Socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19: a UK-wide qualitative interview study

Athena Ip; Georgia Black; Cecilia Vindrola-Padros; Claire Taylor; Sophie Otter; Madeleine Hewish; Afsana Bhuiya; Julie Callin; Angela Wong; Michael Machesney; Naomi J Fulop; Cath Taylor; Katriina L Whitaker

doi:10.3399/BJGP.2021.0644

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Socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19 - Response to Atherton et al
Athena Ip, Georgia Black, Cecilia Vindrola, Claire Taylor, Sophie Otter, Madeleine Hewish, Afsana Bhuiya, Julie Callin, Angela Wong, Michael Machesney, Naomi J Fulop, Cath Taylor and Katriina L Whitaker

Published on: 04 July 2022
Socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19
Vanashree Sexton, Jeremy Dale, Sarah Hillman, Eleanor Hoverd, Helen Leach, Becky MacGregor, Bethany McLoughlin, Armina Paule, Helen Atherton, Zakia Shariff, Rachel Spencer, Nicky Thomas, Daniela Valdes, Eleanor Watson and Sachintha Weerasingha Navarathnage

Published on: 27 June 2022

Published on: (4 July 2022)
Page navigation anchor for Socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19 - Response to Atherton et al
Socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19 - Response to Atherton et al
Athena Ip, Research Fellow, University of Surrey
Other Contributors:
Georgia Black, THIS Institute postdoctoral fellow and Principal Research Fellow, University College London

Cecilia Vindrola, Senior Research Fellow and Director of RREAL, University College London

Claire Taylor, Macmillan Nurse Consultant in Colorectal Cancer, London North West University Healthcare NHS Trust

Sophie Otter, Consultant Clinical Oncologist, Royal Surrey County Hospital NHS Foundation Trust

Madeleine Hewish, Consultant Medical Oncologist, Royal Surrey County Hospital NHS Foundation Trust

Afsana Bhuiya, Cancer GP lead, University College London Hospitals NHS Foundation Trust

Julie Callin, Patient Representative

Angela Wong, Consultant Gastroenterologist, Barts Health NHS Trust

Michael Machesney, Consultant General Surgeon, Barts Health NHS Trust

Naomi J Fulop, Professor of healthcare organisation and management, University College London

Cath Taylor, Professor of Healthcare Workforce Organisation and Wellbeing, University of Surrey

Katriina L Whitaker, Reader in Cancer Care, University of Surrey
We welcome the opportunity to respond to Atherton et al and to reassure of the methodological validity of our study:

We include details of other SES indices (included in IMD) in the supplementary file. Furthermore, the paper cited in the eLetter also states that education is a frequently used indicator of socioeconomic status because it is relevant to people regardless of age.

The symptoms we report in our paper are supported by robust sources e.g. Bowel Cancer UK., and were agreed with our co-authors, including a GP and those specialising in diagnosing and treating colorectal cancer. Our participants’ eventual diagnosis was outside scope - we were interested in how people made sense and sought help for symptoms. In doing so, this adds important information to a broader picture about how inequalities were exacerbated.

Our patient representative who sadly died was involved in the study design and early analysis discussions. Julie Callin (our other patient representative) is a co-author on the paper and was involved in the entire research process.

The recommendation regarding infection control is relevant because reticence to seek help due to fears about COVID infection was reported particularly in lower SES groups.

Finally, this study is based on patient accounts of help-seeking during the pandemic, so it is incorrect to suggest that we did not include patients from general practices. We are pleased to share that we hav...
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We welcome the opportunity to respond to Atherton et al and to reassure of the methodological validity of our study:

We include details of other SES indices (included in IMD) in the supplementary file. Furthermore, the paper cited in the eLetter also states that education is a frequently used indicator of socioeconomic status because it is relevant to people regardless of age.

The symptoms we report in our paper are supported by robust sources e.g. Bowel Cancer UK., and were agreed with our co-authors, including a GP and those specialising in diagnosing and treating colorectal cancer. Our participants’ eventual diagnosis was outside scope - we were interested in how people made sense and sought help for symptoms. In doing so, this adds important information to a broader picture about how inequalities were exacerbated.

Our patient representative who sadly died was involved in the study design and early analysis discussions. Julie Callin (our other patient representative) is a co-author on the paper and was involved in the entire research process.

The recommendation regarding infection control is relevant because reticence to seek help due to fears about COVID infection was reported particularly in lower SES groups.

