TY - JOUR
T1 - Impact of multicentre diagnostic workup in patients with pancreatic cancer on repeated diagnostic investigations, time-to-diagnosis and time-to-treatment
T2 - A nationwide analysis
AU - Hopstaken, Jana S
AU - Vissers, Pauline A J
AU - Quispel, Rutger
AU - de Vos-Geelen, Judith
AU - Brosens, Lodewijk A A
AU - de Hingh, Ignace H J T
AU - van der Geest, Lydia G
AU - Besselink, Marc G
AU - van Laarhoven, Kees J H M
AU - Stommel, Martijn W J
N1 - Funding Information:
Judith de Vos-Geelen has served as a consultant for Amgen, AstraZeneca, MSD, Pierre Fabre, and Servier, and has received institutional research funding from Servier. All outside the submitted work. Lodewijk Brosens served as a paid consultant for Bristol-Myers Squibb. The other authors have no interests to declare. Abstract: 244 words Manuscript body: 2951 Tables: 2 - Supplementary Table: 1 Figures: 4
Publisher Copyright:
© 2022 The Authors
PY - 2022/10
Y1 - 2022/10
N2 - Background: Due to the centralization of pancreatic surgery, patients with suspected pancreatic cancer may undergo diagnostic workup in both a non-pancreatic centre and a pancreatic centre, i.e. multicentre workup. This retrospective study assessed whether multicentre diagnostic workup is associated with repeated diagnostics, delayed time-to-diagnosis, delayed time-to-treatment, survival and whether variation existed among pancreatic cancer networks. Methods: This nationwide study included all patients diagnosed with non-metastatic pancreatic ductal adenocarcinoma (PDAC) in 2015, registered by the Netherlands Cancer Registry. A delayed time-to-diagnosis was defined as ≥3 weeks from initial hospital visit to final diagnosis. A delayed time-to-treatment was defined as ≥6 weeks from the first hospital visit to start of first tumour treatment. Multilevel logistic regression analyses and survival analyses were performed. Results: In total, 931 patients with non-metastatic PDAC were included. Overall, 175 patients (19%) underwent a multicentre diagnostic workup, which was significantly associated with repeated diagnostic investigations (OR = 6.31, 95% CI 4.13–9.64, P < 0.0001), a delayed time-to-diagnosis (OR = 2.66 95% CI 1.74–4.06, P < 0.001), and a delayed time-to-treatment (OR = 1.93 95% CI 1.12–3.31, P = 0.02), but not with decreased survival (HR = 1.09 95% CI 0.83–1.44; P = 0.532). Variation in outcomes per network was observed, especially for time-to-treatment, though the ICC was not statistically significant (P = 0.065). Conclusion: Multicentre diagnostic workup for patients with PDAC is associated with repeated diagnostic investigations, a delayed time-to-diagnosis and delayed time-to-treatment compared to patients with monocentre workup. To reduce costs and improve treatment times, efforts should be made to improve network coordination, for example via network care pathways.
AB - Background: Due to the centralization of pancreatic surgery, patients with suspected pancreatic cancer may undergo diagnostic workup in both a non-pancreatic centre and a pancreatic centre, i.e. multicentre workup. This retrospective study assessed whether multicentre diagnostic workup is associated with repeated diagnostics, delayed time-to-diagnosis, delayed time-to-treatment, survival and whether variation existed among pancreatic cancer networks. Methods: This nationwide study included all patients diagnosed with non-metastatic pancreatic ductal adenocarcinoma (PDAC) in 2015, registered by the Netherlands Cancer Registry. A delayed time-to-diagnosis was defined as ≥3 weeks from initial hospital visit to final diagnosis. A delayed time-to-treatment was defined as ≥6 weeks from the first hospital visit to start of first tumour treatment. Multilevel logistic regression analyses and survival analyses were performed. Results: In total, 931 patients with non-metastatic PDAC were included. Overall, 175 patients (19%) underwent a multicentre diagnostic workup, which was significantly associated with repeated diagnostic investigations (OR = 6.31, 95% CI 4.13–9.64, P < 0.0001), a delayed time-to-diagnosis (OR = 2.66 95% CI 1.74–4.06, P < 0.001), and a delayed time-to-treatment (OR = 1.93 95% CI 1.12–3.31, P = 0.02), but not with decreased survival (HR = 1.09 95% CI 0.83–1.44; P = 0.532). Variation in outcomes per network was observed, especially for time-to-treatment, though the ICC was not statistically significant (P = 0.065). Conclusion: Multicentre diagnostic workup for patients with PDAC is associated with repeated diagnostic investigations, a delayed time-to-diagnosis and delayed time-to-treatment compared to patients with monocentre workup. To reduce costs and improve treatment times, efforts should be made to improve network coordination, for example via network care pathways.
KW - Cancer networks
KW - Centralization
KW - Diagnostic investigations
KW - Pancreatic cancer
KW - Quality of care
UR - http://www.scopus.com/inward/record.url?scp=85131799322&partnerID=8YFLogxK
U2 - 10.1016/j.ejso.2022.05.031
DO - 10.1016/j.ejso.2022.05.031
M3 - Article
C2 - 35701256
SN - 0748-7983
VL - 48
SP - 2195
EP - 2201
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 10
ER -