KEY TAKEAWAYS
- The PACAP-1 trial aimed to improve pancreatic cancer care nationwide using a stepped wedge design.
- The primary outcome was to determine OS. Secondary outcomes include guideline compliance and QoL.
- The study showed successful implementation of best practices but no improvement in one-year survival and QoL.
The implementation of new cancer treatment strategies is often slow and suboptimal. Researchers aimed to improve pancreatic cancer care nationwide using a stepped wedge design.
The study compared the implementation of best practices with usual care. These best practices involved ensuring the proper use of perioperative and palliative chemotherapy, pancreatic enzyme replacement therapy (PERT), and metal biliary stents. The implementation phase spanned 6 weeks across all 17 Dutch pancreatic centers and their respective regional referral networks. This included monitoring, follow-up visits, provider feedback, education, and reminders. The primary outcome was to measure one-year overall survival(OS) for all disease stages, while secondary outcomes included evaluating guideline compliance and assessing the quality of life(QoL).
The study included 5,580 patients(pts) diagnosed with pancreatic cancer, with 2,939 enrolled after implementing best practices and 2,641 pts before. There was no significant difference in one-year survival rates between the two groups (HR 0.98, 95% CI 0.88-1.08). Regarding treatment practices, the 2 groups had no significant difference in the overall use of perioperative chemotherapy (neoadjuvant and adjuvant). The use of palliative chemotherapy increased (from 23.9% to 30.3%, OR 1.38, 95% CI 1.10-1.74). There was a significant increase in the utilization of PERT (from 34.2% to 45.2%, OR 1.64, 95% CI 1.28-2.11) and metal biliary stents(from 74.1% to 83.3%, OR 1.78, 95% CI 1.13-2.08). Despite these changes in treatment approaches, the Global Health Score remained relatively consistent (AUC 43.8 to 42.7, median difference -1.12, 95% CI -3.13-0.80, n=655).
The study showed successful implementation of best practices but no improvement in one-year survival and QoL.
Source: https://ascopubs.org/doi/abs/10.1200/JCO.2023.41.16_suppl.4152
Clinical Trial: https://www.clinicaltrials.gov/study/NCT03513705
Tara Mackay, Anouk EJ Latenstein, Simone Augustinus, Lydia G. van der Geest, Auke Bogte, Bert A. Bonsing, Hendrik Bos, Koop Bosscha, Lodewijk Brosens, Geert A. Cirkel, Lieke Hol, Olivier R.C. Busch, Geert-Jan Creemers, Wouter L. Curvers, Sarah Derks, Jeanin E. van Hooft, Casper H.J. Van Eijck, Johanna Wilmink, Hanneke W.M. Van Laarhoven, Marc G. Besselink, and for the Dutch Pancreatic Cancer Group. DOI: 10.1200/JCO.2023.41.16_suppl.4152 Journal of Clinical Oncology 41, no. 16_suppl (June 01, 2023) 4152-4152.
