Optimal timeframes & summary

Evidence-based guidelines, where they exist, should inform timeframes. Treatment teams need to recognise that shorter timeframes for appropriate consultations and treatment can promote a better experience for patients. Three steps in the pathway specify timeframes for care. They are designed to help patients understand the timeframes in which they can expect to be assessed and treated, and to help health services plan care delivery in accordance with expert-informed time parameters to meet the expectation of patients. These timeframes are based on expert advice from the Pancreatic Cancer Working Group.

Timeframes for care

Step in pathway	Care point	Timeframe
Presentation, initial investigations and referral	Signs and symptoms	Presenting symptoms should be promptly and clinically triaged with a health professional
	Initial investigations initiated by GP	Patients who present with jaundice should be referred for tests within 48 hours and followed up rapidly Other symptoms require review within 2 weeks
	Referral to specialist	Patients with suspected or proven pancreatic cancer should be seen by a specialist within 1 week of referral to the specialist
Diagnosis, staging and treatment planning	Diagnosis and staging	Diagnostic and staging investigations should be completed within 2 weeks of referral
Diagnosis, staging and treatment planning	Multidisciplinary meeting and treatment planning	The patient case must be discussed within 1 week of completion of the diagnostic and staging investigations and a management plan finalised
Treatment	Surgery	Surgery should be undertaken within 4 weeks of initial diagnosis, depending on urgency and modality
Treatment	Systemic chemotherapy and/or radiation therapy	Treatment should begin within 4 weeks of initial diagnosis, depending on urgency and modality Adjuvant chemotherapy in the postoperative setting should begin within 12 weeks of surgery

Seven steps of the optimal care pathway

Step 1: Prevention and early detection

Step 2: Presentation, initial investigations and referral

Step 3: Diagnosis, staging and treatment planning

Step 4: Treatment

Step 5: Care after initial treatment and recovery

Step 6: Managing recurrent, residual or metastatic disease

Step 7: End-of-life care

In Australia the incidence of pancreatic cancer has remained stable over the past three decades, with 10 cases per 100,000 people in 1982 and 12 cases per 100,000 people in 2016 (Cancer Australia 2020b). The average age at diagnosis is 72.8 years (AIHW 2017a). Pancreatic cancer has a very poor prognosis, and five-year survival rates are extremely low. Median survival from diagnosis ranges from 10 to 30 months (Lambert el al. 2019). In Australia over the past three decades the five-year survival rate has increased slightly from 3.2 per cent between 1987 and 1991 to 11 per cent between 2012 and 2016 (Cancer Australia 2020b). Despite the increase in survival, pancreatic cancer still has the lowest survival rate of all cancer types, with mortality-to-incidence ratio approaching 1 (0.83; Cancer Australia 2019b). Even if there are good initial treatment outcomes, the recurrence rate is very high. Given the poor prognosis of this cancer at present, for most patients, treatment is often given with palliative, rather than curative, intent. Early specialist palliative care will be required for patients with pancreatic cancer.

This optimal care pathway covers pancreatic adenocarcinoma. Pancreatic neuroendocrine tumours (PNETs) are not included in this pathway, given the differences in the risk factors and management of these tumours.