 260, "question_text": "My loved one has pancreatic cancer and we’re dealing with the challenge of maintaining hope while being realistic about prognosis. How do we find this balance?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response recommends open communication between patient and caregivers.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response recommends discussing this with a social worker, spiritual worker, counselor, or Palliative Care specialist.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response recommends establishing the patient’s goals of care.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response recommends cancer support groups as helpful resources.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response provides examples of organizations with resources for cancer patients and their families and includes contact information or a website.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should emphasize the importance of maintaining mental health throughout the cancer diagnosis and treatment process.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should state that it is normal to feel this conflict in the face of a pancreatic cancer diagnosis.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should explain quality of life, and describe factors of cancer treatment that can impact the patient’s quality of life.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should provide online resources for pancreatic cancer information and support groups for the patient to consider reaching out to a community about their struggles.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should emphasize supporting the patient’s autonomy in care and treatment decision-making.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should suggest asking the oncology team for specific prognostic information and the expected outcomes of treatment.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 261, "question_text": "My father has pancreatic cancer and we want to understand more about cancer cell traction forces. How do the forces cells exert on their environment affect cancer?", "rubric_items": [ { "item_number": 1, "description": "The response explains the biology of how cells sense mechanical stress using layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response discusses the biology of how cells respond to mechanical stress using layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response relates tissue properties to their potential effect on cancer spread.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response relates tissue properties to their potential consequences for treatment effectiveness and resistance.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response provides published scientific journal articles as evidence for its statements and cites its sources.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response defines traction forces that exist in normal cells.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response defines the extracellular matrix.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response describes how traction forces are changed in cancer cells, as opposed to normal cells.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response describes how increased traction forces from pancreatic cancer cells on their environment promote cancer cell proliferation and migration.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response describes changes in the pancreatic cancer environment that are prompted by traction forces from the cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response defines mechanotransduction.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response defines desmoplastic stroma in pancreatic cancer’s tumor microenvironment.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response describes the effect of desmoplastic stroma on cancer cell’s ability to metastasize.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response describes how traction forces in cancer cells contribute to drug resistance in pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 15, "description": "The response describes the extracellular matrix, including its composition, structure, or role in supporting and signaling to cells.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 262, "question_text": "My mother has pancreatic cancer and we’re trying to understand the role of viscosity in the tumor environment. How does tissue thickness affect cancer behavior?", "rubric_items": [ { "item_number": 1, "description": "The response explains how increased tissue thickness can influence cancer cell behavior or disease progression.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response explains that increased tissue thickness, including reduced perfusion, hypoxia, or limited immune infiltration, can reduce treatment effectiveness by impairing drug delivery or promoting treatment resistance.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "Define viscosity and explain its role in normal cells, including the term “viscosity” and its function in cellular environments.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "Describe changes in viscosity within the pancreatic cancer microenvironment, mentioning “viscosity” and specific alterations in cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response should define tumor microenvironment.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response should define desmoplastic stroma and how pancreatic cancer promotes the formation of this in its environment.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "Describe the influence of desmoplasia on cancer cells, mentioning “desmoplasia” and its effects on proliferation, migration, or invasion.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "Describe how desmoplasia limits oxygen delivery to tumor tissue, attributing reduced oxygen delivery specifically to “desmoplasia.”", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "Explain how hypoxia affects cancer cell behavior, describing hypoxia’s role in selecting aggressive, therapy-resistant cells.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "Describe how desmoplasia limits tumor access by the immune system, mentioning “desmoplasia” and its impact on immune cell infiltration.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "Explain how desmoplasia causes drug resistance in pancreatic cancer, connecting “desmoplasia” to reduced treatment efficacy.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "Explain how desmoplastic stroma selects for aggressive tumor cell behavior, linking “desmoplastic stroma” to increased migratory behavior.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response offers published scientific journal articles as evidence of its claims and provides citations.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 263, "question_text": "My loved one has pancreatic cancer and we’re dealing with the challenge of cultural differences in medical decision-making. How do we navigate this sensitively?", "rubric_items": [ { "item_number": 1, "description": "The response recommends discussing this with a social worker, spiritual counselor, or Palliative Care specialist.