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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

Start Date May 2018

Code U2-C

Status Ongoing

Project Lead
Dr Cristina Renzi
Senior Lead
Prof Yoryos Lyratzopoulos
Institution
University College London
Others
Prof Willie Hamilton (Exeter), Prof Fiona Walter (Cambridge), Dr Monica Koo (UCL), Prof Niek de Wit (Utrecht), Dr Bernard Rachet (London School of Hygiene and Tropical Medicine), Dr Sara Majano Benitez, Dr Edmund Njeru Njagi  (London School of Hygiene and Tropical Medicine)

Introduction

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

Aims & objectives

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. Specific objectives include:

Methodology

We have completed a critical literature review 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 has been developed to elucidate the mechanisms through which comorbidities can facilitate or interfere with timely cancer diagnosis.
Using primary care, secondary care and cancer registration data we are currently analysing 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.

Outputs & impact

The project will shed light on mechanisms through which specific comorbidities can influence the diagnostic process and increase or reduce the risk of advanced stage at diagnosis and/or 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.

Next steps

Using linked electronic health records we will analyse diagnostic processes and healthcare utilisation patterns pre-cancer diagnosis among patients with specific comorbidities, taking into account presenting symptoms, patient and healthcare factors.

An external grant/fellowship application will be developed focusing on diagnostic strategies for patients with comorbid chronic conditions.

Publications

 

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