Health watchdogs have warned general practitioners to pay careful attention to unexplained weight loss after a doctor at an unnamed practice in the Scottish Highlands failed to recognize lethal pancreatic cancer in a patient who died weeks later.
An investigation by the Scottish Public Services Ombudsman (SPSO) concluded that an "unreasonable delay" in diagnosis led to inadequate end-of-life care, worsened by an "unreasonable reliance on telephone consultations."
Missed opportunities and delayed diagnosis
The patient initially presented to the medical practice after experiencing significant unexplained weight loss. Doctors diagnosed diabetes and prescribed medication for the condition, but symptoms including ongoing weight loss continued.
After months of suffering, the patient directly asked the family doctor if the symptoms could indicate pancreatic cancer. The practice eventually referred the patient to gastroenterology specialists, where blood tests confirmed pancreatic cancer. The patient died six weeks later.
The SPSO report found that "red flag symptoms of pancreatic cancer" were present from the patient's first contact with the practice. Watchdog investigators stated: "From this point until the urgent suspicion of cancer referral, there were missed opportunities to recognise the significance of A's symptoms and refer them onward for further investigation."
The watchdog ordered the unnamed Highland medical practice to issue an apology to the patient's family for an "unreasonable delay in recognising specific symptoms" indicative of cancer. The report also criticized the GP's heavy reliance on telephone appointments, which may have exacerbated the delay.
Pancreatic cancer symptoms and survival rates
Pancreatic cancer is one of the deadliest forms of the disease, killing roughly three-quarters of diagnosed patients within a year. Around 10,500 people in the United Kingdom are diagnosed with pancreatic cancer annually, and more than half die within three months because most cases are detected only at an advanced stage.
Early detection is challenging because the disease causes few vague symptoms initially. Health officials stress that doctors cannot afford to ignore potential warning signs, which include unexplained weight loss, fatigue, nausea, and abdominal pain. Additional potential symptoms include jaundice, where the skin and whites of the eyes turn yellow, alongside itchy skin and dark urine.
Rates of pancreatic cancer have risen by around 17 per cent in Britain since the 1990s, driven by soaring obesity rates and environmental factors. While the disease overwhelmingly affects older adults, including actor Alan Rickman who died from pancreatic cancer at age 69, cases have increased fastest among younger patients and women over the past 30 years. Known risk factors include smoking, obesity, consuming processed meats, and alcohol intake.
Pancreas function and pancreatitis risks
The pancreas is a palm-sized, pear-shaped gland located behind the stomach that plays a vital role in digestion. When the gland becomes inflamed, it causes acute pancreatitis, resulting in severe abdominal pain, nausea, and fever.
Although acute pancreatitis typically settles within days or weeks, persistent or recurring inflammation can develop into chronic pancreatitis. Chronic pancreatitis is a long-term condition known to increase the risk of developing pancreatic cancer.
New drug treatments and clinical developments
Until recently, highly toxic chemotherapy has been the only treatment option available for patients with pancreatic cancer. However, patients may soon benefit from new therapeutic options following a medical breakthrough in May.
Clinical trials revealed that a novel once-daily pill, daraxonrasib, can double the life expectancy of pancreatic cancer patients without their disease progressing. Experts have hailed the drug as "landscape changing." Findings have been submitted to regulators in the United States, with an application to UK regulatory authorities expected to follow as developers seek approval.
