Excerpt

The evidence reviewed for this guideline has highlighted the lack of useful national data on 19 pancreatic cancer in the UK. In many cancers, national datasets have contributed 20 significantly to improving outcomes of patient management. For pancreatic cancer, there has 21 been no comprehensive national database and therefore comparing outcomes between 22 pancreatic centres and pancreatic specialists has not been possible. This lack of continuous 23 audit may result in inappropriate variation in the standard of treatments between centres. The 24 Committee is of the unanimous opinion that a national database of pancreatic cancer 25 patients needs to be established to provide a continuous comparative audit of patient 26 management.

Contents

• 1. Introduction
• 2. Guideline summary
  • 2.1. Guideline Committee membership, NGA staff and acknowledgements
  • 2.2. Other versions of the guideline
  • 2.3. Schedule for updating the guideline
  • Acknowledgements
• 3. Development of this guideline
  • 3.1. What is a NICE Guideline?
  • 3.2. Remit
  • 3.3. Who developed this guideline?
  • 3.4. What this guideline covers
  • 3.5. What this guideline does not cover
  • 3.6. Relationship between the guideline and other NICE guidance
• 4. Guideline development methodology
  • 4.1. Developing the review questions and outcomes
  • 4.2. Searching for evidence
  • 4.3. Reviewing and synthesising research evidence
  • 4.4. Developing recommendations
  • 4.5. Validation process
  • 4.6. Updating the guideline
  • 4.7. Disclaimer
  • 4.8. Funding
  • 4.9. References
• 5. Diagnosis
  • 5.1. People with jaundice
  • 5.2. People without jaundice but with a pancreatic abnormality
  • 5.3. Pancreatic Cysts
  • 5.4. People with inherited high risk of pancreatic cancer
• 6. Referral to specialist multidisciplinary teams
  • 6.1. Introduction
  • 6.2. Description of the clinical evidence
  • 6.3. Summary of included studies
  • 6.4. Clinical evidence profile
  • 6.5. Economic evidence
  • 6.6. Evidence statements
  • 6.7. Recommendations
  • 6.8. Evidence to recommendations
  • 6.9. References
• 7. Staging
  • 7.1. Introduction
  • 7.2. Description of clinical evidence
  • 7.3. Summary of included studies
  • 7.4. Clinical evidence profile
  • 7.5. Economic evidence
  • 7.6. Evidence statements
  • 7.7. Recommendations
  • 7.8. Evidence to recommendations
  • 7.9. References
• 8. Support needs
  • 8.1. Psychological support needs
  • 8.2. Pain
  • 8.3. Nutritional Interventions
• 9. Interventions to relieve biliary and duodenal obstruction
  • 9.1. Biliary obstruction
  • 9.2. Duodenal obstruction
• 10. Management of resectable and borderline resectable pancreatic cancer
  • 10.1. Neoadjuvant treatment
  • 10.2. Resectable and borderline resectable pancreatic cancer
  • 10.3. Adjuvant treatment
  • 10.4. Follow-up for people with resected pancreatic cancer
• 11. Management of unresectable pancreatic cancer
  • 11.1. Management of locally advanced pancreatic cancer
  • 11.2. Management of metastatic pancreatic cancer
• 12. Economic modelling: cost effectiveness of different types of stent for the management of biliary obstruction in people with unresectable pancreatic cancer
  • 12.1. Introduction
  • 12.2. Methods
  • 12.3. Results
  • 12.4. Discussion
  • 12.5. References
• 13. Network Meta-Analysis (Mixed Treatment Comparison) and Economic Model on treatment of unresectable locally advanced non-metastatic pancreatic cancer
  • 13.1. Methods
  • 13.2. Network Meta-analysis Results
  • 13.3. Economic Model
  • 13.4. Results Economic Model
  • 13.5. References
• Appendix A. Scope
• Appendix B. Stakeholders
• Appendix C. Review protocols
• Appendix D. Combined Search Strategy
• Appendix E. Prisma Flow Charts
• Appendix F. Evidence tables
• Appendix G. Excluded studies
• Appendix H. Forest plots and Summary ROC curves
• Appendix I. GRADE Tables
• Appendix J. Risk of bias summaries
• Appendix K. Health economics evidence profiles
• Appendix L. Health economics evidence tables

Final

National Guideline Alliance, hosted by the Royal College of Obstetricians and Gynaecologists

Disclaimer

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.