Improvements in Surgical Practice: SCAN Patient Trial

In 2019, Professor John Zalcberg and Dr Daniel Croagh received PanKind Grant funding to lead a multi-disciplinary team of researchers, radiologists and surgeons to compare European and Australian pancreatic cancer healthcare practices. The funds, made possible by the fundraising efforts from ‘Remember September 2019’, allowed the team to investigate whether treatment options for Australian patients with potentially operable tumours were different to those available to a similar group in Europe.

Four years later, the study has been completed, with results showing there is high variability in recommended treatment options globally when reading CT scans for patients diagnosed with borderline resectable tumours.

In relation to tumours, the term ‘borderline resectable’ refers to a situation where the tumour is located near important structures in the body, such as blood vessels or organs, making it’s surgical removal (resection) more challenging. Tumours that are classified as ‘borderline resectable’ are not clearly inoperable, but surgery might be riskier due to the proximity of the tumour to these critical areas.

The team of researchers (Henry Badgery, Tjuntu Muhlen-Shulte, John Zalcberg, Bianka D’Souza, Jan Gerstenmaier, Craig Pickett, Jaswinder Samra and Daniel Croagh) found that there was no unanimous agreement globally as to what the term ‘borderline resectable’ meant, and thus there was no unanimous treatment plan for patients within this category. This meant patients across the world with similar tumours were having surgeons carefully assess their cancer, but end up receiving different treatment options. This brought forward questions of consistency of clinical decision-making for patients and suggests that central review and ongoing quality control initiatives must be introduced. 

In short, the team discovered that current pancreatic cancer patients face classification guidelines when treatment plans are being developed, however interobserver variability between reviewing surgeons and radiologists makes the final decision on treatment plans slightly murkier, and far less concrete.

However, the good news for patients is that these findings are being used in a brand-new pilot program funded by the Medical Research Future Fund (MRFF). Entitled ‘ScanPatient’, this program is testing Professor Zalcberg and Dr Croagh’s findings in a clinical setting, with the aim to improve the effectiveness of reporting CT scans for the diagnosis and treatment of pancreatic cancer.

Headed by Dr Charles Pilgrim, the program involves a committee of surgeons, radiologists and researchers coming together to use a synoptic radiological report when reporting on pancreatic CT scans to determine the best course of treatment.

Early signs have been promising, with the program’s implementation demonstrating a clinically significant improvement in the accuracy of assessment of localised pancreatic cancer. The program has now commenced in 25 major hospitals in Victoria and Queensland.

Dr Pilgrim said “This program has been fantastic in improving the standards of care for pancreatic cancer patients. Whilst previously surgeons and radiologists were looking at patients in different ways, we are now all talking the same language. If a radiologist finds a tumour to be borderline, this had been proven via the comprehensive prose they have to address in their report. Our findings, and subsequently treatment plans, are now far more systematic and thorough, leading to better outcomes for patients across Australia.”

You can read more about ‘ScanPatient: Synoptic Reporting of CT scans assessing cancer of the pancreas, A stepped-wedge randomised controlled trial’ here: https://ugicr.org.au/scanpatient/