Symptoms at diagnosis of (metastatic) pancreatic adenocarcinoma ([m]PAC) in routine practice and frequency variation across Europe

Date 24 November 2018
Event ESMO Asia 2018 Congress
Session Poster display - Cocktail
Topics Pancreatic Cancer
Presenter Alfredo Carrato Mena
Citation Annals of Oncology (2018) 29 (suppl_9): ix46-ix66. 10.1093/annonc/mdy432
Authors A. Carrato Mena1, D. Melisi2, B. Westphalen3, Å.B.C. Mellbring4, J. Taieb5, G. Prager6, T. Macarulla Mercadé7, N. D´esquermes8, A. Ferreras9, F. de Jong10
  • 1Medical Oncology Department, Hospital Universitario Ramon y Cajal, 28031 - Madrid/ES
  • 2Department Of Medicine, AOU Integrata Verona "Borgo Roma", 37134 - Verona/IT
  • 3Comprehensive Cancer Center München, Klinikum der Universität München, Munich/DE
  • 4-, Shire, - - Stockholm/SE
  • 5Department Of Gastroenterology And Digestive Oncology, Hopital European George Pompidou, 75015 - Paris/FR
  • 6Clinical Department For Oncology, Vienna General Hospital (AKH) - Medizinische Universität Wien, 1090 - Vienna/AT
  • 7Medical Oncology Department, Vall d’Hebron University Hospital (HUVH), Barcelona/ES
  • 8Advanced Analytics, Genactis, Mougins/FR
  • 9Health Care & Life Science, Genactis, Mougins/FR
  • 10-, Shire, 6300 - Zug/CH



Late-stage PAC diagnosis is often due to a lack of screening, clear risk factors, and late appearance of clear symptoms. Advanced disease treatments vary and recent real-world data are scarce. This pan-European chart review study analysed diagnosis, treatment patterns and outcomes from patient (pt) records after completion of 1st-line (m)PAC treatment. Here, we report selected incidences of symptoms at PAC diagnosis.


Physicians completed retrospective electronic records from initial diagnosis onwards for pts who had completed 1st-line mPAC treatment between 07/2014-01/2016. Physicians were recruited across different national regions and types of treatment centre and were encouraged to enter 2nd-line pts. Data collected included treatments, dose modifications, and outcomes. Data are descriptive.


225 physicians completed 2,565 pt records (9 countries; n = 500-504 for France/Germany/Italy/Spain/UK). At diagnosis, 89.5% of pts had advanced disease, median age was 64 yrs, and 57.7% were male. Pts reported an average of 3.14 symptoms from 15 pre-listed symptoms. Averages for France/Germany/Italy/Spain/UK varied with -6.3%/+18.9%/-18.4%/+12.3%/-6.7%. Symptoms are listed in decreasing frequency in the table. Variation was highest for more frequently reported symptoms. Absolute differences between countries (highest vs lowest) were greatest for nausea (Δ22.1%: Germany vs France), mid-back pain (Δ18.7%: Germany vs UK), and weight loss (Δ18.3%: Germany vs Italy).Table: 195P

Symptoms reported at initial (m)PAC diagnosis in routine clinical practice and frequency variation across Europe

SymptomAll pts (N = 2,565) %France (n = 504) %Germany (n = 504) %Italy (n = 500) %Spain (n = 504) %UK (n = 504) %
Abdominal pain65.069.269.463.063.359.5
Weight loss61.560.768.750.463.963.7
Mid-back pain26.821.039.321.431.020.6
Dark urine12.711.713.98.415.912.9
Deep vein thrombosis8.19.712.
Recent unexpected diabetes3.


In this study, the average number of physician-reported symptoms and individual symptoms at initial (m)PAC diagnosis varied between countries. The most frequently reported symptoms were abdominal pain, weight loss, jaundice, nausea, and mid-back pain. Awareness of and attention to symptoms in the general public and by health care providers may help improve PAC diagnosis, care and outcomes.

Editorial acknowledgement

Nathan Susnik of Physicians World Europe GmbH, Mannheim, Germany.

Clinical trial identification

Legal entity responsible for the study





A. Carrato Mena: Advisory boards: Roche, Merck, MSD, Baxter, Shire, Celgene, Bayer. D. Melisi: Research Funding Shire, Incyte, Celgene; Consulting role: Eli Lilly, Shire, Baxter, Incyte. B. Westphalen: Advisory boards: Roche, Celgene, Shire, RedHill; Research support: Roche. Å.B.C. Mellbring, F. de Jong: Employee and stockholder: Shire. J. Taieb: Honoraria for consulting or speaker roles: Amgen, Roche, Merck, Celgene, Shire, Lilly, Sanofi, Sirtex and Servier. G. Prager: Advisory board, speaker fees: Shire, Celgene, Halozyme. T. Macarulla Mercadé: Consultant/advisor: Shire. All other authors have declared no conflicts of interest.