# Preference versus protocol: oncology clinicians’ perspectives on central venous access for administration of chemotherapy in pancreatic cancer

## TL;DR

This study explores how oncology clinicians in the Netherlands choose central venous access devices for pancreatic cancer chemotherapy, highlighting variability in practice and the role of patient preference.

## Contribution

The study reveals significant variability in CVAD selection and clinician autonomy, emphasizing the gap between evidence and practice in pancreatic cancer care.

## Key findings

- Nearly half of clinicians primarily recommend PICCs for pancreatic cancer chemotherapy.
- Logistical delays and sedation needs are key barriers to using PORTs.
- Only 28% involve patients in CVAD decisions despite 60% rating patient preference as a top factor.

## Abstract

Pancreatic cancer treatment significantly impacts patients’ quality of life, making both safety and patient preference key considerations. Central venous access devices (CVADs) are indispensable for chemotherapy administration in pancreatic cancer, yet device selection varies widely. This study explored which CVADs oncology specialists use in pancreatic cancer care, focusing on the basis for their recommendations.

A nationwide expert survey was distributed among Dutch medical oncologists and nurse specialists involved in pancreatic cancer care via the Dutch Pancreatic Cancer Group, the Dutch Association for Medical Oncology, the Dutch association for nurses, and the study committee’s network.

Ninety-one clinicians responded. Most (88%) had access to both port-a-caths (PORTs) and peripherally inserted central catheters (PICCs), while 12% could only offer one device. Decision-making autonomy varied: 53% reported full autonomy, while others followed hospital-wide preferences (39%) or guidelines (9%). Even within these subgroups, preferred CVAD varied greatly. Although 60% listed patient preference among the top five influential factors, only 28% incorporated patients in that decision. Logistical constraints were key barriers influencing device choice.

Substantial variability exists in CVAD selection, availability, and clinician autonomy in pancreatic cancer care. While evidence supports PORTs as the safer option, PICCs remain widely used in daily practice. This discrepancy appears driven by disease-specific and logistical factors, including poor prognosis and uncertainty regarding treatment tolerance. Addressing real-world barriers through improved access to PORTs, clearer guideline recommendations, and enhanced patient counseling may help align clinical practice with evidence and ensure high-quality care for patients receiving chemotherapy.

•Nearly half primarily recommend PICCs for pancreatic cancer chemotherapy.•Logistical delays and sedation needs are key barriers to PORT use.•60% rated patient preference among top factors, but only 28% involve patients in choice.•Wide variability exists in CVAD selection, availability and clinician autonomy.

Nearly half primarily recommend PICCs for pancreatic cancer chemotherapy.

Logistical delays and sedation needs are key barriers to PORT use.

60% rated patient preference among top factors, but only 28% involve patients in choice.

Wide variability exists in CVAD selection, availability and clinician autonomy.