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

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 appropriate symptomatic assessment now and in the future.