Impact of Multicenter Diagnostic Workup on Time-to-Diagnosis and Time-to-Treatment in Patients with Pancreatic Ductal Adenocarcinoma: A Nationwide Analysis

Abstract

Background: Due to centralization of pancreatic surgery, patients with suspected pancreatic cancer may undergo multicenter diagnostic workup, i.e. in both a local hospital and a pancreatic expert center. The aim of this study was to assess whether this multicenter diagnostic workup is associated with repetition of diagnostics, a prolonged diagnostic phase, and treatment delay. Materials and methods: This retrospective study included all patients diagnosed with non-metastatic pancreatic ductal adenocarcinoma (PDAC) in 2015, registered in the Netherlands Cancer Registry. Multicenter diagnostic workup was defined as diagnostic investigations in both a local hospital and a pancreatic expert center. A prolonged diagnostic phase was defined as ≥3 weeks from initial hospital visit to final diagnosis. A delayed time-to-treatment was defined as ≥6 weeks from the first hospital visit to start of tumor treatment. Multivariable logistic regression analyses were performed. Results: In total, 951 patients were included. Nineteen percent (n=181) underwent multicenter diagnostic workup. Significantly more patients with a multicenter workup had a prolonged diagnostic phase (70% vs 56%, P<0.01) and a delayed time-to-treatment (76% vs 64%, P<0.01) when compared with patients with monocenter workup. In multivariate analysis, multicenter diagnostic workup was a strong risk factor for a delayed diagnostic phase (OR=2.4; 95%CI 1.64–3.52, P<0.001). Conclusion: Multicenter diagnostic workup for patients suspected of PDAC is associated with a delayed time-to-diagnosis and delayed time-to-treatment compared to patients with monocenter diagnostic workup. These preliminary results suggest that pancreatic expert centers and local hospitals may need to improve their collaborative pancreatic care network. Note: These are preliminary results, we will analyse associations between multicenter diagnostics and the repetition of diagnostic investigations, delayed time-to-treatment (adjusted for covariates) and survival. Multilevel analysis will be performed, which will reveal how much variation in the outcome can be attributed to the different pancreatic cancer networks (expert hospital+ non-expert hospitals).