Time interval from last visit to imaging diagnosis influences outcome in pancreatic adenocarcinoma: A regional population-based study on linked medico-administrative and clinical data

Vittoria Balzano; Emeline Laurent; Aline-Marie Florence; Anne-Isabelle Lecuyer; Carole Lefebvre; Patrick Heitzmann; Pascal Hammel; Thierry Lecomte; Leslie Grammatico-Guillon

doi:10.1177/17588359221113264

Time interval from last visit to imaging diagnosis influences outcome in pancreatic adenocarcinoma: A regional population-based study on linked medico-administrative and clinical data

Ther Adv Med Oncol. 2022 Sep 5:14:17588359221113264. doi: 10.1177/17588359221113264. eCollection 2022.

Authors

Vittoria Balzano^{1

2}, Emeline Laurent^{3

4}, Aline-Marie Florence^{3

5}, Anne-Isabelle Lecuyer^{3

4}, Carole Lefebvre¹, Patrick Heitzmann¹, Pascal Hammel^{6

7}, Thierry Lecomte^{1

8

2}, Leslie Grammatico-Guillon^{9

10}

Affiliations

¹ OncoCentre, Cancer network of the Centre-Val de Loire region, Tours, France.
² Gastroenterology and Digestive Oncology Department, Teaching Hospital of Tours, Tours, France.
³ Public Health Unit, Epidemiology (EpiDcliC), Teaching Hospital of Tours, Tours, France.
⁴ Research Unit EA7505 "Education, Ethics and Health", University of Tours, Tours, France.
⁵ Department of Public Healht, Faculty of Medicine,University of Tours, France.
⁶ Digestive and Medical Oncology Department, Paul Brousse University Hospital, Villejuif, France.
⁷ Paris-Saclay University, Villejuif, France.
⁸ University of Tours, Faculty of Medicine, Tours, France.
⁹ Department of Public Healht, Faculty of Medicine, University of Tours, France.
¹⁰ Public Health Unit, Epidemiology (EpiDcliC), Teaching Hospital of Tours, 2 Boulevard Tonnellé, 37044 Tours cedex 9, France.

Abstract

Background: Excessive waiting time intervals for the diagnosis and treatment of patients with pancreatic cancer can influence their prognosis but they remain unclear. The objective was to describe time intervals from the medical visit to diagnostic imaging and to treatment and their prognostic impact in pancreatic cancer in one French region.

Methods: This retrospective observational multicentre study included all patients with pancreatic cancer seen for the first time in 2017 in multidisciplinary team meetings (MTMs), where clinical data were collected. A probabilistic matching with the medico-administrative data from the French national healthcare database (Système National des Données de Santé) was performed to define the care pathway from clinical presentation to the beginning of treatment. Median key time intervals were estimated for both resected and unresected tumours. Factors associated with 1-year survival were studied using Cox model.

Results: A total of 324 patients (88% of total patients with MTM presentation) were matched and included: male 54%, mean age 72 years ±9.2, Eastern Cooperative Oncology Group (ECOG) PS > 1 19.5%, metastatic disease at diagnosis 47.4%, tumour resection 16%. At 1 year, 57% had died (65% in the unresected group and 17% in the resected group). The median time interval from the medical visit to diagnostic imaging was 15 days [Q1-Q3: 8-44]. After imaging, median time intervals to definite diagnosis and to first treatment were 11 and 20 days, respectively. Significant prognostic factors associated with the risk of death at 1 year were ECOG PS > 1 (hazard ratio (HR) 2.1 [1.4-3.0]), metastasis (HR 2.7 [1.9-3.9]), no tumour resection (HR 2.7 [1.3-5.6]) and time interval between the medical visit and diagnostic imaging ⩾25 days (HR 1.7 [1.2-2.3]).

Conclusion: Delay in access to diagnostic imaging impacted survival in patients with pancreatic cancer, regardless of whether tumour resection had been performed.

Keywords: care pathways; epidemiology; matching databases; pancreatic adenocarcinoma; time intervals.