Improving the timely diagnosis of cancer in patients with pre-existing long term conditions

Cristina Renzi, Clinical Research Fellow at UCL, shares her experiences from her CanTest Travelling Fellowship to the Julius Center at the University Medical Center Utrecht and discusses her recently published review on co-morbidities and cancer

Many people diagnosed with cancer have a pre-existing long term condition (often referred to as a comorbidity). Comorbidities can influence how promptly cancer is diagnosed.  This is because these pre-existing conditions can affect how a patient interpretates any new symptoms and whether they seek medical help, as well as impacting a doctor’s decisions regarding the use of diagnostic investigations. Research has shown that individuals with comorbidities are at higher risk of having their cancer diagnosed at an advanced stage and following an emergency presentation. They also have worse cancer survival, compared to non-comorbid individuals.

Currently, there is no evidence on how to improve early cancer diagnosis and health outcomes for these complex patients. For this reason, I recently carried out collaborative work with other UK and international members of CanTest, which has led to the publication of a review on the effects of specific comorbidities on the timely diagnosis of cancer. By including more than 80 studies on more than 20 different cancers, the review has highlighted how some conditions (for example, neurological, mental health and heart conditions) influence the diagnostic journey leading to prolonged time before the diagnosis of cancer and worse cancer outcomes.

For example, heart conditions can lead to patients waiting longer before seeking help for cancer symptoms, as well as doctors postponing diagnostic investigations, such as endoscopies. Reasons for this include that managing the heart condition might take priority over investigating initially vague cancer symptoms (such as tiredness or pain) and worries about invasive investigations might also play a role when patients have serious heart conditions.

The review may help guide future research and possible interventions for improving the timely diagnosis of cancer in these complex patients.

With the aim of taking research in this area further, I recently visited the Julius Center for Health Sciences and Primary Care at the University Medical Center, Utrecht, in the Netherlands. This was made possible thanks to a CanTest Travelling Fellowship.

It has been a fantastic opportunity to exchange ideas with international experts on chronic conditions and cancer diagnosis in primary care. Through in-depth discussions with various researchers and clinicians and particularly thanks to Professor Niek de Wit and Dr Charles Helsper, we explored how we can use primary care and hospital data linked to cancer registration data for examining the timely diagnosis of cancer, diagnostic pathways and cancer outcomes in patients with chronic conditions. The visit allowed us to plant the seeds for future international work aimed at identifying patient and healthcare factors that can be addressed for improving early cancer diagnosis in individuals with chronic conditions.

The CanTest Travelling Fellowships are designed to support visits by Junior Faculty to partner CanTest institutions, or to attend conferences and courses. The aim is to enhance research skills and expertise in early detection research, as well as fostering links and collaborations across international boundaries.