Five-year psychological impact and surveillance compliance in the Australian Pancreatic Cancer Screening Program

Evidence of benefit for pancreatic ductal adenocarcinoma (PDAC) surveillance is accumulating, including earlier staging, extended survival, and improved psychological function. This study aimed to assess the 5-year psychological impact of high-risk PDAC surveillance, performed at St Vincent’s Hospital, Sydney, Australia. Participants were offered annual endoscopic ultrasound (EUS) or magnetic resonance imaging (MRI), with frequency increasing if clinically indicated. The impact of event scale (IES), comprising intrusion and avoidance subscales, and the psychological consequences questionnaire (PCQ), which assesses emotional, physical and social domains, were administered at baseline, 1-month, 1-year and 5-years post-baseline EUS. Generalized linear mixed-effects models were used to assess for differences in reported outcomes. Of the 143 participants under surveillance, 108 underwent annual investigations, and 35 had one or more episode(s) of intensified surveillance. Overall, screening compliance was high, though understandably, increased deferrals occurred during COVID-19 pandemic restrictions. Two participants were diagnosed with pancreatic neoplasms and half had pre-malignant pancreatic lesions that remained stable (n = 45) or showed progression (n = 28). There was a significant reduction in IES intrusion and an increase in positive PCQ emotional, physical and total scores at 5-years. Negative PCQ scores remained stable compared to baseline. There was no difference in IES, negative PCQ or positive PCQ scores based on EUS/MRI findings. Individuals undergoing intensified surveillance reported significantly lower positive PCQ physical and total scores, but there was no difference in negative PCQ or IES scores. These data provide reassurance regarding the acceptability and psychological safety of PDAC surveillance, despite frequent abnormal findings and intensified investigation.