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

M. U.J.E. Graus; R. A.L. Willems; N. C. Biesma; A. J. de Wilde; F. W.P.J. van den Berkmortel; S. A.W. Bouwense; G. A. Cirkel; M. Y.V. Homs; E. Jellema-Betten; N. Pepels-Aarts; H. C. van Santvoort; E. C.J. van Vliet; M. L. Wumkes; J. W. Wilmink; I. H.J.T. de Hingh; L. B.J. Valkenburg-van Iersel; J. de Vos-Geelen

doi:10.1016/j.esmogo.2026.100311

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

M. U.J.E. Graus
, R. A.L. Willems
, N. C. Biesma
, A. J. de Wilde
, F. W.P.J. van den Berkmortel
, S. A.W. Bouwense
, G. A. Cirkel
, M. Y.V. Homs
, E. Jellema-Betten
, N. Pepels-Aarts
, H. C. van Santvoort
, E. C.J. van Vliet
, M. L. Wumkes
, J. W. Wilmink
, I. H.J.T. de Hingh
, L. B.J. Valkenburg-van Iersel
, J. de Vos-Geelen^*
,

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: 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. Materials and methods: 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. Results: 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. Conclusion: 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.

Original language	English
Article number	100311
Journal	ESMO Gastrointestinal Oncology
Volume	11
DOIs	https://doi.org/10.1016/j.esmogo.2026.100311
Publication status	Published - Mar 2026

Keywords

5-fluorouracil
pancreas adenocarcinoma
peripheral inserted central catheter
port-a-cath
quality of life

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Graus, M. U. J. E., Willems, R. A. L., Biesma, N. C., de Wilde, A. J., van den Berkmortel, F. W. P. J., Bouwense, S. A. W., Cirkel, G. A., Homs, M. Y. V., Jellema-Betten, E., Pepels-Aarts, N., van Santvoort, H. C., van Vliet, E. C. J., Wumkes, M. L., Wilmink, J. W., de Hingh, I. H. J. T., Valkenburg-van Iersel, L. B. J., de Vos-Geelen, J. (2026). Preference versus protocol: oncology clinicians’ perspectives on central venous access for administration of chemotherapy in pancreatic cancer. ESMO Gastrointestinal Oncology, 11, Article 100311. https://doi.org/10.1016/j.esmogo.2026.100311

@article{0b5fbcb550a340fbad1d8448871aff21,

title = "Preference versus protocol: oncology clinicians{\textquoteright} perspectives on central venous access for administration of chemotherapy in pancreatic cancer",

abstract = "Background: Pancreatic cancer treatment significantly impacts patients{\textquoteright} 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. Materials and methods: 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. Results: 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. Conclusion: 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.",

keywords = "5-fluorouracil, pancreas adenocarcinoma, peripheral inserted central catheter, port-a-cath, quality of life",

author = "Graus, \{M. U.J.E.\} and Willems, \{R. A.L.\} and Biesma, \{N. C.\} and \{de Wilde\}, \{A. J.\} and \{van den Berkmortel\}, \{F. W.P.J.\} and Bouwense, \{S. A.W.\} and Cirkel, \{G. A.\} and Homs, \{M. Y.V.\} and E. Jellema-Betten and N. Pepels-Aarts and \{van Santvoort\}, \{H. C.\} and \{van Vliet\}, \{E. C.J.\} and Wumkes, \{M. L.\} and Wilmink, \{J. W.\} and \{de Hingh\}, \{I. H.J.T.\} and \{Valkenburg-van Iersel\}, \{L. B.J.\} and \{de Vos-Geelen\}, J.",

note = "Publisher Copyright: {\textcopyright} 2026 The Author(s)",

year = "2026",

month = mar,

doi = "10.1016/j.esmogo.2026.100311",

language = "English",

volume = "11",

journal = "ESMO Gastrointestinal Oncology",

issn = "2949-8198",

publisher = "Elsevier",

}

Graus, MUJE, Willems, RAL, Biesma, NC, de Wilde, AJ, van den Berkmortel, FWPJ, Bouwense, SAW, Cirkel, GA, Homs, MYV, Jellema-Betten, E, Pepels-Aarts, N, van Santvoort, HC, van Vliet, ECJ, Wumkes, ML, Wilmink, JW, de Hingh, IHJT, Valkenburg-van Iersel, LBJ, de Vos-Geelen, J 2026, 'Preference versus protocol: oncology clinicians’ perspectives on central venous access for administration of chemotherapy in pancreatic cancer', ESMO Gastrointestinal Oncology, vol. 11, 100311. https://doi.org/10.1016/j.esmogo.2026.100311

TY - JOUR

T1 - Preference versus protocol

T2 - oncology clinicians’ perspectives on central venous access for administration of chemotherapy in pancreatic cancer

AU - Graus, M. U.J.E.

AU - Willems, R. A.L.

AU - Biesma, N. C.

AU - de Wilde, A. J.

AU - van den Berkmortel, F. W.P.J.

AU - Bouwense, S. A.W.

AU - Cirkel, G. A.

AU - Homs, M. Y.V.

AU - Jellema-Betten, E.

AU - Pepels-Aarts, N.

AU - van Santvoort, H. C.

AU - van Vliet, E. C.J.

AU - Wumkes, M. L.

AU - Wilmink, J. W.

AU - de Hingh, I. H.J.T.

AU - Valkenburg-van Iersel, L. B.J.

AU - de Vos-Geelen, J.

PY - 2026/3

Y1 - 2026/3

N2 - Background: 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. Materials and methods: 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. Results: 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. Conclusion: 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.

AB - Background: 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. Materials and methods: 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. Results: 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. Conclusion: 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.

KW - 5-fluorouracil

KW - pancreas adenocarcinoma

KW - peripheral inserted central catheter

KW - port-a-cath

KW - quality of life

UR - https://www.scopus.com/pages/publications/105031569838

U2 - 10.1016/j.esmogo.2026.100311

DO - 10.1016/j.esmogo.2026.100311

M3 - Article

AN - SCOPUS:105031569838

SN - 2949-8198

VL - 11

JO - ESMO Gastrointestinal Oncology

JF - ESMO Gastrointestinal Oncology

M1 - 100311

ER -

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

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