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response encourages the patient, family members, and medical team to remain respectful and open toward one another throughout the decision-making process.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response recommends that the patient or family ask the oncology team whether cultural mediators are available to help with communication and medical decision-making.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response recommends that the patient and family members communicate their important cultural beliefs to their oncology team for better understanding.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response strongly recommends that a medical interpreter is present for all medical appointments.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response suggests that the patient request more time for their appointments, especially if a medical interpreter is needed.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response suggests the patient and/or family inquire about services a patient advocacy office could provide.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response encourages the patient to communicate their preferences around medical decision-making with their oncology team.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response recommends online resources for both patients and medical teams to learn about particular cultural norms around medical care.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response recommends medical teams to complete thorough documentation on patient preferences surrounding communication and medical decision-making.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response recommends organizations that support cancer patients and their families and includes contact information or a website for each.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response recommends setting boundaries.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 264, "question_text": "My husband has pancreatic cancer and we want to understand more about cancer cell elasticity. How does cell stiffness or softness affect cancer progression?", "rubric_items": [ { "item_number": 1, "description": "The response mentions tissue stiffness.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response relates tissue properties to their potential effect on cancer spread.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response relates tissue properties to their potential effect on treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response offers published scientific journal articles as evidence of its claims and provides citations.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response explains cancer cell deformability.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response defines extracellular matrix and cytoskeleton.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response explains cell adhesion processes.", "min_points": 0, "max_points": 3 }, { "item_number": 8, "description": "The response describes how cell deformity changes in cancer cells as compared to normal cells.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response describes the impact of enhanced deformability of cancer cells on their ability to metastasize.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response explains ways that cancer cells migrate from the primary tumor, including hematologic and lymphatic spread, perineural invasion, and direct invasion.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response describes how cancer cells with increased ability to deform survive stresses that normal cells would not.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response explains how increased deformability capabilities are necessary for cells to travel within the desmoplastic stroma of pancreatic cancer.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response describes desmoplastic stroma as a dense, fibrotic, extracellular-matrix-rich component of the pancreatic cancer tumor microenvironment.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 265, "question_text": "My loved one has pancreatic cancer and we’re trying to understand the role of confinement in cancer cell behavior. How does physical space restriction affect cancer cells?", "rubric_items": [ { "item_number": 1, "description": "The response explains how physical space restriction affects cancer cell behavior.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response explains how confinement caused by desmoplastic stroma promotes cancer cell migration, invasion, or metastasis.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response explains how confinement caused by desmoplastic stroma can promote genetic mutations, such as through nuclear deformation, DNA damage, or genomic instability.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response explains how confinement caused by desmoplastic stroma enhances cancer cells’ ability to survive and adapt to stress, for example by activating survival pathways, increasing stress tolerance, or promoting therapy resistance.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response explains the biology of how cells sense mechanical stress using layman’s terms, including at least one analogy or example that avoids jargon.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response discusses the biology of how cells respond to mechanical stress using layman’s terms, including at least one analogy or example that avoids jargon.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response provides at least one specific citation from a published scientific journal article as evidence for its statements.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response explicitly relates tissue properties to their potential effect on cancer spread, including at least one specific example or mechanism.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response explicitly relates tissue properties to their potential consequences for treatment effectiveness and resistance, including at least one specific example or mechanism.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response defines confinement in the context of cancer cells by explaining that cancer cells are physically constrained or mechanically restricted by their surrounding environment.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response defines desmoplastic stroma in pancreatic cancer as dense fibrotic tissue surrounding the tumor and explains how it forms.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response explicitly connects desmoplastic stroma to the confinement of cancer cells, explaining how it creates physical restriction.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response mentions the role of hypoxia in pancreatic cancer and describes why pancreatic tumors are in a hypoxic environment, using terms like “low-oxygen” or “dense stroma.”", "min_points": 0, "max_points": 7 }, { "item_number": 14, "description": "The response states that understanding confinement is an area of active scientific research.