BackgroundPre-existing concurrent medical conditions (multimorbidity) complicate cancer diagnosis when they provide plausible diagnostic alternatives for cancer symptoms.AimTo investigate associations in bladder cancer between: first, pre-existing condition count and advanced-stage diagnosis; and, second, comorbidities that share symptoms with bladder cancer and advanced-stage diagnosis.Design and settingThis observational UK cohort study was set in the Clinical Practice Research Datalink with Public Health England National Cancer Registration and Analysis Service linkage.MethodIncluded participants were aged ≥40 years with an incident diagnosis of bladder cancer between 1 January 2000 and 31 December 2015, and primary care records of attendance for haematuria, dysuria, or abdominal mass in the year before diagnosis. Stage at diagnosis (stage 1 or 2 versus stage 3 or 4) was the outcome variable. Putative explanatory variables using logistic regression were examined, including patient-level count of pre-existing conditions and ‘alternative-explanations’, indicating whether pre-existing condition(s) were plausible diagnostic alternatives for the index cancer symptom.ResultsIn total, 1468 patients (76.4% male) were studied, of which 399 (35.6%) males and 217 (62.5%) females had alternative explanations for their index cancer symptom, the most common being urinary tract infection with haematuria. Females were more likely than males to be diagnosed with advanced-stage cancer (adjusted odds ratio [aOR] 1.62; 95% confidence interval [CI] = 1.20 to 2.18; P = 0.001). Alternative explanations were strongly associated with advanced-stage diagnosis in both sexes (aOR 1.69; 95% CI = 1.20 to 2.39; P = 0.003).ConclusionAlternative explanations were associated with advanced-stage diagnosis of bladder cancer. Females were more likely than males to be diagnosed with advanced-stage disease, but the effect was not driven entirely by alternative explanations.
Figure 1. (A) Colonoscope view of transverse colon; inflammation characterized by congestion, erythema, and friability in a continuous and circumferential pattern from descending colon to the transverse colon, graded as Mayo Score 3 (severe, with spontaneous bleeding, ulcerations) preventing colonoscope from advancing past the transverse colon. (B) Rectal biopsy found severe chronic active proctitis, crypt abscesses, and mucosal erosions/ulceration; negative for dysplasia or granulomas. (C) Repeat colonoscope view of transverse colon; colitis with altered vascularity, congestion and pseudopolyps in a continuous circumferential pattern from transverse colon to the cecum. (D) Final colonoscope view of transverse colon; mild to severe pancolitis from rectum to cecum, with superficial ulcerations and friability of mucosa, Mayo Score 3.
Background Pre-existing conditions interfere with cancer diagnosis by offering diagnostic alternatives, competing for clinical attention or through patient surveillance. Objective To investigate associations between oesophagogastric cancer stage and pre-existing conditions. Methods Retrospective cohort study using Clinical Practice Research Datalink (CPRD) data, with English cancer registry linkage. Participants aged ≥40 years had consulted primary care in the year before their incident diagnosis of oesophagogastric cancer in 01/01/2010–31/12/2015. CPRD records pre-diagnosis were searched for codes denoting clinical features of oesophagogastric cancer and for pre-existing conditions, including those providing plausible diagnostic alternatives for those features. Logistic regression analysed associations between stage and multimorbidity (≥2 conditions; reference category: no multimorbidity) and having ‘diagnostic alternative(s)’, controlling for age, sex, deprivation and cancer site. Results Of 2444 participants provided, 695 (28%) were excluded for missing stage, leaving 1749 for analysis (1265/1749, 72.3% had advanced-stage disease). Multimorbidity was associated with stage [odds ratio 0.63, 95% confidence interval (CI) 0.47–0.85, P = 0.002], with moderate evidence of an interaction term with sex (1.76, 1.08–2.86, P = 0.024). There was no association between alternative explanations and stage (odds ratio 1.18, 95% CI 0.87–1.60, P = 0.278). Conclusions In men, multimorbidity is associated with a reduced chance of advanced-stage oesophagogastric cancer, to levels seen collectively for women.
Background: Existing comorbid diseases may delay the diagnosis of bladder cancer. This study tested two hypotheses. First, there is an association between existing comorbidity burden and advanced-stage cancer, where the conditions compete for clinical attention and cancer symptoms are overlooked. Second, there is an association between the presence of comorbid conditions that mimic the patient's first possible symptom of cancer and advanced-stage cancer, through symptom misattribution. Methods: This population-based, observational study was set in The Clinical Practice Research Datalink (CPRD; a dataset of UK primary care medical records) with linkage to Public Health England National Cancer Registration and Analysis Service data. We studied adults (≥40 years) with an incident bladder cancer diagnosis (ICD10 code C67) between 01/01/2000 and 12/31/2015. CPRD records made in the year before cancer diagnosis were searched for codes indicating attendance for bladder cancer symptoms (hematuria, dysuria, and abdominal mass). CPRD records made in the 2 years before the earliest cancer symptom were searched for diagnostic codes for common comorbid conditions (e.g., diabetes and cardiovascular diseases) and for conditions sharing symptoms with bladder cancer (urinary tract infection, sexually transmitted disease, kidney disease, tuberculosis, sickle cell disease, nephrolithiasis, prostatitis, menorrhagia, endometriosis, benign prostatic hyperplasia, uterine fibroids, aortic aneurysm, and retention). The data were analyzed using logistic regression. The outcome variable was stage of bladder cancer diagnosis: advanced (3 or 4) vs. early (1 or 2). Explanatory variables included count of pre-existing comorbid conditions, and an “alternative-explanations” variable indicating when a patient's comorbid condition could explain their first possible bladder cancer symptom. The model adjusted for age, sex, and deprivation. Results: The analysis included 1,469 (76.4% male) patients, of whom 270 (18.4%) had advanced-stage cancer. 1,178/1,469 (80.2%) patients (73.6% male) had 1 or more comorbid conditions. 616/1,469 (41.9%) patients (64.8% male) had alternative explanations for the first possible symptom of cancer. Women were more likely than men to be diagnosed with advanced-stage cancer (odds ratio 1.62; 95% confidence interval 1.20 to 2.18; p=0.001). Alternative explanations for the first possible symptom of bladder cancer were strongly associated with advanced-stage diagnosis similarly in men and women (1.69, 1.20 to 2.39, p=0.003). Count of conditions was not associated with stage at diagnosis (p=0.64). Conclusion: Existing comorbid diseases that mimic the presentation of bladder cancer are associated with advanced stage at diagnosis. Women are more likely than men to be diagnosed with advanced-stage cancer, but the effect is not driven by alternative explanations. Note: This abstract was not presented at the conference. Citation Format: Madeline H. Carney, Sarah Price, Elizabeth Shephard, Luke Mounce, Myra Quiroga, Willie Hamilton. Effect of pre-existing conditions on bladder cancer diagnosis: A cohort study using electronic primary care records [abstract]. In: Proceedings of the AACR Special Conference on Bladder Cancer: Transforming the Field; 2019 May 18-21; Denver, CO. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(15_Suppl):Abstract nr A25.
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