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Pre-diagnostic delays caused by gastrointestinal investigations do not affect outcomes in pancreatic cancer

BACKGROUND: Pancreatic ductal adenocarcinomas are poor prognostic cancers accounting for 3% of all cancer cases in the UK. They often present late in the course of the disease process with non-specific symptoms, including gastro-intestinal(GI) symptoms. Delays in diagnosis occur when investigations...

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Autores principales: Apollos, Jeyakumar R., Sami, Sharukh, Prasanth, Manju Nadh, Jeyakumar, Jerusha, McFadyen, Angus K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6149195/
https://www.ncbi.nlm.nih.gov/pubmed/30254746
http://dx.doi.org/10.1016/j.amsu.2018.07.011
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author Apollos, Jeyakumar R.
Sami, Sharukh
Prasanth, Manju Nadh
Jeyakumar, Jerusha
McFadyen, Angus K.
author_facet Apollos, Jeyakumar R.
Sami, Sharukh
Prasanth, Manju Nadh
Jeyakumar, Jerusha
McFadyen, Angus K.
author_sort Apollos, Jeyakumar R.
collection PubMed
description BACKGROUND: Pancreatic ductal adenocarcinomas are poor prognostic cancers accounting for 3% of all cancer cases in the UK. They often present late in the course of the disease process with non-specific symptoms, including gastro-intestinal(GI) symptoms. Delays in diagnosis occur when investigations are carried out in a primary care setting for GI symptoms. The aim of this study was to assess delays in pancreatic cancer diagnosis when patients were referred for GI investigations and evaluate its effect on survival. METHODS: Retrospective cohort study of all patients diagnosed with pancreatic adenocarcinoma in a Scottish district general hospital over a seven year period from January 2010 to December 2016. Patients were divided into two groups, those who had a GI investigation 18 months prior to the pancreatic cancer diagnosis and those who did not have GI investigations. Data on demographics, symptoms on referral, stage of disease at diagnosis, treatment undergone and length of survival collected and analysed. RESULTS: One hundred and fifty-three patients were diagnosed with pancreatic cancer in the study period. Forty (26%) of the 153 underwent gastrointestinal investigations in the 18 months prior to diagnosis. The remaining 113 (74%) had no gastro-intestinal investigations in the same time period. Demographic data were comparable. Significant delays occurred from referral to diagnosis in the GI investigated group compared to those who did not have GI investigations. (64.5days vs 9 days, p = 0.001). No difference was noted in disease stage or treatments undergone between the groups. There was no difference in the average survival after diagnosis between the two groups with median of 108 days for those who underwent GI investigations to 97 days for those who did not.(U = 2079.5, p = 0.454). CONCLUSION: Delays caused by pre-diagnostic GI investigations do not appear to contribute to the poor prognosis of pancreatic cancer. Recently updated NICE Guidelines recommends early ultrasound or CT in patients with GI symptoms and weight loss which may reduce delays in diagnosis. Screening tests in future may become cost effective and diagnose this condition at a curable stage which in turn may improve survival rates.
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spelling pubmed-61491952018-09-25 Pre-diagnostic delays caused by gastrointestinal investigations do not affect outcomes in pancreatic cancer Apollos, Jeyakumar R. Sami, Sharukh Prasanth, Manju Nadh Jeyakumar, Jerusha McFadyen, Angus K. Ann Med Surg (Lond) Original Research BACKGROUND: Pancreatic ductal adenocarcinomas are poor prognostic cancers accounting for 3% of all cancer cases in the UK. They often present late in the course of the disease process with non-specific symptoms, including gastro-intestinal(GI) symptoms. Delays in diagnosis occur when investigations are carried out in a primary care setting for GI symptoms. The aim of this study was to assess delays in pancreatic cancer diagnosis when patients were referred for GI investigations and evaluate its effect on survival. METHODS: Retrospective cohort study of all patients diagnosed with pancreatic adenocarcinoma in a Scottish district general hospital over a seven year period from January 2010 to December 2016. Patients were divided into two groups, those who had a GI investigation 18 months prior to the pancreatic cancer diagnosis and those who did not have GI investigations. Data on demographics, symptoms on referral, stage of disease at diagnosis, treatment undergone and length of survival collected and analysed. RESULTS: One hundred and fifty-three patients were diagnosed with pancreatic cancer in the study period. Forty (26%) of the 153 underwent gastrointestinal investigations in the 18 months prior to diagnosis. The remaining 113 (74%) had no gastro-intestinal investigations in the same time period. Demographic data were comparable. Significant delays occurred from referral to diagnosis in the GI investigated group compared to those who did not have GI investigations. (64.5days vs 9 days, p = 0.001). No difference was noted in disease stage or treatments undergone between the groups. There was no difference in the average survival after diagnosis between the two groups with median of 108 days for those who underwent GI investigations to 97 days for those who did not.(U = 2079.5, p = 0.454). CONCLUSION: Delays caused by pre-diagnostic GI investigations do not appear to contribute to the poor prognosis of pancreatic cancer. Recently updated NICE Guidelines recommends early ultrasound or CT in patients with GI symptoms and weight loss which may reduce delays in diagnosis. Screening tests in future may become cost effective and diagnose this condition at a curable stage which in turn may improve survival rates. Elsevier 2018-09-10 /pmc/articles/PMC6149195/ /pubmed/30254746 http://dx.doi.org/10.1016/j.amsu.2018.07.011 Text en © 2018 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research
Apollos, Jeyakumar R.
Sami, Sharukh
Prasanth, Manju Nadh
Jeyakumar, Jerusha
McFadyen, Angus K.
Pre-diagnostic delays caused by gastrointestinal investigations do not affect outcomes in pancreatic cancer
title Pre-diagnostic delays caused by gastrointestinal investigations do not affect outcomes in pancreatic cancer
title_full Pre-diagnostic delays caused by gastrointestinal investigations do not affect outcomes in pancreatic cancer
title_fullStr Pre-diagnostic delays caused by gastrointestinal investigations do not affect outcomes in pancreatic cancer
title_full_unstemmed Pre-diagnostic delays caused by gastrointestinal investigations do not affect outcomes in pancreatic cancer
title_short Pre-diagnostic delays caused by gastrointestinal investigations do not affect outcomes in pancreatic cancer
title_sort pre-diagnostic delays caused by gastrointestinal investigations do not affect outcomes in pancreatic cancer
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6149195/
https://www.ncbi.nlm.nih.gov/pubmed/30254746
http://dx.doi.org/10.1016/j.amsu.2018.07.011
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