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 266, "question_text": "My father has pancreatic cancer and we’re dealing with the challenge of maintaining family traditions during treatment. What approaches help preserve meaningful activities?", "rubric_items": [ { "item_number": 1, "description": "The response recommends flexibility in plans and modifications to allow the father to participate in family traditions.", "min_points": 0, "max_points": 3 }, { "item_number": 2, "description": "The response recommends discussing this with a social worker, spiritual worker, counselor, or Palliative Care specialist.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response mentions the importance of a strong support system during cancer treatment.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response provides examples of organizations with resources for cancer patients and their families and includes contact information or a website.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response recommends open communication.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response recommends cancer support groups as helpful resources.", "min_points": 0, "max_points": 3 }, { "item_number": 7, "description": "The response should recommend that the patient prioritize management of cancer or cancer-treatment related side effects to feel as “normal” as possible to be present for himself and his family.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should recommend that the family members consider documentation of the family traditional events with their father, as a way to reminisce and honor his presence.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should encourage the family members to be thoughtful about ways their father can feel included in family events.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response should suggest that the family seek their father’s input on what meaningful events and activities he desires to participate in.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response explicitly encourages the patient and loved ones to consider professional mental health support during this challenging time.", "min_points": 0, "max_points": 4 } ] }, { "question_number": 267, "question_text": "My mother has pancreatic cancer and we want to understand more about cancer cell swimming. How do cancer cells move through fluid environments?", "rubric_items": [ { "item_number": 1, "description": "The response explains cancer metastasis in layman’s terms, using accessible language and avoiding jargon, including that cancer cells can move from the primary tumor to other parts of the body.", "min_points": 0, "max_points": 8 }, { "item_number": 2, "description": "The response describes major routes of cancer spread, including direct invasion, lymphatic metastasis, and hematologic spread through the blood.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response clarifies that cancer cells do not “swim” like bacteria or sperm because they generally lack swimming machinery such as flagella or motile cilia.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response distinguishes cancer cell movement in solid tissues from movement in fluid-filled environments.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response explicitly mentions epithelial-to-mesenchymal transition (EMT) by name and explains how it can help cancer cells become more migratory or invasive.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response explains active cancer cell movement mechanisms in fluid-filled environments, including amoeboid motility and/or membrane fluctuations.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response explains chemical gradients, defines chemotaxis, and gives at least one example of how cancer cells may follow chemical signals.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response defines desmoplastic stroma in pancreatic cancer and explains how the dense stromal environment affects cancer cell movement.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response provides links to scientific literature discussing ways cancer cells can move through fluid substances, including PMIDs when available.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 268, "question_text": "My loved one has pancreatic cancer and we’re trying to understand the role of surface tension in cancer. How do interfacial forces affect cancer cell behavior?", "rubric_items": [ { "item_number": 1, "description": "The response defines surface tension.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response defines interfacial forces.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response describes the influence of surface tension on pancreatic cancer cells, specifically mentioning cell detachment, migration, or tumor spheroid formation.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response describes the role of interfacial forces during cancer cell metastasis, specifically mentioning cell detachment, migration, or invasion.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response states interfacial tissue planes typically serve as barriers for cancer spread.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response explains cancer metastasis in layman’s terms.", "min_points": 0, "max_points": 7 }, { "item_number": 7, "description": "The response gives examples of how cancer spreads in the body, including direct invasion by the tumor, spread through the lymphatic system, and spread through the blood.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response discusses some of the cellular mechanisms by which cancer spreads in the body.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response mentions epithelial to mesenchymal transition.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response describes cell-to-cell adhesion, specifically in the context of tumor spheroid formation and the balance with surface tension.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response describes at least two mechanical cues in the tumor microenvironment, such as stiffness or surface tension, and how cancer cells sense these signals.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response mentions desmoplastic stroma and its relevance to pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response defines the extracellular matrix.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response describes how normal cells and cancer cells interact with the extracellular matrix.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 269, "question_text": "My husband has pancreatic cancer and we’re dealing with the challenge of long-term uncertainty. How do we live with not knowing what the future holds?", "rubric_items": [ { "item_number": 1, "description": "The response explicitly recommends discussing uncertainty or care planning with the patient’s oncologist.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explicitly recommends discussing with a social worker, spiritual worker, counselor, or Palliative Care specialist.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response explicitly recommends cancer support groups as helpful resources.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response explicitly recommends establishing the patient’s goals of care.", "min_points": 0, "max_points": 10 }, { "item_number": 5, "description": "The response explicitly recommends open communication between patient and caregivers.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response provides examples of organizations with resources for cancer patients and their families.