We surveyed 400 GPs in November 2015 about their awareness of pancreatic cancer and its symptoms.

1. 1
Topline Report of
Pancreatic Cancer Survey
Prepared for Pancreatic Cancer Action
17th November 2015

2. 2
Executive Summary
The Key Points of The Research
 Although two thirds of GPs stated they had some experience in recognising
pancreatic cancer symptoms, only 3% stated they were fully confident and
informed
 Pancreatic cancer was deemed to be more difficult to diagnose than other
types of cancer
 The level of awareness of NICE guidelines for referral of pancreatic patients
was quite low
 Smoking was deemed the main risk factor that could be mitigated with age
being considered the main risk factor overall.
 The main barrier to diagnosis was deemed to be the difficulty in recognising
pancreatic cancer symptoms
 The main ways to overcome barriers was seen as having better access to
diagnostic testing as well as better awareness of symptoms from the public
and GPs. With pancreatic cancer being such a virulent disease, some GPs
(31%) were still unsure how much this would affect survival rates
 Patients needed to be made more aware of symptoms and present
themselves sooner. They agreed that earlier presentation and recognition of
symptoms would lead to earlier diagnosis

3. 3
Executive Summary
The Key Points of The Research
 GPs felt it was very important to be able to refer quickly for symptoms that
were not specific, but seemingly serious. They agreed that earlier recognition
would lead to earlier diagnosis.
 There didn’t appear to be great issues in terms of primary and secondary care
interaction, however only 29% of GPs felt that CT-scans were easy to arrange.
 It is worth noting that 35% of GPs stated that they had direct referral/access to
CT Scans
 A certain amount (up to 50%) of CT-scans appeared to be arranged by
secondary care
 The main difficulties were not having direct access to CT-scans and the need
to refer for these. Other reasons including having to justify the need to
request a scan
 4% of GPs had completed Pancreatic Cancer Action's e-learning modules on
diagnosing pancreatic cancer either on the RCGP or BMJ websites

4. 4
Background and Objectives
The Premise
 Pancreatic cancer is currently the 5th biggest killing cancer in the UK. It is
expected that it will move to 4th position in the next 15 years, overtaking
breast cancer in terms of mortality rates
 Primary care professionals are under increasing pressure to diagnose cancer
earlier. For doctors to diagnose pancreatic cancer earlier, it is essential that
they have the tools and knowledge to help them to do this.
 The premise is that GPs need to have a greater knowledge of particular red
flag symptoms relating to pancreatic cancer to allow earlier investigation and
quicker referral
 Currently the majority of pancreatic cancer patients are being diagnosed at a
late stage of the disease (often in A&E), thus it is imperative that GPs and
primary care professionals are able to recognise and diagnose pancreatic
cancer in the early stages.
 It is likely that early diagnosis is possible with both knowledge of the signs
and symptoms of pancreatic cancer, and effective tools to record and monitor
patients along with quicker access to CT scans

5. 5
Background and Objectives
The Objectives
• Research Now was commissioned by Pancreatic Cancer Action to run a survey
with 400 GPs in order to investigate the following areas:
• The current level of understanding among GPs of pancreatic cancer as well of its
early signs and symptoms
• The level of belief that early recognition of symptoms by primary care providers will
lead to earlier diagnosis
• How comfortable or informed were GPs in terms of recognising pancreatic cancer
symptoms
• The main symptoms (including combinations) which should lead to initiating testing
• What GPs believe to be the main risk factors for pancreatic cancer
• What are perceived to be the main barriers to diagnosing pancreatic cancer for GPs
• The factors that will have the most impact in supporting GPs to diagnose pancreatic
cancer more effectively
• What GPs believe patients should do to take more responsibility for their health
• How GPs comprehend and adopt NICE guidelines for referring suspected pancreatic
cancer patients
• The frequency of referrals as well as the frequency, time frame and ease of
ordering CT Scans from a GP’s perspective
• The survey took place between the 19/10/2015 and 27/10/2015

