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dc.contributor.authorPrice, S
dc.contributor.authorAbel, GA
dc.contributor.authorHamilton, W
dc.date.accessioned2022-06-27T08:06:21Z
dc.date.issued2021-06-19
dc.date.updated2022-06-24T17:53:24Z
dc.description.abstractBACKGROUND: 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.sponsorshipCancer Research UKen_GB
dc.description.sponsorshipNational Institute for Health Research (NIHR)en_GB
dc.format.extent101969-
dc.format.mediumPrint-Electronic
dc.identifier.citationVol. 73, article 101969en_GB
dc.identifier.doihttps://doi.org/10.1016/j.canep.2021.101969
dc.identifier.grantnumber21550en_GB
dc.identifier.grantnumberPRU-1217-21601en_GB
dc.identifier.grantnumberC8640/A23385en_GB
dc.identifier.urihttp://hdl.handle.net/10871/130060
dc.identifierORCID: 0000-0002-2228-2374 (Price, Sarah)
dc.identifierScopusID: 57195915869 (Price, Sarah)
dc.identifierResearcherID: D-2641-2016 (Price, Sarah)
dc.identifierORCID: 0000-0003-2231-5161 (Abel, Gary A)
dc.identifierScopusID: 57202757335 (Abel, Gary A)
dc.identifierORCID: 0000-0003-1611-1373 (Hamilton, Willie)
dc.identifierScopusID: 55031252700 | 57209301809 (Hamilton, Willie)
dc.identifierResearcherID: G-8612-2014 (Hamilton, Willie)
dc.language.isoenen_GB
dc.publisherElsevieren_GB
dc.relation.urlhttps://www.ncbi.nlm.nih.gov/pubmed/34157609en_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.subjectDatabases and data miningen_GB
dc.subjectDiagnostic intervalen_GB
dc.subjectElectronic health recordsen_GB
dc.subjectModelling healthcare servicesen_GB
dc.titleGuideline interval: A new time interval in the diagnostic pathway for symptomatic canceren_GB
dc.typeArticleen_GB
dc.date.available2022-06-27T08:06:21Z
dc.identifier.issn1877-7821
exeter.article-number101969
exeter.place-of-publicationNetherlands
dc.descriptionThis is the final version. Available on open access from Elsevier via the DOI in this recorden_GB
dc.identifier.eissn1877-783X
dc.identifier.journalCancer Epidemiologyen_GB
dc.relation.ispartofCancer Epidemiol, 73
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en_GB
dcterms.dateAccepted2021-06-12
dc.rights.licenseCC BY
rioxxterms.versionVoRen_GB
rioxxterms.licenseref.startdate2021-06-19
rioxxterms.typeJournal Article/Reviewen_GB
refterms.dateFCD2022-06-26T13:13:26Z
refterms.versionFCDVoR
refterms.dateFOA2022-06-27T08:06:26Z
refterms.panelAen_GB


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© 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/).
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/).