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should attempt to normalize the challenge of living with long-term uncertainty with a family member dealing with pancreatic cancer.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should recommend attempting to preserve normal routines in the home as much as possible.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should emphasize the importance of quality of life when facing a serious diagnosis.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should suggest ways to maintain good quality of life for patients.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should recommend that patients and family members learn about the disease to understand expected outcomes.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response names at least one specific cancer support group, peer group, community group, or support platform as a resource.", "min_points": 0, "max_points": 7 }, { "item_number": 13, "description": "The response includes a website or other contact information for at least one organization that offers resources for cancer patients and their families.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response provides a link or website to a concrete resource where pancreatic cancer patients and family members can find support groups and information.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response explicitly recommends asking the oncology team for updates and communication as often as needed to stay informed about the diagnosis, treatment, or prognosis.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 270, "question_text": "My loved one has pancreatic cancer and we want to understand more about cancer cell climbing. How do cancer cells move along surfaces and fibers?", "rubric_items": [ { "item_number": 1, "description": "The response explains cancer metastasis in layman’s terms.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response gives examples of how cancer spreads in the body, including direct invasion by the tumor, spread through the lymphatic system, and spread through the blood.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response explains the biology of cell adhesion in layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response mentions integrins and cadherins.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response contrasts the biology of cancer cell adhesion with normal cell adhesion using layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response provides published scientific journal articles as evidence for its statements and cites its sources.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response mentions changes to cell adhesion in pancreatic cancer specifically.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response should describe cell-to-cell adhesion and include definitions of integrins, collagen, and fibronectin.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should define extracellular matrix.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response should define actin and myosin, and describe how these proteins act to deform cells to assist in traction and movement.", "min_points": 0, "max_points": 7 }, { "item_number": 11, "description": "The response should define chemotaxis.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should define amoeboid migration.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should desmoplastic stroma.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should describe how pancreatic cancer forms desmoplastic stroma in its environment.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should describe how pancreatic cells interact with desmoplastic stroma.", "min_points": 0, "max_points": 7 }, { "item_number": 16, "description": "The response should define tumor microenvironment.", "min_points": 0, "max_points": 5 }, { "item_number": 17, "description": "The response should describe how pancreatic cancer cells interact with the tumor microenvironment, and how different elements encourage cell travel, such as inflammation and hypoxia.", "min_points": 0, "max_points": 5 }, { "item_number": 18, "description": "The response should describe the effect of DNA mutations, such as KRAS, on a pancreatic cancer cell’s potential to travel outside of the primary site.", "min_points": 0, "max_points": 5 }, { "item_number": 19, "description": "The response should explain that pancreatic cancer can also spread by perineural invasion, meaning cancer cells travel along or around nerves.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 271, "question_text": "My father has pancreatic cancer and we’re trying to understand the role of geometry in cancer. How do shapes and structures in tissues affect cancer progression?", "rubric_items": [ { "item_number": 1, "description": "The response describes how normal tissue structure is disrupted in solid cancer.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response describes that cancer cells proliferate in an unchecked fashion, disrupting the architecture of their environment.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response defines geometry in biology and medicine, and with regards to human cells and their surrounding structures.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response describes that normal cells exist in a neat, orderly, and structured space within their respective tissues.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response describes the components of normal tissue architecture, such as collagen and extracellular matrix.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response describes desmoplastic stroma in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response describes the effect of desmoplastic stroma on pancreatic cell proclivity to migrate and spread.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response mentions the role of blood vessels in drug delivery, and how this can be impacted by pancreatic tumors and desmoplastic stroma.", "min_points": 0, "max_points": 7 }, { "item_number": 9, "description": "The response clearly explains cancer metastasis in layman’s terms, avoiding jargon and providing accessible explanations.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response explicitly mentions all three main routes of cancer spread: direct invasion, lymphatic spread, and hematogenous spread.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response discusses at least two cellular mechanisms by which cancer spreads, such as changes in cell shape, loss of adhesion, or influence of the microenvironment.", "min_points": 0, "max_points": 7 }, { "item_number": 12, "description": "The response explicitly mentions epithelial to mesenchymal transition (EMT) by name or describes the process.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response mentions cancer metastasis as a response to cell stress, including stress-induced mechanisms.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 272, "question_text": "My mother has pancreatic cancer and we’re dealing with the challenge of maintaining privacy while seeking support. How do we balance these needs?", "rubric_items": [ { "item_number": 1, "description": "The response recommends respectful and honest communication.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response recommends maintaining personal boundaries.