Abstract
BackgroundEarly diagnosis is key to improve cancer outcomes, and most cancers are diagnosed in primary care after initial symptomatic presentation. Emerging evidence suggests an increase in avoidable cancer deaths owing to the COVID-19 pandemic.AimTo understand GPs’ views on the impact of the COVID-19 pandemic on the clinical assessment of possible cancer.Design & settingA qualitative semi-structured interview study with GPs from the East of England.MethodGPs were purposively sampled based on age, sex, and years of experience. Interviews were conducted via Zoom or Microsoft Teams in August and September 2020. Transcribed recordings were analysed inductively using thematic analysis. The Model of Pathways to Treatment guided the analysis.ResultsThree themes were identified across 23 interviews on GP views on the impact of: (1) changes in patient help-seeking behaviour on symptoms at presentation; (2) remote consultations on managing patients with possible cancer symptoms; and (3) the COVID-19 pandemic on triaging and referring patients with possible cancer. There were positive changes to practice, but concerns were raised about the adequacy of remote consultations for assessing symptoms. Some GPs reported delayed cancer diagnoses, and uncertainty about how backlog in referrals would be managed.ConclusionThis study provides new evidence on the impact of the COVID-19 pandemic on assessing symptomatic patients. Recommendations are made to inform safe and effective primary care clinical practice. Urgent action is needed to mitigate the impact of the COVID-19 pandemic, and ensure appropriate symptomatic assessment now and in the future.
Highlights
Cancer is the leading cause of death in many countries, and its burden and prognosis are highly dependent on disease stage at diagnosis.[1]
Three themes were identified across 23 interviews on GP views on the impact of: (1) changes in patient help-seeking behaviour on symptoms at presentation; (2) remote consultations on managing patients with possible cancer symptoms; and (3) the COVID-19 pandemic on triaging and referring patients with possible cancer
Urgent action is needed to mitigate the impact of the COVID-19 pandemic, and ensure appropriate symptomatic assessment and in the future
Summary
Cancer is the leading cause of death in many countries, and its burden and prognosis are highly dependent on disease stage at diagnosis.[1] In countries such as England, with a gatekeeper healthcare system, up to 90% of patients with cancer are diagnosed after initial symptomatic presentation in primary care. There are likely to be implications for primary care detection of cancer owing to the impact of remote consultations on clinical assessment,[2] and the process and timescales for referral to specialist services,[9,12,13] but these have not yet been reported. Diagnosis is key to improve cancer outcomes, and most cancers are diagnosed in primary care after initial symptomatic presentation. Emerging evidence suggests an increase in avoidable cancer deaths owing to the COVID-19 pandemic
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