ADEPTS: Accelerated Diagnosis in neuroEndocrine and Pancreatic TumourS
What were the objectives of the study?
Pancreatic cancer is the 11th most common cancer in the UK. Diagnoses are often made late when the cancer is advanced. Less than 20% of patients are suitable for surgery and 84% of patients are likely to have died within a year of diagnosis giving the worst survival rate for any cancer. However better survival is more likely if patients present at an early stage. There are only a few established risk factors for pancreatic cancer such as age, smoking, genetic factors, chronic pancreatitis and alcohol. It is unlikely that there will be a national screening programme for pancreatic cancer since there are few established risk factors and currently no reliable screening test. Hence, it is likely that most pancreatic cancers will be diagnosed in symptomatic patients presenting to primary care. The challenge then becomes enabling earlier diagnosis to help improve treatment options (eg possibility of surgery) and prognosis. Earlier diagnosis could be helped by increased public awareness of symptoms which might indicate pancreatic cancer such as weight loss, loss of appetite and abdominal pain. It could also be improved by more prompt investigation of symptomatic patients presenting to their GP. In the UK, GPs will soon have better direct access to diagnostic investigations such as ultrasound, CT scanning and MRI. GPs need better assessment tools to quantify a patients risk of different types of cancer so that the right patients are sent for the right investigations making efficient use of, scarce resources.
This study aimed to find the symptom profiles that are recorded in general practice healthcare records in the time before diagnosis for both types of pancreatic cancer.
How was the research done?
We used a method called a nested case-control study, were people that were diagnosed with the cancers were matched with people not affected but with similar ages, sex, and registered at the same general practice. This way, we were able to compare the symptoms that occur in people with pancreatic cancer before their diagnosis.
Lead Applicant Organisation Name
University of Oxford
Location of research
University of Oxford
Date on which research approved
Project reference ID
Generic ethics approval reference
Are all data accessed are in anonymised form?
Brief summary of the dataset to be released (including any sensitive data)
GP data linked to hospital, mortality and cancer registry data for pancreatic tumours. Data will include tumour characteristics (type, stage, grade), risk factors and symptoms which might indicate a diagnosis of pancreatic cancer
What were the main findings?
The study included 23,640 people that were diagnosed with PDAC, 596 that were diagnosed with a PNET, and 230,034 people without these cancers.
We found 23 symptoms that were significantly increased in people that were diagnosed with PDAC – 9 of these same symptoms were similarly increased in people diagnosed with PNETs. These 23 symptoms included abdominal pain, bleeding from the gut, weight loss, nausea, thirst, and tiredness. The 9 symptoms increased in PNETs were bleeding from the gut, jaundice (yellowing of the skin), vomiting, abdominal pain, weight loss (either within the last 2 years, or more than 2 years ago), change in bowel habits, heartburn, and an abdominal lump.
Together, these results provide insight into the symptoms that patients may experience prior to eventual diagnosis, and might inform future strategies to find these patients earlier, before they are diagnosed with advanced disease.
Pancreatic Cancer UK
Public Benefit Statement
OX2 Understanding the pattern of symptoms for pancreatic neuroendocrine neoplasms (PNENs) to improve the early diagnosis of pancreatic cancer: analysis of the QResearch database
Authors: Liao W, Clift A, Patone M, Coupland C, Hippisley-Cox J
Identifying symptoms associated with diagnosis of pancreatic exocrine and neuroendocrine neoplasms: a nested case-control study of the UK primary care population
Authors: Weiqi Liao, Ashley K Clift, Martina Patone, Carol Coupland, Arturo González-Izquierdo, Stephen P Pereira, Julia Hippisley-Cox
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Trusted Research Environment (TRE)