Later-Stage Diagnosis and Poorer Survival in Pancreatic Cancer Patients With Vague Symptoms: A Population-Based Study

Most pancreatic cancer (PC) patients present symptomatically to cancer services, are diagnosed at late stage, and have poor survival. Patients with alarm symptoms (AS), such as jaundice or altered stool/urine colour, may be more readily recognised within current referral pathways than those with vague symptoms (VS).

To examine the associations of presenting symptom category (alarm vs. vague) with route to diagnosis, stage at diagnosis, treatment, and survival in PC patients.

Of 540 primary PC cases identified in the population-based Northern Ireland Cancer Registry PC Audit (2019-2020), 28 were excluded because referral pathway information was insufficient to classify route to diagnosis, leaving 512 patients for analysis. Patients were categorised by presenting symptoms as AS or VS. χ² tests assessed group differences; Kaplan-Meier and Log-Rank tests compared 1-year survival. Cox proportional hazards models compared mortality risk, adjusting for sex, age, socioeconomic status, referral route, tumour location, and stage at diagnosis. All statistical tests were two-sided, and p < 0.05 was considered statistically significant.

More patients presented with VS (60.4%) than AS (39.6%). Emergency admission was more common in AS than in VS patients (66.0% vs. 33.7%, p < 0.001). VS patients more often had stage IV disease (62.1% vs. 39.9%, p < 0.001) and were less likely to receive tumour-reductive treatment (34.0% vs. 50.2%, p < 0.001). One-year survival was poorer in VS than in AS patients (24.9% vs. 33.7%, p = 0.001). VS was associated with a 48% increased mortality risk [HR = 1.48 (1.14-1.91)] after full adjustment.

PC patients with VS were more often presented via GP; they had later-stage disease and poorer survival. VS remained independently associated with poorer survival. Greater awareness of PC symptoms, especially VS, together with effective diagnostic pathways for non-specific symptoms, may help support more timely investigation.