Age and Gender Variations in Cancer Diagnostic Intervals in 15 Cancers: Analysis of Data from the UK Clinical Practice Research Datalink

Time from symptomatic presentation to cancer diagnosis (diagnostic interval) is an important, and modifiable, part of the patient's cancer pathway, and can be affected by various factors such as age, gender and type of presenting symptoms. The aim of this study was to quantify the relationships...

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Published in:PloS one Vol. 10; no. 5; p. e0127717
Main Authors: Din, Nafees U., Ukoumunne, Obioha C., Rubin, Greg, Hamilton, William, Carter, Ben, Stapley, Sal, Neal, Richard D.
Format: Journal Article
Language:English
Published: United States Public Library of Science 15.05.2015
Public Library of Science (PLoS)
Subjects:
Age
Age Factors
Aged
Biomedical Research
Bladder
Breast cancer
Cancer
Cancer research
Care and treatment
Clinical medicine
Codes
Colorectal cancer
Colorectal carcinoma
Complications and side effects
Data processing
Databases, Factual
Datasets
Diagnosis
Diagnostic systems
Early Detection of Cancer - methods
Endometrium
Esophagus
Female
Females
Gender
Gender differences
Head & neck cancer
Head and neck
Humans
Intervals
Kidneys
Leukemia
Lists
Lungs
Lymphoma
Male
Medical diagnosis
Medical prognosis
Medical research
Medical screening
Middle Aged
Neoplasms - diagnosis
Neoplasms - pathology
Ovarian cancer
Pancreas
Patients
Practice research
Primary care
Public health
Regression analysis
Regression models
Sex differences (Biology)
Sex Factors
Studies
Time Factors
United Kingdom
Urinary bladder
Womens health
United Kingdom
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary:Time from symptomatic presentation to cancer diagnosis (diagnostic interval) is an important, and modifiable, part of the patient's cancer pathway, and can be affected by various factors such as age, gender and type of presenting symptoms. The aim of this study was to quantify the relationships of diagnostic interval with these variables in 15 cancers diagnosed between 2007 and 2010 using routinely collected data from the Clinical Practice Research Datalink (CPRD) in the UK. Symptom lists for each cancer were prepared from the literature and by consensus amongst the clinician researchers, which were then categorised into either NICE qualifying (NICE) or not (non-NICE) based on NICE Urgent Referral Guidelines for Suspected Cancer criteria. Multivariable linear regression models were fitted to examine the relationship between diagnostic interval (outcome) and the predictors: age, gender and symptom type. 18,618 newly diagnosed cancer patients aged ≥40 who had a recorded symptom in the preceding year were included in the analysis. Mean diagnostic interval was greater for older patients in four disease sites (difference in days per 10 year increase in age; 95% CI): bladder (10.3; 5.5 to 15.1; P<0.001), kidney (11.0; 3.4 to 18.6; P=0.004), leukaemia (18.5; 8.8 to 28.1; P<0.001) and lung (10.1; 6.7 to 13.4; P<0.001). There was also evidence of longer diagnostic interval in older patients with colorectal cancer (P<0.001). However, we found that mean diagnostic interval was shorter with increasing age in two cancers: gastric (-5.9; -11.7 to -0.2; P=0.04) and pancreatic (-6.0; -11.2 to -0.7; P=0.03). Diagnostic interval was longer for females in six of the gender non-specific cancers (mean difference in days; 95% CI): bladder (12.2; 0.8 to 23.6; P=0.04), colorectal (10.4; 4.3 to 16.5; P=0.001), gastric (14.3; 1.1 to 27.6; P=0.03), head and neck (31.3; 6.2 to 56.5; P=0.02), lung (8.0; 1.2 to 14.9; P=0.02), and lymphoma (19.2; 3.8 to 34.7; P=0.01). Evidence of longer diagnostic interval was found for patients presenting with non-NICE symptoms in 10 of 15 cancers (mean difference in days; 95% CI): bladder (62.9; 48.7 to 77.2; P<0.001), breast (115.1; 105.9 to 124.3; P<0.001), cervical (60.3; 31.6 to 89.0; P<0.001), colorectal (25.8; 19.6 to 31.9; P<0.001), gastric (24.1; 3.4 to 44.8; P=0.02), kidney (22.1; 4.5 to 39.7; P=0.01), oesophageal (67.0; 42.1 to 92.0; P<0.001), pancreatic (48.6; 28.1 to 69.1; P<0.001), testicular (36.7; 17.0 to 56.4; P< 0.001), and endometrial (73.8; 60.3 to 87.3; P<0.001). Pooled analysis across all cancers demonstrated highly significant evidence of differences overall showing longer diagnostic intervals with increasing age (7.8 days; 6.4 to 9.1; P<0.001); for females (8.9 days; 5.5 to 12.2; P<0.001); and in non-NICE symptoms (27.7 days; 23.9 to 31.5; P<0.001). We found age and gender-specific inequalities in time to diagnosis for some but not all cancer sites studied. Whilst these need further explanation, these findings can inform the development and evaluation of interventions intended to achieve timely diagnosis and improved cancer outcomes, such as to provide equity across all age and gender groupings.
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Competing Interests: The authors have declared that no competing interests exist.
Conceived and designed the experiments: NUD RDN OCU. Performed the experiments: NUD OCU BC SS. Analyzed the data: NUD OCU BC. Contributed reagents/materials/analysis tools: GR WH RDN. Wrote the paper: NUD OCU GR WH BC SS RDN.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0127717