Improving pancreatic cancer outcomes

Clearer referral pathways and more awareness is needed for better pancreatic cancer outcomes, argues Dr Ian Watson

Compression and constriction of the duodenum by a carcinoma of the pancreatic head. Abdominal x-ray in front view (SPL)
Compression and constriction of the duodenum by a carcinoma of the pancreatic head. Abdominal x-ray in front view (SPL)

November is pancreatic cancer awareness month. As a GP, efforts to raise public awareness of any disease can make the heart sink at the prospect of having to reassure patients with over active imaginations that think they’re dying.  On the other hand, pancreatic cancer is without a doubt a disease that has not received its fair share of attention. Over 8,350 people a year are diagnosed with the disease and around 7,900 people a year die from it.

Pancreatic cancer is particularly challenging as symptoms can be non-specific and by the time it is diagnosed it is often too late to be treated. Many patients die within six months of diagnosis and only around 4% live for five years or more. It’s a lethal cancer – representing the fifth most common cause of cancer deaths in the UK after lung, bowel, breast and prostate.

Not surprisingly most of us know, through our practice or in our personal life, someone who has died from this disease.

On both a personal and a professional level I support initiatives that could make a positive difference to this disease. Earlier this year I attended the Early Diagnosis Summit on pancreatic cancer organised by national charity Pancreatic Cancer UK.

I was unsure what to expect from the summit but was encouraged to learn that some progress is being made to evidence pancreatic cancer symptoms and greater insight into how patients present leading up to the point of diagnosis. Even better, there are tools now available that would greatly help GPs identify patients where there may be some cause for concern.

Non-specific symptoms

On a slightly more disheartening note I was struck by the fact that as GPs one of the key challenges we continue to face with a disease like pancreatic cancer is what to do for those patients that have non-specific, persistent symptoms or where we have a high degree of suspicion that something isn’t right but have no obvious sign of what that might be. There was a time when the lines of communication between GPs and secondary care clinicians were such that a quick telephone conversation with a consultant we knew well was easily sorted – not so in today’s modern NHS.

Clearer referral pathways

Furthermore, as secondary care clinicians have rightly moved towards being specialists, referral pathways have followed in kind. For the women with a breast lump or a patient who has had a persistent cough the pathways are clear. Not so clear though for the patient that has had made several visits to the surgery with systemic symptoms that don’t neatly fit into a specific area of specialist medicine.

Focus on symptoms, not sites

In 2013 the DH will be launching a new cancer public awareness campaign that focuses on generic cancer symptoms, not tumour sites. As a GP that does want to make a difference I fully support this move – we need to improve early diagnosis of cancer right across the board and this kind of campaign will hopefully cast a wider cancer net that includes less common cancers like pancreatic cancer. To support this we must start to think how we can reinvigorate how we communicate with consultant colleagues should we face a clinical conundrum and need some advice on the next best steps in the pathway.

There were lots of good ideas put forward at the Early Diagnosis Summit – from both clinicians and patients – from simple hotlines into primary care for informal consultations to more structured clinic arrangements for patients that fall between the specialist stools. I hope that with the changes in the NHS and the drive being much more clinically focused, we as clinicians can work together and achieve quick wins with our secondary care colleagues such that when we see a patient with something that our sixth sense says is wrong, local agreement on who to speak to or refer urgently to can be agreed easily. This then would marry very nice with a public awareness campaign and allow patients to be fast tracked into a pathway.

  • Dr Watson is a GP principal, Associate Medical Director, Pennine Care NHS Foundation Trust, and National Clinical Lead Primary Care, NHS Improvement – Cancer

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