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response recommends considering online cancer support groups as a way to seek support while preserving confidentiality from local social circles.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response provides examples of organizations with resources for cancer patients and their families and includes contact information or a website.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response emphasizes the importance of a strong support system.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response should inform the patient and family members that medical records are subject to HIPAA laws, which prevent divulgence of medical information unless a patient has specifically consented to this.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should recommend that the patient inform their oncology care team of their wishes to keep their diagnosis confidential.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response should recommend that the patient and family members be careful and thoughtful with social media posting to maintain her confidentiality.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should recommend that the patient and/or family members seek a balance; it is OK to be selective with sharing her diagnostic information however isolation for patients and/or caregivers can accelerate burnout.", "min_points": 0, "max_points": 10 }, { "item_number": 10, "description": "The response recommends explicitly telling everyone already aware of the diagnosis not to share that information with others.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response provides online links to pancreatic-cancer-specific support resources for both patients and caregivers.", "min_points": 0, "max_points": 10 } ] }, { "question_number": 273, "question_text": "My loved one has pancreatic cancer and we want to understand more about cancer cell squeezing. How do cancer cells move through tight spaces?", "rubric_items": [ { "item_number": 1, "description": "The response explains cancer metastasis in layman’s terms, avoiding jargon and providing context for a lay audience.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response explicitly mentions and explains the three main routes of cancer spread: direct invasion by the tumor, spread through the lymphatic system, and spread through the blood.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response discusses at least three cellular mechanisms by which cancer spreads, such as changes in cell shape, breakdown of the extracellular matrix, increased deformability, use of filopodia/invadopodia, or epithelial-to-mesenchymal transition (EMT).", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response explicitly mentions epithelial-to-mesenchymal transition (EMT) and explains its relevance to cancer cell migration and invasion.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response mentions cancer metastasis as a response to cell stress.", "min_points": 0, "max_points": 3 }, { "item_number": 6, "description": "The response should define the extracellular matrix.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response should describe the different components of the extracellular matrix.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should define desmoplastic stroma and describe how this is formed in the pancreatic cancer environment.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should describe how cancer cells are able to deform their shapes.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should explain the cellular cytoskeleton and its main component parts, such as actin and myosin.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should describe amoeboid movement in cells and include a description of filopodia.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should describe mesenchymal movement in cancer cells and provide examples of enzymes used by cancer cells in this phenomenon.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should provide links to any scientific literature it references, including PMID.", "min_points": 0, "max_points": 7 }, { "item_number": 14, "description": "The response should explain how cells can use ion gradients to prompt movement.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should describe the importance of pancreatic cancer cells’ ability to deform or “squeeze” in the desmoplastic stromal environment for survival and spread.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should include information about how the nucleus is thought to be deformable in cancer cell migration.", "min_points": 0, "max_points": 5 }, { "item_number": 17, "description": "The response explicitly defines cancer cell migration as the movement of cancer cells and defines metastasis as the spread of cancer cells from the original tumor to other parts of the body.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 274, "question_text": "My husband has pancreatic cancer and we’re trying to understand the role of topology in cancer. How do the connectivity and structure of tissue networks affect cancer spread?", "rubric_items": [ { "item_number": 1, "description": "The response defines topology.", "min_points": 0, "max_points": 10 }, { "item_number": 2, "description": "The response describes non-neural routes of cancer spread, including direct invasion by the tumor, lymphatic spread, and hematologic spread through the blood.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response states that in cancer care, topology may relate to the organization of tissues, blood vessels, or lymphatics.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response states the anatomic organization of cancer may impact the cancer’s stage or likelihood to respond to certain treatments like surgery or radiation.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response explains cancer metastasis in layman’s terms.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response discusses some of the cellular mechanisms by which cancer spreads in the body.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should describe tissue networks and their component parts.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response should define the extracellular matrix and describe its component parts.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should describe the desmoplastic stroma that pancreatic cancer encourages to grow in its environment.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should describe how abnormal tissue, such as desmoplastic stroma, increases in density of tissue network structures and encourages cancer growth and spread.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response should describe the roles of blood and lymph vessels in cancer spread.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should explain how disrupted tissue architecture can encourage cancer growth and spread.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should describe cell-to-cell adhesions in normal cells, and how cancer cells can disrupt these adhesions making them more able to migrate.", "min_points": 0, "max_points": 7 }, { "item_number": 14, "description": "The response should describe how mechanical properties of tissue can stimulate tumor growth and spread.