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Research article:

Can analyses of electronic patient records be independently and externally validated? Study 2: the Effect of Beta-Adrenoceptor Blocker Therapy on Cancer Survival; a Retrospective Cohort Study

Reference:

David a Springate, Darren M Ashcroft, Evangelos Kontopantelis, Tim Doran, Ronan Ryan, David Reeves(2015) Can analyses of electronic patient records be independently and externally validated? Study 2: the Effect of Beta-Adrenoceptor Blocker Therapy on Cancer Survival; a Retrospective Cohort Study. BMJ Open, doi: 10.1136/bmjopen-2014-007299

Link to fulltext article
Abstract
Objectives To conduct a fully independent and external validation of a research study based on one electronic health record database, using a different database sampling the same population. Design Retrospective cohort analysis of beta-blocker therapy and all-cause mortality in cancer patients. Setting Two UK national primary care databases (PCDs): the Clinical Practice Research Datalink (CPRD) and Doctors’ Independent Network (DIN). Participants CPRD data for 11302 cancer patients compared to published results from DIN for 3462 patients. Study period January 1997 to December 2006. Primary and secondary outcome measures All-cause mortality: overall; by treatment subgroup (betablockers only, beta-blockers plus other blood pressure lowering medicines (BPLM), other BPLMs only); and by cancer-site. Results Using CPRD, beta-blocker use was not associated with mortality (HR=1.03, 95%CI 0.93-1.14, vs patients prescribed other BPLMs only), but in DIN beta-blocker users had significantly higher mortality (HR=1.18, 95%CI 1.04 to 1.33). However, these hazard ratios were not statistically different (p=0.063), but did differ for patients on beta-blockers alone (CPRD=0.94, 95%CI 0.82-1.07; DIN=1.37, 95%CI 1.16-1.61; p<0.001). Results for nine individual cancer sites differed by study, but only significantly for prostate and pancreas cancers. Results were robust under sensitivity analyses, but we could not be certain that mortality was identically defined in both databases. Conclusions We found a complex pattern of similarities and differences between databases. Our finding that overall treatment effect estimates were not statistically different, adds to a growing body of evidence that different UK PCDs produce effect estimates comparable within statistical tolerance. However, some subgroup effects differed significantly and individually the two studies lead to different conclusions regarding the safety of beta-blockers for cancer patients. Single studies based on internally well-validated databases therefore do not guarantee generalisable results, especially for subgroups. In all cases, confirmatory studies using at least one other independent data source are strongly recommended.
Author for correspondence
David Reeves
Email for correspondence
david.reeves@manchester.ac.uk

Code list: res24: stomach cancer

20 codes in list

Code Coding system Description Entity type List name
B11..00 Read Malig neop of stomach diagnostic res24: stomach cancer
B110.00 Read Malig neop cardia of stomach diagnostic res24: stomach cancer
B110000 Read Malig neop card orific stomach diagnostic res24: stomach cancer
B110100 Read Malig neop cardio-oesoph junct diagnostic res24: stomach cancer
B110z00 Read Malig neop cardia stomach NOS diagnostic res24: stomach cancer
B111.00 Read Malig neop pylorus of stomach diagnostic res24: stomach cancer
B111000 Read Malig neop prepylorus stomach diagnostic res24: stomach cancer
B111100 Read Malig neop pylor canal stomach diagnostic res24: stomach cancer
B111z00 Read Malig neop pylorus stomach NOS diagnostic res24: stomach cancer
B112.00 Read Malig neop pyloric ant stomach diagnostic res24: stomach cancer
B113.00 Read Malig neop fundus of stomach diagnostic res24: stomach cancer
B114.00 Read Malig neop body of stomach diagnostic res24: stomach cancer
B115.00 Read Malig neop less curv stom unsp diagnostic res24: stomach cancer
B116.00 Read Malig neop great curv stom uns diagnostic res24: stomach cancer
B117.00 Read Malig neopl overlap lesn stom diagnostic res24: stomach cancer
B11y.00 Read Malig neop oth spec stomach diagnostic res24: stomach cancer
B11y000 Read Malig neop ant wall stom NOS diagnostic res24: stomach cancer
B11y100 Read Malig neop post wall stom NEC diagnostic res24: stomach cancer
B11yz00 Read Malig neop oth spec stom NOS diagnostic res24: stomach cancer
B11z.00 Read Malignant neoplasm stomach NOS diagnostic res24: stomach cancer

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