Leukaemia is a type of blood cancer that is diagnosed in approximately 9,000 people per year. For about one third of these patients, the condition is diagnosed during an emergency hospital admission. Patients who are diagnosed as an emergency have fewer treatment options and only 40% will survive for more than three years compared to 75% of patients who are diagnosed sooner through their general practitioner. In this study we wish to select patients with a diagnosis of leukaemia within the Clinical Practice Research Datalink linked to the Hospital Episode Statistics to understand how these patients are diagnosed and to see what factors such as age, gender, geographic region, ethnicity and social deprivation are associated with a patient being diagnosed as an emergency rather than through their general practitioner. We then wish to understand how this affects their chances of survival. We also want to explore how long it takes for somebody to be diagnosed after first presenting with possible symptoms of leukaemia and what investigations and how many contacts they have with their general practitioner or hospital prior to a diagnosis being made. After they have been diagnosed, we wish to explore how many contacts they then have and in which setting (general practice or hospital) these contacts occur. This study will provide valuable information about the impact of emergency diagnosis of leukaemia for patients and may highlight potential treatment options that may improve the patient experience and reduce overall healthcare burden in the National Health Service.
Leukaemia is a haematological cancer with an estimated annual incidence of 15 cases per 100,000 in the United Kingdom. Early symptoms of leukaemia include chest pain, shortness of breath, cough, fatigue, fever, infection, bone pain, bruising, bleeding, and petechiae but approximately one third of patients with leukaemia will first present as an emergency hospital admission. Those presenting as an emergency have significantly reduced survival compared to those diagnosed routinely. This study will use the Clinical Practice Research Datalink Aurum dataset linked to the Hospital Episode Statistics (HES) admitted patient care (APC), outpatient, accident and emergency, and patient level index of multiple deprivation (IMD) datasets. Mortality data will be obtained from CPRD primary care data and HES APC. Patients diagnosed with leukaemia will be selected from between 1st January 2009 to 31st December 2019 from either the HES admitted patient care linked dataset or Aurum Observation table. Annual incidence and prevalence rates of leukaemia will be presented. Those cases selected with a first diagnosis on an emergency admission will be flagged and demographic and clinical characteristics compared with those diagnosed within primary care or as an elective admission. Time from first symptoms to blood tests, bone marrow biopsy and diagnosis will be presented graphically and with summary statistics. Prior resource use from first symptoms to diagnosis will be described. Mortality will be compared in a Cox proportional hazards model between emergency vs non-emergency presentation. We then wish to compare subsequent resource use and associated costs from the primary care and linked admitted patient care, outpatient and accident and emergency datasets. These will be compared in regression models using the Poisson distribution for contacts and the Gamma distribution for costs. This study will provide evidence to better inform health care professionals and may highlight the importance of earlier diagnosis in improving survival..
Incidence and prevalence, demographic profile, treatment pathways, resource use and mortality
David Sgorbati - Chief Investigator - The Health Economics Unit
JULIA WILKINS - Corresponding Applicant - NHS MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT
Joseph Lillington - Collaborator - The Health Economics Unit
SANTOSH KUMAR - Collaborator - NHS MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT
XIAOXU Zou - Collaborator - The Health Economics Unit
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;Patient Level Index of Multiple Deprivation