SCANPatient project aims to improve pancreatic cancer outcomes

A/Prof Charles PilgrimSurgeon A/Prof Charles Pilgrim leads a team of researchers from the School of Public Health and Preventive Medicine's Cancer Research Program who were recently awarded just shy of $3 million to improve care for pancreatic cancer patients. Almost 4,000 Australians are diagnosed with this deadly disease each year. The grant was one of $19.3 million in grants the University won via the MRFF’s Rare Cancers, Rare Diseases and Unmet Needs funding round.

Upon diagnosis, if a pancreatic tumour is deemed resectable and the patient is fit, they often proceed straight to surgery. Those with non-resectable tumours will usually commence chemotherapy. A borderline resectable patient may or may not be offered chemotherapy prior to surgery. However, there has historically been a lack of standardisation around what constitutes this group called ‘borderline’ resectable. This has led to variation in care among these patients, and potential missed opportunities for chemotherapy or surgery that could prove life-saving.

This funding will drive a national randomised clinical trial investigating whether more structured radiology reporting can improve the accuracy of staging, and more accurate discrimination of these borderline resectable patients and therefore support better treatment decisions and outcomes.

A/Prof Pilgrim is a surgeon at Alfred Health, and is an Adjunct Associate Professor at Monash’s Central Clinical School. He says, “This is a really exciting opportunity that brings together people across multiple disciplines. It’s a radiological project, but the end users are surgeons, and the reality is that neither of those craft groups are often represented in clinical trials. The timing of it is also very exciting given the release of the National Pancreatic Cancer Roadmap this year. It shows a real investment in improving the quality of care in this space.”

The project is the culmination of a process begun in 2017, following identification of variations in care identified during the Victorian Integrated Cancer Services Pancreas Cancer tumour summit (Department of Health). They realised that a gap in treatment pathways existed, around accurate staging and progression to different types of care.

Supported by the Southern and Northern Melbourne Integrated Cancer Services, the team agreed to adopt the international consensus statement on the definition of borderline resectable pancreas cancer (published fortuitously in 2018) as a common statewide definition of the three categories of non-metastatic pancreatic cancer to support treatment decisions: resectable, borderline, and non-resectable.

The group used these new definitions to create a standardised, structured CT scan reporting template. This was used in a pilot study at both the Alfred and Austin Hospitals in Melbourne throughout 2020-2021.

“The new funding allows us to take this trial national. We’ll be jumping up from just the two Melbourne sites to 40 participating sites across Australia,” A/Prof Pilgrim says.

“Using a stepped wedge clinical trial design, we’ll be on-boarding sites in groups of eight every six months to using the new template. After three years all of them will have data using their existing reporting methods (control) and the new reporting template (intervention). We’ll be able to see if the new template makes a difference to staging and care pathways.”

Currently around eight per cent of patients have documented borderline resectable pancreatic cancer. A/Prof Pilgrim anticipates this will almost double using the new template, partly by better documentation, but also partly through more detailed, consistent and reproducible application of this standardised definition of what constitutes borderline resectable disease.

“This is a win as it means those patients will be treated more appropriately given their type of cancer. They’ll be flagged for chemotherapy prior to surgery, giving them the additional treatment they will benefit from. Chemotherapy prior to surgery is a really important step, as many patients are simply too exhausted after surgery to face it at that point when they proceed to surgery first.

“Even if we don’t see the jump in rate of borderline cases we expect, this trial is still a ‘win’ in that we’ll have the first accurate estimation of the rate of borderline cases in Australia, and we will be sure we are not missing cases through poor documentation, or loose application of otherwise standardised definitions.