Understanding missed diagnostic opportunities in bladder and kidney cancer (PhD)

Project Summary

Early diagnosis of cancer is important for improved survival and patient experience. Reaching a diagnosis needs correct and timely collection of information from consultations, tests and follow-up of results. However, diagnosis can be difficult as non-cancerous conditions are common and cancer is rare. The use of tests is a very important part of the diagnostic process, but they may also increase the time to diagnosis. It is likely that what and when tests are done, and how results are communicated, can vary for different patients with the same cancer. These differences may represent missed diagnostic opportunities in some cases.

In this project, we will use bladder and kidney cancer as exemplars to identify missed diagnostic opportunities in early cancer diagnosis. These cancers have been chosen because kidney cancer is being diagnosed increasingly commonly, and the number of patients with some types of bladder cancer is also growing. Previous studies have also shown that there is a difference between men and women in how quickly they are diagnosed with these cancers, and how long they survive after diagnosis. Therefore, finding out what happens during the diagnostic process and whether there are gender differences and delays in the use of tests is important to understand how we can improve early diagnosis of these cancers.

We will explore 1) what factors affect how quickly bladder and kidney cancer are diagnosed; 2) what, and how frequently, missed opportunities for early diagnosis happen, and 3) how and why they occur. The findings will inform the development of ways to obtain a quicker diagnosis of these cancers in general, and specifically to reduce the male/female difference seen in patients with these cancers.

Publications

• Zhou Y, Funston G, Lyratzopoulos G, Walter FM. Improving the Timely Detection of Bladder and Kidney Cancer in Primary Care. Advances in Therapy, 2019, https://doi.org/10.1007/s12325-019-00966-x
• Zhou Y, van Melle M, Singh H, Hamilton W, Lyratzopoulos G, Walter FM. Quality of the Diagnostic Process in Patients Presenting with Symptoms Suggestive of Bladder or Kidney Cancer: A Systematic Review. British Medical Journal Open, 2019, 2019;9:e029143. doi: 10.1136/bmjopen-2019-029143
• Zhou Y, Abel GA, Hamilton W, Singh H, Walter FM, Lyratzopoulos G. Imaging activity possibly signalling missed diagnostic opportunities in bladder and kidney cancer: A longitudinal data-linkage study using primary care electronic health records. Cancer Epidemiology, 2020, doi: 10.1016/j.canep.2020.101703
• Zhou Y, Walter FM, Singh H, Hamilton W, Abel GA, Lyratzopoulos. Prolonged Diagnostic Intervals as Marker of Missed Diagnostic Opportunities in Bladder and Kidney Cancer Patients with Alarm Features: A Longitudinal Linked Data Study. Cancers, 2021, 13(1): 156, doi: 10.3390/cancers13010156
• Zhou Y, Walter FM, Mounce L, Abel GA, Singh H, Hamilton W, Stewart GD, Lyratzopoulos G. Identifying opportunities for timely diagnosis of bladder and renal cancer via abnormal blood tests: a longitudinal linked data study. British Journal of General Practice, Dec 2021; BJGP.2021.0282. doi: 10.3399/BJGP.2021.0282