The human pancreas and duodenum.Malta’s negligent reporting and poor documentation of the incidence of pancreatic cancer “is causing the death of Maltese patients,” according to a European study.
The local system came under harsh criticism by Arne Bjornberg, head of the Health Consumer Powerhouse, who said Malta had to focus on “the very basics in pancreatic cancer care – training doctors to detect the cancer at an early stage and monitor basic treatment data”.
The Swedish-based research organisation, which yesterday published the Euro Pancreatic Cancer Index, pointed out that poor documentation hindered efficient cancer care.
“In Malta, the lack of reporting is even worse than in neighbouring countries, which make most assessments futile. But I am afraid that such negligence causes the death of Maltese patients,” Dr Bjornberg said.
Dubbed the “silent killer”, the cancer of the pancreas – an organ that helps digestion through the breakdown of food and absorption of nutrients and also produces important hormones such as insulin – is often detected too late, making treatment impossible.
Malta ranked seventh out of 30 countries in mortality from pancreatic cancer in men and women in 2012 – with an estimated incidence of 13 out of 100,000 and mortality rate of 10.5 out of 100,000. It is the fourth largest cause of cancer deaths in the EU, killing more than 100,000 Europeans every year, with the number constantly rising, the report said.
Most patients with pancreatic cancer will die the first year of diagnosis.
In the first comparison of pancreatic care in Europe, the index covered sectors such as patient rights, information and accessibility to care, prevention, treatment outcomes, diagnostics, pharmaceuticals and palliative care.
Malta ranked the second lowest in the report’s scoreboard with 525 out of 1,000 points – 29th out of 30 countries – and only Bulgaria ranked lower at 470 points.
The Netherlands came out on top, at 879, followed by Denmark with 872 points and Ireland – 807. The index looked at various risk factors – including smoking and obesity. It said that smoking, the most recognised risk factor, could account for recent trends of pancreatic cancer in men, as lung cancer was declining.
However, it said that “increases in obesity prevalence may play a role in the recent trends”. Malta had the third highest obesity rate of the 30 countries studied, going on WHO statistics.
Once the cancer is diagnosed, “the worst thing that can happen to any patient is too wait far too long for a CT scan or MRI exam”. Anyone with slightest symptoms or indication of pancreatic cancer had to be scanned “as soon as possible as delays in diagnosis is the reason why long-term survival is so low”.
Malta ranked the highest out of all 30 countries in the waiting time for non-acute CT scans, the index said. Waiting times for a CT or MRI scan meant poor service quality and increased costs, as keeping track of patient for weeks or months “is by no means costless”.
Malta ranked well in the section of patient rights and prevention but low in diagnostics and treatment. Together with Denmark, Finland and Spain, it was praised for the integration of homecare delivery coordinated with family doctors, hospitals, nursing and residential homes.
It was also listed as one of the few countries that offered palliative care.
Europe findings
• The low survival rate seems to have created a sense of hopelessness, even among medical professionals.
• It would seem that the low survival rates of pancreatic cancer – largely due to late diagnosis of the disease – have de-motivated registry holders from monitoring progress of pancreatic cancer care.
• There might be a risk for complacency as a result of palliative care being well established, thus blurring the focus on curative treatment.
Recommendations for European best practice
• Early detection: educate primary care doctors to recognise and act on the combination of vague symptoms of pancreatic cancer.
• Because of the relative rarity of pancreatic cancer, surgery should be concentrated to specialist centres while information and rapid access to such centres should be a high priority.
• Collect and report pancreatic cancer data to national cancer registries and make this information layman-friendly and readily available.
• Better manage survival rates by taking action to narrow the gaps in pancreatic cancer care provision.
• Measure pancreatic care provision in the same way as any other more common cancer.
• Encourage governments to invest in pancreatic cancer research especially in the field of early diagnostics.
• Improve integrated care for pancreatic cancer patients by ensuring rapid referral for specialist treatment as speed is vital for survival.