Changes in presentations with features potentially indicating cancer in primary care during the COVID-19 pandemic: a retrospective cohort study

Abstract

ObjectivesTo investigate how the COVID-19 pandemic affected the number of people aged 50+ years presenting to primary care with features that could potentially indicate cancer, and to explore how reporting differed by patient characteristics and in face-to-face vs remote consultations.Design, setting and participantsA retrospective cohort study of general practitioner (GP), nurse and paramedic primary care consultations in 21 practices in South-West England covering 123 947 patients. The models compared potential cancer indicators reported in April–July 2019 with April–July 2020.Main outcome measuresPotential indicators of cancer were identified using code lists for symptoms, signs, test results and diagnoses listed in the National Institute for Health and Care Excellence suspected cancer referral guidance (NG12).ResultsDuring April–July 2019, 17% of registered patients aged 50+ years reported a potential cancer indicator in a consultation with a GP or nurse. During April–July 2020, this reduced to 11% (incidence rate ratio (IRR) 0.64, 95% CI 0.62 to 0.67, p<0.001). Reductions in potential cancer indicators were stable across age group, sex, ethnicity, index of multiple deprivation quintile and shielding status, but less marked in patients with mental health conditions than without (IRR 0.75, 95% CI 0.72 to 0.79, interaction p<0.001). Proportions of GP consultations with potential indicators of cancer reduced between 2019 and 2020 for face-to-face consultations (IRR 0.84, 95% CI 0.76 to 0.92, p<0.001) and increased for remote consultations (IRR 1.17, 95% CI 1.07 to 1.29, p=0.001), although it remained lower in remote consulting than face-to-face in April–July 2020. This difference was greater for nurse/paramedic consultations (face-to-face: IRR 0.61, 95% CI 0.44 to 0.83, p=0.002; remote: IRR 1.60, 95% CI 1.10 to 2.333, p=0.014).ConclusionThe number of patients consulting with presentations that could potentially indicate cancer reduced during the first wave of the COVID-19 pandemic. Patients should be encouraged to continue contacting primary care for persistent signs and symptoms, and GPs and nurses should be encouraged to probe patients for further information during remote consulting, in the absence of non-verbal cues.

Consultations for clinical features of possible cancer and associated urgent referrals before and during the COVID-19 pandemic: an observational cohort study from English primary care

“…Globally, reports are emerging about the impact of COVID-19 on routine cancer testing, diagnostic timeliness, and the proportion of patients diagnosed with late-stage cancer [ 2 , 4 , 7 , 16 , 22 , 35 – 38 ]. To date, the majority of English studies examining the impact of the COVID-19 pandemic have focussed on secondary care activity [ 14 , 15 , 17 , 22 , 39 – 41 ].…”

“…However, the deficit in cancer diagnoses was not statistically significant [ 6 ]. A second retrospective cohort study of GP consultations for 123,947 patients aged 50 years and older across 21 English practices between April and July 2020 showed a 27% reduction in consultations for symptoms that could potentially indicate cancer during the first wave of the COVID-19 pandemic but did not examine trends following this or the impact on urgent cancer referrals [ 38 ]. Our current analyses are therefore very timely.…”

Lung cancer and Covid-19: lessons learnt from the pandemic and where do we go from here?

“…The first wave of the pandemic saw a reduction in the number of consultations carried out in primary care as fewer patients presented to their GP 20 – 22 with a 24.1% reduction in consultations for potential cancer symptoms between 2019 and 2020 in England 23 . This was most marked during the initial lockdown period.…”

“…Presentations of cough to primary care showed one of the largest sustained reductions throughout 2020 23 . This may reflect the overlapping nature of the symptom of cough with Covid-19, whereby individuals with a new cough and breathlessness were advised to isolate and get tested.…”

The experience of conducting collaborative and intensive pragmatic qualitative (CLIP-Q) research to support rapid public health and healthcare innovation

“…Findings were also presented to the Department of Health and Social Care (DHSC) to inform their COVID-19 response. The team published three journal papers (Murphy et al, 2021 ; Scott et al, 2021 ; Turner et al, 2021 ) with preprint versions posted online prior to formal peer review and disseminated via twitter.…”