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Table 1 Case vignette

From: Treatment recommendations within the leeway of clinical guidelines: A qualitative interview study on oncologists’ clinical deliberation

Patient demographics

M, 64 yrs.; married

Status praesens

Nausea and pain in the upper abdomen, back pain, unintended weight loss of 6 kg, condition stable, but generally restricted.

Past medical history (PMH)

Three-vessel CAD; s/p CABG occasionally AP on exertion-controlled arterial hypertension, COPD GOLD II, under medication.

Family history (FH)

Unknown

Social History (SH)

Smoker (60 pack-years), lives at home with his wife who supports him with domestic activities; he formerly worked as a butcher, now unfit for work.

Allergies (ALL)

None

Physical examination (PE) and test results

 - Slightly diminished general condition, BMI 27, 3, 140/95, heart and lungs: NAD, neurology: NAD

 - Endoscopic ultrasound: mass located in the pancreatic head, inhomogeneous

 - MRI scan abdomen: 3.5 cm mass in processus uncinatus, multiple peripancreatic lymph nodes

 - MR angiography: primary cancer not resectable: full vessel involvement and infiltration of SMA

 - Histology (endosonography): high-grade pancreatic ductal adenocarcinoma, no metastases detected

 - LAB: Hemoglobin 13.2 g/dl; Leukocyte 5200/μl; Thrombozyten 150,000/μl

  Creatinin: 1.2 mg/dl

  Bilirubin: 1.1 mg/dl

  Amylase: 100 U/l

  Lipase: 55 U/l

  CA19–9 (carbohydrate antigen 19.9): 1350 U/ml

Diagnosis

Locally advanced, pancreatic ductal adenocarcinoma cT4N1M0 (UICC stage III)