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The effect of comorbidities on diagnostic interval for lung cancer in England: a cohort study using electronic health record data.

Rogers, Imogen, Cooper, Max, Memon, Anjum, Forbes, Lindsay J.L., Van Marwijk, Harm, Ford, Elizabeth (2024) The effect of comorbidities on diagnostic interval for lung cancer in England: a cohort study using electronic health record data. British Journal of Cancer, 131 (7). pp. 1147-1157. ISSN 0007-0920. E-ISSN 1532-1827. (doi:10.1038/s41416-024-02824-2) (KAR id:106724)

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https://doi.org/10.1038/s41416-024-02824-2

Abstract

Background: Comorbid conditions may delay lung cancer diagnosis by placing demand on clinician’s time reducing the possibility of prompt cancer investigation (“competing demand conditions”), or by offering a plausible non-cancer explanation for signs/symptoms (“alternative explanation conditions”).

Method: Patients in England born before 1955 and diagnosed with incident lung cancer between 1990 and 2019 were identified in the Clinical Practice Research Datalink and linked hospital admission and cancer registry data. Diagnostic interval was defined as time from first presentation in primary care with a relevant sign/symptom to the diagnosis date. 14 comorbidities were classified as ten “competing demand“ and four “alternative explanation” conditions. Associations with diagnostic interval were investigated using multivariate linear regression models.

Results: Complete data were available for 11870 lung cancer patients. In adjusted analyses diagnostic interval was longer for patients with “alternative explanation” conditions, by 31 and 74 days in patients with one and ≥2 conditions respectively compared to those with none. Number of “competing demand” conditions did not remain in the final adjusted regression model for diagnostic interval.

Conclusions: Conditions offering alternative explanations for lung cancer symptoms are associated with increased diagnostic intervals. Clinical guidelines should incorporate the impact of alternative and competing causes upon delayed diagnosis.

Item Type: Article
DOI/Identification number: 10.1038/s41416-024-02824-2
Additional information: For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Uncontrolled keywords: lung cancer; diagnostic interval; diagnosis; cancer symptoms; Clinical practice research datalink
Subjects: R Medicine
R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine > RC254 Neoplasms. Tumors. Oncology
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Centre for Health Services Studies
Funders: National Institute for Health Research (https://ror.org/0187kwz08)
Depositing User: Lindsay Forbes
Date Deposited: 29 Jul 2024 12:27 UTC
Last Modified: 05 Nov 2024 13:12 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/106724 (The current URI for this page, for reference purposes)

University of Kent Author Information

Forbes, Lindsay J.L..

Creator's ORCID: https://orcid.org/0000-0002-4654-9520
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