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Injuries before and after diagnosis of cancer: nationwide register based study
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden .
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Epidemiology and Register Centre South, Region Skåne, Lund, Sweden; Unit of Cardiovascular Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Epidemiology and Register Centre South, Region Skåne, Lund, Sweden; Division of Occupational and Environmental Medicine, Department of Laboratory Medicine Lund, Lund University, Lund, Sweden.
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2016 (English)In: BMJ (Clinical Research Edition), ISSN 0959-8138, Vol. 354, i4218Article in journal (Refereed) Published
Abstract [en]

Objective:  To examine the relative risks of iatrogenic and non-iatrogenic injuries during the period shortly before and after a diagnosis of cancer.

Design:  Nationwide register based study.

Setting:  Swedish national population and health registers.

Participants:  720 901 patients with diagnosis of cancer, 1991-2009, in Sweden.

Main outcome measures:  All hospital admissions in patients with cancer with a main discharge diagnosis of iatrogenic (from medical complications) or non-iatrogenic injuries in 1990-2010 identified from the Swedish patient register. Conditional Poisson regression was used to compare the incidence rate of injuries during the "diagnostic period" (16 weeks before to 16 weeks after diagnosis) with the incidence rate during a "pre-diagnostic period" (the same 32 weeks one year before diagnosis) among the same patients.

Results:  During the diagnostic period, there were 7306 iatrogenic (incidence rate 0.60 per 1000 person months) and 8331 non-iatrogenic injuries (incidence rate 0.69 per 1000 person months). For iatrogenic injuries, the incidence rate ratio was 7.0 (95% confidence interval 6.6 to 7.4) during the diagnostic period compared with the pre-diagnostic period. The increase in risk started two weeks before cancer diagnosis and peaked during the two weeks after diagnosis (48.6, 37.3 to 63.5). For non-iatrogenic injuries, the incidence rate ratio was 1.9 (1.8 to 2.0) during the diagnostic period compared with the pre-diagnostic period. The increase in risk began four weeks before diagnosis and peaked during the two weeks before diagnosis (5.3, 4.6 to 6.1). There were increased risks of both types of injury during the diagnostic period for all common cancers, with the smallest risk increase noted for non-melanoma skin cancer.

Conclusions:  Patients with cancer have highly increased risks of both iatrogenic and non-iatrogenic injuries requiring inpatient care : shortly before and after their diagnosis. These findings shed further light on the total burden of medical complications and call for prevention of intentional and unintentional injuries during the diagnostic process of cancer.

Place, publisher, year, edition, pages
London, United Kingdom: BMJ Publishing Group Ltd, 2016. Vol. 354, i4218
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:oru:diva-52004DOI: 10.1136/bmj.i4218ISI: 000382792500001PubMedID: 27582045OAI: oai:DiVA.org:oru-52004DiVA: diva2:958317
Funder
Swedish Cancer Society, CAN 2014/417Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-0498Swedish Society for Medical Research (SSMF)
Note

Funding Agencies:

China Scholarship Council

Karolinska Institute 2368/10-221

Available from: 2016-09-06 Created: 2016-09-06 Last updated: 2017-10-18Bibliographically approved

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