The ‘two-week’ target for the diagnosis of pancreatic carcinoma: an achievable aim?

• Published in: European journal of surgical oncology Vol. 29; no. 7; pp. 575 - 579
• Main Authors: Gilliam, A.D, Lobo, D.N, Rowlands, B.J, Beckingham, I.J
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01-09-2003; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; cancer; diagnosis; Diagnosis, Differential; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hospitals, University - statistics & numerical data; Humans; jaundice; Jaundice - etiology; Length of Stay - statistics & numerical data; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; pancreas; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - mortality; Patient Admission - statistics & numerical data; Process Assessment (Health Care); Retrospective Studies; survival; Survival Analysis; Time Factors; Tumors; two-week rule; United Kingdom - epidemiology; two-week rule; diagnosis; cancer; jaundice; pancreas; survival; Adenocarcinoma; Human; Hospitalization delay; Treatment efficiency; Clinical form; Surgical resection; Malignant tumor; Waiting time; Retrospective; Cohort study; Digestive diseases; Medical imagery; Diagnosis; Pancreas; Survival curve; Pancreatic disease
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/S0748-7983(03)00112-4

Aim: The aim of this study was to evaluate the current diagnostic process for patients with pancreatic cancer in a University teaching hospital and to determine whether the ‘two-week’ target for rapid assessment was being met.
Methods: The notes of all patients with pancreatic cancer from June 1998 to June 2000 were reviewed to determine the time to diagnosis, investigations and procedures performed, number of admissions, length of hospital stay and survival.
Results: There were 146 patients in total with a median (range) age of 71 (38–92) years. 18 (12%) had resectable lesions, while the remaining 128 patients had 134 palliative interventions (33 surgical; 101 radiological or endoscopic). The median number of hospital admissions for each patient was 2 (range 1–6) with a median length of hospital stay of 9 days (range 1–35 days). The median (IQR) time to diagnosis was significantly less in the jaundiced patients [7 (6–10) days vs. 32 (18–46) days,
P<0.0001]. There was no significant correlation between age and time to diagnosis (
r=0.08,
P=0.36). There were 105 (72%) deaths in the study population, 82 in the jaundiced group and 23 in the non-jaundiced group. There was no significant difference in median (IQR) duration from referral to death in the jaundiced and non-jaundiced groups [59.5 (18–175) days vs. 35 (16–137) days,
P=0.45].
Conclusions: A diagnosis within 14 days was achieved in 77% of patients. Patients with jaundice were more likely to have an earlier diagnosis than those without jaundice but this had no impact on survival.