6. 6
Key Findings

7. 7
Key Findings
The Background
• 74% of the GPs who took part had been in practice for between 10 and 29 years,
with an average of 47, so can be considered experienced in dealing and
recognising symptoms for a variety of diseases. Based on the last 5 years, the
prevalence of pancreatic cancer amongst their patient base was deemed to be on
average 5.7%. There were slightly higher incidences in London
• The majority of the GPs stated they had some experience in recognising
pancreatic cancer symptoms
• However only a limited number of GPs felt fully confident that they had sufficient
knowledge to recognise pancreatic cancer symptoms
• 28% of GPs felt they were not confident nor informed enough to recognise
pancreatic cancer symptoms, with 25% being neutral.
• Even with 7% of GPs stating they were very experienced in recognising symptoms,
only 3% of GPs overall felt they were they were fully confident and informed in
terms of recognising these symptoms
Level of Experience Confident and Informed
No experience 1 % Lacking confidence 28%
Limited experience 27 % Neither nor 25%
Some experience 65 % Some degree of confidence 47%
Very experienced 7 %
Regional variances seem
to indicate that GPs in the
Southwest felt they were
better informed and
confident compared to
colleagues in other parts
of the UK. London, the
Southeast, Northwest and
Scotland had better levels
of confidence and
information compared to
those in Northern Ireland
and the Northeast

8. 8
Key Findings
The Background
 90% of GPs felt that pancreatic cancer was more difficult to diagnose
compared to other forms of cancer, with 38% stating it was much more
difficult
Less difficult 1 %
The same 9 %
More difficult 52 %
Much more difficult 38 %
Do you feel pancreatic cancer is more or less difficult to diagnose
compared to other types of cancer?
9%
18%
23%
21% 20%
5%
3%
Not at all
aware 1
2 3 4 5 6 Fully
informed
7
 The large majority (77%) stated their practice
had made between on average being between
7 and 8 referrals for pancreatic cancer in the
last 12 months
 The level of awareness of NICE guidelines for
referring suspected pancreatic cancer patients
can be deemed quite low with only 3%
stating they were fully informed
How aware are you of NICE guidelines for
referring suspected pancreatic cancer patients?

9. 9
Key Findings
The Risk Factors
 Age was deemed to be the main risk factor overall, however it could be
considered a “given” as with most other diseases. Smoking was the main
risk factor that could mitigated. On average it was believed that 27% of
pancreatic cancer cases were attributable to smoking
The main risk factors for pancreatic cancer
35
34
154
122
48
7
Diabetes
Obesity
Age
Smoking
Familial
Other:
Chart based on the number of main risk factor mentions. Base: 400
The other risk
factor was
principally alcohol
 55% of GPs agreed that new
2015 NICE guidelines for
suspected cancer included
new-onset diabetes as a
symptom for pancreatic cancer.
 43% weren’t aware of this fact

10. 10
Key Findings
Symptoms
 The main symptom on its own which would trigger tests for pancreatic cancer
including pain (214 mentions) (mainly abdominal pain) and Jaundice (212
mentions). serious weight loss (96) on its own was usually a warning sign.
 The most common combination of symptoms which would trigger tests for
pancreatic cancer included weight loss (316 mentions) with pain (281)
(abdominal 189, back pain 69) and jaundice (229)
 Diabetes was rarely mentioned as a main symptom (6), but new onset of
diabetes was mentioned 31 times in combination, which was less frequent
than vomiting (33). Bloating was mentioned 28 times in combination

11. 11
Key Findings
The Barriers
 The main barrier to diagnosis was due to the symptoms of pancreatic
cancer not being easy to recognise.
 Late presentation by patients due to their lack of awareness exacerbated the
situation
The 5 main barriers to diagnosing pancreatic cancer
Chart based on the number of main barrier mentions. Base: 400
243
96
25
11
6
Pancreatic cancer symptoms are not easy
to recognise
Patient lack of awareness of
symptoms/not taking responsibility for
symptoms
Lack of early testing protocols
Doctor not comfortable or informed in
pancreatic cancer diagnosis
Time delay in scheduling diagnostic tests
/Lack of media exposure of symptoms
 Lack of early testing protocols
and doctor not comfortable or
informed in pancreatic cancer
diagnosis were often
mentioned as important
barriers
 Other barriers spontaneously
mentioned centred around late
presentation and delays

12. 12
Key Findings
Overcoming Barriers
 Although GPs felt that better access to diagnostic testing would help
improve the situation, it was the level of public symptom awareness leading
to patients presenting themselves sooner, as well as better understanding by
GPs that would greatly improve patient prognosis.
 Referral guidelines also needed to be clearer, however there didn’t appear to be
any issues in terms of primary and secondary care interaction
 The issue of in-house CT scanning capabilities was not deemed to have a major
impact in terms of improving outcomes. Perhaps most GPs felt that their
practices would not be able to support such capabilities although 35% had direct
access to CT-scans/EUS in their practice/clinic
 86% of GPs denied delaying referrals for a CT scan on the grounds of cost
Figures based on the number of main mentions. Base: 400
Better access to diagnostic tests 90
Symptoms awareness (public) 75
Improved or clearer referral guidelines 65
Better education/information for GP 56
Symptoms awareness (GPs) 45
Patients more proactive in visiting the GP sooner 41
In-house CT scans 21
Improve speed of referrals to secondary care 4
Closer relationships with secondary care 3
 38% stated that they been refused
tests for their patients in the past
12 months for all diseases
What do you think will have the most impact in supporting GPs
to diagnose pancreatic cancer more effectively?

