2026-04-14T03:56:47Zhttps://recercat.cat/oai/request

oai:recercat.cat:11351/109532025-09-30T02:07:42Zcom_2072_378070com_2072_378040col_2072_378092

Timing of Initiation of Palliative Chemotherapy in Asymptomatic Patients with Metastatic Pancreatic Cancer: An International Expert Survey and Case-Vignette Study Augustinus, Simone van Laarhoven, H.W.M. Cirkel, Geert A. de Groot, Jan Willem B. Groot Koerkamp, Bas Macarulla, Teresa Institut Català de la Salut [Augustinus S] Department of Surgery, Location University of Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands. Cancer Center Amsterdam, Amsterdam, The Netherlands. [van Laarhoven HWM] Cancer Center Amsterdam, Amsterdam, The Netherlands. Department of Medical Oncology, Location University of Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands. [Cirkel GA] Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. [de Groot JWB] Department of Medical Oncology, Isala Oncology Center, Zwolle, The Netherlands. [Groot Koerkamp B] Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. [Macarulla T] Servei d’Oncologia Mèdica, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain Vall d'Hebron Barcelona Hospital Campus Pàncrees - Càncer - Quimioteràpia Pàncrees - Càncer - Tractament pal·liatiu Metàstasi DISEASES::Neoplasms::Neoplasms by Site::Digestive System Neoplasms::Pancreatic Neoplasms Other subheadings::Other subheadings::Other subheadings::/drug therapy ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Patient Care::Palliative Care DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Asymptomatic Diseases DISEASES::Neoplasms::Neoplastic Processes::Neoplasm Metastasis ENFERMEDADES::neoplasias::neoplasias por localización::neoplasias del sistema digestivo::neoplasias pancreáticas Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::asistencia al paciente::cuidados paliativos ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::atributos de la enfermedad::enfermedades asintomáticas ENFERMEDADES::neoplasias::procesos neoplásicos::metástasis neoplásica Asymptomatic; Expert survey; Pancreatic cancer Asimptomàtic; Enquesta d'experts; Càncer de pàncrees Asintomático; Encuesta de expertos; Cáncer de páncreas Background: The use of imaging, in general, and during follow-up after resection of pancreatic cancer, is increasing. Consequently, the number of asymptomatic patients diagnosed with metastatic pancreatic cancer (mPDAC) is increasing. In these patients, palliative systemic therapy is the only tumor-directed treatment option; hence, it is often immediately initiated. However, delaying therapy in asymptomatic palliative patients may preserve quality of life and avoid therapy-related toxicity, but the impact on survival is unknown. This study aimed to gain insight into the current perspectives and clinical decision=making of experts regarding the timing of treatment initiation of patients with asymptomatic mPDAC. Methods: An online survey (13 questions, 9 case-vignettes) was sent to all first and last authors of published clinical trials on mPDAC over the past 10 years and medical oncologists of the Dutch Pancreatic Cancer Group. Inter-rater variability was determined using the Kappa Light test. Differences in the preferred timing of treatment initiation among countries, continents, and years of experience were analyzed using Fisher’s exact test. Results: Overall, 78 of 291 (27%) medical oncologists from 15 countries responded (62% from Europe, 23% from North America, and 15% from Asia–Pacific). The majority of respondents (63%) preferred the immediate initiation of chemotherapy following diagnosis. In 3/9 case-vignettes, delayed treatment was favored in specific clinical contexts (i.e., patient with only one small lung metastasis, significant comorbidities, and higher age). A significant degree of inter-rater variability was present within 7/9 case-vignettes. The recommended timing of treatment initiation differed between continents for 2/9 case-vignettes (22%), in 7/9 (77.9%) comparing the Netherlands with other countries, and based on years of experience for 5/9 (56%). Conclusions: Although the response rate was limited, in asymptomatic patients with mPDAC, immediate treatment is most often preferred. Delaying treatment until symptoms occur is considered in patients with limited metastatic disease, more comorbidities, and higher age. 2024-02-01T11:44:58Z 2024-02-01T11:44:58Z 2023-11-27 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Augustinus S, Van Laarhoven HWM, Cirkel GA, Willem J, De Groot B, Koerkamp BG, et al. Timing of Initiation of Palliative Chemotherapy in Asymptomatic Patients with Metastatic Pancreatic Cancer: An International Expert Survey and Case-Vignette Study. Cancers. 2023 Nov 27;15(23):5603. 2072-6694 https://hdl.handle.net/11351/10953 10.3390/cancers15235603 38067306 001116116700001 eng Cancers;15(23) https://doi.org/10.3390/cancers15235603 Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess application/pdf MDPI Scientia