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response states that pancreatic cancer can also spread by perineural invasion, meaning cancer cells track along or around nerves.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 275, "question_text": "My loved one has pancreatic cancer and we’re dealing with the challenge of maintaining optimism for our children while being honest about the situation. How do we handle this?", "rubric_items": [ { "item_number": 1, "description": "The response suggests asking the oncology team for prognostic information to better understand the expected outcomes of treatment.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response recommends discussing this with a social worker, spiritual worker, counselor, or Palliative Care specialist.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response recommends honest and open communication between patient and caregivers.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response recommends tailoring the discussion to the age of the children.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response provides pancreatic-cancer-specific online resources, including both disease information and support group or community resources.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response provides examples of organizations with resources for cancer patients and their families and includes contact information or a website.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response recommends establishing the patient’s goals of care.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should emphasize the importance of maintaining mental health throughout the cancer diagnosis and treatment process.", "min_points": 0, "max_points": 10 }, { "item_number": 9, "description": "The response should state that it is normal to feel this conflict in the face of a pancreatic cancer diagnosis.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should explain quality of life, and describe factors of cancer treatment that can impact the patient’s quality of life.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should suggest that the patient and/or family members leverage support systems.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response recommends professional counseling or therapy to help the patient and/or family cope and maintain a positive attitude in the face of serious illness.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response emphasizes supporting the patient’s autonomy in decisions about their care.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response provides resources specifically for children affected by a family member’s pancreatic cancer diagnosis.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response recommends remaining honest and open with children about the family member’s pancreatic cancer.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 276, "question_text": "My father has pancreatic cancer and we want to understand more about cancer cell collective migration. How do groups of cancer cells move together?", "rubric_items": [ { "item_number": 1, "description": "The response describes at least three metastatic routes for pancreatic cancer, selected from local solid tissue invasion, hematologic spread, lymphatic spread, and perineural invasion.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response discusses cell-to-cell adhesions in both normal cells and cancer cells, highlighting differences.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response explains cancer metastasis in layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 4, "description": "The response discusses some of the cellular mechanisms by which cancer spreads in the body.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response mentions epithelial to mesenchymal transition.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response explains the biology of cell adhesion in layman’s terms.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response provides published scientific journal articles as evidence for its statements and cites its sources.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response explains the concept of “leader cells” and implies the presence of “follower cells” in a group of cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response describes amoeboid movement in cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response describes mesenchymal migration in cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response defines the extracellular matrix.", "min_points": 0, "max_points": 3 }, { "item_number": 12, "description": "The response defines desmoplastic stroma.", "min_points": 0, "max_points": 3 }, { "item_number": 13, "description": "The response describes how pancreatic cancer cells interact with desmoplastic stroma to encourage cancer cell growth and migration.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response explains how “leader cells” influence a clump of traveling cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response defines at least one additional cell-to-cell adhesion protein other than cadherins, such as selectins, claudins, occludins, or immunoglobulin-superfamily cell adhesion molecules.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response describes how cells communicate with each other, such as through chemical signals or enzymes.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 277, "question_text": "My mother has pancreatic cancer and we’re trying to understand the role of curvature in cancer. How do curved surfaces and structures affect cancer cell behavior?", "rubric_items": [ { "item_number": 1, "description": "The response defines curvature.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response states that in cancer care, curvature may relate to the organization of tissues, blood vessels, or lymphatics.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response states the anatomic organization of cancer may impact the cancer’s stage or likelihood to respond to certain treatments like surgery or radiation.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response explains cancer metastasis in layman’s terms.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response gives examples of how cancer spreads in the body, including direct invasion by the tumor, spread through the lymphatic system, and spread through the blood.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response discusses some of the cellular mechanisms by which cancer spreads in the body.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should define the extracellular matrix.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should define epithelial-to-mesenchymal transition (EMT).", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should explain cancer cell migration.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should describe the effect of mechanical forces on cell signaling.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should describe how varying levels of positive or negative curvature at the cellular level influence EMT and cancer cell migration.