Impact of the COVID-19 pandemic on cancer assessment in primary care: a qualitative study of GP views

Stephanie Archer; Natalia Calanzani; Stephanie Honey; Margaret Johnson; Richard Neal; Suzanne E Scott; Fiona M Walter

doi:10.3399/BJGPO.2021.0056

Impact of the COVID-19 pandemic on cancer assessment in primary care: a qualitative study of GP views

BJGP Open. 2021 Aug 24;5(4):BJGPO.2021.0056. doi: 10.3399/BJGPO.2021.0056. Print 2021 Aug.

Authors

Stephanie Archer¹, Natalia Calanzani¹, Stephanie Honey², Margaret Johnson³, Richard Neal⁴, Suzanne E Scott⁵, Fiona M Walter⁶

Affiliations

¹ Research Associate, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
² Research Associate, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
³ Patient/Public Partner, The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
⁴ Professor of Primary Care Oncology, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
⁵ Senior Lecturer in Health Psychology, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK.
⁶ Reader in Primary Care Cancer Research, The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK fmw22@medschl.cam.ac.uk.

Abstract

Background: Early diagnosis is key to improve cancer outcomes, and most cancers are diagnosed in primary care after initial symptomatic presentation. Emerging evidence suggests an increase in avoidable cancer deaths owing to the COVID-19 pandemic.

Aim: To understand GPs' views on the impact of the COVID-19 pandemic on the clinical assessment of possible cancer.

Design & setting: A qualitative semi-structured interview study with GPs from the East of England.

Method: GPs were purposively sampled based on age, sex, and years of experience. Interviews were conducted via Zoom or Microsoft Teams in August and September 2020. Transcribed recordings were analysed inductively using thematic analysis. The Model of Pathways to Treatment guided the analysis.

Results: Three themes were identified across 23 interviews on GP views on the impact of: (1) changes in patient help-seeking behaviour on symptoms at presentation; (2) remote consultations on managing patients with possible cancer symptoms; and (3) the COVID-19 pandemic on triaging and referring patients with possible cancer. There were positive changes to practice, but concerns were raised about the adequacy of remote consultations for assessing symptoms. Some GPs reported delayed cancer diagnoses, and uncertainty about how backlog in referrals would be managed.

Conclusion: This study provides new evidence on the impact of the COVID-19 pandemic on assessing symptomatic patients. Recommendations are made to inform safe and effective primary care clinical practice. Urgent action is needed to mitigate the impact of the COVID-19 pandemic, and ensure appropriate symptomatic assessment now and in the future.

Keywords: coronavirus; early diagnosis; general practice; neoplasms.