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

Lauren J Scott, C Murphy*, Sarah Price, Jeremy P Horwood, Rachel E Denholm, Rhys Lewis, Tom M Palmer, Chris Salisbury

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Objectives To investigate how the COVID-19 pandemic affected the number of people aged 50+ presenting to primary care with features which could potentially indicate cancer, and to explore how reporting differed by patient characteristics and in face-to-face vs. remote consultations. Design, Setting and Participants A retrospective cohort study of 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 measures Potential 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 (NICE) suspected-cancer referral guidance (NG12). Results During 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% (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 (IMD) 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), though 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). Conclusion The 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.
Original languageEnglish
Article numbere050131
Number of pages11
JournalBMJ Open
Issue number5
Publication statusPublished - 24 May 2021

Bibliographical note

Funding Information:
Twitter Mairead Murphy @mairead_murf, Jeremy Horwood @JPHorwood and Chris Salisbury @prof_tweet Acknowledgements The authors would like to thank all the participants in this study, Bristol North Somerset and South Gloucestershire Clinical Commissioning Group, One Care for providing the data extract, the NIHR Clinical Research Network for adopting the study on the NIHR portfolio and the NIHR SPCR for funding the research. The authors would also like to thank Willie Hamilton for his work on developing the potential cancer indicator lists (alongside author Sarah Price).

Funding Information:
Funding This study was funded by the National Institute for Health Research (NIHR) School for Primary Care Research. Additional funding for staff time was provided by the Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust and One Care. CS is a NIHR Senior Investigator. SP is funded by the NIHR Policy Research Programme via the Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, PR-PRU-1217-21601. TP is supported by the Integrative Epidemiology Unit, which receives funding from the UK Medical Research Council and the University of Bristol (MC_UU_00011/1 and MC_UU_00011/3) Disclaimer The funder had no role in the study design, collection and analysis of data, or the writing of the manuscript. The views expressed are those of the authors and not necessarily those of, the NIHR or the Department of Health and Social Care.

Publisher Copyright:
© 2021 Author(s). Published by BMJ.

Structured keywords

  • Covid19


  • COVID-19
  • General practice


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