Georgia Papacleovoulou, Policy and Intelligence Manager at Pancreatic Cancer UK, tells us about a new fast-track surgery pathway in pancreatic cancer care, and explains why she believes clinical nurse specialists are crucial.


Enhancing efficiency in cancer care to improve patient outcomes is the cornerstone of All.Can’s mission. This can be achieved through identifying ways to optimise the use of limited resources, and reducing waste by eliminating ineffective interventions.

Pancreatic cancer is the 11th most common cancer in the UK, and the fifth leading cause of cancer death. It is difficult to diagnose, and treatment options are limited. The national charity Pancreatic Cancer UK provides funding for innovative projects aiming to improve diagnosis, treatment or patient experience, through its Clinical Pioneers Awards scheme. It awarded £50,000 to Mr Keith Roberts, Consultant Hepatobiliary and Pancreatic Surgeon at University Hospitals Birmingham (UHB) NHS Foundation Trust, to support the development and review of a fast-track surgery pathway for pancreatic cancer. A key element of this project is the specialist pancreatic pathway nurse, who facilitates referrals, communicates with the secondary and tertiary teams, and supports patients throughout the care pathway.

Why did Pancreatic Cancer UK get involved with the fast-track pathway project?

‘Most patients who undergo surgery for pancreatic cancer are diagnosed with jaundice due to obstruction of the bile duct. They undergo diagnostic tests, such as a CT scan, to explore the possibility of pancreatic cancer. At this point, surgery could be performed but delays in the pathway often result in patients needing treatment of jaundice which involves placement of a stent within the bile duct before they go on to have surgery. This can lead to complications and higher morbidity.

‘The team at UHB introduced a pilot fast-track pathway where a CNS facilitates the referral and helps to arrange the date for surgery, admission and preoperative tests for patients. This has led to a reduction in the average waiting time from CT scan to surgery from 65 days to 16 days.’

What impact has the fast-track surgery pathway had on patient outcomes?

‘It is hoped that the reduction of waiting time to 16 days will improve outcomes for patients by enabling more to undergo surgery. For example, when patients have to wait for more than 21 days for surgery, 15% of potentially operable cases will no longer be operable. This rises to 20% when patients wait for more than 40 days.

‘Given that surgery is the only potentially curative treatment for pancreatic cancer, we hope that we will see improvements in survival rates through this pathway. The fast-track pathway is still being developed, and more data on patient outcomes will be available within the next five months, including data on survival. Outcomes from the preliminary data, however, are already promising.’

Do you have an idea of the impact on costs and efficiency of care?

‘It has been estimated that the whole pathway saves £3,200 per patient, mainly attributed to preoperative costs (stenting, associated complications and hospital readmissions). These savings could be utilised to employ the CNS to make long-term implementation of the fast-track pathway possible, as well as providing support to patients. This has the potential to bring additional savings through reducing emergencies and unnecessary admissions. So we believe it’s possible to implement this new pathway on a larger scale in other areas, which would create even more benefits.’

What is the role of the cancer CNS in the fast-track pathway?

‘The CNS facilitates the fast-track referral. Involvement of a CNS has the added advantage of close contact throughout the patient’s journey through referral, diagnosis and treatment. It is clear, from data from the National Cancer Patient Experience Survey, that patients’ experience of and satisfaction with the care they receive is directly linked to the support provided by CNS staff. This is particularly important in pancreatic cancer, in which patients consistently report lower satisfaction in their diagnosis process compared with other cancers. Survival rates are extremely low for pancreatic cancer, at just 5% – the lowest five-year survival rate of common cancers. So it’s essential to support the role of the CNS throughout the whole journey for pancreatic cancer patients and their families.

‘We are also confident that patients on this fast-track pathway will have improved wellbeing, as they stand to benefit from better pathways in terms of support – physically, emotionally and psychologically. This is an area where the CNS has a crucial role, as the main contact between the patient and all the other healthcare professionals and services. The CNS provides that personal interaction, ensuring the patient receives high-quality care throughout their experience.’

Aside from the work being done by Pancreatic Cancer UK, what national policy priorities would you like to see introduced that could improve outcomes in pancreatic cancer?

‘We would like to see more investment in employing more key workers and CNSs to support patients with pancreatic cancer and coordinate all levels of the care journey. The fast-track surgery pathway shows how the NHS needs to employ more CNS staff because along with improving patient outcomes, this would also have cost benefits.

‘The provision of focused training for specific cancers, rather than having nurses who deal with many types of cancer, could also be beneficial in the quality of care that patients receive. We need to see the development of CNS roles by cancer type. Every cancer is different, and management is different.

‘Improved communication between specialist centres and referring Trusts, particularly around care pathways and treatment decision-making, is another area that we believe should be developed further. For example, the current referral process can be lengthy and complicated, and isn’t standardised across the UK. So a clear pathway that bridges the gaps between different services and teams would accelerate the process and lead to better outcomes for patients.’

What’s next for Pancreatic Cancer UK?

‘We have many initiatives and activities in the pipeline. Our Promoting Innovative Practice work seeks to raise standards of pancreatic cancer care throughout the UK. We have begun this by launching a Patient Charter, which informs patients of the standard of care they should receive. Over the next couple of years, we’ll be working closely with patients, carers and healthcare professionals to identify innovative care practices that help to improve patients’ lives – and then we will work with policymakers to call for national adoption of these practices.

‘Pancreatic Cancer UK has grown a lot in the past year, and we’re really passionate about the work that we do. Today we launched our general election manifesto, in which we call for the next government to commit to improving patient outcomes in care and survival. We’re calling for an increase in funding for research, infrastructure and access to more clinical trials and treatments. Over the past decade, pancreatic cancer has received less than 1% of total UK cancer research funding. We call for the new government to tackle the challenges of Brexit, so that we do not lose access to European funding, collaboration and clinical trials; nor can we afford to lose all the talented healthcare professionals, including nurses and key workers, who work in pancreatic cancer.

‘Our vision is everyone with pancreatic cancer living for longer and having a better quality of life – and there is no doubt that a strong CNS workforce is integral to achieving that.’


For more information about Pancreatic Cancer UK, please see: