Table 2

PC Optimal Care Pathway (OCP) mapped to modified Delphi quality indicators

PC OCPOCP elementsMapped quality indicators from modified Delphi consensus40
Step 1: Prevention and early detection1.1 Prevention.
1.2 Risk factors.
1.3 Early detection.
Step 2: Presentation, initial investigations and referral2.1 Signs and symptoms.
2.2 Assessments by general practitioner or medical practitioner.
2.3 Referral.
  • Documented baseline CA19-9 level before treatment.

  • Documented ECOG and/or ASA at presentation.

  • Time from referral to definitive treatment within 60 days.

2.4, 3.5, 4.6, 5.4, 6.6 and 7.3
Support and communication
Step 3: Diagnosis, assessment and treatment planning3.1 Diagnostic workup.
3.2 Staging.
3.3 Treatment planning.
  • Documented pancreatic protocol CT or MRI scan for diagnosis and/or staging.

  • Operability of tumour is clearly defined and documented as either operable/resectable, borderline resectable, locally advanced (unresectable) or metastatic (unresectable).

  • Disease management for all patients discussed at an MDT meeting.

3.4, 4.4, 5.3, 6.5 and 7.2
Research and clinical trials
  • Number of patients included in a clinical trial.

3.1 and 3.2
  • Time from referral to definitive treatment within 60 days.

Step 4: Treatment4.1 Treatment intentNil
4.2.1 Surgery (curative)
  • All patients who did not undergo surgery should have a valid reason documented.

  • Number of patients undergoing PC surgery in a level 1–4 hospital.

4.2.1 Chemotherapy or chemoradiation.
  • Adjuvant chemotherapy administered following surgery or a reason documented for not undergoing treatment.

4.2.2 and 4.3
Treatment of unresectable PC/palliative care.
  • Chemotherapy±chemoradiation offered to patients with locally advanced disease, or a reason documented for not undergoing treatment.

  • Number of patients who saw a medical or radiation oncologist or a reason documented for not doing so.

4.5 Complementary or alternative therapies.Nil
Step 5: Care after initial treatment and recovery5.1 Survivorship.
5.2 Post-treatment care planning.
  • All patients having completed treatment followed up by a specialist every 3–6 months for up to 2 years.

Step 6: Managing recurrent, residual and metastatic disease6.1 Signs and symptoms of recurrent, residual or metastatic disease.
Step 7: End-of-life-care6.4 Palliative care.
7.1 Multidisciplinary palliative care.
  • All patients with metastatic disease referred to (or seen by) palliative care specialist.

  • Some elements in each step of the pathway are overlapping. Elements 6.2 and 6.3 readdress steps 3 and 4. Please note: the purpose of this document is to provide a broad overview of the areas within the OCP that the developed PC quality indicators measure. Only the key indicators that map to the elements are listed.

  • ASA, American Society of Anesthesiologists (performance status); ECOG, Eastern Cooperative Oncology Group (performance status); MDT, Multidisciplinary Team.