Quantifying the risk of multiple myeloma from symptoms reported in primary care patients: a large case–control study using electronic records

Shephard, Elizabeth A; Neal, Richard D; Rose, Peter W.; Walter, Fiona M; Litt, Emma J; Hamilton, William

doi:10.3399/bjgp15x683545

Cited by 52 publications

(87 citation statements)

References 25 publications

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“…Myeloma is one of the rarer cancers, and an average GP in the UK will see only one new case every 8-10 years. The presenting symptoms all have low positive predictive values, 141 meaning that many cases are not diagnosed until irreversible organ damage has occurred. Symptom onset could be gradual and attributable to ageing.…”

Section: Diffi Cult Diagnoses and Rare Cancersmentioning

confidence: 99%

The expanding role of primary care in cancer control

Rubin

Berendsen

Crawford

et al. 2015

The Lancet Oncology

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The nature of cancer control is changing, with an increasing emphasis, fuelled by public and political demand, on prevention, early diagnosis, and patient experience during and after treatment. At the same time, primary care is increasingly promoted, by governments and health funders worldwide, as the preferred setting for most health care for reasons of increasing need, to stabilise health-care costs, and to accommodate patient preference for care close to home. It is timely, then, to consider how this expanding role for primary care can work for cancer control, which has long been dominated by highly technical interventions centred on treatment, and in which the contribution of primary care has been largely perceived as marginal. In this Commission, expert opinion from primary care and public health professionals with academic and clinical cancer expertise-from epidemiologists, psychologists, policy makers, and cancer specialists-has contributed to a detailed consideration of the evidence for cancer control provided in primary care and community care settings. Ranging from primary prevention to end-of-life care, the scope for new models of care is explored, and the actions needed to eff ect change are outlined. The strengths of primary care-its continuous, coordinated, and comprehensive care for individuals and families-are particularly evident in prevention and diagnosis, in shared follow-up and survivorship care, and in end-of-life care. A strong theme of integration of care runs throughout, and its elements (clinical, vertical, and functional) and the tools needed for integrated working are described in detail. All of this change, as it evolves, will need to be underpinned by new research and by continuing and shared multiprofessional development.

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Section: Diffi Cult Diagnoses and Rare Cancersmentioning

confidence: 99%

The expanding role of primary care in cancer control

Rubin

Berendsen

Crawford

et al. 2015

The Lancet Oncology

Self Cite

437

450

View full text Add to dashboard Cite

show abstract

“…This study uses a robust data source, the CPRD, which has been used extensively in past studies of cancer risk markers. [11][12][13][14] The use of NCRS data is a further strength, identifying incident cases that may have been unrecorded in the CPRD. Blood counts are electronically transmitted to the CPRD, reducing the risk of recording error.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Cancer incidence in patients with a high normal platelet count: a cohort study using primary care data

Ankus

Price²,

Ukoumunne

et al. 2018

Family Practice

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“…Consultation rates generally increase before cancer is diagnosed (Lyratzopoulos et al , 2012, 2013, 2015; Shephard et al , 2012, 2013, 2015a, 2015b, c; Stapley et al , 2012, 2013). These excess consultations may represent ‘missed’ opportunities for expediting the diagnosis.…”

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confidence: 99%

Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records

et al. 2017

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Background:Pre-existing non-cancer conditions may complicate and delay colorectal cancer diagnosis.Method:Incident cases (aged ⩾40 years, 2007–2009) with colorectal cancer were identified in the Clinical Practice Research Datalink, UK. Diagnostic interval was defined as time from first symptomatic presentation of colorectal cancer to diagnosis. Comorbid conditions were classified as ‘competing demands’ (unrelated to colorectal cancer) or ‘alternative explanations’ (sharing symptoms with colorectal cancer). The association between diagnostic interval (log-transformed) and age, gender, consultation rate and number of comorbid conditions was investigated using linear regressions, reported using geometric means.Results:Out of the 4512 patients included, 72.9% had ⩾1 competing demand and 31.3% had ⩾1 alternative explanation. In the regression model, the numbers of both types of comorbid conditions were independently associated with longer diagnostic interval: a single competing demand delayed diagnosis by 10 days, and four or more by 32 days; and a single alternative explanation by 9 days. For individual conditions, the longest delay was observed for inflammatory bowel disease (26 days; 95% CI 14–39).Conclusions:The burden and nature of comorbidity is associated with delayed diagnosis in colorectal cancer, particularly in patients aged ⩾80 years. Effective clinical strategies are needed for shortening diagnostic interval in patients with comorbidity.

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Quantifying the risk of multiple myeloma from symptoms reported in primary care patients: a large case–control study using electronic records

Cited by 52 publications

References 25 publications

The expanding role of primary care in cancer control

The expanding role of primary care in cancer control

Cancer incidence in patients with a high normal platelet count: a cohort study using primary care data

Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records

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