Gemcitabine plus Abraxane can sometimes shrink pancreatic cancer and relieve symptoms caused by the cancer, but it can also cause fatigue, low blood counts, infection risk, nausea, appetite loss, neuropathy and weakness.

If you are already in significant discomfort, I think the important question isn't simply, “Can I tolerate chemotherapy?” It is, “What is the realistic chance this treatment will make me feel better or give me meaningful additional time, and how likely is it to make me feel worse?”

I would ask your oncologist very directly:

“For someone in my condition, what are the realistic chances that this treatment will shrink the cancer and improve how I feel? How much additional time might it give me, and what would you recommend if maintaining my quality of life is my highest priority?”

You could also ask whether starting with a reduced dose or modified schedule would be reasonable. Another possibility is agreeing with your oncologist to try treatment for a short period and reassessing. Starting chemotherapy doesn't mean you are committed to continuing it if the side effects become unacceptable or it isn't helping.

I would also consider getting a second opinion from a pancreatic cancer specialist before making an irreversible decision, particularly if you haven't already done so. Being told that a cancer is incurable doesn't necessarily mean there are no treatments capable of controlling it for a meaningful period of time.