Even if the cancer is deemed surgically curable the following should be considered (NCI 2019a):

• neoadjuvant chemotherapy for all high-risk patients
• neoadjuvant chemotherapy or chemoradiation therapy, especially in patients with borderline resectable disease or delay in surgery
• adjuvant chemotherapy in the postoperative setting
• chemoradiation therapy (or SBRT on a trial) for borderline resectable or locally advanced patients who are still potentially operable
• adjuvant chemotherapy within 12 weeks following resection.

Timeframes for starting treatment

Neoadjuvant chemotherapy should begin within four weeks of the initial diagnosis, depending on urgency and modality.

Adjuvant chemotherapy in the postoperative setting should begin within 12 weeks of surgery.

Training and experience required of the appropriate specialists

Medical oncologists must have training and experience of this standard:

• Fellow of the Royal Australian College of Physicians (or equivalent)
• adequate training and experience that enables institutional credentialing and agreed scope of practice within this area (ACSQHC 2015).

Cancer nurses should have accredited training in these areas:

• anti-cancer treatment administration
• specialised nursing care for patients undergoing cancer treatments, including side effects and symptom management
• the handling and disposal of cytotoxic waste (ACSQHC 2020).

Systemic therapy should be prepared by a pharmacist whose background includes this experience:

• adequate training in systemic therapy medication, including dosing calculations according to protocols, formulations and/or preparation.

In a setting where no medical oncologist is locally available (e.g. regional or remote areas), some components of less complex therapies may be delivered by a general practitioner or nurse with training and experience that enables credentialing and agreed scope of practice within this area. This should be in accordance with a detailed treatment plan or agreed protocol, and with communication as agreed with the medical oncologist or as clinically required.

The training and experience of the appropriate specialist should be documented.

Health service characteristics (systemic therapy)

To provide safe and quality care for patients having systemic therapy, health services should have these features:

• a clearly defined path to emergency care and advice after hours
• access to diagnostic pathology including basic haematology and biochemistry, and imaging
• cytotoxic medicines prepared in a pharmacy with appropriate facilities or externally sourced from Therapeutics Goods Association–licensed manufacturers
• occupational health and safety guidelines regarding handling of cytotoxic drugs, including preparation, waste procedures and spill kits (eviQ 2019;)
• guidelines and protocols to deliver treatment safely (including dealing with extravasation of drugs)
• coordination for combined therapy with radiation therapy, especially where facilities are not co-located
• appropriate molecular pathology access.

Training and experience required of radiation oncologists

Radiation oncologists must have training and experience of this standard:

• Fellowship of the Royal Australian and New Zealand College of Radiologists (or equivalent)
• adequate training and experience, institutional credentialing and agreed scope of practice in pancreatic cancer (ACSQHC 2015).

The training and experience of the radiation oncologist should be documented.

Health service unit characteristics (radiation therapy)

To provide safe and quality care for patients having radiation therapy, health services should have these features:

• linear accelerator (LINAC) capable of image-guided radiation therapy (IGRT)
• dedicated CT planning
• access to MRI and PET imaging
• automatic record-verify of all radiation treatments delivered
• a treatment planning system
• trained medical physicists, radiation therapists and nurses with radiation therapy experience
• coordination for combined therapy with systemic therapy, especially where facilities are not co-located
• participation in Australian Clinical Dosimetry Service audits
• an incident management system linked with a quality management system.