Duration of pre-existing anxiety, depression or chronic analgesic use and associations with emergency lung cancer diagnosis and pre-diagnostic chest-imaging activity

Pre-existing conditions may influence emergency cancer diagnosis risk and decisions on investigations for potential cancer symptoms. In this retrospective cohort study we investigated whether the duration of pre-existing Anxiety/Depression and chronic analgesic use was associated with emergency lung cancer diagnosis and pre-diagnostic chest-imaging activity. We used linked primary care, hospital records and cancer registration data in patients with lung cancer. Pre-existing Anxiety/Depression and chronic analgesic use were categorised as recent-onset (first recorded <12months pre-cancer diagnosis) or long-term (first recorded >12months and <72months pre-diagnosis). Multivariable logistic regression explored associations between duration of Anxiety/Depression or chronic analgesic use and i) lung cancer diagnosis following Emergency Presentation (EP), and ii) use of Chest X-Ray/CT 1–6months pre-diagnosis. Among 6650 lung cancer patients, 26% had anxiety/depression (9% recent-onset) and 39% chronic analgesic use (28% recent-onset). Long-term and recent-onset chronic analgesic use were associated with reduced odds of EP (OR = 0.26; 95%CI 0.20, 0.33 and OR = 0.60; 95%CI 0.52, 0.70, respectively) versus no analgesic use. Pre-existing Anxiety/Depression were not associated with EP. Long-term chronic analgesic use was associated with increased odds of chest-imaging 1–6months pre-diagnosis (OR = 1.33; 95%CI 1.11, 1.60), versus no analgesic use. No associations were found for imaging use with recent-onset analgesics nor Anxiety/Depression. Long-term analgesic use for painful conditions was associated with lower odds of EP and higher odds of pre-diagnostic chest-imaging. This is consistent with a possible surveillance effect, whereby long-term conditions offer opportunities for diagnosing cancer before it becomes a medical emergency. Paying attention to symptomatic patients with no long-term treatment for painful conditions and ensuring appropriate follow up may help to expedite cancer diagnosis and avoid EP.