World Pancreatic Cancer Day 2018: Combating misconceptions in pancreatic cancer

World Pancreatic cancer day

Patients diagnosed with pancreatic cancer face a dismal prognosis, with the disease having the lowest survival rate of all major cancers. In spite of this, pancreatic cancer research is chronically underfunded and awareness is low, in part because of widespread misconceptions regarding the disease. This World Pancreatic Cancer Day, let’s educate ourselves so that we can all ‘Demand Better’ in the fight against the world’s toughest cancer.

Today, 15 November, marks World Pancreatic Cancer Day. This year’s focus is to ‘Demand Better’ in the fight against pancreatic cancer, pushing for more attention, more awareness and more progress to help patients fight and survive the disease [1].

The statistics for pancreatic cancer statistics make for grim reading. Patients usually only live for up to 6 months [2] and a meagre 8% of patients survive for 5 years [3]. This shocking survival rate has barely improved over the last 40 years [4] while, in the same period, we have seen vast improvements in the numbers of people surviving other cancers [5]. In spite of these statistics, funding for pancreatic cancer and disease awareness are low. Indeed, the disease receives only 3% of UK cancer research funding [6], and a patient survey showed that nearly half of patients had never even heard of the disease prior to their diagnosis [7].

There are several misconceptions that contribute to these issues and these may represent the single most significant barrier to achieving improved survival and patient experience, according to a parliamentary inquiry undertaken by the All-Party Parliamentary Group (APPG) on Pancreatic Cancer. These misconceptions were widespread, from the public through to healthcare professionals and policymakers [8].

Misconception Reality
Pancreatic cancer is rare [8] Although the incidence of pancreatic cancer is lower than other common cancers like breast, bowel and lung, pancreatic cancer is the 5th most common cause of all cancer deaths in the UK [8].
Pancreatic cancer affects mostly elderly, male patients [8] The risk of pancreatic cancer does increase with age; however, nearly 35% of all diagnoses of pancreatic cancer occur in people under the age of 65. In addition, pancreatic cancer affects men and women equally [8].
Pancreatic cancer is a silent killer with indistinguishable symptoms [8] Pancreatic cancer systems are often non‑specific; however, research shows that many people seek medical attention for these symptoms some time before diagnosis [8].
Once diagnosed, there is nothing that can be done to change the course of the disease or to offer a prolonged life of good quality [8] Patients diagnosed in time for surgery are up to 30% more likely to survive beyond 5 years than those who are diagnosed later [6]. Even if diagnosed at an advanced stage, treatments are available that may extend life and will almost certainly improve the quality of life [8].

 

The APPG stated concerns that these misconceptions result in [8]:

  • Low levels of awareness of thedisease
  • Low levels of awareness of the extent to which the disease represents a leading cause of cancer deaths in theUK
  • A lack of investment that is proportionate to the impact of thisdisease
  • A lack of urgency in ensuring that everyone affected by pancreatic cancer is diagnosed as early aspossible
  • A lack of urgency in ensuring that, once diagnosed, everyone receives the most prompt and up-to-date treatmentpossible

Early diagnosis is key to improving survival in pancreatic cancer. Currently, only 10%–20% of people with pancreatic cancer are diagnosed when they are still eligible for resection surgery, the only potentially curative treatment for pancreatic cancer. The reasons for this are multifaceted. Poor public awareness of the symptoms of the disease is an important issue; however, there are also delays in diagnosis once a patient has sought medical attention for pancreatic cancer–related symptoms. According to Pancreatic Cancer UK’s 2015 Symptoms and Diagnosis Survey, 63% of respondents reported that they or their family member visited their GP three times or more before diagnosis, and 23% had visited seven times or more. In fact, almost half of all patients are diagnosed as an emergency in A&E, when they have begun to experience severe symptoms. At this point, it is more likely that the cancer has already spread to other parts of the body, and is therefore associated with substantially poorer survival rates than other routes of diagnosis [9].

Worryingly, even when the disease is diagnosed when still localised, surgical resection remains strikingly underutilised. One reason hypothesised for this is that patients might never be evaluated by a surgeon because of the misconception held by many primary physicians: that there is nothing that can be done to change the course of the disease. Indeed, in one analysis, only 75% of patients with localised pancreatic cancer underwent surgical evaluation. Simply maximising rates of surgical resection is one way we can make an immediate improvement in survival and impact thousands of patients [10].

Unless substantial improvements are made now, pancreatic cancer will soon overtake breast cancer and become the 4th most common cancer killer in the UK [11]. The need to raise awareness, improve investment and change our views and approaches to the diagnosis and treatment of pancreatic cancer is evident, and the onus is on everyone – the public, healthcare professionals and policymakers – to take part in these efforts.

References:

  1. World Pancreatic Cancer Day. Take action. Accessed November 2018. Available at: http://www.worldpancreaticcancerday.org/take-action/.
  2. Pancreatic cancer patients to have routine access to life extending drug after new deal, says NICE. Accessed November 2018. Available at: https://www.nice.org.uk/news/article/pancreatic-cancer-patients-to-have-routine-access-to-life-extending-drug-after-new-deal-says-nice
  3. Hirshberg Foundation for Pancreatic Cancer Research. Pancreatic cancer facts. Accessed November 2018. Available at: http://pancreatic.org/pancreatic-cancer/pancreatic-cancer-facts/
  4. Cancer Research UK. Pancreatic cancer statistics. Accessed November 2018. Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/pancreatic-cancer#heading-One
  5. Pancreatic Cancer UK. Pancreatic cancer deaths to overtake breast cancer. Accessed November 2018. Available at: https://www.pancreaticcancer.org.uk/latest-news/2016/november/pancreatic-cancer-deaths-to-overtake-breast-cancer/
  6. Pancreatic Cancer Action. Pancreatic cancer facts. Accessed November 2018. Available at: https://pancreaticcanceraction.org/about-pancreatic-cancer/pancreatic-cancer-facts/Pancreatic Cancer Action. Patient and carer survey 2015. Accessed November 2018. Available at: https://pancreaticcanceraction.org/wp-content/uploads/2015/08/Patient-and-carer-survey-2015.pdf
  7. APPG on Pancreatic Cancer. Time to change the story: A plan of action for pancreatic cancer. Accessed November 2018. Available at: https://www.pancreaticcancer.org.uk/media/86665/time-to-change-the-story_a-plan-of-action-for-pancreatic-cancer.pdf
  8. APPG on Pancreatic Cancer. The need for speed: Diagnosing pancreatic cancer earlier, giving patients a chance of living better for longer. Accessed November 2018. Available at: https://pancreaticcanceraction.org/wp-content/uploads/2018/03/The-Need-For-Speed-Report.pdf
  9. Riall TS and Lillemoe KD. Underutilization of surgical resection in patients with localized pancreatic cancer. Ann Surg 2007; 246 (2): 181–
  10. House of Commons Hansard. Pancreatic Cancer. Accessed November 2018. Available at: https://hansard.parliament.uk/commons/2015-01-15/debates/15011570000003/PancreaticCancer