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.
背景：总体而言，影像学检查在胰腺癌切除术后随访中的应用日益增多。因此，被诊断为转移性胰腺癌（mPDAC）的无症状患者数量也在增加。对于这些患者，姑息性全身治疗是唯一的肿瘤导向治疗选择，因此通常立即启动。然而，在无症状的姑息治疗患者中延迟治疗可能有助于维持生活质量并避免治疗相关毒性，但其对生存的影响尚不明确。本研究旨在深入了解专家对无症状mPDAC患者治疗启动时机的当前观点和临床决策。 方法：向过去10年内发表mPDAC临床试验的所有第一作者和通讯作者，以及荷兰胰腺癌小组的肿瘤内科医生发送了一份在线调查（包含13个问题和9个临床案例）。使用Kappa Light检验评估评分者间差异。采用Fisher精确检验分析不同国家、大洲和经验年限在治疗启动时机偏好上的差异。 结果：来自15个国家的291名肿瘤内科医生中，共有78人（27%）回复了调查（其中62%来自欧洲，23%来自北美，15%来自亚太地区）。大多数受访者（63%）倾向于在诊断后立即开始化疗。在9个临床案例中的3个里，特定临床情境下（如患者仅有单个小型肺转移灶、存在显著合并症或年龄较高）更倾向于延迟治疗。在9个案例中的7个里，评分者间存在显著差异。治疗启动的推荐时机在2/9（22%）的案例中因大洲而异，在比较荷兰与其他国家时，7/9（77.9%）的案例存在差异，而基于经验年限的差异出现在5/9（56%）的案例中。 结论：尽管回复率有限，但对于无症状mPDAC患者，立即治疗是最常见的选择。对于转移灶有限、合并症较多及年龄较高的患者，会考虑延迟治疗直至症状出现。
肿瘤(癌症)患者之家