Health care use before a diagnosis of primary intracranial tumor: a Danish nationwide register study

Abstract

IntroductionDetailed knowledge of prediagnostic health care use among patients with primary intracranial tumors is sparse. We aimed to investigate the health care use among adults during the 2 years preceding a diagnosis of a benign or malignant primary intracranial tumor in Denmark.MethodsWe conducted a population-based matched cohort study using historical data from Danish nationwide registries, including all patients aged 30–90 years diagnosed with a first-time primary intracranial tumor from January 1, 2009 to December 31, 2014, and with no prior cancer diagnosis (n=5,926). For each patient, ten comparison subjects were identified using density sampling. We analyzed differences in the frequency and timing of health care use within general practice, physiotherapy, radiology, ear –nose –throat, ophthalmology, neurology, and psychiatry. Odds ratios of having multiple contacts were calculated using a conditional logistical regression model. Monthly incidence rate ratios were estimated using a negative binomial regression model.ResultsOf all patients, 62% had a benign tumor. Patients with benign tumors were more likely to have multiple consultations with health care providers in the period 2–12 months prior to diagnosis and to have increased rates of consultations 1–24 months prior to diagnosis, depending on health service.ConclusionPatients diagnosed with a benign or a malignant primary intracranial tumor use the health care services differently. Increased health care use is seen within relatively close proximity to the diagnosis for patients with malignant tumors. However, patients with benign tumors have increased health care use from up to 2 years prior to diagnosis; this suggests a window of opportunity for earlier diagnosis.

Does changing healthcare use signal opportunities for earlier detection of cancer? A review of studies using information from electronic patient records

“…763 studies were initially identified, of which 28 were included in the final review ( Fig. 2 ) [10] , [11] , [12] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] . All but four of the selected studies were carried out in Denmark or the UK, while the four remaining studies were set in Germany, Sweden, Australia, and the Netherlands.…”

“…In cohorts of patients subsequently diagnosed with cancer, consultation rates, and the use of diagnostic tests or prescriptions are known to increase from baseline long before their diagnosis [10] , [11] , [12] . For example, rates of primary care consultations among women subsequently diagnosed with colorectal cancer started to increase from nine months before diagnosis, compared to controls ( Fig.…”

Patterns of Primary Care Use Prior to a First Diagnosis of Nonaffective Psychotic Disorder in Ontario, Canada: Modèles d’utilisation des soins de première ligne avant un premier diagnostic de trouble psychotique non affectif en Ontario, Canada

“…24,25,39 It is important to note that this pattern may also be seen prior to first onset for other nonpsychiatric medical conditions. 40 –44…”

“…24,25,39 It is important to note that this pattern may also be seen prior to first onset for other nonpsychiatric medical conditions. [40][41][42][43][44] The trends we observed may reflect physician difficulty recognizing and responding to the emerging signs and symptoms of psychosis-including prodromal symptoms-possibly due to nonspecific or changing clinical presentation over time. 45 People with early psychosis use a range of mental health services for a wide array of psychiatric conditions prior to first diagnosis of psychosis, 5,16,46 and this generalized presentation often makes for a complex diagnostic process.…”

Early indicators of primary brain tumours: a population‐based study with 10 years’ follow‐up

“…Indeed, preceding a primary brain tumour diagnosis, some patients experience recurrent examinations and even treatment of disorders with related or even seemingly unrelated pathophysiology [3]. A recent study examined healthcare use prior to a brain tumour ( N = 5926) compared to healthy controls (1:10) and found that patients with malignant tumours had increased use of healthcare services close to diagnosis, whereas patients with benign tumours had increased use of healthcare up to 2 years prior to diagnosis [5]. However, no information on specific diagnoses or medications was provided.…”