Defining and Understanding Diagnostic Delays Among Pancreatic Cancer Patients: A Retrospective Cohort Study.

ABSTRACT

BACKGROUND AND AIMS: Pancreatic cancer is a lethal cancer of increasing incidence, presenting with several clinically detectable signals allowing for earlier diagnosis. However, there is limited data related to diagnostic process, including prevalence of diagnostic delays and their contributing factors. We aimed to develop a standardized definition of diagnostic delay, evaluate its prevalence, and identify its contributing factors among pancreatic cancer patients. METHODS: We convened an expert panel who defined "diagnostic delay" among pancreatic cancer patients. We then conducted a retrospective cohort study among pancreatic adenocarcinoma patients consecutively diagnosed from 2007-2019 at a tertiary care Veterans Affairs medical center. We manually reviewed diagnostic delay instances for contributing factors. Secondary analyses, using multivariate logistic regression and Cox proportional hazards models, explored associations between diagnostic delays and cancer outcomes. RESULTS: "Diagnostic delay" was defined as cancer diagnosis made ≥60 days after first clinical presence of predefined red-flag(s). Among 197 pancreatic adenocarcinoma patients, 38.6% experienced a diagnostic delay. Among delay cases, the most common primary contributing factor was related to the patient-provider encounter (44.7% with lack of recognition of objective weight loss). Patients with delays were more likely to be diagnosed at advanced stage disease (adjusted odds ratio (OR) 1.62; 95% confidence interval (CI) 0.79-3.30) and less likely to receive potentially curative treatment (adjusted OR 0.72; 95% CI 0.28-1.84), although these trends did not reach statistical significance. CONCLUSIONS: Over one-third of pancreatic cancer patients experienced a diagnostic delay, mostly due to inadequate recognition of red-flag findings. Results can inform targeted interventions to reduce preventable diagnostic delays among pancreatic cancer patients.