Poster Presentation The Pancreas Summit 2025

Identifying patients with pancreatic cancer in primary care: comparing the sensitivity of decision support tools. (#11)

Rachel E Neale 1 2 , Susan Jordan 3 , Bridie Thompson 1 , Christina M Bernardes 1 3 , Judi Adams 4 , Christopher Baggoley 4 , S. George Barreto 5 6 , Catherine M Baxter 1 , Daniel Croagh 7 8 , Benedict Devereaux 9 10 11 , Jon Emery 12 , Louisa Collins 1 3 13 , Rajit Gilhotra 9 10 , Paul Grogan 14 , Luke Hourigan 9 15 , Javiera Martinez-Gutierrez 12 16 , Andrew Metz 17 18 , Stephen Philcox 19 , Meena Rafiq 12 20 , Joel Rhee 21 , Silja Schrader 12 , Michelle Stewart 4 , John Windsor 22 , John Zalcberg 23 24 , Mary Waterhouse 1
  1. Population Health Program, QIMR Berghofer, Brisbane, Queensland, Australia
  2. School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
  3. School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
  4. Pankind, Pancreatic Cancer Australia, Sydney, New South Wales, Australia
  5. Flinders Medical Centre, Adelaide, South Australia, Australia
  6. Flinders MD, Flinders University, Adelaide, South Australia, Australia
  7. Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
  8. St Vincent’s Healthcare Association, Melbourne, Victoria, Australia
  9. Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  10. Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  11. Digestive Diseases Queensland, Brisbane, Queensland, Australia
  12. University of Melbourne, Melbourne, Victoria, Australia
  13. Cancer Prevention and Survivorship, Cancer Council Queensland, Brisbane, Queensland, Australia
  14. University of Sydney, Sydney, New South Wales, Australia
  15. Princess Alexandra Hospital, Brisbane, Queensland, Australia
  16. Pontificia Universidad Catolica de Chile , Santiago, Chile
  17. Epworth Hospital, Melbourne, Victoria, Australia
  18. Jreissati Pancreatic Centre, Melbourne, Victoria, Australia
  19. John Hunter Hospital, Newcastle, New South Wales, Australia
  20. University College London, London, United Kingdom
  21. Discipline of General Practice, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
  22. Surgical and Translational Research Centre, University of Auckland, Auckland, New Zealand
  23. Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
  24. Cancer Research Program, Monash School of Public Health, , Monash University, Melbourne, Victoria, Australia

Background and Aims

Pancreatic cancer typically presents with non-specific symptoms, often leading to diagnostic delays. We aimed to evaluate and compare the sensitivity of three decision support tools designed to assist primary care practitioners in identifying patients who may require pancreatic imaging.

Methods

We conducted an observational study in Australia evaluating three decision support tools: the Risk Assessment Tool (RAT), QCancer®, and a qualitative tool developed through consensus at QIMR Berghofer (QPaC Tool). We applied these tools to data from people diagnosed with pancreatic ductal adenocarcinoma (n=191) who were interviewed about their signs, symptoms, and risk factors at first clinical presentation. For QCancer®, we excluded patients with jaundice (n=142 remaining). Sensitivity was calculated as the percentage of participants correctly "flagged" by each tool according to predefined criteria.

Results

The mean age at first presentation was 66 years, 53% were men, and 24% had ever been diagnosed with diabetes. At the time of interview, 29% of participants had had surgery that successfully removed their tumour. In the full cohort (n=191), 62% experienced at least one pain symptom at first presentation. Other symptoms included jaundice (22%), altered bowel habits (18%), weight loss (17%), and malaise (16%). In these patients the QPaC Tool demonstrated a higher sensitivity than the RAT (54% versus 27%). Among the subset of patients without jaundice (n=142), QCancer® had a sensitivity of 14% at a 1% probability threshold, and the sensitivities of QPaC Tool and RAT were 44% and 7%, respectively. The superior sensitivity of the QPaC Tool was due mainly to its inclusion of severe epigastric pain and newly unstable diabetes.

Conclusions

Only the QPaC Tool achieved a sensitivity of more than 50%; however, its specificity remains unknown. Including the QPaC Tool in educational resources would encourage GPs to have a heightened index of suspicion for pancreatic cancer in patients without red flag symptoms such as jaundice and weight loss. Whether this approach decreases the delay to diagnosis without over-investigation of common symptoms will require further research.