UW Health: Ultrasounds for pancreatic cancer may not help patients

CONTACT: Lisa Brunette

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MADISON, Wis. — A large, population-based study of patients with pancreatic cancer has shown that some newer imaging methods may delay the time to surgery for patients.

            Scientists at the University of Wisconsin Carbone Cancer Center combed through data of 2,782 Medicare patients from around the country to learn whether endoscopic ultrasounds were being used judiciously.

             Pancreatic cancer is a devastating disease, with just six percent of patients alive five years after diagnosis. Although relatively rare – about 48,000 cases are diagnosed every year – pancreatic cancer is the fourth-leading cause of cancer deaths in the United States.

            In the first study, researchers led by Dr. Ryan Schmocker, a resident in the UW Department of Surgery, and UW Carbone Cancer Center surgeon Dr. Emily Winslow wondered when these imaging techniques were being ordered and whether they benefited patients. These imaging tests are being ordered more frequently in patients suspected of having pancreatic cancer.

In the past, “staging” the disease to determine how far it had spread was done via surgery. But tests like endoscopic ultrasounds can be accurate and less invasive. Endoscopic ultrasounds use a small tube inserted into the mouth, through the stomach and into the first part of the small intestine. At the tip of the tube is a small ultrasound probe that emits sound waves to create images. In addition, doctors can use a fine needle with the probe to take a tissue sample and test it for cancer.

            The question was whether the ultrasounds helped patients.

            The researchers found that whether a patient received an ultrasound depended more on where the care was provided than on the particular needs of the patient. Patients at larger academic medical centers – which tend to have the latest equipment – were more likely to have endoscopic ultrasounds than those at smaller hospitals. A study by another group has shown that endoscopic ultrasounds do not affect patients’ survival rates.

            For some patients, Winslow says, having an ultrasound tumor biopsy could be a benefit because they were going to have a newer treatment regimen that involves using chemotherapy first, to shrink the tumor, before having surgery.

            But most patients were going to have surgery regardless, to remove the tumor, and the ultrasound tended to delay their surgery by an average of 17 days.

            “This study demonstrates that how patients receive care may depend more on where they are treated and not their disease, which may impact their overall treatment pathway,’’ Schmocker says. “It adds to the growing sense amongst physicians and researchers that addressing inequitable care delivery could improve the quality and efficiency of healthcare.”

            Winslow says the results point to a need for better coordination of care for cancer patients, so that the physician ordering the ultrasound considers the next steps for the patient.

            “We should be making decisions based on how they will affect the downstream care,’’ Winslow says.

            Winslow says this is the first of several population studies being funded in part by the local Pancreas Cancer Task Force. She says the computer coding created for this first study lays the groundwork for future studies.

            “This is a proof of principle that we can use this large data set to answer important questions about pancreatic cancer,’’ Winslow says. “We’re now ready to use more recent data to search for risk factors that could set the stage for pancreas cancer development.”

            The study will be published in the journal HPB (The Official Journal of the International Heapato-Pancreatico-Biliary Association). Other UW researchers involved in the study were Dr. David Van Ness, Dr. Caprice Greenberg, Jeff Havlena, Dr. Noelle LoConte, Dr. Jennifer Weiss, Dr. Heather Neuman, Dr. Glen Leverson, and Dr. Maureen Smith.