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Transforming treatment and care through a fast-track pancreatic cancer treatment pathway

Posted by: Research 1 August 2017

Research is the key to transforming the future for everyone with pancreatic cancer. Over the past five years, we’ve invested £5 million in research and our scientists have already made some important advances in the lab. But, not only do we need cutting-edge research to unlock discoveries that will help us diagnose pancreatic cancer earlier and find new treatment options, but we also need to dramatically transform the experience of people living with pancreatic cancer right now.

This is why we launched our Clinical Pioneer Awards, a funding opportunity that called on health professionals and researchers to develop and test promising and innovative ideas to transform the diagnosis, treatment and care of people affected by pancreatic cancer. We called for ideas that could ultimately lead to improvements in quality of life and patient experience, not just in the long-term, but for families dealing with pancreatic cancer right now.

With £50,000 in funding from our Clinical Pioneer Awards scheme we’ve seen major progress in the treatment of pancreatic cancer at University Hospitals Birmingham NHS Foundation Trust, one of the largest centres for complex pancreatic cancer surgery in the country.

The current treatment pathway

Patients with pancreatic cancer typically present with jaundice due to obstruction of the bile duct. Treatment of jaundice requires investigations and procedures which are not only invasive, but also put patients at risk of infections and complications. These complications often require hospital admission and intravenous antibiotics, which not only delay the possibility of curative surgery but also increase clinical costs to the NHS. Furthermore, doctors will often wait for test results before considering referral to specialist pancreatic teams — these tests may prove inconclusive and can lead to further delays in the pathway. Overall, the current patient pathway from diagnosis to eventual surgery takes between six weeks to two months.

Through our funding, specialist surgeon Keith Roberts undertook a pilot project aiming to reduce the time taken for patients to move from diagnosis to surgery, through implementing a new ‘fast-track’ surgical pathway. This new pathway aimed to quickly move pancreatic cancer patients with jaundice through to surgery without pre-operative treatment, and was facilitated by a Clinical Nurse Specialist which gave the added advantage of close contact and ensured each patient received high-quality care throughout their experience.

Increasing surgical success rates

The results of the pilot project were published in HPB Journal and found that implementation of the fast-track pathway reduced time from CT scan to treatment by a quarter that resulted in increased numbers of patients whose surgery was successful by around a fifth (22 per cent). Patients on the fast-track pathway underwent surgery within 16 days on average as opposed to 65 days for patients who underwent stenting. This meant that 97 per cent of patients who were eligible for surgery went on to have the treatment successfully, compared to a current average of 75 per cent of eligible patients.

There was also a clear benefit in healthcare cost in the fast-track group of patients, which was mainly due to savings made by cutting out the treatment for jaundice before surgery, as well as reducing complications and hospital readmissions after surgery. In implementing the fast-track surgery pathway, the team was able to save the NHS around £3,200 per patient.

What next?

Early surgery without stenting is possible within the NHS and increases the likelihood of successful resection. It is also associated with reduced costs in NHS. By reducing the time to surgery, it appears that more patients undergo potentially curative surgery and this could improve long-term survival of pancreatic cancer which has seen very little progress in treatments since the early 1970s.

The fast-track pathway has been welcomed by a range of clinicians, including surgeons, gastroenterologists and radiologists, from both the referring units and receiving unit in Birmingham. It should be possible to expand the pathway locally and to spread the pathway nationally, providing the knowledge of its existence is widened and practical issues with implementation are addressed.

It is hoped that at University Hospitals Birmingham NHS Foundation Trust the pathway will be permanently funded and available for patients diagnosed with pancreatic cancer, and the results of the pilot are being shared far and wide in the hope that more trusts will roll it out and consultants will use it.

More research is now needed to investigate the impact of the pathway on long-term outcomes and to see if the pathway could be implemented further across the NHS, but in the short term this work has had major impact in transforming the outlook for patients in Birmingham with operable pancreatic cancer.

In the future, savings made through implementing the fast-track pathway could be used to employ a Clinical Nurse Specialist to make long-term implementation of the fast-track pathway possible, as well as providing support to patients. This also has the potential to bring additional savings through reducing emergencies and unnecessary admissions.