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should describe the effect of mechanical forces of tissues on cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should describe desmoplastic stroma in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response should include that cellular curvature acts as both a signal and constraint in cancer cell progression.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should describe cancer cell membrane tension, and what occurs when this force is too high.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should describe how high cell surface membrane tension, such as from curvature, can hinder movement of the cytoskeleton.", "min_points": 0, "max_points": 7 }, { "item_number": 17, "description": "The response should describe the effects of mechanical tension at the level of tissue and organs, particularly if imbalanced, on the spread of pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 18, "description": "The response should define paracrine signaling and explain its role in pancreatic cancer cell communication.", "min_points": 0, "max_points": 5 }, { "item_number": 19, "description": "The response references scientific literature on how cellular curvature influences epithelial-to-mesenchymal transition (EMT) and cancer cell migration, and includes a PMID if available.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 278, "question_text": "My loved one has pancreatic cancer and we’re dealing with the challenge of celebrating milestones during treatment. How do we acknowledge important moments while managing the illness?", "rubric_items": [ { "item_number": 1, "description": "The response should recommend that patients discuss plans for celebrations with their oncology teams, to better plan treatments around in order to ensure the patient is feeling their best.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response recommends discussing this with a social worker, counselor, or Palliative Care professional.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response recommends cancer support groups as a resource.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response offers examples of organizations that support cancer patients and their families and provides contact information or a website.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response emphasizes the importance of quality of life.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response emphasizes the importance of establishing a strong support system.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should emphasize the importance of controlling symptoms related to pancreatic cancer or its treatment.", "min_points": 0, "max_points": 10 }, { "item_number": 8, "description": "The response should recommend that caregivers take measures to prevent burnout.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response should recommend that loved ones plan small, meaningful gatherings with the patient.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should emphasize the importance of flexibility when planning events with a patient with pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response should recommend that planners of celebrations consider incorporating time for rest and keep gatherings small and simple.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should suggest that a professional therapist or counselor can help maintain mental health in patients experiencing pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response should recommend that patients and/or family members take care of any legal and/or medical paperwork as soon as possible.", "min_points": 0, "max_points": 7 }, { "item_number": 14, "description": "The response should explain that there will likely be a decline in overall health of the patient over time, and expectation management should be discussed by the patient and their oncology team.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response should emphasize remaining patient and understanding if celebration plans fall through because of the patient’s condition.", "min_points": 0, "max_points": 5 }, { "item_number": 16, "description": "The response should explain that completing legal and medical paperwork early can help prevent those topics from needing to be discussed during celebrations.", "min_points": 0, "max_points": 3 } ] }, { "question_number": 279, "question_text": "My husband has pancreatic cancer and we want to understand more about cancer cell jamming. How do crowded conditions affect cancer cell movement?", "rubric_items": [ { "item_number": 1, "description": "The response clearly explains how changes in tissue density and architecture (cell jamming) influence cancer cell movement, tumor aggressiveness, and metastasis.", "min_points": 0, "max_points": 7 }, { "item_number": 2, "description": "The response defines and explains cancer cell jamming.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response defines and describes cancer cells that are in an unjammed state.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response describes how cancer cells become unjammed.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response describes the intrinsic properties of cells that contribute to jamming and unjamming of cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 6, "description": "The response describes the extrinsic properties of cells that contribute to jamming and unjamming of cancer cells.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response explains how unjamming of cancer cells contributes to cancer spread and migration of cancer cells.", "min_points": 0, "max_points": 7 }, { "item_number": 8, "description": "The response explains methods of cancer cell movement.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response explains how jamming occurs in normal cells.", "min_points": 0, "max_points": 3 }, { "item_number": 10, "description": "The response explicitly discusses changes to tissue architecture specific to pancreatic cancer, such as desmoplastic reaction, fibrosis, or stromal remodeling.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response explicitly discusses the implications of altered tissue architecture on cancer treatment, specifically mentioning reduced drug delivery or immune cell penetration.", "min_points": 0, "max_points": 10 }, { "item_number": 12, "description": "The response includes citations from published scientific journal articles to support its claims.", "min_points": 0, "max_points": 7 }, { "item_number": 13, "description": "The response explicitly states that cancer cells in a jammed state have restricted or minimal movement compared with an unjammed state.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 280, "question_text": "My loved one has pancreatic cancer and we’re trying to understand the role of pattern formation in cancer. How do organized structures emerge in tumors?", "rubric_items": [ { "item_number": 1, "description": "The response must define mechanical forces in the tumor environment, such as tissue stiffness or solid stress, and explain how these forces contribute to the emergence of organized tumor structures.