Imaging activity possibly signalling missed diagnostic opportunities in bladder and kidney cancer: A longitudinal data-linkage study using primary care electronic health records

Zhou, Yin; Abel, Gary; Hamilton, William; Singh, Hardeep; Walter, Fiona M; Lyratzopoulos, Georgios

doi:10.1016/j.canep.2020.101703

Cited by 16 publications

(20 citation statements)

References 31 publications

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“…Population-based studies have documented that among some patients subsequently diagnosed with cancer, use of investigations starts to increase many months before the eventual diagnosis. This evidence highlights the presence of periods (or "diagnostic windows") during which earlier diagnosis could in principle be possible for at least some patients [17][18][19][20] . However, previous evidence mostly focused on the use of tests (regardless of results), as opposed to whether tests were abnormal.…”

Section: Introductionmentioning

confidence: 82%

“…The month immediately before diagnosis (that is, excluding month 1 pre-diagnosis) was excluded, because of the likelihood that these patients would have already entered the final stage of the diagnostic process for possible cancer. 17 , 25 , 28 Each patient’s index abnormal test was defined as the first abnormal test within the 12-month period before diagnosis, concordant with prior literature. 17 , 29 …”

Section: Methodsmentioning

confidence: 95%

“…Details of data acquisition and cohort identification have been described in previous studies. 17 , 29 Data on patients aged ≥25 years who were diagnosed with bladder and renal cancer between April 2012 and December 2015 were extracted from the CPRD. These data were linked at source to the cancer registry, from which additional patients were identified using International Classification of Diseases, Tenth Revision (ICD-10) cancer codes.…”

Section: Methodsmentioning

confidence: 99%

“…This evidence highlights the presence of periods (or ‘diagnostic windows’) during which earlier diagnosis could, in principle, be possible for at least some patients. 17 – 20 However, previous evidence has mostly focused on the use of tests (regardless of results), as opposed to whether tests were abnormal. Furthermore, evidence from well-characterised case series studies indicate that abnormal test results were commonly not followed up in patients subsequently found to have cancer.…”

Section: Introductionmentioning

confidence: 99%

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Identifying opportunities for timely diagnosis of bladder and renal cancer via abnormal blood tests: a longitudinal linked data study

et al. 2021

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Background: Understanding pre-diagnostic test use could reveal diagnostic windows where more timely evaluation for cancer may be indicated. Aim: To examine pre-diagnostic patterns of results of abnormal blood tests in bladder and renal cancer patients. Design and setting: Retrospective cohort study using primary care and cancer registry data on bladder and renal cancer patients diagnosed between 2012-2015 in England. Method: We examined the rates of patients with a first abnormal result in the year before diagnosis, for “generic” (full blood count components, inflammatory markers, calcium) and “organ-specific” blood tests (creatinine, liver function test components) which may lead to subsequent detection of incidental cancers. We used Poisson regression, to detect the month during which the cohort’s rate of each abnormal test started to increase from baseline, and examined the proportion of patients with a test found in the first half of the window, as these ‘early’ tests might represent opportunities where further evaluation could be initiated. Results: Data from 4,533 bladder and renal cancer patients were analysed. The monthly rate of patients with a first abnormal test increased towards the time of cancer diagnosis. Abnormalities of both generic and organ-specific tests started to increase from 6-8 months pre-diagnosis, with 25-40% of these patients having an abnormal test in the “early half” of the diagnostic window. Conclusion: Population-level signals of bladder and renal cancer can be observed in abnormalities in commonly performed primary care blood tests up to 8 months before diagnosis, indicating the potential for earlier diagnosis in some patients.

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Section: Introductionmentioning

confidence: 82%

Section: Methodsmentioning

confidence: 95%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Identifying opportunities for timely diagnosis of bladder and renal cancer via abnormal blood tests: a longitudinal linked data study

et al. 2021

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“…Linked data from primary care records (Clinical Practice Research Datalink, CPRD) and Cancer Registry were obtained for a series of studies, with details of the data extraction process and cancer cohort identification previously described [ 16 ]. Patients aged 25 and above who were diagnosed with bladder and kidney cancer between April 2012 and December 2015 were extracted from the CPRD.…”

Section: Methodsmentioning

confidence: 99%

Prolonged Diagnostic Intervals as Marker of Missed Diagnostic Opportunities in Bladder and Kidney Cancer Patients with Alarm Features: A Longitudinal Linked Data Study

Zhou

Walter

Singh

et al. 2021

Cancers

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Background: In England, patients who meet National Institute for Health and Care Excellence (NICE) guideline criteria for suspected cancer should receive a specialist assessment within 14 days. We examined how quickly bladder and kidney cancer patients who met fast-track referral criteria were actually diagnosed. Methods: We used linked primary care and cancer registration data on bladder and kidney cancer patients who met fast-track referral criteria and examined the time from their first presentation with alarm features to diagnosis. Using logistic regression we examined factors most likely to be associated with non-timely diagnosis (defined as intervals exceeding 90 days), adjusting for age, sex and cancer type, positing that such occurrences represent missed opportunity for timely referral, possibly due to sub-optimal guideline adherence. Results: 28%, 42% and 31% of all urological cancer patients reported no, one or two or more relevant symptoms respectively in the year before diagnosis. Of the 2105 patients with alarm features warranting fast-track assessment, 1373 (65%) presented with unexplained haematuria, 382 (18%) with recurrent urinary tract infections (UTIs), 303 (14%) with visible haematuria, and 45 (2%) with an abdominal mass. 27% overall, and 24%, 45%, 18% and 27% of each group respectively, had a non-timely diagnosis. Presentation with recurrent UTI was associated with longest median diagnostic interval (median 83 days, IQR 43–151) and visible haematuria with the shortest (median 50 days, IQR 30–79). After adjustment, presentation with recurrent UTIs, being in the youngest or oldest age group, female sex, and diagnosis of kidney and upper tract urothelial cancer, were associated with greater odds of non-timely diagnosis. Conclusion: More than a quarter of patients presenting with fast-track referral features did not achieve a timely diagnosis, suggesting inadequate guideline adherence for some patients. The findings highlight a substantial number of opportunities for expediting the diagnosis of patients with bladder or kidney cancers.

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Abdominal investigations in the year preceding a diagnosis of abdominal cancer: A register-based cohort study in Denmark

Jessen

Jensen²,

Falborg³

et al. 2021

Cancer Epidemiology

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Imaging activity possibly signalling missed diagnostic opportunities in bladder and kidney cancer: A longitudinal data-linkage study using primary care electronic health records

Cited by 16 publications

References 31 publications

Identifying opportunities for timely diagnosis of bladder and renal cancer via abnormal blood tests: a longitudinal linked data study

Identifying opportunities for timely diagnosis of bladder and renal cancer via abnormal blood tests: a longitudinal linked data study

Prolonged Diagnostic Intervals as Marker of Missed Diagnostic Opportunities in Bladder and Kidney Cancer Patients with Alarm Features: A Longitudinal Linked Data Study

Abdominal investigations in the year preceding a diagnosis of abdominal cancer: A register-based cohort study in Denmark

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