Factors affecting the rates of adherence to surveillance recommendations for incidental pancreatic cystic lesions in a large urban safety net hospital

Abstract

BackgroundPancreatic cystic lesions (PCLs) are a heterogenous group of lesions with varying degrees of malignant potential. PCLs are often incidentally detected on imaging. Management for patients without an immediate indication for resection or tissue sampling entails radiographic surveillance to assess for features concerning for malignant transformation. This study aims to determine the rates of adherence to surveillance recommendations for incidental PCLs, and identify factors associated with adherence or loss of follow-up.MethodsWe conducted a single-centre retrospective study of patients at a tertiary safety net hospital with incidentally discovered asymptomatic PCLs. Follow-up was defined as having undergone repeat imaging as recommended in the radiology report. Data were analysed using logistic regression.ResultsWithin our cohort (n=172), 123 (71.5%) subjects completed follow-up imaging. Attending a gastroenterology appointment was most strongly associated with completing follow-up for PCLs and remained significant (p=0.001) in a multivariate logistic regression model. Subjects without a documented primary care provider were less likely to have follow-up (p=0.028). Larger cyst size was associated with completion of follow-up in univariate only (p=0.067).ConclusionWe found that follow-up of an incidentally discovered PCLs was completed in the majority of our subjects. Incomplete follow-up for PCLs occurred in up to one in three to four patients in our cohort. Access to primary care and utilisation of subspecialty gastroenterology care are associated with completion of follow-up for PCLs. If validated, our findings can guide potential interventions to improve follow-up rates for PCLs.

Pancreatic cystic neoplasms

“…Adherence rate in our study appears to be concordant with a similar single center retrospective study conducted in 123 subjects with PCNs that showed 71.5% completion of recommended follow-up. [ 10 ] In contrast, two other studies found a compliance rate less than 50%. More specifically, in a cohort of 100 patients with incidentally identified pancreatic cysts, 47% of patients followed the recommended surveillance, whereas in the second study only 42% adhered to follow-up guidelines.…”

“…Canakis et al . [ 10 ] concluded that cyst size smaller than 1.5 cm was associated with incompletion of follow-up, although statistical significance was not reached. Schenck et al [ 11 ] observed that the size and location of the lesion do not influence the compliance to follow-up, whereas MPD dilation and the absence of multiple cysts were predictors of higher adherence rates.…”

“…Previous studies have shown that socioeconomic status is not a predictor of surveillance for PCN. [ 10 12 ] Tabrizian et al . found that patients with major co-morbidities were less adherent to follow-up of PCN ( P < 0.01).…”

“…[ 12 ] In addition, Canakis et al . [ 10 ] emphasized two parameters that correlated with increased adherence rates: involvement of a documented primary care physician and organized follow-up by a gastroenterology specialty clinic. This suggests that proactive follow-up of these patients with a reminder telephonic call may improve their compliance.…”

State-of-the-Art Update of Pancreatic Cysts

“…These calculations did not factor in the cost of surgery or EUS. There is also the concern that patients can be lost to follow up with recent studies finding that 47% to 71.5% of patients received follow-up imaging for incidental cysts [ 106 , 107 ]. In a large urban safety net hospital, access to gastroenterology care was associated with surveillance completion [ 106 ].…”