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Abstract
BackgroundMore people are surviving a first primary cancer and experiencing a second, different cancer. However, little is known about the diagnostic journeys of patients with second primary cancer (SPC). This study explores the views of patients and general practitioners (GPs) on their experiences of pathways to diagnosis of SPC, including the influence of a previous diagnosis of cancer on symptom appraisal, help-seeking and referral decisions.MethodsQualitative interviews with patients with a SPC diagnosis and case-linked GP interviews in a Scottish primary care setting. In-depth face to face or telephone interviews were conducted, underpinned by a social constructionist approach. Interviews were transcribed and Braun and Clarke’s thematic analysis undertaken. Three analysts from the research team read transcripts and developed the coding framework using QSR NVivo version 10, with input from a fourth researcher. Themes were developed from refined codes and interpreted in the context of existing literature and theory.ResultsInterviews were conducted with 23 patients (aged 43–84 years) with a SPC diagnosis, and 7 GPs. Five patient themes were identified: Awareness of SPC, symptom appraisal and help-seeking, pathways to diagnosis, navigating the healthcare system, and impact of SPC. GPs interviews identified: experience and knowledge of SPC and referrals and decision-making.ConclusionsInsights into the pathway to diagnosis of SPC highlights the need for increased awareness of and vigilance for SPC among patients and healthcare providers (HCPs), and emotional support to manage the psychosocial burden.
Highlights
More people are surviving a first primary cancer and experiencing a second, different cancer
The limited evidence suggests that fear of a second cancer has been identified as a source of worry and psychosocial distress [4], there is a general lack of awareness regarding risk of second primary cancer (SPC) [5]
The study involved a series of in-depth interviews carried out in 2018 with patients diagnosed with SPC in Scotland, and the General Practitioner (GP) involved in diagnosing and managing SPCs
Summary
More people are surviving a first primary cancer and experiencing a second, different cancer. Little is known about the diagnostic journeys of patients with second primary cancer (SPC). This study explores the views of patients and general practitioners (GPs) on their experiences of pathways to diagnosis of SPC, including the influence of a previous diagnosis of cancer on symptom appraisal, help-seeking and referral decisions. The number of people surviving cancer is increasing [1] and, in combination with an ageing population, the incidence of second primary cancers (SPCs) will inevitably rise [2]. Little is known about pathways to diagnosis of SPC. The Pathways to Treatment Model (see Fig. 1) highlights the complexities of multiple patient factors - including psychological features and prior experiences in influencing symptom appraisal and help-seeking behaviours, which may be applicable to SPCs [14]. There are implications for awareness-raising and, if appropriate, designing behavioural interventions to facilitate early detection of SPC [4, 15]
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