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response explicitly discusses intercellular communication between pancreatic cancer cells and stromal cells, such as fibroblasts or pancreatic stellate cells.", "min_points": 0, "max_points": 7 }, { "item_number": 3, "description": "The response explicitly connects specific tissue properties, such as stiffness or fibrosis, to the process of cancer spread, including invasion or metastasis.", "min_points": 0, "max_points": 5 }, { "item_number": 4, "description": "The response explicitly relates specific tissue properties, such as stiffness or fibrosis, to treatment response or resistance in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 5, "description": "The response provides at least one citation from a published scientific journal article to support its claims.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response must describe the concept of pattern formation in cellular structures, including at least two biological processes contributing to these patterns.", "min_points": 0, "max_points": 10 }, { "item_number": 7, "description": "The response must provide at least two commonly recognizable examples of biological pattern formation, such as embryonic development or tissue architecture.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response must describe how organized structures develop in tumors, mentioning at least two mechanisms.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response must explain how DNA mutations in cancer cells can change their behavior, linking these changes to pattern formation.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response must describe how cancer cells promote angiogenesis, including the secretion of signals for new blood vessel growth.", "min_points": 0, "max_points": 5 }, { "item_number": 11, "description": "The response must explain how cancer cells interact with tissues in their environment, including interactions with the extracellular matrix.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response must define and describe the extracellular matrix, including its composition or function.", "min_points": 0, "max_points": 5 }, { "item_number": 13, "description": "The response must define and describe desmoplastic stroma in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 14, "description": "The response must explain the influence of the tumor microenvironment on tumor cell pattern formation, including at least one component.", "min_points": 0, "max_points": 5 }, { "item_number": 15, "description": "The response must describe evolutionary pressures on cancer cells and the acquisition of DNA mutations, including at least one selective advantage.", "min_points": 0, "max_points": 7 } ] }, { "question_number": 281, "question_text": "My father has pancreatic cancer and we’re dealing with the challenge of making memories while managing the reality of limited time. What approaches help create meaningful experiences?", "rubric_items": [ { "item_number": 1, "description": "The response should emphasize the importance of focusing on prioritization of quality time, over quantity.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response recommends discussing this with a social worker, counselor, Hospice services, or Palliative Care professional.", "min_points": 0, "max_points": 10 }, { "item_number": 3, "description": "The response recommends discussing this with the patient’s healthcare team.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response recommends cancer support groups as a resource.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response offers examples of organizations that support cancer patients and their families and provides contact information or a website.", "min_points": 0, "max_points": 7 }, { "item_number": 6, "description": "The response emphasizes the importance of establishing a strong support system.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response should encourage patients to open lines of communication with their affected family member, such as daily phone calls to check in.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response should encourage loved ones of a pancreatic cancer patient to consider legacy-building activities, such as photobook creation or writing letters to loved ones.", "min_points": 0, "max_points": 3 }, { "item_number": 9, "description": "The response should recommend keeping family members and loved ones involved in the patient’s life, being mindful of the patient’s energy level.", "min_points": 0, "max_points": 5 }, { "item_number": 10, "description": "The response should suggest that the patient and/or family members prioritize symptom management related to cancer or treatment, in order to ensure the patient is feeling their physical best if possible.", "min_points": 0, "max_points": 10 }, { "item_number": 11, "description": "The response should recommend ways to document events and/or moments for future reference.", "min_points": 0, "max_points": 5 }, { "item_number": 12, "description": "The response should recommend the use of technology, such as video calls (e.g., Zoom) to keep in contact with loved ones without having to travel.", "min_points": 0, "max_points": 7 }, { "item_number": 13, "description": "The response should emphasize the importance of preventing caregiver burnout.", "min_points": 0, "max_points": 5 } ] }, { "question_number": 282, "question_text": "My mother has pancreatic cancer and we want to understand more about cancer cell waves. How do coordinated movements propagate through cancer cell populations?", "rubric_items": [ { "item_number": 1, "description": "The response describes cellular waves as a form of coordinated cell-to-cell signaling or intercellular communication in pancreatic cancer.", "min_points": 0, "max_points": 5 }, { "item_number": 2, "description": "The response states that tumors are not typically functioning tissues.", "min_points": 0, "max_points": 5 }, { "item_number": 3, "description": "The response reviews the biology of intercellular communication.", "min_points": 0, "max_points": 7 }, { "item_number": 4, "description": "The response provides published scientific journal articles as evidence for its statements and cites its sources.", "min_points": 0, "max_points": 7 }, { "item_number": 5, "description": "The response defines cancer cell waves and explicitly states that there are several different types of waves known to exist in cancer cell biology.", "min_points": 0, "max_points": 10 }, { "item_number": 6, "description": "The response describes calcium waves and provides a PMID of referenced scientific literature.", "min_points": 0, "max_points": 5 }, { "item_number": 7, "description": "The response describes bioelectric waves and provides a PMID of referenced scientific literature.", "min_points": 0, "max_points": 5 }, { "item_number": 8, "description": "The response describes metabolic (glycolytic) waves and provides a PMID of referenced scientific literature.", "min_points": 0, "max_points": 5 }, { "item_number": 9, "description": "The response explains at least three different mechanisms of cell-to-cell communication, such as cell-cell adhesion, signaling pathways, chemokine gradients, mechanical forces, or heterotypic interactions.", "min_points": 0, "max_points": 7 }, { "item_number": 10, "description": "The response defines and describes paracrine signaling explicitly.", "min_points": 0, "max_points": 3 }, { "item_number": 11, "description": "The response explains how cellular waves may affect pancreatic cancer behavior, such as invasion, metastasis, proliferation, or therapy resistance.", "min_points": 0, "max_points": 5 } ] } ] }