The sensitivity of decision support tools for identifying patients with pancreatic cancer

Background Pancreatic cancer causes non-specific symptoms, potentially leading to delays in diagnosis. Decision support tools may help primary care practitioners to triage patients for pancreatic imaging.

Aim To investigate the sensitivity of three different tools for identifying patients who may have pancreatic cancer.

Design and setting Observational study in Australia.

Method We investigated the performance of the risk assessment tool (RAT) for pancreatic cancer, the QCancer^® tool, and a tool developed through a consensus process led by QIMR Berghofer (the QPaC Tool). We applied these tools to people with pancreatic cancer who were interviewed about their symptoms upon first presentation to a clinician. We designated patients as ‘flagged’ by each tool if they met specific criteria, and calculated the percentage flagged (ie, the sensitivity). Participants with jaundice were excluded from analyses of QCancer^®.

Results We included 190 participants in analyses of the RAT and QPaC Tools (142 in analyses of QCancer). The sensitivity of the QPaC Tool and the RAT were 54% and 27% respectively. QCancer^® had a sensitivity of 14% percent, at a probability threshold of 1%; in the same 142 participants, QPaC and the RAT flagged 44% and 7%, respectively.

Conclusion The QPaC Tool was the most sensitive, largely due to its inclusion of severe epigastric pain and emphasis on diabetes, but it has unknown specificity. More research is needed to determine whether any tool could reduce delays in diagnosis; in the interim, the QPaC Tool may support clinicians to consider pancreatic cancer in their differential diagnoses.