Suspected cancer diagnoses made by general practitioners in a population with subsequently confirmed cancer diagnoses in Germany: a retrospective study of 31,628 patients

Psychiatric disorder and its association with gastrointestinal cancer: a retrospective cohort study with 45,842 patients in Germany

PURPOSE

Psychiatric disorders and cancer are both common, and comorbidity has detrimental impacts on cancer outcomes. Previous studies focus on affective disorders which arise after cancer diagnosis, not on the impact of psychiatric disorders on cancer risk. We investigate the association between psychiatric disorders and subsequent gastrointestinal cancer in a large cohort in Germany.

METHODS

This case-control study used secondary data (electronic medical records) from the national IQVIA Disease Analyzer database. We evaluated the association between previous psychiatric diagnosis in 44,582 matched patients with and without gastrointestinal (GI) cancer. Regression analyses were stratified by psychiatric diagnosis and adjusted by chronic comorbidities and previous psychiatric treatments.

RESULTS

No association between any previous psychiatric disease and GI cancers was found (OR = 0.98 (0.95-1.02 95%CL, p = 0.39). Previous psychosomatic disorder and GI cancer showed a significant negative association (OR: 0.86, 0.81-0.90 95%CL, p < 0.0001). No association was found between previous diagnosis with depression or PTSD and GI cancer. These results remained consistent when including previous psychiatric treatments in the regression analyses.

CONCLUSION

Psychiatric disease was not associated with GI cancer risk. Further investigation into the pathways linking psychiatric disease and cancer needs to be conducted, taking into consideration psychiatric treatments administered, to enhance our understanding of the relationship between these two common and devastating diseases.

Cancer risk in stroke survivors followed for up to 10 years in general practices in Germany

AIMS

The goal of this study was to analyze cancer risk in stroke survivors followed for up to 10 years in general practices in Germany.

METHODS

The current study sample included patients who received an initial stroke diagnosis in one of 1262 general practices in Germany between 2006 and 2015 (index date). Patients without stroke were matched (1:1) to patients with stroke by age, gender, index year, and 16 comorbidities diagnosed in the 12 months prior to the index date using a propensity score method. The main outcome of the study was the risk of cancer as a function of stroke within 10 years of the index date.

RESULTS

The stroke and non-stroke groups included 9579 men and 9089 women. After 10 years of follow-up, 29.3% of men with stroke and 23.8% of those without stroke developed any of the included types of cancer (log-rank p value < 0.001). During the same time, the prevalence of cancer was 25.0% in women with stroke and 20.5% in women without stroke (log-rank p value < 0.001). There was a positive association between stroke and any cancer in men (hazard ratio [HR] = 1.18, 95% confidence interval [CI] 1.09-1.28) and in women (HR = 1.22, 95% CI 1.12-1.34). This association was significant for cancers of respiratory and intrathoracic organs in men and women and for cancers of digestive organs in men.

CONCLUSIONS

This study, including more than 37,000 patients from Germany, found that stroke was associated with an increased cancer risk.

Association between GPs' suspicion of cancer and patients' usual consultation pattern in primary care: a cross-sectional study

BACKGROUND

Patients who rarely consult a GP in the 19-36 months before a cancer diagnosis have more advanced cancer at diagnosis and a worse prognosis. To ensure more timely diagnosis of cancer, the GP should suspect cancer as early as possible.

AIM

To investigate the GP's suspicion of cancer according to the patient with cancer's usual consultation pattern in general practice.

DESIGN AND SETTING

A cross-sectional study based on survey data from general practice of 3985 Danish patients diagnosed with cancer from May 2010 to August 2010, and linked to national register data.

METHOD

Using logistic regression analysis with restricted cubic splines, the odds ratio (OR) of the GP to suspect cancer as a function of the patient's number of face-to-face consultations with the GP in the 19-36 months before a cancer diagnosis was estimated.

RESULTS

GPs' cancer suspicion decreased with higher usual consultation frequency in general practice. A significant decreasing trend in ORs for cancer suspicion was seen across usual consultation categories overall (P<0.001) and for each sex (males: P<0.05; females: P<0.05). GPs' cancer suspicion was lower in patients aged <55 years in both rare and frequent attenders compared with average attenders.

CONCLUSION

GPs suspect cancer more often in rare attenders ≥55 years. GPs' cancer suspicion was lower in younger patients (<55 years), in both rare and frequent attenders. GPs should be aware of possible missed opportunities for cancer diagnosis in young attenders and use safety netting to reduce the risk of missing a cancer diagnosis.

Diagnoses of suspected cancer in otolaryngology practices in Germany

The aim of this study was to estimate the prevalence of suspected head and neck cancer (HNC) diagnoses made by otolaryngologists in a population with subsequently confirmed cancer diagnoses in Germany. This study included patients with an initial documentation of confirmed cancer diagnosis made in 137 otolaryngology practices between January 2012 and December 2016 (index date). The main outcome of the study was the prevalence of diagnoses of suspected cancer in otolaryngology practices within one year prior to the first documentation of a confirmed cancer diagnosis. The association between the defined demographic and clinical variables with diagnoses of suspected cancer was analyzed using a logistic regression model. A total of 6,446 patients received a confirmed cancer diagnosis. A total of 23.1% of the population received a diagnosis of suspected cancer within 12 months prior to the first documentation of a confirmed cancer diagnosis. Patients over the age of 50 (ORs ranging from 1.44 to 1.55) and men (OR=1.52) were more likely to receive a diagnosis of suspected cancer compared with patients aged 50 or under and women. Cancer of the pyriform sinus (OR=3.00) and cancer of the thyroid gland (OR=0.27) were associated with increased and decreased odds of a diagnosis of suspected cancer compared to laryngeal cancer respectively. Overall, approximately 23% of individuals received a diagnosis of suspected cancer within a year prior to the first documentation of confirmed HNC.