Perspectives of the medical oncologist regarding adjuvant chemotherapy for pancreatic cancer: An international expert survey and case vignette study

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2024-12-12 DOI:10.1016/j.ejso.2024.109544

N.C. Biesma , M.U.J.E. Graus , G.A. Cirkel , M.G. Besselink , J.W.B. de Groot , B. Groot Koerkamp , K.H. Herbschleb , M. Los , R.C. Verdonk , J.W. Wilmink , A. Cervantes , J.W. Valle , L.B.J. Valkenburg-van Iersel , F.E.M. Froeling , I.Q. Molenaar , L.A. Daamen , J. de Vos-Geelen , H.C. van Santvoort

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Abstract

Introduction

Adjuvant chemotherapy improves survival in patients with resected pancreatic ductal adenocarcinoma (PDAC). The decision to initiate chemotherapy involves both patient and physician factors, decision-specific criteria, and contextual considerations. This study aimed to assess medical oncologists' views on adjuvant chemotherapy following pancreatic resection for PDAC.

Methods

An online survey and case vignette study were distributed to medical oncologists via the Dutch Pancreatic Cancer Group (DPCG), International Hepato-Pancreato-Biliary Association (IHPBA) and related networks.

Results

A total of 91 oncologists from 14 countries participated, 46 % of whom treated more than 40 new PDAC patients annually, with a median experience of 15 years. Significant discrepancies were noted in their recommendations for adjuvant chemotherapy across case vignettes. In patients over 70, 17 % advised against chemotherapy, while 31 % said age was not a factor. Oncologists with less than 10 years of experience and those in non-academic settings were less likely to recommend adjuvant therapy. While 87 % agreed mFOLFIRINOX is the preferred adjuvant treatment, consensus on individual cases was lacking. The recommended interval between surgery and chemotherapy ranged from 3 to 26 weeks, with varying reasons for withholding treatment, primarily due to postoperative recovery and performance status.

Conclusions

Our study revealed substantial variation among oncologists in counseling on adjuvant chemotherapy after PDAC resection. This emphasizes the need for more patient involvement in decision-making and improving shared decision-making.

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医学肿瘤学家对胰腺癌辅助化疗的看法：一项国际专家调查和病例研究。

导读：辅助化疗可提高胰腺导管腺癌（PDAC）切除术患者的生存率。决定是否开始化疗涉及患者和医生的因素、决定的具体标准和环境考虑。本研究旨在评估医学肿瘤学家对PDAC胰腺切除术后辅助化疗的看法。方法：通过荷兰胰腺癌组织（DPCG）、国际肝胆胆协会（IHPBA）及相关网络向内科肿瘤学家分发在线调查和病例研究。结果：共有来自14个国家的91名肿瘤学家参与，其中46%的人每年治疗超过40名新的PDAC患者，中位经验为15年。不同病例的辅助化疗建议存在显著差异。在70岁以上的患者中，17%的人建议反对化疗，而31%的人表示年龄不是一个因素。经验少于10年的肿瘤学家和那些在非学术环境中的肿瘤学家不太可能推荐辅助治疗。虽然87%的人同意mFOLFIRINOX是首选的辅助治疗，但在个别病例上缺乏共识。推荐的手术和化疗间隔时间为3 - 26周，不治疗的原因各不相同，主要是由于术后恢复和运动状态。结论：我们的研究揭示了肿瘤学家在PDAC切除术后辅助化疗的咨询方面存在实质性差异。这强调需要更多的患者参与决策和改善共同决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.