Pathways of Care for Patients with Suspected Cancer of the Pancreas: A Tiered Questionnaire-Based Survey of Medical Personnel Across a Single United Kingdom Calman-Hine Cancer Network

OBJECTIVE: This study examines clinical management pathways for patients with suspected pancreatic cancer within a single United Kingdom Calman-Hine NHS cancer network with particular focus on referral patterns and the primary care-hospital specialist interface. METHODS: A questionnaire-based study appraising responses from three key groups (general practitioners, gastrointestinal physicians and gastrointestinal surgeons) practising within a cancer network. The questionnaire addressed caseload, referral pathways, multidisciplinary care teams and involvement of specialists. PARTICIPANTS: The study population comprised 448 general practitioners, 14 gastroenterologists and 23 gastrointestinal surgeons. RESULTS: The mean number of new patients with suspected pancreatic cancer seen per general practitioner per annum was 0.4 (range: 0-1). Fifty-three percent of general practitioners refer to gastrointestinal physicians and 47% to gastrointestinal surgeons. In hospital, a relatively large number of physicians and surgeons see a small number of new patients each per annum. The involvement of multidisciplinary teams and referral of patients with non-resectable disease for chemotherapy is limited. Fourteen (60.9% out of 23 general surgeons) refer all patients to pancreatic specialists, 4 (17.4%) selectively refer and 5 (21.7%) never refer. CONCLUSION: The findings suggest divergence in standards of care from those advocated in governmental cancer strategic plans. In particular, not all patients with suspected pancreatic cancer see specialists, many hospital specialists see small numbers of cases and multidisciplinary care is limited.