Context:
Consistent management of PDAC is hindered in Victoria by the lack of agreed guidelines to classify disease staging. As a result, there is recognised variation in clinical practice. Adoption of a statewide definition on resectability in pancreatic cancer would help ensure appropriate and consistent management of patients.
Aims:
To agree use of a governing set of guidelines to classify resectability in non-metastatic PDAC patients.
To use the agreed definition to develop and assess the use of a structured radiology reporting tool to support hepatopancreatobiliary (HBP) multidisciplinary assessment of resectability in pancreatic cancer.
Methods:
Southern Melbourne and North Eastern Melbourne Integrated Cancer Services engaged local pancreatic cancer specialists to review and identify the most appropriate criteria to guide disease staging in PDAC. To test the adopted definition clinically (radiology, oncology, and surgical) specialists were tasked with co-designing a radiological synoptic report based on the definition. The tool was implemented in two health service HPB multidisciplinary meetings (MDMs) that regularly discuss pancreatic cancer cases. Uptake was monitored and clinical documentation analysed against key measures.
Results:
Local cancer specialists agreed adoption of the ‘International consensus on definition and criteria of borderline resectable PDAC 2017’ for classification of disease staging in PDAC. This informed fields for the new radiological synoptic report.
88 suspected PDAC cases were assessed using the radiological synoptic tool. 81% had their resectability status determined. 80% had resectability status documented in MDM summary notes and uploaded to the medical record for use by the wider treating team. 77% of cases had the synoptic report electronically uploaded to the medical record.
Conclusions:
Radiological synoptic reporting based on an agreed definition supports consistent classification of disease staging in PDAC assessment and facilitates systematic MDM case discussion and documentation.