A large, population–based study of patients with pancreatic cancer has shown that some newer imaging methods may delay the time to surgery for patients.

Scientists at the University of Wisconsin Carbone Cancer Center combed through data of 2,782 Medicare patients from around the country to learn whether endoscopic ultrasounds were being used judiciously.

In the first study, researchers led by Dr. Ryan Schmocker, a resident in the UW Department of Surgery, and UW Carbone Cancer Center surgeon Dr. Emily Winslow wondered when these imaging techniques were being ordered and whether they benefited patients. These imaging tests are being ordered more frequently in patients suspected of having pancreatic cancer.

The researchers found that whether a patient received an ultrasound depended more on where the care was provided than on the particular needs of the patient. Patients at larger academic medical centers – which tend to have the latest equipment – were more likely to have endoscopic ultrasounds than those at smaller hospitals. A study by another group has shown that endoscopic ultrasounds do not affect patients’ survival rates.

For some patients, Winslow says, having an ultrasound tumor biopsy could be a benefit because they were going to have a newer treatment regimen that involves using chemotherapy first, to shrink the tumor, before having surgery.

But most patients were going to have surgery regardless, to remove the tumor, and the ultrasound tended to delay their surgery by an average of 17 days.

“This study demonstrates that how patients receive care may depend more on where they are treated and not their disease, which may impact their overall treatment pathway,” Schmocker says. “It adds to the growing sense amongst physicians and researchers that addressing inequitable care delivery could improve the quality and efficiency of healthcare.”

Winslow says the results point to a need for better coordination of care for cancer patients, so that the physician ordering the ultrasound considers the next steps for the patient.

“We should be making decisions based on how they will affect the downstream care,” Winslow says.

Winslow says this is the first of several population studies being funded in part by the local Pancreas Cancer Task Force. She says the computer coding created for this first study lays the groundwork for future studies.

“This is a proof of principle that we can use this large data set to answer important questions about pancreatic cancer,” Winslow says. “We’re now ready to use more recent data to search for risk factors that could set the stage for pancreas cancer development.”

The study was published in the journal HPB.