Pancreatic cancer outcomes remain poor

Pancreatic cancer is the most fatal form of cancer in the UK, with only 3% of patients surviving for five years or more, a statistic that has not changed in over 40 years. In the UK, around 80% of pancreatic cancer patients are diagnosed at an advanced stage of the disease when cure is no longer an option, despite the fact that many pancreatic cancer patients do experience symptoms for some time before they are diagnosed and act on their concerns, visiting their GP and hospital. Even patients who are diagnosed at a stage when their cancer can be treated with surgery do poorly, with between 7% and 25% surviving for five years or more. According to a report from Pancreatic Cancer UK, outcomes for pancreatic cancer patients in the UK fall well below acceptable levels. The Study for Survival report draws on the experiences of over 1,000 people living with and working with pancreatic cancer. It has highlighted that five year survival rates for UK pancreatic cancer patients are among the worst in the world. Commenting on the results of the report, Professor Sir Mike Richards, national clinical director for Cancer and End-of-Life Care, said: “Pancreatic Cancer UK’s Study for Survival has shown that we clearly have a long way to go before we can say with confidence that everyone diagnosed with pancreatic cancer has access to the best possible treatment and care available. This includes access to expert input from multidisciplinary teams located at specialist pancreatic cancer centres and one to one support from clinical nurse specialists. Pancreatic cancer is a challenging cancer – but we need to take this information and the opportunity it presents to improve survival and quality of life for everyone. Pancreatic cancer must not be written off as a hopeless cause.” Alex Ford, Pancreatic Cancer UK’s chief executive, adds: “For the first time, Pancreatic Cancer UK’s Study for Survival provides vital evidence about what is required to improve the appalling situation for people diagnosed with pancreatic cancer in the UK. Our ambition must be to give everyone the best possible chance to survive this disease and improve quality of life for pancreatic cancer patients.” Looking towards a more hopeful future for patients suffering from pancreatic cancer, and using the results of the study as a starting point, Pancreatic Cancer UK has launched the Campaign for Hope which has set a goal to double survival rates for pancreatic cancer patients in the UK within five years, helping to save up to 250 lives a year.

GPs – more support needed

Pancreatic Cancer UK has found that GPs feel strongly that more could be done to support them to identify pancreatic cancer concerns at an earlier stage. This could include, for example: more symptoms research; the provision of more effective referral guidelines; the development of risk assessment aids and better access to diagnostic tools for pancreatic cancer; as well as more information about the disease. The report has also raised questions about consistency of outcomes across England. Similar to other studies of cancer survival, the data suggests that a north/south divide exists, with patients in the north of the country generally faring less well on a number of different measures, including survival. In addition, while it is estimated that about 20% of pancreatic cancer will be diagnosed at a stage when the disease may be cured by surgery, analysis based on data from 2006 found that less than 10% of these patients were offered surgery that could cure their disease. Research also shows that pancreatic cancer patients are much less likely to receive life-saving surgery than almost every other cancer patient, including those with breast, lung and bowel cancer. There are many reasons why some pancreatic cancer patients are not suitable for surgery – for example, they may be too frail or ill with other health problems. However, many people who contributed to the study expressed concern that not all patients are benefiting from access to the full range of possible treatment options, including surgery, because a of lack of insight into the survival benefits of surgery and negative attitudes held by some clinicians about pancreatic cancer outcomes. The publication, 10 years ago, of guidance to improve outcomes in upper gastrointestinal cancers,1 led to implementation of a centralised model of pancreatic cancer care with surgical and multidisciplinary team expertise located at accredited specialist centres. However, Pancreatic Cancer UK does not believe that all pancreatic cancer patients who could benefit from specialist expertise are being referred on to specialist centres for proper consideration. They are therefore not gaining access to the full range of treatments from which they could benefit, including surgery. It is important to ensure that treatment decisions are influenced by an understanding of the range and benefits of treatments available – and not by an attitude that nothing can be done. The report therefore recommends that the Healthcare Quality Partnership (England and Wales) urgently commission a clinical audit of pancreatic cancer services to provide further insight, in particular, into concerns related to the level of direct referral to specialist centres from local hospitals as well as the rate of surgical resection. Similar audits have been managed by the National Clinical Audit Support Programme (NCASP) for lung, bowel and oesophagogastric cancers. If possible, Scottish and Northern Ireland data should be incorporated into, or independent audits commissioned by, the Northern Ireland Cancer Registry and ISD Scotland, in collaboration with the Scottish Regional Cancer Networks. The report also recommends that research be conducted to find out why UK pancreatic cancer outcomes are poorer than in many other countries and what these differences can be attributed to. More up-to-date data about pancreatic cancer activity and outcomes is also needed to enable a conclusive analysis of how well or poorly pancreatic cancer services are performing. Perhaps the most significant pancreatic cancer challenge highlighted by the report relates to the lack of options available to diagnose and treat the disease. There is still not enough known about pancreatic cancer progression and resistance to therapy to understand why it does not respond well to available cancer drugs – or to support the development of new drugs and treatment approaches. Research holds the answers to these questions. However, compared to other cancers, the UK’s spend on pancreatic cancer is very low – particularly so when the burden of the disease is taken into account. Pancreatic Cancer UK says that pancreatic cancer is the fifth most common cause of cancer death in the UK and represents 5% of all cancer deaths – yet it accounts for less than 1% of overall cancer research funding in the UK.