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

Project summary

Early diagnosis of cancer is associated with improved survival and patient-reported outcomes. However, timely detection of bladder and kidney cancer within primary care can be challenging as urinary tract symptoms, which can herald cancer, are often non-specific. These symptoms commonly occur in benign conditions such as urinary tract infections, which poses a diagnostic dilemma for GPs. Patients may initially be treated for non-cancerous conditions prior to cancer diagnosis which could delay their detection and treatment. 

Previous research has shown that primary care activity, including consultation rates and the numbers of blood tests performed, increases in the lead up to diagnosis of bladder and kidney cancer, suggesting opportunities for earlier clinical action. There is also evidence from other types of cancer that prescription of medications for related benign conditions increases before cancer diagnosis.  

In this study we will use coded anonymised GP records from over 5,000 patients to examine primary care prescription patterns in the 24 months prior to diagnosis of bladder and kidney cancer. We will focus on medications used in the treatment of common urinary tract symptoms and urinary tract infections that may mimic or coexist with bladder and renal cancer. Given that women and patients presenting with urinary tract infections are more likely to experience non-timely diagnosis, we hypothesize that treatments for UTIs and symptoms of UTI (which are more common in women than men) increase earlier in women than men in the pre-diagnostic period.  We will use statistical approaches to determine whether these medications are prescribed more frequently in the pre-diagnostic period and to identify how long before diagnosis any change in prescription pattern occurs. This knowledge could help us identify opportunities to improve the diagnosis of bladder and renal cancer in primary care.