ImportanceNeoadjuvant therapy (NT) is an increasingly used treatment strategy for patients with localized pancreatic ductal adenocarcinoma (PDAC). Little research has been conducted on cancer care delivery during NT, and the standards for optimal delivery of NT have not been defined.ObjectiveTo develop consensus best practices for delivering NT to patients with localized PDAC.Design, Setting, and ParticipantsThis study used a modified Delphi approach consisting of 2 rounds of voting, and a series of virtual conferences (from October to December 2023) to reach expert consensus on candidate best practice statements generated from a systematic review of the literature and expert opinion. An interdisciplinary panel was formed including 47 North American experts from surgical, medical, and radiation oncology, radiology, pathology, gastroenterology, integrative oncology, anesthesia, pharmacy, nursing, cancer care delivery research, and nutrition as well as patient and caregiver stakeholders.Main Outcome and MeasuresStatements that reached 75% agreement or greater were included in final consensus statements.ResultsOf the 47 participating panel members, 27 (57.64%) were male, and the mean (SD) age was 47.6 (8.2) years. Physicians reported completing training a mean (SD) 14.6 (8.6) years prior and seeing a mean (SD) 110.6 (38.4) patients with PDAC annually; 35 (77.7%) were in academic practice. Final consensus was reached on 82 best practices for delivering NT. Of these, 38 statements focused on pre-NT practices, including diagnosis and staging (n = 15), evaluation and optimization (n = 20), and decision-making (n = 3); 29 statements defined best practices during NT, including initiation (n = 3), delivery of therapy (n = 8), restaging practices (n = 12), and management of complications during NT (n = 6); and 15 best practices were identified to guide treatment post-NT, focusing on surgery (n = 7), pathology (n = 4), and follow-up (n = 3).ConclusionsUsing a modified Delphi consensus technique, best practice guidelines were developed focusing on the optimal standards for delivering NT to patients with localized PDAC. Given the prognostic importance of completing multimodality therapy, efforts to standardize and optimize the delivery of NT represent an immediate opportunity to decrease care variation and improve outcomes for patients with PDAC. Future research should focus on validating and implementing best practice standards into clinical practice.

中文翻译：

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胰腺导管腺癌新辅助治疗的最佳实践


重要性新辅助治疗 （NT） 是一种越来越多地用于局限性胰腺导管腺癌 （PDAC） 患者的治疗策略。对 NT 期间癌症护理服务的研究很少，NT 的最佳服务标准尚未确定。目的制定向具有局部 PDAC.Design、环境和参与者的患者提供 NT 的共识最佳实践本研究使用改良的 Delphi 方法，包括 2 轮投票和一系列虚拟会议（2023 年 10 月至 2023 年 12 月），以就候选最佳实践声明达成专家共识来自对文献和专家意见的系统评价。成立了一个跨学科小组，包括来自外科、内科和放射肿瘤学、放射学、病理学、胃肠病学、综合肿瘤学、麻醉学、药学、护理、癌症护理提供研究和营养学以及患者和护理利益相关者的 47 名北美专家。主要结局和措施达到 75% 或更高的一致性的陈述包含在最终共识声明中。结果47 名参与的小组成员中，男性 27 名 （57.64%），平均 （SD） 年龄为 47.6 （8.2） 岁。医生报告说，平均 （SD） 14.6 （8.6） 年前完成培训，平均每年看到 （SD） 110.6 （38.4） 名 PDAC 患者;35 人 （77.7%） 从事学术实践。就交付 NT 的 82 个最佳实践达成了最终共识。 其中，38 篇陈述侧重于 NT 之前的实践，包括诊断和分期 （n = 15）、评估和优化 （n = 20） 和决策 （n = 3）;29 项陈述定义了 NT 期间的最佳实践，包括开始 （n = 3）、治疗实施 （n = 8）、重新分期做法 （n = 12） 和 NT 期间并发症的管理 （n = 6）;确定了 15 项最佳实践来指导 NT 后治疗，重点关注手术 （n = 7） 、病理学 （n = 4） 和随访 （n = 3）。结论使用改良的 Delphi 共识技术，制定了最佳实践指南，重点关注向局部 PDAC 患者提供 NT 的最佳标准。鉴于完成多模式治疗的预后重要性，标准化和优化 NT 的实施工作代表了减少护理差异和改善 PDAC 患者预后的直接机会。未来的研究应侧重于验证最佳实践标准并将其实施到临床实践中。