Decision support tools for pancreatic cancer detection: external validation in Australian primary care - a retrospective cohort study

Schrader, S; Martinez-Gutierrez, J; Rafiq, M; Neale, RE; Waterhouse, M; Lee, B; Emery, J

Author(s): Schrader, S; Martinez-Gutierrez, J; Rafiq, M; Neale, RE; Waterhouse, M; Lee, B; Emery, J;
Details: Publication Year 2026-04-01,Volume 76,Issue #765,Page e319-e328
Journal Title: British Journal of General Practice
Publication Type: Research article
Abstract: BACKGROUND: Pancreatic cancer is often diagnosed at an advanced stage with poor survival. Risk assessment tools have been developed to aid early diagnosis of pancreatic cancer in primary care settings (QCancer(®), electronic Risk Assessment Tool [eRAT], and the Queensland Institute of Medical Research [QIMR] Berghofer Pancreatic Cancer Decision Support Tool [QPaC Tool]) but have not been validated in the Australian setting. AIM: To estimate and compare the performance of these tools for identifying patients with undiagnosed pancreatic cancer using Australian primary care data. DESIGN AND SETTING: A cohort study was conducted using linked primary care and cancer registry data from Victoria, Australia. METHOD: Patients presenting to primary care with signs and/or symptoms included in the tools (recorded in the primary care 'reason for encounter') were included. Diagnostic accuracy statistics for each tool (and their individual signs and symptoms) were compared. RESULTS: Patients with pancreatic cancer were more likely (P<0.001) to present with new-onset diabetes, jaundice, and unexpected weight loss pre-diagnosis than patients without pancreatic cancer. The most common pre-diagnostic presentations in patients with pancreatic cancer were jaundice (29.0%), abdominal pain (25.6%), change in bowel habits (17.6%), and new-onset diabetes (14.8%). Jaundice, steatorrhoea, and pancreatitis had the highest positive predictive values (PPV) for pancreatic cancer (1.96%, 1.77%, and 0.89%, respectively). Among the tools, eRAT had the highest PPV of 1.37% (95% confidence interval [CI] = 1.12 to 1.66); the PPV for QPaC was 1.01% (95% CI = 0.82 to 1.22) and QCancer(®) was 0.8% (95% CI = 0.54 to 1.15). CONCLUSION: When applied to Australian primary care data, none of the tools were strongly predictive of pancreatic cancer. New diagnostic models incorporating additional data could potentially improve their predictive performance.
Keywords: Humans; *Pancreatic Neoplasms/diagnosis; *Primary Health Care; Male; Female; Retrospective Studies; Aged; Middle Aged; *Early Detection of Cancer/methods; Risk Assessment/methods; Victoria/epidemiology; *Decision Support Techniques; Australia; Abdominal Pain/etiology; cohort studies; decision support tools; general practice; pancreatic cancer; primary health care; risk assessment tools
Department(s): Medical Oncology
Publisher's Version: https://doi.org/10.3399/bjgp.2025.0328
Open Access at Publisher's Site: https://doi.org/10.3399/bjgp.2025.0328
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2026-01-23 03:46:45

Last Modified: 2026-04-07 03:20:36