GICS 2009: Delay in Diagnosis and Treatment of Pancreatic Cancer Common

Roxanne Nelson

January 21, 2009

January 21, 2009 (San Francisco, California) — A delay in time to diagnosis or treatment in pancreatic cancer could negatively affect treatment outcome, according to research presented here at the 2009 Gastrointestinal Cancers Symposium. Resectable pancreatic cancer was associated with a shorter time to treatment, whereas nonhead pancreatic cancer and a history of abdominal surgery were associated with longer delays.

"Hopefully, our findings can be used to assist in the development of improved community strategies for earlier diagnosis and treatment of pancreatic cancer," lead author Vincent J. Picozzi Jr, MD, an oncologist at Virginia Mason Medical Center, in Seattle, Washington, told Medscape Oncology during a poster session.

The reasons for treatment delay are multifactorial, driven by patient, provider, and system factors. "Patients may not pay close enough attention to symptoms and not seek care," said Dr. Picozzi. "The signs and symptoms are nonspecific, and doctors may not consider pancreatic cancer as a diagnosis."

The healthcare system as a whole can also be problematic, with bureaucratic delays prolonging time from diagnosis to definitive care. These delays can result in patients presenting with advanced disease, Dr. Picozzi pointed out. "It is quite tragic when delays cause candidates for potentially curative treatment to instead present with more advanced disease."

Pancreas cancer has the poorest overall survival of any major cancer. The typical median survival rate for patients with resectable disease is 16 to 22 months, and is 9 to 14 months for locally advanced pancreatic tumors. Among patients with metastatic disease, overall survival is only about 6 to 8 months. Given these statistics, the researchers note, a significant delay in time to diagnosis and/or treatment could have a significant adverse impact on patient outcomes.

According to the literature, it is not uncommon to have delays of 6 months or more from the initial onset of symptoms to diagnosis. In this study, Dr. Picozzi and colleagues evaluated delays in diagnosis and/or treatment from the perspective of a contemporary experience of a tertiary referral center. The objective of the study was to analyze the magnitude of and causes for delays in treatment and diagnosis among patients who presented to their facility. "Our goal was to create an improved population-based strategy for the diagnostic evaluation of pancreatic cancer," said Dr. Picozzi.

The researchers reviewed patient records from the Virginia Mason Medical Center Tumor Registry from 2004 and 2005, and 134 patients who met the inclusion criteria were identified. Of this group, 40 had resectable pancreatic cancer, 40 had locally advanced disease, and 48 had metastatic disease.

They found that the median time from first patient symptom to first provider contact was 30 days, with a range of 1 to 1460 days. The median time from first provider contact to date of tissue diagnosis was 35 days (range, 1 to 365 days), and time from diagnosis to treatment was 21 days (range, 0 to 120 days). The median delay was nearly 4 months (112 days), and 25 of 134 patients (19%) experienced a delay of 6 months or longer.

Further analysis showed that disease stage and other factors also influenced the timing of diagnosis and treatment. Delay was significantly shorter in patients with resectable disease, but longer in patients with nonhead pancreatic cancer and in those who had undergone previous abdominal surgery.

Length of Delay According to Disease Stage

Pancreatic Cancer Stage Number of Patients Delay, days Range, days
Resectable 46 82 20-1610
Locallyadvanced 40 141 42-448
Metastatic 48 117 46-436

The researchers also reviewed the potential contribution of other factors — including age at diagnosis; presenting symptoms; history of diabetes mellitus, pancreatitis, or gastrointestinal condition; patient insurance (private, managed care, Medicare, Medicaid); sex; and dwelling distance from the referral center. However, none of these factors influenced delay.

"As this magnitude of delay represents a significant fraction of overall survival for many pancreatic cancer patients," they conclude, "such a delay may negatively impact patient outcome."

2009 Gastrointestinal Cancers Symposium (GICS). Abstract 137. Presented January 16, 2009.

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