Current practices, barriers and facilitators toward simultaneous care management in patients affected by pancreatic adenocarcinoma: An Italian cross-sectional survey

Background: In pancreatic ductal adenocarcinoma (PDAC), early integration of simultaneous care plays a key role in maintaining function, improving treatment tolerance, and aligning care with patient preferences. Aims: This national survey, promoted by the Italian Association for the Study of the Pancreas (AISP), assessed current practices, barriers, and facilitators related to supportive and simultaneous care in Italian centers managing pancreatic cancer. Methods: Between April and July 2024, a 19-item cross-sectional online survey, including a clinical vignette, was distributed to healthcare professionals involved in PDAC care. The questionnaire explored screening, counseling, and referral practices for nutrition, physical activity, and psycho-oncological support, as well as the organization of simultaneous care pathways. The vignette evaluated regret of omission and commission regarding multimodal prehabilitation (0-100 scale). Results: Overall, 191 professionals responded (94.7% physicians; 65% AISP members). Although most acknowledged the value of simultaneous care, implementation was inconsistent: 70% routinely provided nutritional advice, but only 20% screened for physical activity or psychological distress. Younger clinicians showed greater awareness and readiness to integrate supportive care. Main barriers were limited funding (22%), insufficient knowledge (21%), and lack of dedicated specialists (19%). Key facilitators included supportive care experts within teams (30%) and structured training (27%). Regret of omission (median 60) exceeded regret of commission (median 10). Conclusions: Standardized simultaneous care pathways, structured education, and dedicated personnel are urgently needed to improve pancreatic cancer care in Italy.