Changes in potential cancer indicator reporting in primary-care during the COVID-19 pandemic

Abstract

Background In March 2020, the World Health Organisation declared COVID-19 a pandemic.Aim To investigate how the pandemic affected presentation to primary-care with features potentially indicating cancer, and explore how reporting differed by patient characteristics and in face-to-face vs. remote consultations.Design and setting Retrospective cohort study in 21 practices in South-West England.Methods Potential cancer indicators were identified using pre-defined code lists for symptoms, signs, test results and diagnoses. Negative binomial regression models compared reporting of potential cancer indicators in April-July 2020 to April-July 2019. Incidence rate ratios (IRRs), 95% confidence intervals (CIs) and p-values are reported.Results During April-July 2019 and 2020, respectively, 152,447/344,184 (44%) and 123,775/350,966 (35%) patients consulted, with 44,662/344,184 (13%) and 29,150/350,966 (8%) reporting a potential cancer indicator (IRR=0.65, 95%CI 0.62-0.68, p<0.001). Reduced indicator reporting was stable across ethnicity, deprivation and shielding status, was greater in children (0-4 years IRR=0.50, 95%CI 0.46-0.55, p<0.001; 5-17 years IRR=0.45, 95%CI 0.41-0.49, p<0.001) and males (IRR=0.61, 95%CI 0.58-0.64), and less marked in patients with mental health conditions (IRR=0.75, 95%CI 0.72-0.79, p<0.001). Indicator reporting dropped for GP face-to-face consultations (IRR=0.88, 95%CI 0.80-0.97, p=0.011) and increased for remote consultations (IRR=1.22, 95%CI 1.11-1.34, p<0.001), but despite this, remained lower in remote consulting than face-to-face in April-July 2020.Conclusion Patient consulting in general, and for potential cancer indicators specifically, reduced during the first-wave of the COVID-19 pandemic. Remote consulting may be part of the reason for the reduction in reporting of potential cancer indicators, along with the reduced spreading of viral (non-cancer) infections.