The Impact of COVID-19 on Cancer Symptom Experience and Help-Seeking Behaviour in the United Kingdom: A Cross-Sectional Population Survey

Abstract

Background: The impact of COVID-19 on timely symptomatic diagnosis of cancer is likely to be considerable. We examined symptom help-seeking behaviour in the UK population during the pandemic.Methods: A population-based sample of 7,543 UK adults aged 18+ was recruited online between August and September 2020. Measures included experiences and perceptions of 15 potential cancer symptoms, help-seeking barriers and behaviour. Multivariable logistic regression was used to model correlates of help-seeking behaviour in participants who experienced at least one potential cancer symptom during the previous six months. Qualitative interviews were conducted with a purposive sample of 30 survey participants and analysed thematically.Findings: Frequently endorsed help-seeking barriers included worries about wasting the doctor’s time (15·4%), putting strain on healthcare services (12·6%) and not wanting to be seen making a fuss (12·0%). Of 3,025 (40·1%) participants who experienced a potential cancer symptom, 44·8% (1,355/3,025) had not contacted their General Practitioner (GP). Odds of seeking help were higher among participants with disability (95% CI 1·11-1·71, aOR=1·38) and who experienced more potential cancer symptoms (95% CI 1·56-1·82, aOR=1·68) and lower among those who perceived COVID-19 as the cause of symptom(s) experienced (95% CI 0·25-0·52, aOR=0·36). Qualitative data revealed a reluctance to contact the GP due to concerns about catching or transmitting COVID-19. Participants were fearful of seeking help in hospitals and described putting their health concerns on hold to avoid burdening healthcare services. When experienced, remote GP consultations were well received.Interpretation: Many people stayed away from healthcare services during the first six months of the UK pandemic, despite experiencing potential cancer symptoms. National campaigns are needed to signal that cancer cannot wait and that services are open safely for those with unusual or persistent symptoms.Trial Registration: ISRCTN17782018Funding Statement: Economic and Social Research Council as part of UK Research and Innovation’s Rapid Response to COVID-19 (ES/V00591X/1).Declaration of Interests: The authors declare no conflict of interest.Ethics Approval Statement: Ethical approval was granted by the School of Medicine Research Ethics Committee, Cardiff University (ref 20.68).