What is the impact of COVID-19 on cancer symptom experience and help-seeking behaviour in the United Kingdom? A cross-sectional population survey

Problem

Cancer is the leading cause of mortality in the UK, with most diagnosed symptomatically through primary care. During the first UK lockdown from March 2020, the UK government message to “stay home, protect the NHS, save lives” was intended to control the spread of COVID-19, but also sent a strong signal to the public that cancer can wait. The impact of COVID-19 on timely symptomatic diagnosis of cancer is likely to be considerable. We examined symptom help-seeking behaviour in the UK population during the pandemic.

Approach

Two cross-sectional online surveys were conducted in parallel, the COVID-19 Health and Help-Seeking Behaviour Study and the Cancer Research UK (CRUK) COVID-19 Cancer Awareness Measure (COVID-CAM). COVID-CAM was based on CRUK’s Cancer Awareness Measure 2019. Key measures were aligned across the two surveys and data pooled where appropriate. A population-based sample of 7,543 UK adults aged 18+ was recruited online between August and September 2020. Measures included experiences and perceptions of 15 potential cancer symptoms, help-seeking barriers and behaviour. Multivariable logistic regression was used to model correlates of help-seeking behaviour in participants who experienced at least one potential cancer symptom during the previous six months. Qualitative interviews were conducted with a purposive sample of 30 survey participants and analysed thematically.

Findings

Frequently endorsed help-seeking barriers included worries about wasting the doctor’s time (15·4%), putting strain on healthcare services (12·6%) and not wanting to be seen making a fuss (12·0%). Of 3,025 (40·1%) participants who experienced a potential cancer symptom, 44·8% (1,355/3,025) had not contacted their General Practitioner (GP). Odds of seeking help were higher among participants with disability (95% CI 1·11-1·71, aOR=1·38) and who experienced more potential cancer symptoms (95% CI 1·56-1·82, aOR=1·68) and lower among those who perceived COVID-19 as the cause of symptom(s) experienced (95% CI 0·25-0·52, aOR=0·36). Qualitative data revealed a reluctance to contact the GP due to concerns about catching or transmitting COVID-19. Participants were fearful of seeking help in hospitals and described putting their health concerns on hold to avoid burdening healthcare services. However, those who did attend face-to-face in primary and/or secondary care described feeling ‘safe’ and ‘secure’ when attending. When experienced, remote GP consultations were well received, and participants suggested that they were happy for remote consultations to remain providing face-to-face was still available based on clinical need.

Consequences

Many people stayed away from healthcare services during the first six months of the UK pandemic, despite experiencing potential cancer symptoms. Evidence from this study highlights the need for continued investment in evidence-led, nationally funded and coordinated cancer awareness campaigns to legitimise seeking help for unusual or persistent symptoms. As the COVID-19 pandemic continues, research must continue to monitor the influences on help-seeking for potential cancer symptoms.