Diagnostic processes and use of investigations before a cancer diagnosis in patients with comorbidities

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Project Summary

Adults with possible cancer symptoms often have pre-existing health problems (hereafter called comorbidities). Although it is believed that comorbidities can influence the timeliness of diagnosis of cancer and decisions about testing strategies, evidence on the underlying mechanisms and on morbidity-specific effects is scant.

The overall aim is to generate evidence for optimising diagnostic strategies in patients with comorbidities experiencing possible cancer symptoms, in order to improve diagnostic timeliness. The project will have a specific focus on the role of morbidities in diagnoses of cancer as an emergency. Specific objectives include:
1. a) To systematically evaluate the available evidence on the effects of comorbidity, overall and for specific conditions, on each step along diagnostic pathways and develop a comprehensive conceptual framework.
b) Inform and validate the conceptual framework using qualitative approaches to acquire lay and healthcare professional input regarding key mechanisms by which comorbidity may influence each step of the diagnostic process.
2. Analyse primary and secondary care data in order to evaluate diagnostic processes and healthcare utilisation patterns and identify testing strategies associated with increased or reduced risk of prolonged diagnostic intervals and/or emergency presentation in patients with different comorbidities.
3. Develop a grant/fellowship application, aiming to acquire competitive external funding, for a project that will further enhance the analytical work and include developing and assessing the feasibility in a UK primary care setting of an experimental intervention.

A critical literature review will be performed evaluating the evidence on the effects of comorbidities, overall and by specific morbid condition, on each step along the diagnostic pathways, from symptomatic presentations to investigations. A comprehensive framework will be developed to elucidate the mechanisms through which comorbidities can facilitate or interfere with timely cancer diagnosis. The framework development will also be informed and validated by interviewing healthcare professionals (including GPs and specialist doctors) and members of the public who will provide their input and enhance our understanding of the mechanisms by which comorbidity may influence the diagnostic process.
Using primary care, secondary care and cancer registration data we will analyse diagnostic processes and healthcare utilisation patterns pre-cancer diagnosis among patients with specific comorbidities by diagnostic route taking into account presenting symptoms, patient and healthcare factors.

The project will shed light on mechanisms through which specific comorbidities can influence the diagnostic process and increase the risk of emergency presentations in certain patient groups. Possible targets for interventions to improve the diagnostic process for new symptom onset in comorbid patients will be identified.

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