Table 4.
Section IV results: treatment
| Median (IQR) | Agreement (%) | Result | |
|---|---|---|---|
| 22. In all cases, the treatment to be applied (or, if appropriate, the conduct of new diagnostic examinations) should be established by the MDC constituted in the center | 9 (8–9) | 91.0 | First round agreement |
| 23. The MDC should always include specialists in medical and radiotherapeutic oncology, surgery, pathology, radiology, digestive apparatus, ecoendoscopy and nutrition/dietetics. Optionally, each center may opt for the additional participation of specialists in critical care (ICU/anesthesia), endocrinology, interventional radiology or other specialties | 9 (7–9) | 88.8 | First round agreement |
| 24. Centers that do not have MDC should refer the patient with a clear diagnosis or suspicion of pancreatic cancer to a referral center that does | 9 (8–9) | 88.8 | First round agreement |
| 25. MDC decision-making sessions should be held at least weekly | 9 (7–9) | 79.8 | First round agreement |
| 26. Overall, the maximum time elapsed from the definitive diagnosis (including preliminary staging) to the start of treatment should be 15 days–1 month | 9 (8–9) | 92.1 | First round agreement |
| 27. In approximately 20–30% of patients the decision of CMD may be surgical treatment with curative intent. In such a case, the maximum time elapsed from decision to intervention should be 4 weeks, but it should be attempted to reduce that time limit as much as possible, ideally less than 15 days | 9 (8–9) | 94.4 | First round agreement |
| 28. Treatment of adjuvant chemotherapy should be initiated not before 3–4 weeks from the intervention nor later than 6–8 weeks after the intervention, unless the patient’s recovery is insufficient | 9 (8–9) | 88.8 | First round agreement |
| 29. In 70–80% of patients who are not candidates for curative intent surgery, treatment should be applied or coordinated by medical oncology specialists. The maximum time elapsed from the decision to the start of treatment should be 7 days for chemotherapy and 15 days for chemoradiotherapy | 8 (7–9) | 84.3 | First round agreement |
| 30. Concomitant chemotherapy and radiotherapy treatment will be scheduled according to the planning of the latter, but should not be delayed for more than 2 weeks | 8 (7–9) | 91.0 | First round agreement |
| 31. Some resection cases can be treated with preoperative chemotherapy or chemoradiotherapy. In this case, the maximum time elapsed from the decision to the start of treatment should be 4 weeks, but an attempt should be made to shorten the time limit as much as possible, to be less than 15 days | 8 (8–9) | 93.3 | First round agreement |
| 32. The initiation of palliative chemotherapy should not be delayed for more than 7 days, if the patient’s condition allows it | 8 (7–9) | 76.4 | First round agreement |
| 33. The treatment, both surgical and medical, should be performed in tertiary centers that have experienced teams and access to all the complementary services that may be needed: ICU, interventional vascular treatment, etc. | 9 (8–9) | 89.9 | First round agreement |
IQR interquartile range