Pre-diagnostic prescription patterns in bladder and renal cancer: a longitudinal linked data study

Garth Funston; Marie Moullet; Luke Mounce; Georgios Lyratzopoulos; Fiona M Walter; Yin Zhou

doi:10.3399/BJGP.2023.0122

Pre-diagnostic prescription patterns in bladder and renal cancer: a longitudinal linked data study

Br J Gen Pract. 2023 Dec 12;74(740):e149-e155. doi: 10.3399/BJGP.2023.0122. Online ahead of print.

Authors

Garth Funston¹, Marie Moullet², Luke Mounce³, Georgios Lyratzopoulos⁴, Fiona M Walter², Yin Zhou¹

Affiliations

¹ Department of Public Health and Primary Care, University of Cambridge, Cambridge; Wolfson Institute of Population Health, Queen Mary University of London, London.
² Wolfson Institute of Population Health, Queen Mary University of London, London.
³ University of Exeter Medical School, University of Exeter, Exeter.
⁴ Insititute of Epidemiology and Healthcare, University College London, London.

Abstract

Background: Understanding pre-diagnostic prescribing activity could reveal windows during which more timely cancer investigation and detection may occur.

Aim: To examine prescription patterns for common urological clinical features prior to renal and bladder cancer diagnoses.

Design and setting: A retrospective cohort study was performed using electronic primary care and cancer registry data on patients with bladder and renal cancer, who received their diagnosis between April 2012 and December 2015 in England.

Method: Primary care prescriptions up to 2 years pre- diagnosis were analysed for five groups of clinical features (irritative urological symptoms, obstructive symptoms, urinary tract infections [UTIs], genital infections, and atrophic vaginitis). Poisson regressions estimating the inflection point from which the rate of prescriptions increased from baseline were used to identify the start of diagnostic windows during which cancer could be detected.

Results: A total of 48 094 prescriptions for 5322 patients were analysed. Inflection points for an increase in UTI prescriptions were identified 9 months pre- diagnosis for renal (95% confidence interval [CI] = 5.3 to 12.7) and bladder (95% CI = 7.4 to 10.6) cancers. For bladder cancer, the change in UTI antibiotic prescription rates occurred 4 months earlier in females (11 months pre- diagnosis, 95% CI = 9.7 to 12.3) than in males (7 months pre-diagnosis, 95% CI = 5.4 to 8.6). For other clinical features, no inflection points were identified and, as such, no diagnostic windows could be defined.

Conclusion: Prescription rates for UTIs increased 9 months before bladder and renal cancer diagnoses, indicating that there is potential to expedite diagnosis of these cancers in patients presenting with features of UTI. The greatest opportunity for more timely diagnosis may be in females with bladder cancer, who experienced the earliest increase in UTI prescription rate.

Keywords: atrophic vaginitis; bladder cancer; kidney cancer; primary health care; renal cell cancer; urinary tract infections.

Grants and funding

18180/CRUK_/Cancer Research UK/United Kingdom