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Effect of pre-existing conditions on bladder cancer stage at diagnosis: a cohort study using electronic primary care records in the UK

BACKGROUND: Pre-existing concurrent medical conditions (multimorbidity) complicate cancer diagnosis when they provide plausible diagnostic alternatives for cancer symptoms. AIM: To investigate associations in bladder cancer between: first, pre-existing condition count and advanced-stage diagnosis; a...

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Autores principales: Carney, Madeline, Quiroga, Myra, Mounce, Luke, Shephard, Elizabeth, Hamilton, Willie, Price, Sarah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Royal College of General Practitioners 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363276/
https://www.ncbi.nlm.nih.gov/pubmed/32661011
http://dx.doi.org/10.3399/bjgp20X710921
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author Carney, Madeline
Quiroga, Myra
Mounce, Luke
Shephard, Elizabeth
Hamilton, Willie
Price, Sarah
author_facet Carney, Madeline
Quiroga, Myra
Mounce, Luke
Shephard, Elizabeth
Hamilton, Willie
Price, Sarah
author_sort Carney, Madeline
collection PubMed
description BACKGROUND: Pre-existing concurrent medical conditions (multimorbidity) complicate cancer diagnosis when they provide plausible diagnostic alternatives for cancer symptoms. AIM: To 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 SETTING: This observational UK cohort study was set in the Clinical Practice Research Datalink with Public Health England National Cancer Registration and Analysis Service linkage. METHOD: Included 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. RESULTS: In 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). CONCLUSION: Alternative 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.
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spelling pubmed-73632762020-07-16 Effect of pre-existing conditions on bladder cancer stage at diagnosis: a cohort study using electronic primary care records in the UK Carney, Madeline Quiroga, Myra Mounce, Luke Shephard, Elizabeth Hamilton, Willie Price, Sarah Br J Gen Pract Research BACKGROUND: Pre-existing concurrent medical conditions (multimorbidity) complicate cancer diagnosis when they provide plausible diagnostic alternatives for cancer symptoms. AIM: To 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 SETTING: This observational UK cohort study was set in the Clinical Practice Research Datalink with Public Health England National Cancer Registration and Analysis Service linkage. METHOD: Included 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. RESULTS: In 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). CONCLUSION: Alternative 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. Royal College of General Practitioners 2020-07-14 /pmc/articles/PMC7363276/ /pubmed/32661011 http://dx.doi.org/10.3399/bjgp20X710921 Text en ©The Authors http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by-nc/4.0/).
spellingShingle Research
Carney, Madeline
Quiroga, Myra
Mounce, Luke
Shephard, Elizabeth
Hamilton, Willie
Price, Sarah
Effect of pre-existing conditions on bladder cancer stage at diagnosis: a cohort study using electronic primary care records in the UK
title Effect of pre-existing conditions on bladder cancer stage at diagnosis: a cohort study using electronic primary care records in the UK
title_full Effect of pre-existing conditions on bladder cancer stage at diagnosis: a cohort study using electronic primary care records in the UK
title_fullStr Effect of pre-existing conditions on bladder cancer stage at diagnosis: a cohort study using electronic primary care records in the UK
title_full_unstemmed Effect of pre-existing conditions on bladder cancer stage at diagnosis: a cohort study using electronic primary care records in the UK
title_short Effect of pre-existing conditions on bladder cancer stage at diagnosis: a cohort study using electronic primary care records in the UK
title_sort effect of pre-existing conditions on bladder cancer stage at diagnosis: a cohort study using electronic primary care records in the uk
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363276/
https://www.ncbi.nlm.nih.gov/pubmed/32661011
http://dx.doi.org/10.3399/bjgp20X710921
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