The audit published today, Tuesday 9 May, was funded by local pancreatic cancer charity NIPANC with the audit work undertaken by the Northern Ireland Cancer Registry (NICR) at Queen’s University Belfast in partnership with HPB clinical staff in the Belfast Trust.   

Its findings have prompted Mark Taylor, NI Director of the Royal College of Surgeons and Consultant Hepatobiliary and Pancreatic Cancer Surgeon, to call for a strengthening of local pancreatic cancer services as ‘incidences are likely to continue to rise’ due to multifactorial reasons such as ‘increasing age, obesity and diabetes.’ 

The audit measures the pathway of pancreatic cancer patients during 2019 and 2020 in secondary (hospital) care and is the first audit of pancreatic cancer services in the UK since the pandemic. It will help to inform the soon to be established pancreatic cancer audit in England.  

Key findings in addition to the startling increase in diagnosed cases include:  

• Most patients are symptomatic at diagnosis (94%). The most common route to diagnosis is through emergency admission with the majority being diagnosed at an advanced stage (53%) highlighting the need for increased awareness of symptoms among the public and GPs to support early diagnosis  
• During 2019-2020 access to essential PET-CT was low (17%) with patients waiting a median 44 days for a scan.  
• Patients who had curative oncology as their first treatment waited a median of 72 days in 2019 and 79 days in 2020. 
• Only 1% of patients were enrolled in clinical trials 

The audit also positively showed: 

• Patients accessed a range of support services, including Clinical Nurse Specialist Support, both in secondary (hospital) care and in the community 
• Virtually all patients were discussed at a Multi-Disciplinary Team (MDT) meeting prior to their first treatment; a key aspect of holistic, patient-centred care.  

Professor Mark Taylor, also a Trustee of NIPANC, said: “We can see on the ground, how pancreatic cancer referrals are increasing, and we must strengthen our services in response. 

“It is concerning the most common route to diagnosis was via emergency admissions (43%) and the majority of patients presented with advanced (Stage 4) cancer where the cancer has spread to a distant site. This underpins the importance of continuing in all our campaigning efforts to raise awareness of early signs and symptoms to enable timely diagnosis and treatment.” 

The audit also reveals urgent need for timely access to diagnostics such as CT-PET scans to ensure patients have the most appropriate staging investigations. Improvements are also required for treatment pathways to allow patients to be treated within 62 days of referral.  

Dr Damien Bennett, Interim Director of the NI Cancer Registry (NICR) at Queen’s University Belfast, added: “We also want to see better access to clinical trials for NI pancreatic cancer patients in addition to a strengthening of personalised and holistic care for those who face a diagnosis of the disease. 

“This audit shows that, unfortunately, most people with pancreatic cancer are still diagnosed with advanced disease, which leads to worse outcomes and poorer survival.  Diagnosing pancreatic cancer at an earlier stage has a major impact on survival, with 52% of patients with early cancer (Stage 1) living for 1 year compared to only 6% for those with advanced cancer (Stage 4). 

“We found that only 1% of patients were enrolled in clinical trials.  Better access to clinical trials for eligible pancreatic cancer patients should be provided.” 

Dr Damien Bennett added: “This audit by the NI Cancer Registry was only possible with the support of NIPANC, but for audits to be effective they need to be funded to repeat on a regular basis.” 

Sinéad Hawkins, Lead Author from the NI Cancer Registry (NICR) at Queen’s University Belfast, said: “This audit offers some hope for future pancreatic cancer patients with survival increasing significantly for patients who are offered tumour-reductive therapies such as surgery, radiotherapy and/or chemotherapy compared to those who are not: 52% vs. 7% surviving one year post diagnosis. Survival is higher still if patients undergo a resection of their tumour (one year survival of 76%). 

“Unfortunately, 40% of patients did not have a treatment plan to reduce their tumour in 2019, and this increased to 46% in 2020 during the pandemic.  This audit also found the majority of patients presented with symptoms (94%) with the top five symptoms being abdominal pain, weight loss, jaundice, nausea/vomiting and decreased appetite. Despite pancreatic patients presenting mainly symptomatic the most common referral route to cancer services is via emergency services, with the majority being late stage at diagnosis. 

“If more patients can be diagnosed earlier and fitter, they may be able to receive tumour-reducing therapies and survive longer.  This would require increased focus from the health agencies and wider stakeholders to increase awareness of pancreatic cancer symptoms and support earlier diagnosis reducing diagnoses at hospital emergency departments.” 

Media

Media inquiries to Sian Devlin at s.devlin@qub.ac.uk