Abstract
IntroductionDiagnostic delay is associated with lower chances of cancer survival. Underlying comorbidities are known to affect the timely diagnosis of cancer. Diffuse large B-cell (DLBCL) and follicular lymphomas (FL) are primarily diagnosed amongst older patients, who are more likely to have comorbidities. Characteristics of clinical commissioning groups (CCG) are also known to impact diagnostic delay. We assess the association between comorbidities and diagnostic delay amongst patients with DLBCL or FL in England during 2005–2013.MethodsMultivariable generalised linear mixed-effect models were used to assess the main association. Empirical Bayes estimates of the random effects were used to explore between-cluster variation. The latent normal joint modelling multiple imputation approach was used to account for partially observed variables.ResultsWe included 30,078 and 15,551 patients diagnosed with DLBCL or FL, respectively. Amongst patients from the same CCG, having multimorbidity was strongly associated with the emergency route to diagnosis (DLBCL: odds ratio 1.56, CI 1.40–1.73; FL: odds ratio 1.80, CI 1.45–2.23). Amongst DLBCL patients, the diagnostic delay was possibly correlated with CCGs that had higher population densities.ConclusionsUnderlying comorbidity is associated with diagnostic delay amongst patients with DLBCL or FL. Results suggest a possible correlation between CCGs with higher population densities and diagnostic delay of aggressive lymphomas.
Highlights
Diagnostic delay is associated with lower chances of cancer survival
Summary statistics In this study, we included 45,629 patients diagnosed with Diffuse large B-cell (DLBCL) (30,078; 65.9%) or follicular lymphomas (FL) (15,551; 34.1%) between January 1, 2005 and December 31, 2013 (Table 1A, B)
Multivariable mixed-effect logistic regression models Table 2A, B shows the results from the multivariable generalised linear mixed-effect models (GLMM) for odds of the emergency route to the diagnosis of DLBCL and FL, respectively. For both DLBCL and FL, under complete case analysis, we found that for any given clinical commissioning groups (CCG), the presence of comorbidity was associated with the emergency route to diagnosis: the association was largest amongst those with a comorbidity status of two or more (Table 2A, B)
Summary
Diagnostic delay is associated with lower chances of cancer survival. Underlying comorbidities are known to affect the timely diagnosis of cancer. Diffuse large B-cell (DLBCL) and follicular lymphomas (FL) are primarily diagnosed amongst older patients, who are more likely to have comorbidities. We assess the association between comorbidities and diagnostic delay amongst patients with DLBCL or FL in England during 2005–2013. Results suggest a possible correlation between CCGs with higher population densities and diagnostic delay of aggressive lymphomas. The most common of which are diffuse large B-cell (DLBCL) and follicular lymphomas (FL), exhibiting an annual rate of 8.2 and 3.3 cases (respectively) per 100,000 people in the UK. These subtypes are relatively common in adults, with incidence increasing amongst older ages [2]. Public health policies have aimed to increase awareness, encourage more patient and healthcare system interactions and set targets for earlier cancer diagnosis [7,8,9,10]
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