13. 13
Key Findings
Overcoming Barriers
 The issues were not just with GPs or due delayed diagnostics. Patients
becoming more aware and taking on responsibility were key in order to
enable earlier diagnosis and better disease management
 GPs believed that being better informed on symptoms as well as visiting a
GP sooner were the main areas to improve from a patient point of view
Figures based on the number of main mentions. Base: 400
What should a patient do to take more responsibility for their health?
246
75
46
19
14
Patients to become better informed of
symptoms
Visit the GP sooner even if uncertain of
initial symptoms
Patient more proactive in visiting the
GP if symptoms worsen
Patients to improve tracking of their
symptoms better
Patient to insist visiting the same GP in
practice

14. 14
Key Findings
Early recognition and quick referral
 GPs felt it was imperative to be able to refer quickly for a non-specific
but seemingly serious symptom. They agreed that earlier recognition
would lead to earlier diagnosis
 However 31% were unsure that this would dramatically improve survival
rates
GPs were asked if they agreed or disagreed with the following statements
92%
91%
90%
85%
84%
79%
50%
56%
37%
The ability to refer urgently to a diagnostic centre for non-
specific but serious symptoms will help speed up cancer…
Pancreatic Cancer is a silent killer
Early recognition of symptoms by the primary care provider
will lead to earlier diagnosis
Patients not returning to the GP if symptoms worsen is a
problem which may delay diagnosis and affect patient…
Patients only present themselves with symptoms when their
disease is already too advanced
Improving the speed of referrals within secondary care will
speed up pancreatic cancer diagnosis
Providing primary care with a named secondary care contact
will improve the speed of referral
Earlier diagnosis of pancreatic cancer will dramatically
improve patient survival rates
Pancreatic cancer affects mainly older men
Unsure 24%
Unsure 31%
Unsure 17%

15. 15
Key Findings
CT-Scans/EUS
 GPs stated, on average, that it was somewhat to moderately difficult to
arrange for CT-scans with London appearing to experience the most
difficulty
 It appears that when CT-scans were arranged externally, in up to 50% of
cases these would be organised by secondary care . This figure assumes
that the 35% who said they had CT –scans capabilities would rarely have
these done externally
 It was stated that it took an average of 23 days with nationally 33% of
tests being arranged at 14 days.
 There were great regional variances: In The Northeast 62% of tests were
at 14 days, while In Wales 56% of tests were arranged at 28 days
 It then took on average 11 days to get the results back. Again there were
major differences between the regions: 33% of results were made
available in 1 day in Northern Ireland, in London 41% were at available
at 1 week
How easy is it to access CT-scans/EUS ?
Extremely difficult 18%
Somewhat difficult 28%
Neither difficult or easy 24%
Quite easy 25%
Very easy 4%

16. 16
Key Findings
CT-Scans/EUS
 The main difficulty encountered by GPS for requesting rapid CT-scans
was that they often had to refer to secondary to arrange for these.
 Although direct access was sometimes precluded, other issues
encountered included needing to justify the request
 Requests being refused with the validity of the request assessed by
radiologists.
 Waiting times were also sometimes deemed to long.
“There is always waiting time, sometimes they are not convinced with my reasoning for
CT and request a referral 1st to a secondary hospital or a specialist who then can
request such CT for such diagnosis…”
“GPs are discouraged from requesting them and we have little training in what action is
necessary from the report…”
“Have to get consent of consultant radiologist. vagueness of symptoms can make it
difficult to justify…”
“Sometimes make request and despite clear reasons it gets questioned - and that delay
in trying to talk to someone ( who invariably agrees to do it - despite the same
information being provided) puts a delay in…”
“Just need to put forward a good clinical case for pancreatic protocol CT to radiologist,
but sometimes they will ask GP to refer 2 week-wait to gastroenterology instead…”
“Can only be accessed for certain indications and can be helpful if negative but actually
cause more delays if positive as they are not part of a 2 week rule pathway…”
“ A request has to have enough clinical reason to be accepted…”