SPOtting Cancer without ComobiditIEs (SPOCCIE): Understanding the issues of the forgotten fit.

Background Cancer is the leading cause of avoidable death in the UK. In 2021, approximately 45% of cancers were diagnosed at a late-stage, which is associated with reduced survival rates relative to early-stage. The NHS Long Term Plan targets reducing the proportion of cancer diagnosed at a late stage to 25% by 2028. Given that approximately 58% of patients in England are living with multiple chronic conditions, we have been exploring the impact of pre-existing conditions on cancer diagnostic outcomes through our ongoing NIHR Programme Grant for Applied Research (NIHR207010), Spotting Cancer Among Comorbidities (SPOCC). In contrast to the perceived narrative, however, we found that increasing morbidity burden was associated with reduced odds of late-stage diagnosis. Patients with no morbidity burden were most at risk of late diagnosis and at a higher risk of emergency diagnoses and 30-day mortality (post diagnosis) than patients with all but the highest morbidity burdens. Aims and Objectives We plan to develop the scope of the SPOCC programme to consider people without pre-existing morbidities. We aim to explore why patients without morbidity are more likely to be diagnosed with late-stage cancer than those with pre-existing morbidities and identify opportunities for intervention. Our objectives are: 1. To investigate whether patients without pre-existing morbidity present with different types of symptoms than patients with morbidity, which may help explain why patients without morbidity are diagnosed later. 2. To identify factors which may affect early diagnosis for patients without recorded morbidity. 3. To examine the role of different mechanisms and behavioural factors contributing to advanced stage cancer diagnosis in patients without pre-existing conditions. 4. To explore patient and GP experiences and perceptions of diagnosis of potential cancer in general practice in patients without pre-existing conditions Development work plan Our proposed work comprises three interlinked work packages (WPs). WP1 (objectives 1-2) is a reanalysis of the linked cancer registration, primary and secondary care, data sets used in the original SPOCC programme. WP2 (objective 3) is a reanalysis of the data collected from a series of online vignette studies collected within SPOCC, with a focus on patients without comorbidities. WP3 (objective 4) is a qualitative examination of the decision-making process in both patients without comorbidities and in general practitioners caring for these patients. Timelines for delivery This work will occur over 12-months, overlapping with the final six-months of the SPOCC programme. The three work packages will run concurrently, with close interaction to ensure that emerging findings from each work package can feed into and inform the others. Anticipated Impact This work will inform the nature, and development of, interventions to improve cancer diagnosis in people without pre-existing conditions. If we find a need to enable patients to recognise and act on symptoms of possible cancer, this suggests a public health focused intervention, potentially through tailoring of awareness campaigns. Alternatively, if recognition and action by GPs is the required focus, that suggests the need for educational material development. There may also be the potential to influence clinical referral/investigation guidelines.