Establish intent of treatment

• Curative
• Anti-cancer therapy to improve quality of life and/or longevity without expectation of cure
• Symptom palliation

Treatment for resectable pancreatic cancer: The potential for curative surgery depends on the staging of the tumour, and only 10–20 per cent of patients have clearly resectable disease after careful pretherapeutic staging. This potential is assessed by the multidisciplinary team.

Curative surgery includes Whipple procedure, distal or total pancreatectomy, with or without chemotherapy (adjuvant or neoadjuvant chemotherapy or neoadjuvant chemoradiation).

Treatment for unresectable pancreatic cancer: If unresectable, any other treatment is almost certainly palliative because pancreatic cancer is unlikely to be cured by chemotherapy or radiation therapy. The most commonly used therapies include:

• endoscopic or radiological intervention
• surgical interventions
• chemotherapy with or without chemoradiation
• coeliac plexus or intrapleural block.

Palliative care: In general, all patients with pancreatic cancer, given the poor prognosis, should be offered a referral for a palliative care assessment as an integrated aspect of their overall oncology care. For more, visit the Palliative Care Australia website.

Communication

The lead clinician and team’s responsibilities include:

• discussing treatment options with the patient and/or carer including the intent of treatment as well as risks and benefits
• discussing advance care planning with the patient and/or carer where appropriate
• communicating the treatment plan to the patient’s GP
• helping patients to find appropriate support for exercise programs where appropriate to improve treatment outcomes.

Checklist

Timeframe

Treatment should begin within 4 weeks of the initial diagnosis, depending on urgency and modality.

Postoperative adjuvant chemotherapy should begin within 12 weeks of surgery.