Comorbidities among patients diagnosed with cancer & how they influence the diagnostic process in primary care

Introduction

The majority of cancer patients are diagnosed after symptomatic presentation in primary care. Pre-existing health problems (usually termed morbidities) may influence how symptomatic individuals are investigated for, and eventually diagnosed with, cancer. However, there is little evidence regarding the nature and frequency of morbidities among the population of cancer patients and on how such conditions may influence diagnostic processes.

Aims and objectives

This project will use data from the English National Cancer Diagnosis Audit (NCDA) 2014 to examine:

• The pre-existing morbidities individuals have before cancer diagnosis and how the nature and frequency of morbidities may vary between different cancers; and
• How morbidities (presence/absence or specific combinations) may be associated with processes and outcomes relating to the investigation or management of individuals who present with symptoms in primary care.

Methodology

This project will use cross-sectional data from the NCDA 2014 which collected information on the diagnostic process based on primary care records for individuals diagnosed with cancer. Using GP-adjudicated data arising from electronic health records, we will examine the morbidities of individuals who are diagnosed with cancer and, taking into account their presenting symptoms, whether/how morbidities are associated with clinical decision making for symptomatic individuals.

Outputs & impact

The project augments the CanTest project “Diagnostic processes and use of investigations before a cancer diagnosis in patients with comorbidities: optimising testing strategies to improve diagnostic timeliness and reduce emergency presentations”) by using a smaller but clinician-adjudicated dataset to generate evidence relating to the presenting symptoms of cancer (overall, and by cancer site), and if morbidities influence how symptomatic individuals are investigated and eventually diagnosed with cancer. The project findings will highlight opportunities to improve clinical practice and service delivery relating to cancer diagnosis in primary care.

Publications

• Koo MM, Swann R, McPhail S, Abel GA, Renzi C, Rubin GP, Lyratzopoulos G. The prevalence of chronic conditions in patients diagnosed with one of 29 common and rarer cancers: A cross-sectional study using primary care data. Cancer Epidemiology, 2020, 69: 101845, doi: 10.1016/j.canep.2020.101845