Individual abstract within a Delegate Designed Symposium Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Patient and clinician perspectives on routine surveillance imaging in pancreaticobiliary and gastroesophageal cancer (142933)

Kristin Wright 1 , Samuel X Stevens 1 2 , Luna Rodriguez Grieve 3 , Brooke E Wilson 1 , Rebecca Mercieca-Bebber 4 , Martin R Stockler 4 , Christopher M Booth 1 , Haryana M Dhillon 3 , Timothy Asmis 5
  1. Division of Medical Oncology, Department of Oncology, Queen's University, Kingston, Ontario, Canada
  2. Department of Medical Oncology, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
  3. Faculty of Science, School of Psychology, The University of Sydney, Camperdown, NSW, Australia
  4. NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, Australia
  5. Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, The University of Ottawa, Ottawa, Ontario, Canada

Background: Guidelines for surveillance imaging after curative-intent treatment for pancreaticobiliary and gastroesophageal cancer are highly heterogeneous1. Routine imaging remains widespread despite the absence of level 1 evidence that early detection of asymptomatic recurrence improves survival or quality of life2,3. We explored patient and clinician perspectives on routine surveillance imaging and how these inform shared decision-making.

Methods: We conducted an exploratory sequential mixed methods study. In this qualitative phase, semi-structured interviews were undertaken with surgeons, medical and radiation oncologists, and patients with early-stage pancreaticobiliary or gastroesophageal cancer, at two Canadian cancer centres. Sample size was guided by information power and data saturation. Data were coded using separate consensus-developed codebooks and analysed using interpretive description and reflexive thematic analysis.

Results: 13 clinicians (23% female, 46% medical oncologists, median 17 years since medical school graduation) and 7 patients (57% female, median age 64, 86% pancreaticobiliary) were interviewed. Clinician data cohered around seven themes: uncertainty about surveillance benefit and prognostication; risk tolerance; factors influencing practice; perceived benefits and drawbacks across clinical, psychological, and system levels; real-world practice patterns (77% default to routine imaging, 23% symptom-directed); and unmet survivorship needs. Patient data cohered around three domains: patient factors (beliefs about surveillance, shared decision-making, fear of recurrence, and reassurance); survivorship care delivery and transitions; and trust in the healthcare team. Surveillance preferences were shaped by risk tolerance and psychosocial factors, mirroring clinician-identified drivers. Reassurance from negative scans was valuable but time-limited, feeding the scanxiety cycle. Both groups emphasized discussing realistic expectations and surveillance goals in shared decision-making.

Conclusions: Clinicians navigate surveillance imaging for pancreaticobiliary and gastroesophageal cancer under genuine evidentiary uncertainty, which interacts with risk tolerance and psychosocial factors to drive practice heterogeneity. Patient perspectives converge with clinician-identified drivers of practice. These findings support the need for pragmatic survivorship evidence and development of patient-informed surveillance guidelines.

  1. Wilson, B. E. et al. Surveillance imaging after curative-intent treatment for cancer: benefits, harms, and evidence. Journal of Clinical Oncology 42, 2245-2249, doi:10.1200/JCO.23.02475 (2024).
  2. Backhus, L. M. et al. Imaging surveillance and survival for surgically resected non-small-cell lung cancer. Journal of Surgical Research 200, 171-176, doi:10.1016/j.jss.2015.06.048 (2016).
  3. Wong, S. K. et al. Impact of surveillance among patients with resected pancreatic cancer following adjuvant chemotherapy. Journal of Gastrointestinal Oncology 12, 446-454, doi:10.21037/jgo-20-422 (2021).