{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T16:02:55Z","timestamp":1785340975609,"version":"3.55.0"},"reference-count":50,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["UEG Journal"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Most pancreatic cancer (PC) patients present symptomatically to cancer services, are diagnosed at late stage, and have poor survival. Patients with alarm symptoms (AS), such as jaundice or altered stool\/urine colour, may be more readily recognised within current referral pathways than those with vague symptoms (VS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the associations of presenting symptom category (alarm vs. vague) with route to diagnosis, stage at diagnosis, treatment, and survival in PC patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Of 540 primary PC cases identified in the population\u2010based Northern Ireland Cancer Registry PC Audit (2019\u20132020), 28 were excluded because referral pathway information was insufficient to classify route to diagnosis, leaving 512 patients for analysis. Patients were categorised by presenting symptoms as AS or VS.\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      tests assessed group differences; Kaplan\u2010Meier and Log\u2010Rank tests compared 1\u2010year survival. Cox proportional hazards models compared mortality risk, adjusting for sex, age, socioeconomic status, referral route, tumour location, and stage at diagnosis. All statistical tests were two\u2010sided, and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05 was considered statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      More patients presented with VS (60.4%) than AS (39.6%). Emergency admission was more common in AS than in VS patients (66.0% vs. 33.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). VS patients more often had stage IV disease (62.1% vs. 39.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) and were less likely to receive tumour\u2010reductive treatment (34.0% vs. 50.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). One\u2010year survival was poorer in VS than in AS patients (24.9% vs. 33.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001). VS was associated with a 48% increased mortality risk [HR\u00a0=\u00a01.48 (1.14\u20131.91)] after full adjustment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PC patients with VS were more often presented via GP; they had later\u2010stage disease and poorer survival. VS remained independently associated with poorer survival. Greater awareness of PC symptoms, especially VS, together with effective diagnostic pathways for non\u2010specific symptoms, may help support more timely investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ueg2.70231","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T09:59:09Z","timestamp":1778839149000},"source":"Crossref","is-referenced-by-count":0,"title":["Later\u2010Stage Diagnosis and Poorer Survival in Pancreatic Cancer Patients With Vague Symptoms: A Population\u2010Based Study"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0351-7709","authenticated-orcid":false,"given":"Vinay Murali","family":"Prasad","sequence":"first","affiliation":[{"name":"School of Medicine, Dentistry and Biomedical Sciences Queen's University  Belfast Northern Ireland UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen G.","family":"Coleman","sequence":"additional","affiliation":[{"name":"School of Medicine, Dentistry and Biomedical Sciences Queen's University  Belfast Northern Ireland UK"},{"name":"Patrick G Johnston Centre for Cancer Research Queen's University  Belfast Northern Ireland UK"},{"name":"Northern Ireland Cancer Registry Centre for Public Health Queen's University  Belfast Northern Ireland UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinead T.","family":"Hawkins","sequence":"additional","affiliation":[{"name":"Northern Ireland Cancer Registry Centre for Public Health Queen's University  Belfast Northern Ireland UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Northern Ireland Cancer Registry Centre for Public Health Queen's University  Belfast Northern Ireland UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"McCain","sequence":"additional","affiliation":[{"name":"Belfast Health and Social Care Trust  Belfast Northern Ireland UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothy","family":"Johnston","sequence":"additional","affiliation":[{"name":"Belfast Health and Social Care Trust  Belfast Northern Ireland UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2053-7078","authenticated-orcid":false,"given":"Damien","family":"Bennett","sequence":"additional","affiliation":[{"name":"Northern Ireland Cancer Registry Centre for Public Health Queen's University  Belfast Northern Ireland UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"Pancreatic Cancer Statistics","author":"Cancer Research UK","year":"2019"},{"key":"e_1_2_12_3_1","volume-title":"Northern Ireland Pancreatic Cancer Audit, Measuring the Quality of Care for Patients Diagnosed in 2019\u20132020","author":"Hawkins S.","year":"2023"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12029\u2010015\u20109724\u20101"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v24.i43.4846"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102019\u2010033008"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885\u2010015\u20101424\u20105"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2021.0153"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2012.190"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ecc.12699"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468\u20101253(16)30079\u20106"},{"key":"e_1_2_12_12_1","unstructured":"Department of Health NI.A Cancer Strategy for Northern Ireland 2022\u20132032(2022) https:\/\/www.health\u2010ni.gov.uk\/sites\/default\/files\/publications\/health\/doh\u2010cancer\u2010strategy\u2010march\u20102022.pdf."},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h5102"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.30072"},{"key":"e_1_2_12_15_1","unstructured":"National Institute for Health and Care Excellence.Pancreatic Cancer in Adults: Diagnosis and Management NICE Guideline(2018) https:\/\/www.nice.org.uk\/guidance\/ng85\/resources\/pancreatic\u2010cancer\u2010in\u2010adults\u2010diagnosis\u2010and\u2010management\u2010pdf\u20101837696373701."},{"key":"e_1_2_12_16_1","unstructured":"National Institute for Health and Care Excellence.Suspected Cancer: Recognition and Referral NICE Guideline. 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