Finally, this study is based on patient accounts of help-seeking during the pandemic, so it is incorrect to suggest that we did not include patients from general practices. We are pleased to share that we have recently completed a related study that gathers views of healthcare professionals across the cancer care trajectory (including GPs).¹

Reference
1. Ip A, Black G, Vindrola-Padros C et al. (In press). Healthcare professional and patient perceptions of changes in colorectal cancer care delivery during the COVID-19 pandemic and impact on health inequalities. Cancer Control.
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Competing Interests: None declared.
Published on: (27 June 2022)
Page navigation anchor for Socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19
Socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19
Vanashree Sexton, PhD student, University of Warwick, University of Warwick
Other Contributors:
Jeremy Dale, Professor of Primary Care, University of Warwick

Sarah Hillman, Clinical lecturer – General Practice, University of Warwick

Eleanor Hoverd, PhD student & research nurse, University of Warwick

Helen Leach, Academic clinical fellow, University of Warwick

Becky MacGregor, Academic clinical fellow, University of Warwick

Bethany McLoughlin, PhD student, University of Warwick

Armina Paule, PhD student, University of Warwick

Helen Atherton, Associate Professor

Zakia Shariff, Research associate, University of Warwick

Rachel Spencer, Associate clinical professor, University of Warwick

Nicky Thomas, PhD student, University of Warwick

Daniela Valdes, Health Executive & PhD student, University of Warwick

Eleanor Watson, Research associate, University of Warwick

Sachintha Weerasingha Navarathnage, Visiting research fellow, University of Warwick
We read with interest the paper by Ip et al. exploring socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19.¹While we agree with the importance of this topic, the study has significant weaknesses that limit its validity.

We felt it should have been clear from the title onwards that the study is about participant reported help seeking associated with educational attainment. The latter is a poor indicator of socioeconomic status,² whereas a measure, such as the “Index of Multiple Deprivation” (IMD)³ that considers several factors that contribute to socioeconomic status would have been more appropriate.

Participant recruitment was conducted through a ‘Market Research Participant Recruitment agency’.⁴ The authors state that participant screening was conducted by the company based on symptoms relating to bowel cancer. However, they do not report in this paper the symptoms that the chosen participants were reported as having, the duration of these symptoms and the subsequent diagnosis (and if it was indeed bowel cancer). The only indication of their symptoms was provided in the quote captions; however, some of these were non-specific, such as “extreme tiredness”, that are not in themselves necessarily indicative of colorectal cancer. Details of the inclusion criteria that were used to identify participants should have been reported, together with a...
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We read with interest the paper by Ip et al. exploring socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19.¹While we agree with the importance of this topic, the study has significant weaknesses that limit its validity.

We felt it should have been clear from the title onwards that the study is about participant reported help seeking associated with educational attainment. The latter is a poor indicator of socioeconomic status,² whereas a measure, such as the “Index of Multiple Deprivation” (IMD)³ that considers several factors that contribute to socioeconomic status would have been more appropriate.

Participant recruitment was conducted through a ‘Market Research Participant Recruitment agency’.⁴ The authors state that participant screening was conducted by the company based on symptoms relating to bowel cancer. However, they do not report in this paper the symptoms that the chosen participants were reported as having, the duration of these symptoms and the subsequent diagnosis (and if it was indeed bowel cancer). The only indication of their symptoms was provided in the quote captions; however, some of these were non-specific, such as “extreme tiredness”, that are not in themselves necessarily indicative of colorectal cancer. Details of the inclusion criteria that were used to identify participants should have been reported, together with any eligibility checks undertaken.

We note that sadly the patient contributor died during the study. It would have been helpful to understand the extent of their involvement in the research design or methods as this detail was missing.

Some of the conclusions and recommendations are not relevant to the findings reported; for example, the recommendation to “ensure infection control measures for COVID (and wider) are overt and embedded into NHS services” is unrelated to the aims of the study.

Finally, it is regrettable that this study did not include general practices or their patients in this study.

As such, we feel that this paper’s conclusions and recommendations should be regarded with considerable caution.

References
1. Ip A, Black G, Vindrola-Padros C et al. Socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19: a UK-wide qualitative interview study of patient experiences in primary care. Br J Gen Pract 2022: BJGP.2021.0644. doi:10.3399/BJGP.2021.0644
2. Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey Smith G. Indicators of socioeconomic position (part 1). J Epidemiol Community Health 2006;60(1):7-12.
3. MHCLG. Indices of Multiple Deprivation (IMD) 2019: Ministry of Housing, Communities and Local Government; 2019. Available from: https://data-communities.opendata.arcgis.com/datasets/5e1c399d787e48c0902e5fe4fc1ccfe3/about
4. SAROS Market Research Participant Recruitment Agency. Available from: www.sarosresearch.com.
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Competing Interests: None declared.