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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 and Katriina L Whitaker
British Journal of General Practice 2022; 72 (720): e472-e482. DOI: https://doi.org/10.3399/BJGP.2021.0644
Athena Ip
School of Health Sciences, University of Surrey, Guildford.
Roles: Research fellow
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Georgia Black
Department of Applied Health Research, University College London, London.
Roles: THIS Institute postdoctoral fellow and principal research fellow
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Cecilia Vindrola-Padros
Department of Targeted Intervention, University College London, London.
Roles: Senior research fellow and director of RREAL
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Claire Taylor
London North West University Healthcare NHS Trust, London.
Roles: Macmillan nurse consultant
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Sophie Otter
Royal Surrey County Hospital NHS Foundation Trust, Guildford.
Roles: Consultant clinical oncologist
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Madeleine Hewish
Royal Surrey County Hospital NHS Foundation Trust, Guildford.
Roles: Consultant medical oncologist
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Afsana Bhuiya
University College London Hospitals NHS Foundation Trust, London.
Roles: Cancer GP lead
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Julie Callin
Bart’s Health NHS Trust, The Royal Hospital, London.
Roles: Patient representative
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Angela Wong
Bart’s Health NHS Trust, The Royal Hospital, London.
Roles: Consultant gastroenterologist
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Michael Machesney
Bart’s Health NHS Trust, The Royal Hospital, London.
Roles: Consultant general surgeon
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Naomi J Fulop
Department of Applied Health Research, University College London, London.
Roles: Professor of healthcare organisation and management
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Cath Taylor
School of Health Sciences, University of Surrey, Guildford.
Roles: Psychol
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Katriina L Whitaker
School of Health Sciences, University of Surrey, Guildford.
Roles: Reader in cancer care
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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...

    Show More

    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.

    Show Less
    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-19.1 While 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-19.1 While 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.

    Show Less
    Competing Interests: None declared.
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British Journal of General Practice: 72 (720)
British Journal of General Practice
Vol. 72, Issue 720
July 2022
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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
British Journal of General Practice 2022; 72 (720): e472-e482. DOI: 10.3399/BJGP.2021.0644

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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
British Journal of General Practice 2022; 72 (720): e472-e482. DOI: 10.3399/BJGP.2021.0644
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Keywords

  • colorectal cancer
  • COVID-19
  • inequalities
  • primary care
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  • qualitative research

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  • Primary care practice and cancer suspicion during the first three COVID-19 lockdowns in the UK: a qualitative study
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