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Reducing pancreatic cancer diagnoses via emergency admission could significantly improve survival

Posted by: Policy and campaigning 4 September 2013

National charity Pancreatic Cancer UK has today released research[i] that shows if pancreatic cancer diagnoses as a result of emergency presentation were reduced to 25 per cent, and these patients were diagnosed via the Two Week Wait route, as many as 150 additional patients would survive for a year or longer. Even a modest reduction of 10 per cent would mean an increase of 50 additional pancreatic cancer patients surviving one year or more.

The research has been published in the charity's new report, Every Life Matters: the real cost of pancreatic cancer diagnoses via emergency admission.

Currently over half of all pancreatic cancer diagnoses in England are made as a result of an emergency presentation, double the average rate of all other cancers. Survival rates for patients diagnosed via this route are also significantly lower with one-year survival at only 9% compared to 26% for those diagnosed as a result of a GP referral.[ii]

Additional research[iii] found the average cost of an emergency admission, where pancreatic cancer is the primary diagnosis, is nearly £5,000 in England - about three times the average cost, per patient (about £1,500)[iv], of all emergency admissions combined.

With an average in-patient stay of 13.2 days, patients diagnosed with pancreatic cancer via this route also spend a considerably longer time in hospital. Although not directly comparable, the average length of stay for patients admitted on an elective basis for treatment of cancer is 7.4 days.[v] Expert clinical opinion on this figure strongly suggests that patients diagnosed with pancreatic cancer as a result of an emergency admission may be experiencing unnecessary delays in accessing diagnostic investigations and, more importantly, to treatment for the relief of symptoms.

Why are there so many emergency admissions?

It is important to acknowledge diagnosing pancreatic cancer represents a challenge. On average a GP will only see one new pancreatic cancer patient every five years.[vi]  Pancreatic cancer symptoms can be non-specific and some may only experience symptoms (for example, sudden onset of jaundice) at a late stage. For these patients diagnosis as a result of an emergency admission might not be avoidable. However, evidence also shows that significant numbers of pancreatic cancer patients do experience symptoms for some time prior to diagnosis and do visit their GPs.[vii]

Pancreatic Cancer UK is calling for:

  • a Government commitment to halve diagnoses of pancreatic cancer as a result of emergency presentation - with a short term three-year target of reducing this by 10%
  • an urgent audit of patients diagnosed via an emergency route to establish exactly how many cases might be avoided in the future and to identify actions to increase the number of patients diagnosed earlier through more appropriate routes
  • implementation of tools to help GPs identify patients sooner who require further investigation
  • access for GPs to more appropriate pathways, for example, single points of referral from primary to secondary care for coordination of diagnostics and rapid access jaundice clinics. This would help to improve survival, reduce treatment delays as well as the number of expensive bed-days incurred as a result of emergency admissions.

In the UK, the one-year survival rate for pancreatic cancer is around 18% and the five-year survival rate is less than 4%. Pancreatic cancer has the lowest rate of survival of all of the 21 most common cancers.

Alex Ford, Chief Executive of Pancreatic Cancer UK, comments, "For those patients who do experience symptoms and do visit their GP prior to an emergency admission diagnosis, it must be acknowledged that this may mean their lives have been needlessly shortened or lost. We believe that the NHS could do much better by all pancreatic cancer patients, including those where a diagnosis as a result of an emergency admission is not avoidable, by taking steps to eliminate unnecessary delays."

Mr Colin Johnson, Pancreatic Cancer Surgeon, Southampton University Hospitals Trust, comments: " Emergency admissions are an increasing source of pressure on the NHS, and pancreatic cancer patients admitted this way usually end up under the care of the 'wrong' specialist. Delays follow, for referral to the correct team, and for requests for in-patient investigations, which could have been planned without admission after an out-patient assessment.

"Unnecessary emergency admissions bring added cost in relation to bed days and play havoc with planned elective activity. More widespread use of alternative ways of managing pancreatic emergencies, like rapid access specialist clinics,  would probably benefit patients as well as the NHS."

Dr Andrew Millar, Consultant Gastroenterologist and Pathway Director for Hepatic Pancreatic and Biliary Cancer at UCL Partners, comments: "We need to look for ways to improve awareness, support clinicians to more quickly make an accurate diagnosis and ensure that the pathways into hospital and access to diagnostic tests all work towards improving survival and the quality of life for patients with pancreatic cancer."

"It is important that the highest standards of care are set across the UK, including equality of access to advanced surgical techniques and, for patients and their relatives and friends, the very best supportive care throughout and increasingly, after treatment."

Pancreatic Cancer UK has launched a new campaign, Every Life Matters. The campaign supports the charity's aim to create a better future for every single person diagnosed with pancreatic cancer and acknowledges that every lifelost to the disease, matters. 

[i] National Cancer Intelligence Network (NCIN), - For Pancreatic Cancer UK; Projections of additional number of people living 1 year or longer if emergency admission diagnosis of pancreatic cancer were reduced and patients were diagnosed through other routes, 2013

[ii] Routes to Diagnosis, 2006-2008, NCIN information supplement, 2012

[iii] Mauro Laudicello, Imperial College London, - For Pancreatic Cancer UK; Estimating the cost of inpatient care in patients diagnosed with pancreatic cancer as a result of an emergency admission, 2013

[iv] https://www.gov.uk/governemnt/publications/2010-11-reference-costs-publication

[v] Hospital Episodes Statistics Headline figures 2008-09

[vi] NHS Executive, Improving Outcomes in Upper Gastro-intestinal Cancer, 2001

[vii] Cancer patient Experience Survey, 2011/12, Department of Health, 2012