Dataset Information

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

ABSTRACT: Pre-existing non-cancer conditions may complicate and delay colorectal cancer diagnosis.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.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).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.

SUBMITTER: Mounce LTA

PROVIDER: S-EPMC5518856 | biostudies-other | 2017 Jun

REPOSITORIES: biostudies-other

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

Mounce Luke T A LTA Price Sarah S Valderas Jose M JM Hamilton William W

British journal of cancer 20170511 12

<h4>Background</h4>Pre-existing non-cancer conditions may complicate and delay colorectal cancer diagnosis.<h4>Method</h4>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 sympto ...[more]

PMID: 28494470

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Project description:ObjectiveThis study evaluated whether serious bacterial infections are more frequent at family practices with lower antibiotic prescribing rates.DesignCohort study.Setting706 UK family practices in the Clinical Practice Research Datalink from 2002 to 2017.Participants10.1 million registered patients with 69.3 million patient-years' follow-up.ExposuresAll antibiotic prescriptions, subgroups of acute and repeat antibiotic prescriptions, and proportion of antibiotic prescriptions associated with specific-coded indications.Main outcome measuresFirst episodes of serious bacterial infections. Poisson models were fitted adjusting for age group, gender, comorbidity, deprivation, region and calendar year, with random intercepts representing family practice-specific estimates.ResultsThe age-standardised antibiotic prescribing rate per 1000 patient-years increased from 2002 (male 423; female 621) to 2012 (male 530; female 842) before declining to 2017 (male 449; female 753). The median family practice had an antibiotic prescribing rate of 648 per 1000 patient-years with 95% range for different practices of 430-1038 antibiotic prescriptions per 1000 patient-years. Specific coded indications were recorded for 58% of antibiotic prescriptions at the median family practice, the 95% range at different family practices was from 10% to 75%. There were 139 759 first episodes of serious bacterial infection. After adjusting for covariates and the proportion of coded consultations, there was no evidence that serious bacterial infections were lower at family practices with higher total antibiotic prescribing. The adjusted rate ratio for 20% higher total antibiotic prescribing was 1.03, (95% CI 1.00 to 1.06, p=0.074).ConclusionsWe did not find population-level evidence that family practices with lower total antibiotic prescribing might have more frequent occurrence of serious bacterial infections overall. Improving the recording of infection episodes has potential to inform better antimicrobial stewardship in primary care.

Dataset Information

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

Publications

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

Similar Datasets

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