An analysis of time to treatment in patients with pancreatic adenocarcinoma.

Abstract

Currently, no guidelines exist regarding the appropriate time from diagnosis to treatment among pancreatic adenocarcinoma patients. Herein, we aim to define the median time to treatment in pancreatic adenocarcinoma, factors associated with treatment delay, and prognostic significance. We conducted a retrospective study of pancreatic adenocarcinoma patients, stage I-IV, at a tertiary referral center (2017-2020). We subdivided time to treatment (days) into 4 components: (1) T_i: symptom onset to initial provider evaluation, (2) T_ii: initial provider evaluation to diagnosis, (3) T_iii: diagnosis to specialist consultation, (4) T_iv: specialist visit to treatment. In total, 217 patients met the inclusion criteria. The median T_i, T_ii, T_iii, and T_iv were 20, 12, 4, and 14 days, respectively. The total time to treatment was 75 days. Patients with weight loss had longer T_i (β = 108.6). More frequent hospitalizations (β = 19.5) and misdiagnosis (β = 33.4) were associated with longer T_ii. Patients with a history of malignancy (β = 15) or active treatment of a second disease (β = 19.4) had longer T_iii. Poor performance status (β = 6.2) or private insurance (β = 50.2) were associated with a longer T_iv. Black patients had longer T_i+ii+iii+iv (β = 100). Time to treatment was not associated with overall survival (P > .05). It takes a median time of less than a month for a patient with pancreatic adenocarcinoma to start treatment, even after they visit a primary provider. The greatest opportunity to shorten the overall time to treatment is by having patients seek medical attention earlier (T_i).