Guideline interval: A new time interval in the diagnostic pathway for symptomatic cancer
dc.contributor.author | Price, S | |
dc.contributor.author | Abel, GA | |
dc.contributor.author | Hamilton, W | |
dc.date.accessioned | 2022-06-27T08:06:21Z | |
dc.date.issued | 2021-06-19 | |
dc.date.updated | 2022-06-24T17:53:24Z | |
dc.description.abstract | BACKGROUND: A standard measure of the cancer diagnostic pathway, diagnostic interval, is the time from "first presentation of cancer" to diagnosis. Cancer presentation may be unclear in patients with multimorbidity or non-specific symptoms, signs or test results ("features"). We propose an alternative, guideline interval, with a more certain start date; namely, when the patient first meets suspected-cancer criteria for investigation or referral. METHODS: This retrospective cohort study used Clinical Practice Research Datalink (CPRD) and English cancer registry data. Participants, aged ≥55 years, had diagnostic codes for oesophagogastric cancers in 1/1/12-31/12/17. Features of oesophagogastric cancer in the year before diagnosis were identified from CPRD codes for dysphagia, haematemesis, upper-abdominal mass or pain, low haemoglobin, reflux, dyspepsia, nausea, vomiting, weight loss or thrombocytosis. Diagnostic interval was the time from first feature to diagnosis; guidance interval, the time from first meeting criteria in NICE suspected-cancer guidance to diagnosis. Multimorbidity burden was quantified using Adjusted Clinical Groups®. Accelerated failure-time models explored associations between multimorbidity burden and length of both diagnostic and guideline interval. RESULTS: There were 3,793 eligible participants (69.0 % male), mean age 74.1 years (SD 10.5). 3,097 (81.7 %) presented with ≥1 feature in the year before diagnosis, and 1,990 (52.5 %) met NICE suspected-cancer criteria. The median for both intervals was 11 days in healthy users, and rose with increasing morbidity burden. At very high multimorbidity burden, diagnostic interval was 5.47 (95%CI 3.25-9.20) times longer and guideline interval was 3.91 (2.63-5.80) times longer than for healthy users. CONCLUSIONS: Guideline interval is proposed as a new measure of the cancer diagnostic pathway. It has a more certain start date than diagnostic interval, and is lengthened less than diagnostic interval in people with a very high multimorbidity burden. Guideline interval has potential for assessing the implementation of suspected-cancer policies. | en_GB |
dc.description.sponsorship | Cancer Research UK | en_GB |
dc.description.sponsorship | National Institute for Health Research (NIHR) | en_GB |
dc.format.extent | 101969- | |
dc.format.medium | Print-Electronic | |
dc.identifier.citation | Vol. 73, article 101969 | en_GB |
dc.identifier.doi | https://doi.org/10.1016/j.canep.2021.101969 | |
dc.identifier.grantnumber | 21550 | en_GB |
dc.identifier.grantnumber | PRU-1217-21601 | en_GB |
dc.identifier.grantnumber | C8640/A23385 | en_GB |
dc.identifier.uri | http://hdl.handle.net/10871/130060 | |
dc.identifier | ORCID: 0000-0002-2228-2374 (Price, Sarah) | |
dc.identifier | ScopusID: 57195915869 (Price, Sarah) | |
dc.identifier | ResearcherID: D-2641-2016 (Price, Sarah) | |
dc.identifier | ORCID: 0000-0003-2231-5161 (Abel, Gary A) | |
dc.identifier | ScopusID: 57202757335 (Abel, Gary A) | |
dc.identifier | ORCID: 0000-0003-1611-1373 (Hamilton, Willie) | |
dc.identifier | ScopusID: 55031252700 | 57209301809 (Hamilton, Willie) | |
dc.identifier | ResearcherID: G-8612-2014 (Hamilton, Willie) | |
dc.language.iso | en | en_GB |
dc.publisher | Elsevier | en_GB |
dc.relation.url | https://www.ncbi.nlm.nih.gov/pubmed/34157609 | en_GB |
dc.rights | © 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). | en_GB |
dc.subject | Databases and data mining | en_GB |
dc.subject | Diagnostic interval | en_GB |
dc.subject | Electronic health records | en_GB |
dc.subject | Modelling healthcare services | en_GB |
dc.title | Guideline interval: A new time interval in the diagnostic pathway for symptomatic cancer | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2022-06-27T08:06:21Z | |
dc.identifier.issn | 1877-7821 | |
exeter.article-number | 101969 | |
exeter.place-of-publication | Netherlands | |
dc.description | This is the final version. Available on open access from Elsevier via the DOI in this record | en_GB |
dc.identifier.eissn | 1877-783X | |
dc.identifier.journal | Cancer Epidemiology | en_GB |
dc.relation.ispartof | Cancer Epidemiol, 73 | |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0/ | en_GB |
dcterms.dateAccepted | 2021-06-12 | |
dc.rights.license | CC BY | |
rioxxterms.version | VoR | en_GB |
rioxxterms.licenseref.startdate | 2021-06-19 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2022-06-26T13:13:26Z | |
refterms.versionFCD | VoR | |
refterms.dateFOA | 2022-06-27T08:06:26Z | |
refterms.panel | A | en_GB |
Files in this item
This item appears in the following Collection(s)
Except where otherwise noted, this item's licence is described as © 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).