Our research aims to describe the diagnostic pathway between presenting to a general practitioner with a variety of symptoms associated with a brain tumour and being referred and treated in hospital and in some cases dying. We want to describe the clinical and non-clinical determinants that predict why some adult patients take longer than others to be diagnosed with a brain tumour and its potential impact on care, health care costs and survival. Patients with brain tumours can have many different symptoms. Some symptoms are more alarming to patients than others. For example, a patient may be less concerned about a headache than a sudden weakness in their arm. A general practitioner will see lots of patients with similar symptoms, most of which will not have a brain tumour, which makes it hard to know who should be referred. Our research, and other related projects not using CPRD, will help produce guidelines for patients and general practitioners to better understand which patients may have a brain tumour and may led to future intervention studies to reduce any avoidable delays.
Delays in cancer diagnosis cause anxiety for patients and their family and may influence management and prognosis. The presenting symptoms of a brain tumour can be broadly divided into two groups. Firstly, non-specific symptoms e.g. headache and behavioural change. Secondly, specific focal neurological symptoms e.g. hemiparesis or seizures. Patients with non-specific symptoms may wait weeks before presenting to primary care and then for referral. Tumour growth during this period may limit the extent of surgical resection, which correlates with poor outcome. Our aim is to describe how patterns of primary care consultation and symptoms as well as socio-demographic factors relate to diagnosis, referral, hospital management and mortality. We will determine the predictive value of a combination of symptoms and socio-demographic factors ('red flags') to aid GPs in appropriate referral of patients for further investigation. We will compare the impact of GP delay in referral on clinical care in terms of surgery, radiotherapy, chemotherapy and subsequent repeat hospital admissions and mortality risk. Our descriptive findings will also contribute to a separate health economic modelling project estimating the costs and outcomes of different imaging and referral pathways.
(a) time until first hospital hospital admission (b) time until major intervention (e.g. surgery, radiotherapy, other (c) time until death or censoring
Yoav Ben-Shlomo - Chief Investigator - University of Bristol
Yoav Ben-Shlomo - Corresponding Applicant - University of Bristol
Edna Keeney - Collaborator - University of Bristol
Michael Poon - Collaborator - University of Edinburgh
Mio Ozawa - Collaborator - University of Bristol
William Hamilton - Collaborator - University of Exeter
William Hollingworth - Collaborator - University of Bristol
HES Accident and Emergency;HES Accident and Emergency;HES Admitted Patient Care;HES Admitted Patient Care;NCRAS Cancer Registration Data;NCRAS Cancer Registration Data;ONS Death Registration Data;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Patient Level Index of Multiple Deprivation