Survival impact of implementation of best practices in pancreatic care in The Netherlands

Between May, 2018 and July, 2020 five best practices were implemented in the centers for pancreatic ductal adenocarcinoma (PDAC) in The Netherlands: optimal use of perioperative chemotherapy, palliative chemotherapy, pancreatic enzyme replacement therapy, referral to a dietician, and us of metal stents in patients with biliary obstruction. A stepped-wedge randomized clinical trial found that 1-year survival rate was 24% after implementation compared with 23% before implementation. There was no difference in use of neoadjuvant chemotherapy, adjuvant chemotherapy, and referral to a dietician. The EORTC global health score was not improved after the implementation. The authors conclude that these findings highlight the need for more personalized treatment options (visual abstract).