{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:19:52Z","timestamp":1788182392718,"version":"build-2803163510"},"reference-count":69,"publisher":"Royal College of General Practitioners","issue":"768","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"accepted":{"date-parts":[[2026,3,11]]},"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prescribing patterns in primary care could demonstrate early clinical features of cancer and windows of opportunity for timely investigation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To analyse primary care prescription patterns before a pancreatic cancer diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>Retrospective cohort study using linked primary care and cancer registry data from patients diagnosed with pancreatic cancer in England between 2011 and 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Prescription records registered in the Clinical Practice Research Datalink were analysed in the 5 years prediagnosis. Eight categories of prescriptions that may be used to treat clinical features of pancreatic cancer were included (anti-emetics, anti-reflux medications, insulin, other hypoglycaemic agents, opioids, non-opioid analgesics, neuropathic analgesics, and non-steroidal anti-inflammatories). Poisson regression was used to estimate the inflection points for increased prescribing above baseline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 12 990 patients, 669 287 prescriptions were analysed. Insulin was the least common prescription (6.9% [\n                      <jats:italic>n<\/jats:italic>\n                      = 892\/12 990] of patients), anti-reflux the most common (52.6% [\n                      <jats:italic>n<\/jats:italic>\n                      = 6833\/12 990] of patients). Insulin prescribing increased 19 months prediagnosis (95% confidence interval [CI] = 14.2 to 23.8), rising earlier in female patients (25 months; 95% CI = 17.4 to 32.5) than male patients (11 months; 95% CI = 5.8 to 16.2). Prescriptions for other hypoglycaemic agents increased 13 months (95% CI = 7.7 to 18.5), anti-reflux and opioid analgesic prescribing 7 months (95% CI = 5.4 to 8.6 and 4.4 to 9.6, respectively), and anti-emetics and non-opioid analgesics 5 months (95% CI = 2.9 to 7.1 and 3.2 to 6.8, respectively) before diagnosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The early increase in insulin prescribing suggests tumour-induced type 3c diabetes, highlighting an opportunity for earlier diagnosis in a small proportion of patients. Opportunities for earlier diagnosis through investigation and referral also exist in patients prescribed anti-emetic, anti-reflux, and analgesic medications in primary care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3399\/bjgp.2025.0780","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T12:50:19Z","timestamp":1776343819000},"page":"e523-e533","source":"Crossref","is-referenced-by-count":1,"title":["Prediagnostic prescription patterns in pancreatic cancer: a retrospective primary care cohort study"],"prefix":"10.3399","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6884-7000","authenticated-orcid":false,"given":"Cecilia","family":"Morel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona M","family":"Walter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawandeep","family":"Virpal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9046-1086","authenticated-orcid":false,"given":"Kirsten D","family":"Arendse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garth","family":"Funston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1987","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"2026083105501302000_76.768.e523.1","unstructured":"Cancer Research UK Pancreatic cancer statistics. accessed. https:\/\/www.cancerresearchuk.org\/health-professional\/cancer-statistics\/statistics-by-cancer-type\/pancreatic-cancer#pancreatic_stats0. 21 May 2026."},{"key":"2026083105501302000_76.768.e523.2","unstructured":"National Pancreatic Cancer Audit Project Team (2025) National Pancreatic Cancer Audit state of the nation report 2025. accessed. https:\/\/www.natcan.org.uk\/wp-content\/uploads\/2025\/09\/NPaCA-SoTN-2025-v2.6.pdf. 21 May 2026."},{"key":"2026083105501302000_76.768.e523.3","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(16)30079-6"},{"key":"2026083105501302000_76.768.e523.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-005720"},{"key":"2026083105501302000_76.768.e523.5","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(12)70041-4"},{"key":"2026083105501302000_76.768.e523.6","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0000000000000527"},{"key":"2026083105501302000_76.768.e523.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30974-0"},{"key":"2026083105501302000_76.768.e523.8","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.01.039"},{"key":"2026083105501302000_76.768.e523.9","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-S002"},{"key":"2026083105501302000_76.768.e523.10","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2012.190"},{"key":"2026083105501302000_76.768.e523.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.canep.2021.102072"},{"issue":"2","key":"2026083105501302000_76.768.e523.12","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1080\/02813432.2022.2069730","article-title":"Healthcare use in the year preceding a diagnosis of pancreatic cancer: a register-based cohort study in Denmark","volume":"40","author":"Rasmussen","year":"2022","journal-title":"Scand J Prim Health Care"},{"key":"2026083105501302000_76.768.e523.13","doi-asserted-by":"crossref","first-page":"101926","DOI":"10.1016\/j.canep.2021.101926","article-title":"Abdominal investigations in the year preceding a diagnosis of abdominal cancer: a register-based cohort study in Denmark","volume":"72","author":"Jessen","year":"2021","journal-title":"Cancer Epidemiol"},{"key":"2026083105501302000_76.768.e523.14","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-023-38088-2"},{"key":"2026083105501302000_76.768.e523.15","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2021-326522"},{"key":"2026083105501302000_76.768.e523.16","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0000000000000590"},{"key":"2026083105501302000_76.768.e523.17","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyz034"},{"key":"2026083105501302000_76.768.e523.18","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyz076"},{"key":"2026083105501302000_76.768.e523.19","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyv098"},{"key":"2026083105501302000_76.768.e523.20","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-018-0442-4"},{"key":"2026083105501302000_76.768.e523.21","unstructured":"National Institute for Health and Care Excellence (NICE) (2026) Suspected cancer: recognition and referral. 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