Time intervals to diagnosis and chemotherapy do not influence survival outcome in patients with advanced pancreatic adenocarcinoma.

Laurent-Badr, Q.; Barbe, Coralie; Brügel, Mathias; Hautefeuille, Vincent; Volet, Julien; Grelet, Simon; Desot, Elise; Botsen, Damien; Deguelte, Sophie; Pitta, Ana C.; Abdelli, Naceur; Brasseur, Mathilde; Mestier, Louis de; Neuzillet, Cindy; Bouché, Olivier

doi:10.1016/j.dld.2020.03.014

Cited by 7 publications

(8 citation statements)

References 34 publications

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“…However, from the patient's perspective, fear and anxiety about COVID-19 may have resulted in reluctance to have medical contact or to perform imaging exams 25 . Although the influence of time to diagnosis or treatment on PA prognosis remains unclear, a surge in later disease stages at diagnosis and a poorer prognosis than expected could be feared 9 , 29 , 30 .…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on disease stage and treatment for patients with pancreatic adenocarcinoma: A French comprehensive multicentre ambispective observational cohort study (CAPANCOVID)

Brügel

Letrillart

Evrard

et al. 2022

European Journal of Cancer

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Background. The COVID-19 pandemic caused major oncology care pathway disruption. The CAPANCOVID study aimed to evaluate the impact on pancreatic adenocarcinoma (PA) – from diagnosis to treatment – of the reorganisation of the health care system during the first lockdown. Methods. This multicentre ambispective observational study included 833 patients diagnosed with PA between September 1 st , 2019 and October 31 st , 2020 from 13 French centres. Data were compared over three periods defined as before the outbreak of COVID-19, during the first lockdown (March 1 st to May 11 th , 2020) and after lockdown. Results. During the lockdown, mean weekly number of new cases decreased compared with that of pre-pandemic levels (13.2 vs. 10.8, -18.2%; p=0.63) without rebound in the post-lockdown period (13.2 vs. 12.9, -1.7%; p=0.97). The number of borderline tumours increased (13.6% to 21.7%) whereas the rate of metastatic diseases rate dropped (47.1% to 40.3%) (p=0.046). Time-to-diagnosis and -treatment were not different over periods. Waiting neoadjuvant chemotherapy in resectable tumours was significantly favoured (24.7% to 32.6%) compared with upfront surgery (13% to 7.8%) (p=0.013). The use of mFOLFIRINOX preoperative chemotherapy regimen decreased (84.9% to 69%; p=0.044). After lockdown, the number of borderline tumours decreased (21.7% to 9.6%) and advanced diseases increased (59.7% to 69.8%) (p=0.046). SARS-CoV-2 infected 39 patients (4.7%) causing 5 deaths (12.8%). Conclusion. This cohort study suggests the existence of missing diagnoses and of a shift in disease stage at diagnosis from resectable to advanced diseases with related therapeutic modifications whose prognostic consequences will be known after the planned follow-up.

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Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on disease stage and treatment for patients with pancreatic adenocarcinoma: A French comprehensive multicentre ambispective observational cohort study (CAPANCOVID)

Brügel

Letrillart

Evrard

et al. 2022

European Journal of Cancer

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“…However, our median time intervals from prior medical visit to diagnostic imaging and from diagnostic imaging to definitive diagnosis seem longer as compared to a median diagnosis time interval of 14 days reported in the French REPERE study of metastatic patients and 0.51 month (about 15 days) in another recent French population-based study. 19 , 20 However, the limitation of these two studies is that they are oligocentric and not population-based and do not accurately reflect the entire healthcare system. Similar trends were shown concerning factors associated with a shortened time interval between diagnostic imaging and first treatment for both patients with resected or unresected disease in several international studies where, however, the role of jaundice remains paradoxical, sometimes associated with delays, sometimes with shortened time intervals.…”

Section: Discussionmentioning

confidence: 99%

“…In France, very few studies have been carried out over the last decade, suggesting that time intervals from the first symptoms to the first specialized visit and from the first visit to the first treatment often exceed 1 month. 18 – 20 However, there are no recommendations in the Guidelines concerning time intervals in diagnostic and treatment.…”

Section: Introductionmentioning

confidence: 99%

Time interval from last visit to imaging diagnosis influences outcome in pancreatic adenocarcinoma: A regional population-based study on linked medico-administrative and clinical data

et al. 2022

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Background: Excessive waiting time intervals for the diagnosis and treatment of patients with pancreatic cancer can influence their prognosis but they remain unclear. The objective was to describe time intervals from the medical visit to diagnostic imaging and to treatment and their prognostic impact in pancreatic cancer in one French region. Methods: This retrospective observational multicentre study included all patients with pancreatic cancer seen for the first time in 2017 in multidisciplinary team meetings (MTMs), where clinical data were collected. A probabilistic matching with the medico-administrative data from the French national healthcare database ( Système National des Données de Santé) was performed to define the care pathway from clinical presentation to the beginning of treatment. Median key time intervals were estimated for both resected and unresected tumours. Factors associated with 1-year survival were studied using Cox model. Results: A total of 324 patients (88% of total patients with MTM presentation) were matched and included: male 54%, mean age 72 years ±9.2, Eastern Cooperative Oncology Group (ECOG) PS > 1 19.5%, metastatic disease at diagnosis 47.4%, tumour resection 16%. At 1 year, 57% had died (65% in the unresected group and 17% in the resected group). The median time interval from the medical visit to diagnostic imaging was 15 days [Q1–Q3: 8–44]. After imaging, median time intervals to definite diagnosis and to first treatment were 11 and 20 days, respectively. Significant prognostic factors associated with the risk of death at 1 year were ECOG PS > 1 (hazard ratio (HR) 2.1 [1.4–3.0]), metastasis (HR 2.7 [1.9–3.9]), no tumour resection (HR 2.7 [1.3–5.6]) and time interval between the medical visit and diagnostic imaging ⩾25 days (HR 1.7 [1.2–2.3]). Conclusion: Delay in access to diagnostic imaging impacted survival in patients with pancreatic cancer, regardless of whether tumour resection had been performed.

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“… 35 However, we cannot exclude that delayed chemotherapy could have had an impact on tumor progression and survival depending on primary site and disease stage. 36 This aspect must be properly assessed in future studies. Prognosis of patients with aggressive diseases might have been more severely impacted than others due to therapeutic delays and inadequate treatment strategy.…”

Section: Discussionmentioning

confidence: 99%

One‐year COVID‐19 outcomes on the oncology care patient pathway: Results of a French descriptive, cross‐sectional comprehensive study (ONCOCARE‐COV)

et al. 2022

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Time intervals to diagnosis and chemotherapy do not influence survival outcome in patients with advanced pancreatic adenocarcinoma.

Cited by 7 publications

References 34 publications

Impact of the COVID-19 pandemic on disease stage and treatment for patients with pancreatic adenocarcinoma: A French comprehensive multicentre ambispective observational cohort study (CAPANCOVID)

Impact of the COVID-19 pandemic on disease stage and treatment for patients with pancreatic adenocarcinoma: A French comprehensive multicentre ambispective observational cohort study (CAPANCOVID)

Time interval from last visit to imaging diagnosis influences outcome in pancreatic adenocarcinoma: A regional population-based study on linked medico-administrative and clinical data

One‐year COVID‐19 outcomes on the oncology care patient pathway: Results of a French descriptive, cross‐sectional comprehensive study (ONCOCARE‐COV)

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