OBJECTIVES: To characterize the healthcare journey of metastatic pancreatic cancer (MPC) patients in Portugal, including care provision, and major factors currently affecting therapeutic decisions, namely BRCA mutations testing.

METHODS: We conducted a descriptive cross-sectional, web-based survey. A snowball sampling approach was used. Portuguese physicians dedicated to MPC were invited to participate (December-2020). Descriptive statistics were performed, with absolute and relative frequencies to describe categorical variables and the median and interquartile range (IQR) for continuous non-normal variables. Pearson’s chi-square test was used to assess variables’ association (StataSE v.15.0).

RESULTS: Fifty-five physicians agreed to participate the study. According to the responders, a median of 20 patients per center (IQR 20-50) was diagnosed with pancreatic ductal adenocarcinoma in the previous year; 13 of them referred (IQR 10-23) to MPC. Half of the clinicians stated that the evaluation of BRCA mutation is performed only for metastatic disease. Most physicians (60%) recommended that BRCA testing should be requested earlier - upon histological diagnosis, especially because the median time for results is of 5.5 weeks (IQR 4-8). PARP inhibitors are the therapeutic choice of most physicians (70%) for patients without progression after four months. Half of the responders refer their patients to palliative care only after exhausting all therapies. First-line treatments are usually selected after oncology consultation, grounded mostly on clinical criteria (eg. performance status, hepatic function). A median of 45% of patients (IQR 30-50) use FOLFIRINOX/mFOLFIRINOX as first-line therapy, while gemcitabine+nab-paclitaxel (36% [IQR 22.5-50]) and gemcitabine alone (57.5% [IQR 40-80]) are the most common second- and third-lines therapies, respectively. All physicians agree that the current evidence on the use of third-line chemotherapy for MPC is still weak and inconclusive.

CONCLUSIONS: We provided insights concerning the journey of MPC patients in Portugal, which may allow comparative effectiveness research of treatments and lead to improve evidence-based decisions and healthcare provision.