Abstract
Abstract
Background
Simple blood tests can play an important role in identifying patients for cancer investigation. The current evidence base is limited almost entirely to tests used in isolation. However, recent evidence suggests combining multiple types of blood tests and investigating trends in blood test results over time could be more useful to select patients for further cancer investigation. Such trends could increase cancer yield and reduce unnecessary referrals. We aim to explore whether trends in blood test results are more useful than symptoms or single blood test results in selecting primary care patients for cancer investigation. We aim to develop clinical prediction models that incorporate trends in blood tests to identify the risk of cancer.
Methods
Primary care electronic health record data from the English Clinical Practice Research Datalink Aurum primary care database will be accessed and linked to cancer registrations and secondary care datasets. Using a cohort study design, we will describe patterns in blood testing (aim 1) and explore associations between covariates and trends in blood tests with cancer using mixed-effects, Cox, and dynamic models (aim 2). To build the predictive models for the risk of cancer, we will use dynamic risk modelling (such as multivariate joint modelling) and machine learning, incorporating simultaneous trends in multiple blood tests, together with other covariates (aim 3). Model performance will be assessed using various performance measures, including c-statistic and calibration plots.
Discussion
These models will form decision rules to help general practitioners find patients who need a referral for further investigation of cancer. This could increase cancer yield, reduce unnecessary referrals, and give more patients the opportunity for treatment and improved outcomes.
Funder
Cancer Research UK Population Research Committee Postdoctoral Fellowship
Publisher
Springer Science and Business Media LLC
Subject
Applied Mathematics,General Mathematics
Reference20 articles.
1. Watson J, Mounce L, Bailey SE, Cooper SL, Hamilton W. Blood markers for cancer. BMJ. 2019;367:l5774.
2. Rubin GP, Saunders CL, Abel GA, McPhail S, Lyratzopoulos G, Neal RD. Impact of investigations in general practice on timeliness of referral for patients subsequently diagnosed with cancer: analysis of national primary care audit data. Br J Cancer. 2015;112(4):676–87.
3. NICE. Suspected cancer: recognition and referral (NG12): National Institute for Health and Care Excellence; 2015. Available online at https://www.nice.org.uk/guidance/ng12. Last accessed 4th March 2022
4. Bull LM, Lunt M, Martin GP, Hyrich K, Sergeant JC. Harnessing repeated measurements of predictor variables for clinical risk prediction: a review of existing methods. Diagn Progn Res. 2020;4:9.
5. Virdee PS, Patnick P, Watkinson P, Birks J, Holt T. Trends in the full blood count blood test and colorectal cancer detection: a longitudinal, case-control study of UK primary care patient data. NIHR Open Res. 2022;2(32):1–53. https://doi.org/10.3310/nihropenres.13266.1.
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