PDF(Pubmed)
Abstract：
BACKGROUND: Understanding pre-diagnostic prescribing activity could reveal windows during which more timely cancer investigation and detection may occur.
OBJECTIVE: To examine prescription patterns for common urological clinical features prior to renal and bladder cancer diagnoses.
METHODS: 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.
METHODS: 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.
CONCLUSIONS: 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.
OBJECTIVE: To examine prescription patterns for common urological clinical features prior to renal and bladder cancer diagnoses.
METHODS: 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.
METHODS: 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.
CONCLUSIONS: 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.
摘要：
背景：了解诊断前的处方活动可以揭示更及时的癌症调查和检测窗口。
目的：在肾癌和膀胱癌诊断前检查常见泌尿系统临床特征的处方模式。
方法：使用电子初级保健和癌症登记数据对膀胱癌和肾癌患者进行了一项回顾性队列研究，他们在2012年4月至2015年12月期间在英国接受了诊断。
方法：对5组临床特征（刺激性泌尿系统症状，阻塞性症状,尿路感染[UTIs]，生殖器感染,和萎缩性阴道炎）。估计处方率从基线增加的拐点的泊松回归用于识别诊断窗口的开始,在所述诊断窗口期间可以检测到癌症。
结果：共分析了5322例患者的48094张处方。在诊断前9个月为肾癌（95％置信区间[CI]=5.3至12.7）和膀胱癌（95％CI=7.4至10.6）确定了UTI处方增加的拐点。对于膀胱癌，UTI抗生素处方率的变化发生在女性4个月前(诊断前11个月，95%CI=9.7至12.3)比男性(诊断前7个月，95%CI=5.4至8.6)。对于其他临床特征，没有确定拐点，因此，无法定义诊断窗口。
结论：尿路感染的处方率在膀胱和肾癌诊断前9个月增加，这表明，在具有UTI特征的患者中，有可能加快这些癌症的诊断。更及时诊断的最大机会可能是女性膀胱癌，谁经历了最早的UTI处方率增加。
目的：在肾癌和膀胱癌诊断前检查常见泌尿系统临床特征的处方模式。
方法：使用电子初级保健和癌症登记数据对膀胱癌和肾癌患者进行了一项回顾性队列研究，他们在2012年4月至2015年12月期间在英国接受了诊断。
方法：对5组临床特征（刺激性泌尿系统症状，阻塞性症状,尿路感染[UTIs]，生殖器感染,和萎缩性阴道炎）。估计处方率从基线增加的拐点的泊松回归用于识别诊断窗口的开始,在所述诊断窗口期间可以检测到癌症。
结果：共分析了5322例患者的48094张处方。在诊断前9个月为肾癌（95％置信区间[CI]=5.3至12.7）和膀胱癌（95％CI=7.4至10.6）确定了UTI处方增加的拐点。对于膀胱癌，UTI抗生素处方率的变化发生在女性4个月前(诊断前11个月，95%CI=9.7至12.3)比男性(诊断前7个月，95%CI=5.4至8.6)。对于其他临床特征，没有确定拐点，因此，无法定义诊断窗口。
结论：尿路感染的处方率在膀胱和肾癌诊断前9个月增加，这表明，在具有UTI特征的患者中，有可能加快这些癌症的诊断。更及时诊断的最大机会可能是女性膀胱癌，谁经历了最早的UTI处方率增加。
