Diagnostic delays in pancreatic cancer relatively common, likely avoidable, study suggests
Thirty-eight percent of patients with pancreatic cancer experienced a diagnostic delay of at least 60 days, with lack of recognition of objective weight loss as the most common cause, a Veterans Affairs study showed.
More than one-third of patients with pancreatic cancer experience a diagnostic delay, due in large part to inadequate recognition of red flags in electronic health records, results of a single-center cohort study suggest.
To develop a standardized definition of diagnostic delay, evaluate its prevalence, and identify contributing factors, researchers conducted a retrospective cohort study of patients diagnosed with pancreatic adenocarcinoma between 2007 and 2019 at a Veterans Affairs medical center. A panel of two primary care physicians, two oncologists, three gastroenterologists, and one surgical oncologist defined a delay as a cancer diagnosis made at least 60 days after the first clinical presence of one or more predefined red flags in the electronic health record, including new-onset jaundice, cachexia, significant unintentional weight loss, and other degrees of unintentional weight loss in combination with at least one other pancreatic cancer-associated sign or symptom. Findings were published by Clinical Gastroenterology and Hepatology on July 27.
Of the 197 pancreatic adenocarcinoma patients in the study, 38.6% experienced a diagnostic delay based on the applied definition. Patients who experienced delays were more likely to be non-Hispanic Black and to have diabetes (P< 0.05 for both). The most common red flag associated with a delay was unintentional weight loss (85.5%), followed by a combination of unintentional weight loss and jaundice (11.8%) and jaundice alone (2.6%). In the 74 patients with sufficient documentation to determine what factors contributed to the delay, the most common factor was related to the patient-health care professional encounter (60.8%), followed by diagnostic testing (23.0%).
Though the difference was not statistically significant, patients with delayed diagnoses were more likely to be diagnosed at an advanced disease stage (adjusted odds ratio [aOR], 1.62; 95% CI, 0.79 to 3.30) and less likely to receive potentially curative treatment (aOR, 0.72; 95% CI, 0.28 to 1.84).
Limitations to the study include a relatively small sample size, lack of information on family history, and a selection of the expert panel members from a single institution.
The study shows that delays in diagnosing pancreatic cancer were relatively common, and many were likely preventable, the researchers wrote. “Timely evaluation of adults with new-onset jaundice or unintentional weight loss may identify patients with pancreatic cancer early and avoid diagnostic delays. Improved understanding of practice gaps that lead to diagnostic delays can inform future targeted interventions to reduce potentially preventable diagnostic delays,” they concluded.