Routes to Diagnosis

A&E signPancreatic cancer is a difficult condition to diagnose. This is, perhaps, reflected in the large numbers of patients who are diagnosed as an emergency presentation.

Routes to Diagnosis for pancreatic cancer

The table below shows the varying routes through which cancer patients can be diagnosed in the UK:

Screen Detected Detected via the breast, cervical or bowel screening programmes
Two Week Wait Urgent GP referral with a suspicion of cancer
GP Referral Routine and urgent referrals where the patient was not referred under the Two Week Wait referral route
Other Outpatient An elective route starting with an outpatient appointment: either self-referral, consultant to consultant, other referral
Inpatient Elective Where no earlier admission can be found prior to admission from a waiting list, booked or planned
Emergency Presentation An emergency route via A&E, emergency GP referral, emergency transfer, emergency consultant outpatient referral, emergency admission or attendance
Death Certificate Only No data available from Inpatient or Outpatient HES, CWT, Screening and with a death certificate only diagnosis flagged by the registry in the NCDR
Unknown No data available from Inpatient or Outpatient HES, CWT, Screening within set time parameters or unknown referral

HES = Outpatient Hospital Episode Statistics; CWT = National Cancer Waiting Times; NCDR = National Cancer Repository Data

Routes to diagnosis for pancreatic cancer patients in comparison to all cancers:

Route All Cancers Pancreatic Cancer(all ages) Pancreatic Cancer(under 69) Pancreatic Cancer(over 70)
Screen Detected 5% 0% 0% 0%
Two Week Wait 27% 12% 12% 11%
GP Referral 27% 20% 23% 18%
Other Outpatient 10% 11% 16% 8%
Inpatient Elective 3% 3% 5% 2%
Emergency Presentation 23% 48% 40% 56%
Death Certificate Only 0% 1% 1% 1%
Unknown 4% 4% 4% 4%

As can be seen from the above table, there is more than double the amount of pancreatic cancer patients who are diagnosed as an emergency presentation than for all cancers combined. This too is reflected in the percentages diagnosed via the GP referral or two week wait system.

Does it matter where you are diagnosed?

Survival by route to diagnosis – all ages 2008-2010 (1)

Graph 1 yr survival by route to diagnosis

 Those diagnosed as an emergency presentation have a lower rate of survival:

The graph above shows the relative survival percentage by route to diagnosis for one to 12 months. Notably, the one-year relative survival for all routes is 17 per cent. However, for those diagnosed as an emergency presentation, this falls to only 9 per cent – that is a reduction of 53 per cent. Survival is lower for this group of patients across all survival intervals.

The number of GP visits before referral:

A UK study of over 13,000 cancer patients (2) has revealed that around one in three pancreatic cancer patients require three or more visits to their GP before they are referred to a specialist. And, as you would expect, the more GP visits patients had to make delayed their diagnosis. For pancreatic cancer patients who visited their GP more than five times, their diagnosis was delayed on average by more than three months.

Late diagnosis is one of the reasons why pancreatic cancer survival rates are lower than for other types of cancer.

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