Changes in presentations with features potentially indicating cancer in primary care during the COVID-19 pandemic: a retrospective cohort study
dc.contributor.author | Scott, LJ | |
dc.contributor.author | Murphy, M | |
dc.contributor.author | Price, S | |
dc.contributor.author | Lewis, R | |
dc.contributor.author | Denholm, R | |
dc.contributor.author | Horwood, J | |
dc.contributor.author | Palmer, T | |
dc.contributor.author | Salisbury, C | |
dc.date.accessioned | 2022-06-27T07:20:40Z | |
dc.date.issued | 2021-05-24 | |
dc.date.updated | 2022-06-24T17:54:02Z | |
dc.description.abstract | OBJECTIVES: To 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 PARTICIPANTS: A 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 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 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% (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). 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. | en_GB |
dc.description.sponsorship | National Institute for Health Research (NIHR) | en_GB |
dc.description.sponsorship | Medical Research Council (MRC) | en_GB |
dc.description.sponsorship | University of Bristol | en_GB |
dc.format.extent | e050131- | |
dc.format.medium | Electronic | |
dc.identifier.citation | Vol. 11(5), article e050131 | en_GB |
dc.identifier.doi | https://doi.org/10.1136/bmjopen-2021-050131 | |
dc.identifier.grantnumber | PR-PRU-1217-21601 | en_GB |
dc.identifier.grantnumber | MC_UU_00011/1 | en_GB |
dc.identifier.grantnumber | MC_UU_00011/3 | en_GB |
dc.identifier.uri | http://hdl.handle.net/10871/130057 | |
dc.identifier | ORCID: 0000-0002-2228-2374 (Price, Sarah) | |
dc.identifier | ScopusID: 57195915869 (Price, Sarah) | |
dc.identifier | ResearcherID: D-2641-2016 (Price, Sarah) | |
dc.language.iso | en | en_GB |
dc.publisher | BMJ Publishing Group | en_GB |
dc.relation.url | https://www.ncbi.nlm.nih.gov/pubmed/34031120 | en_GB |
dc.rights | © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. | en_GB |
dc.subject | COVID-19 | en_GB |
dc.subject | oncology | en_GB |
dc.subject | primary care | en_GB |
dc.subject | COVID-19 | en_GB |
dc.subject | England | en_GB |
dc.subject | Humans | en_GB |
dc.subject | Middle Aged | en_GB |
dc.subject | Neoplasms | en_GB |
dc.subject | Pandemics | en_GB |
dc.subject | Primary Health Care | en_GB |
dc.subject | Retrospective Studies | en_GB |
dc.subject | SARS-CoV-2 | en_GB |
dc.title | Changes in presentations with features potentially indicating cancer in primary care during the COVID-19 pandemic: a retrospective cohort study | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2022-06-27T07:20:40Z | |
dc.identifier.issn | 2044-6055 | |
exeter.article-number | ARTN e050131 | |
exeter.place-of-publication | England | |
dc.description | This is the final version. Available on open access from BMJ Publishing via the DOI in this record | en_GB |
dc.description | Data availability statement: Data are available on reasonable request. Under the Data Transfer Standard Operating Procedure agreed with practices, the patient data for this study will not be shared outside the research team. The codes lists used in the analysis which identify symptoms, signs, test results or diagnoses which could potentially indicate cancer can be made available on reasonable request. | en_GB |
dc.identifier.eissn | 2044-6055 | |
dc.identifier.journal | BMJ Open | en_GB |
dc.relation.ispartof | BMJ Open, 11(5) | |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0/ | en_GB |
dcterms.dateAccepted | 2021-04-27 | |
dc.rights.license | CC BY | |
rioxxterms.version | VoR | en_GB |
rioxxterms.licenseref.startdate | 2021-05-24 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2022-06-26T13:27:50Z | |
refterms.versionFCD | VoR | |
refterms.dateFOA | 2022-06-27T07:20:45Z | |
refterms.panel | A | en_GB |
refterms.dateFirstOnline | 2021-05-24 |
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Except where otherwise noted, this item's licence is described as © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.