Pancreatic cancer is a lethal cancer of increasing incidence, presenting with several clinically detectable signals allowing for earlier diagnosis. However, there are 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. 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 to 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. 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, 1.62; 95% confidence interval, 0.79-3.30) and less likely to receive potentially curative treatment (adjusted odds ratio, 0.72; 95% confidence interval, 0.28-1.84), although these trends did not reach statistical significance. 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.

中文翻译：

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定义和理解胰腺癌患者的诊断延迟：一项回顾性队列研究


胰腺癌是一种发病率不断增加的致命癌症，表现出几种临床可检测到的信号，便于早期诊断。然而，与诊断过程相关的数据有限，包括诊断延迟的发生率及其促成因素。我们旨在制定诊断延迟的标准化定义，评估其患病率，并确定其在胰腺癌患者中的促成因素。我们召集了一个专家小组，确定了胰腺癌患者的诊断延迟。然后，我们对 2007 年至 2019 年在三级护理退伍军人事务医疗中心连续诊断的胰腺癌患者进行了一项回顾性队列研究。我们手动审查了诊断延迟实例以了解影响因素。使用多变量 logistic 回归和 Cox 比例风险模型的二次分析探讨了诊断延迟与癌症结果之间的关联。诊断延迟定义为在首次临床出现预定义危险信号后 ≥60 天做出癌症诊断。在 197 名胰腺癌患者中，38.6% 的患者经历了诊断延迟。在延迟病例中，最常见的主要影响因素与患者与提供者的接触有关 （44.7% 缺乏对客观体重减轻的认识）。延迟患者更有可能在疾病晚期被诊断 （校正比值比，1.62;95% 置信区间，0.79-3.30），并且不太可能接受潜在的治愈性治疗 （校正比值比，0.72;95% 置信区间，0.28-1.84），尽管这些趋势未达到统计学意义。超过三分之一的胰腺癌患者经历了诊断延迟，主要是由于对危险信号发现的认识不足。 结果可以为有针对性的干预措施提供信息，以减少胰腺癌患者可预防的诊断延误。