Delay in pancreatic cancer diagnosis and treatment: Call to action

Pancreatic cancer is a disease with high mortality. In most cases, it is diagnosed in advanced stages and median overall survival is less than 12 months. Time to diagnosis and treatment may be critical. In some high-income countries there are well-established recommendations from recognition and referral suspected cancer cases (2-week rule). Our objective was to describe the time intervals from the onset of symptoms to histological diagnosis, to first oncologic consultation and beginning to treatment in patients with pancreatic cancer.

We performed a retrospective review of medical records in a previous stablished cohort which studied the prevalence of pathogenic germline variants among pancreatic ductal adenocarcinoma (PDA) patients, evaluated between August 3, 2020 and June 13, 2022 in 3 institutions located in Mexico City, Mexico: Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Instituto Nacional de Cancerología, and Centro Médico ABC Observatorio. Patient characteristics and clinical stage at diagnosis were recorded. Time intervals were defined as follows: time from symptom onset to biopsy; time from symptom onset to first oncologic consultation; time from symptom onset to treatment (systemic treatment or surgery, as appropriate). We considered the "time of symptom onset" as the time recorded by the patient at which the cardinal symptom associated with PDA and which led to seek medical assistance appeared.

107 patients were included: 58% women, median age was 63 y/o, clinical stages at diagnosis were: I (24%), II (22%), III (6%), and IV (48%). In 79% of cases the primary tumor was located in the head of the pancreas. Symptoms at presentation were: abdominal pain (81%), weight loss (73%), and jaundice (66%). 65% had vague or unspecified gastrointestinal symptoms. For those with stage IV disease, 50% had 2 o more sites of metastases. The main site of metastasis was liver (64%). The median time from symptom onset to biopsy was 3.7 months (range 7-829 days). The median time from symptom onset to first oncologic consultation was 3.9 months (range 6 – 698 days). Finally, the median time from symptom onset to treatment was 4.9 months (range 14 – 929 days). 64% (N= 67) had a diagnostic interval longer than 3 months. For patients with advanced PDA, median time to biopsy was 4.2 months (range 7 – 390 days). 9 patients (8%) had a biopsy in less than 30 days (range 7 – 30 days).

In this cohort, the median diagnostic interval and beginning to treatment were unacceptably long. Suspicion of pancreatic cancer is crucial, efforts should be focused on early referral in order to ensure appropriate and timely therapy.

The authors.

Has not received any funding.

All authors have declared no conflicts of interest.