title: Care pathway of patients with metastatic pancreatic cancer in daily practice in France: Results from the REPERE national survey.
abstract: Data in the literature regarding the care pathway of pancreatic cancer patients are limited. The objective of the REPERE survey was to identify and describe the initial stages of the care pathway of pancreatic patients in the metastatic phase. From May to October 2015, 62 oncologists (ON) or gastroenterologists specialized in digestive oncology (GESDO) and 300 general practitioners (GP) completed an electronic questionnaire on the pathway of 728 patients recently diagnosed with metastatic pancreatic adenocarcinoma. Of these patients, 200 completed a questionnaire given by a specialized physician (ON/GESDO). Weight loss (65%), fatigue (53%) or anorexia (49%) were the main signs/symptoms that motivated the patients to seek medical advice. For 87% of patients, the general practitioner was the first medicine doctor they consulted. According to the respondents (patient, general practitioner or specialist), the median delay between the onset of the first symptoms and the final diagnosis of pancreatic cancer was between 41 and 65 days. This time lapse tended to decrease with associated jaundice (-15 days on average, standard deviation=8, P<0.1 NS) or with patient concerns triggered by the first symptoms (-11 days on average, standard deviation=6, P<0.05). On the contrary, the time lapse was longer (+14 days on average, standard deviation=6, P<0.05) when the general practitioner prescribed symptomatic treatment. In conclusion, diagnostic management of patients with metastatic pancreatic cancer should be accelerated with efforts to raise practitioners' awareness.
authors.affiliation: Beaujon Hospital (AP-HP), 100, boulevard du Général-Leclerc, 92110 Clichy, France. Electronic address: pascal.hammel@aphp.fr.
authors.forename: Pascal
authors.initials: P
authors.lastname: Hammel
authors.affiliation: Cochin Hospital (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Coriat
authors.affiliation: Jean-Mermoz Private Hospital, 55, avenue Jean-Mermoz, 69008 Lyon, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Lledo
authors.affiliation: Foundation ARCAD, 151, rue du Faubourg-Saint Antoine, 75011 Paris, France.
authors.forename: Mariella
authors.initials: M
authors.lastname: de Bausset
authors.affiliation: Foundation ARCAD, 151, rue du Faubourg-Saint Antoine, 75011 Paris, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Selosse
authors.affiliation: University Regional Hospital (CHRU) of Nîmes, 30029, rue du Professeur-Robert-Debré, 30900 Nîmes, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Obled
authors.affiliation: Jean-Minjoz University Regional Hospital (CHRU), 3, boulevard Fleming, 25030 Besançon, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Bonnetain
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy; D000328:Adult; D000368:Aged; D000855:Anorexia / Q000209:etiology; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D030881:Disclosure / Q000706:statistics & numerical data; D005221:Fatigue / Q000209:etiology; D005260:Female; D005602:France; D005762:Gastroenterology / Q000706:statistics & numerical data; D058006:General Practice / Q000706:statistics & numerical data; D006801:Humans; D007565:Jaundice / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D013997:Time Factors; D015431:Weight Loss
keywords: Cancer; Care pathway; Diagnosis; Diagnostic; Metastasis; Métastases; Pancreas; Pancréas; Parcours de soins