Current clinical practice in the management of Brazilian patients with potentially resectable pancreatic ductal adenocarcinoma (PDAC)

Background and ObjectivesWe aimed to describe the routine clinical practice of physicians involved in the treatment of patients with localized pancreatic ductal adenocarcinoma (PDAC) in Brazil.MethodsPhysicians were invited through email and text messages to participate in an electronic survey sponsored by the Brazilian Gastrointestinal Tumor Group (GTG) and the Brazilian Society of Surgical Oncology (SBCO). We evaluated the relationship between variable categories numerically with false discovery rate-adjusted Fisher's exact test p values and graphically with Multiple Correspondence Analysis.ResultsOverall, 255 physicians answered the survey. Most (52.5%) were medical oncologists, treated patients predominantly in the private setting (71.0%), and had access to multidisciplinary tumor boards (MTDTB; 76.1%). Medical oncologists were more likely to describe neoadjuvant therapy as beneficial in the resectable setting and surgeons in the borderline resectable setting. Most physicians would use information on risk factors for early recurrence, frailty, and type of surgery to decide treatment strategy. Doctors working predominantly in public institutions were less likely to have access to MTDTB and to consider FOLFIRINOX the most adequate regimen in the neoadjuvant setting.ConclusionsConsiderable differences exist in the management of localized PDAC, some of them possibly explained by the medical specialty, but also by the funding source of health care. In this survey, we evaluated the clinical practice of 255 physicians involved in the treatment of patients with localized pancreatic cancer. We observed differences in the perception of benefit from neoadjuvant therapy according to the medical specialty, along with differences in access to multidisciplinary tumor boards and drive to recommend neoadjuvant therapy based on funding source of health care.