Charles Pilgrim, SMICS and NEMICS
The collaborative pancreatic cancer resectability project, led by SMICS in partnership with NEMICS, was headed by project leads Anna Maciejewska (SMICS) and Nadia Ayres (NEMICS) and clinicians A/Prof Charles Pilgrim, A/Prof Samantha Ellis and Dr Mark Goodwin.
The project began in August 2019 and the pilot ran 15 October 2020 – 30 September 2021, trialling a synoptic template for use by radiologists reporting CT scans. It is hoped the synoptic template will ultimately allow for more accurately tailored treatment options and improve outcomes for patients with pancreatic cancer. A grant to take the trial nationwide was awarded in January 2022.
Pancreatic cancer has most commonly already spread to distant sites when it is first discovered, but for those in whom it has not, the tumour itself may be categorised as ‘resectable’, whereby patients may proceed to surgery, ‘locally advanced’, where surgery is not possible, or an intermediate group known as ‘borderline resectable’. The optimal treatment plan for each of these three stages is critically determined by the anatomical extent of the tumour visible on CT scans.
The pancreatic cancer resectability project partnered with the Upper Gastrointestinal Cancer Registry (UGICR) to enable central data collection of synoptic radiological reports outlining these resectability states. Following the pilot, a Medical Research Future Fund grant application was submitted by UGICR. The ‘SCANPatient’ study proposal will test the application of the structured radiology report in distinguishing patients who should receive chemotherapy before surgery versus surgery alone, in order to optimise their pancreatic cancer care based on their resectability classification.
As Nadia Ayres, project lead at NEMICS says,
"It’s about improving care. The synoptic report supports clinicians by providing documented anatomical detail to develop a well-informed treatment plan for their patient. And with more clinical information available, the scope of possible treatment options for patients is improved. Having an optimal treatment plan is really based on having as much accurate and detailed information as possible at the time of diagnosis."
For Anna Maciejewska of SMICS, the project was the perfect vehicle to demonstrate how the findings of a tumour summit can be used as a focus for a discrete piece of work to achieve large-scale and longer term outcomes.
"The 2017 pancreatic summit, which was hosted by the ICS network, facilitated the conversation that identified the gap in the definition of borderline cases. The ICS were integral to hosting the original conversation and then two ICS entities undertook the work to bring about a focussed, measurable result. It also showcased our ability to work in close collaboration with each other and outside entities, such as UGICR and clinicians across disciplines. For me personally, the challenge lay in bringing a solution that was sustainable and attractive to the end users. There is power in combining efforts and talents and I think we all enjoyed working towards a common goal. And on the days that our hopes faded, I kept saying we will find a solution, and we did."
A/Prof Charles Pilgrim agrees there is now an opportunity to trial what worked well locally on a national scale.
"The last time there was a truly nationwide trial of this magnitude in pancreas cancer was probably back in 2012. We think this grant will help identify at a nationwide level what was identified at a statewide level – that there are probably more patients with borderline resectability than we currently recognise, but even if it doesn’t... at least we will all be speaking the same language and know we are using a uniform system that is based on the international guidelines defining borderline resectable pancreas cancer."
"I thank and acknowledge the Department of Health for being supportive in getting the pilot up and going and having the vision to recognise the point we identified during the summit was worth pursuing. I think this has the potential to impress internationally - if an entire country can adopt international guidelines and agree on using a structured method for describing pancreas cancer, I think it’ll be a benchmark almost of what’s possible and what we should be trying to achieve on a world stage. That is to be able to compare, not just within Australia, but from country to country what the best treatment plans are for patients with different cancer stages. So, I think it has the potential to really put Australia in the spotlight for improving the care of patients with pancreas cancer."
A/Prof Charles Pilgrim has authored an article on the pilot, which has been submitted to the ANZ Journal of Surgery.
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