[ { "phenotype_id": "PH643", "phenotype_version_id": 1286, "name": "Breast Cancer", "definition": "Objectives: \n\nTo conduct a fully independent, external validation of a research study based on one electronic health record database using a different database sampling from the same population.\n\n\nDesign: \n\nRetrospective cohort analysis of β-blocker therapy and all-cause mortality in patients with cancer.\n\n\nSetting: \n\nTwo UK national primary care databases (PCDs): the Clinical Practice Research Datalink (CPRD) and Doctors’ Independent Network (DIN).\n\n\nParticipants: \n\nCPRD data for 11 302 patients with cancer compared with published results from DIN for 3462 patients; study period January 1997 to December 2006.\n\n\nPrimary and secondary outcome measures:\n\nAll-cause mortality: overall; by treatment subgroup (β-blockers only, β-blockers plus other blood pressure lowering medicines (BPLM), other BPLMs only); and by cancer site.\n\n\nResults: \n\nUsing CPRD, β-blocker use was not associated with mortality (HR=1.03, 95% CI 0.93 to 1.14, vs patients prescribed other BPLMs only), but DIN β-blocker users had significantly higher mortality (HR=1.18, 95% CI 1.04 to 1.33). However, these HRs were not statistically different (p=0.063), but did differ for patients on β-blockers alone (CPRD=0.94, 95% CI 0.82 to 1.07; DIN=1.37, 95% CI 1.16 to 1.61; p<0.001). Results for 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.\n\n\nConclusions: \n\nWe found a complex pattern of similarities and differences between databases. Overall treatment effect estimates were not statistically different, adding to a growing body of evidence that different UK PCDs produce comparable effect estimates. However, individually the two studies lead to different conclusions regarding the safety of β-blockers and some subgroup effects differed significantly. Single studies using even internally wellvalidated databases do not guarantee generalisable results, especially for subgroups, and confirmatory studies using at least one other independent data source are strongly recommended.\n\n\n\n\n\n\n\n\n", "implementation": "", "publications": [ { "doi": null, "details": "David A Springate, Darrent M Aschroft, Evangelos Kontopantelis, Tim Doran, Ronan Ryan, David Reeves, Can analyses of electronic patient records be independently and externally validated? Study 2—the effect of β-adrenoceptor blocker therapy on cancer survival a retrospective cohort study. BMJ Open, 5(e007299), 2014." } ], "validation": "", "citation_requirements": "", "created": "2021-10-06T16:28:15.051327Z", "author": "David A Springate, Darren M Aschroft, Evangelos Kontopantelis, Tim Doran, Ronan Ryan, David Reeves", "collections": [ { "name": "ClinicalCodes Repository", "value": 25 }, { "name": "Phenotype Library", "value": 18 } ], "tags": null, "organisation": null, "world_access": 1, "updated": "2021-10-06T16:28:15.051354Z", "sex": [ { "name": "Both", "value": "3" } ], "type": [ { "name": "Disease or syndrome", "value": "2" } ], "ontology": null, "phenoflowid": "", "data_sources": [ { "name": "CPRD GOLD", "value": 5, "uid": "a29feafa-7bdd-44e9-b977-c9d26425e67f", "url": "https://healthdatagateway.org/en/dataset/694", "datasource_id": 694 }, { "name": "Doctors Independent Network", "value": 28, "uid": "", "url": "", "datasource_id": 28 } ], "coding_system": [ { "name": "Read codes v2", "value": 5 } ], "event_date_range": "01/01/19997 - 31/12/2006", "concept_information": [ { "concept_id": 2063, "concept_version_id": 5264, "concept_name": "Breast Cancer - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH643", "phenotype_version_id": 1286, "phenotype_name": "Breast Cancer", "code_attribute_header": [ "Entity type", "Category", "Coding System (Read)" ], "codes": [ { "code": "B34..00", "description": "Malig neop female breast (f)", "attributes": { "Entity type": "res24: breast cancer", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "B340.00", "description": "Malig neop nipple/areola (f)", "attributes": { "Entity type": "res24: breast cancer", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "B340000", "description": "Malig neop nipple of breast(f)", "attributes": { "Entity type": "res24: breast cancer", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "B340100", "description": "Malig neop areola of breast(f)", "attributes": { "Entity type": "res24: breast cancer", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "B340z00", "description": "Malig neop nippl/areol (f) NOS", "attributes": { "Entity type": "res24: breast cancer", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "B341.00", "description": "Malig neop cent part breast(f)", "attributes": { "Entity type": "res24: breast cancer", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "B342.00", "description": "Malig neop upp-inner quad (f)", "attributes": { "Entity type": "res24: breast cancer", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "B343.00", "description": "Malig neop low-inner quad (f)", "attributes": { "Entity type": "res24: breast cancer", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "B344.00", "description": "Malig neop upp-outer quad (f)", "attributes": { "Entity type": "res24: breast cancer", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "B345.00", "description": "Malig neop low-outer quad (f)", "attributes": { "Entity type": "res24: breast cancer", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "B346.00", "description": "Malig neop axillary tail (f)", "attributes": { "Entity type": "res24: breast cancer", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "B347.00", "description": "Mal neopl - overlapping breast", "attributes": { "Entity type": "res24: breast cancer", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "B34y.00", "description": "Malig neop oth site breast (f)", "attributes": { "Entity type": "res24: breast cancer", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "B34y000", "description": "Malig neop ectopic breast (f)", "attributes": { "Entity type": "res24: breast cancer", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "B34yz00", "description": "Malig neop oth breast (f) NOS", "attributes": { "Entity type": "res24: breast cancer", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "B34z.00", "description": "Malig neop female breast NOS", "attributes": { "Entity type": "res24: breast cancer", "Category": "diagnostic", "Coding System (Read)": "Read" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/pq47-0256", "is_deleted": null, "publish_status": 2, "owner": "ieuan.scanlon", "template": { "id": 1, "name": "Clinical-Coded Phenotype", "description": "Phenotype definitions that are based on lists of clinical codes, or algorithms using clinical codes.", "version_id": 1 }, "versions": [ { "version_id": 1286, "version_name": "Breast Cancer", "version_date": "2021-10-06T16:28:15.079339Z", "is_published": true, "is_latest": true } ] } ]