Pancreatic cancer: NI cases up 86%, audit reveals

There were 283 confirmed cases in 2020, up from from 152 in 2001, when the last audit was carried out.

Patients were most commonly diagnosed with pancreatic cancer through hospital emergency departments.

The findings have led the NI director of the Royal College of Surgeons to call for "enhanced" services.

Mark Taylor, NI director of the Royal College of Surgeons and consultant Hepatobiliary and Pancreatic Cancer Surgeon, said cases were likely to rise because of "increasing age, obesity and diabetes".

"We can see on the ground how pancreatic cancer referrals are increasing and we must strengthen services in our response," said Prof Taylor.

"It is concerning that the most common route to diagnosis was via emergency admissions and the majority of patients presented with advanced (stage four) cancer where the cancer has spread to a distant site."

The audit is the first look at pancreatic cancer services in the UK since the pandemic. It will help to inform the soon to be established pancreatic cancer audit in England.

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

Key findings include:

Most patients - 94per cent - show symptoms at the diagnosis stage

The most common route to diagnosis is through emergency admission - where most cases 53 per cent are diagnosed at an advanced stage

It highlights the need for increased awareness of symptoms among the public and GPs to support early diagnosis

The majority of patients presented with the top five symptoms of abdominal pain, weight loss, jaundice, nausea/vomiting and decreased appetite

During 2019-2020 access to essential PET-CT was low at 17 per cent, with patients waiting on average 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 one per cent of patients were enrolled in clinical trials

On a more positive note, the audit revealed that patients accessed a range of support services including clinical nurse specialists, both in secondary (hospital) care and in the community.

And virtually all the patients were discussed by a multi-disciplinary team meeting prior to their first treatment - a key aspect of holistic, patient-centred care.

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, said patients needed better access to clinical trials.

"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," Dr Bennett added.

"Diagnosing pancreatic cancer at an earlier stage has a major impact on survival, with 52 per cent of patients with early cancer (Stage 1) living for one year compared to only six per cent for those with advanced cancer (Stage 4).”

The audit also revealed that 40 per cent of patients did not have a treatment plan to reduce their tumour in 2019, a figure that increased to 46% in just over a year.

If more people can be diagnosed earlier and when they are fitter, they might be able to receive tumour-reducing therapies and survive longer, it found.

Sinéad Hawkins, lead author said: “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.”