The SPOtting Cancer among Comorbidities (SPOCC) programme. Supporting clinical decision making in patients with symptoms of cancer and pre-existing conditions.

Research question How can patient and health professional decision making in patients with symptoms of cancer and with pre-existing conditions be optimized for reducing diagnostic delay? Background Cancer accounts for 35% of avoidable deaths in England and Wales. Concurrent health conditions are associated with reduced cancer survival, partly attributable to delayed diagnosis.

There is sparse information on which comorbidities have an impact for which cancers, the mechanisms and points in the diagnostic pathway and that impact is manifest. This lack of information does not allow workable interventions to be delivered.

Our recent review identified a number of priority areas for research which we will address in this programme of work to further produce specific interventions.

Aims and Objectives We aim to optimise patient and health professional decision making in general practice patients with symptoms of possible cancer and with pre-existing conditions.

Objectives include: quantification of the impact of pre-existing conditions on timely presentation, investigation and diagnosis to understand the source of any disparities; quantification of the predictive value of symptoms of cancer in these patients; the development and piloting of an intervention aimed at reducing diagnostic delay in cancer diagnosis for these patients; and the economic exploration of the likely range of the interventions effectiveness and cost-effectiveness.

Methods Six inter-related work-packages (WP).

WP1(Years 1-2): Investigation of the impact of comorbidities on the diagnostic process using linked data from primary care (CPRD), National Cancer Registration and Analysis Service (NCRAS), Hospital Episode Statistics, and Cancer Patient Experience Survey.

WP2(Y1-Y3): Investigation of patient, GP and nurse experiences and perceptions of decision making for cancer symptoms in the presence of pre-existing conditions through interviews with 60-80 patients, 15 GPs and 15 nurses analysed using a critical realist perspective.

WP3(Y2-Y3): Quantification of the impact of comorbidity on patient help-seeking and healthcare provider's attitudes on investigations through online vignette studies with 6000 patients, 800 GPs and 800 nurses.

WP4(Y2-Y3): Quantification of risk of selected cancers in symptomatic patients with pre-existing conditions through case-control studies using linked CPRD and NCRAS data.

WP5(Y3-Y5): Development of an intervention for improving timeliness of investigation of patients with co-morbidities and symptoms of cancer based on MRC Framework for Complex Interventions and Intervention Mapping, and feasibility testing in 8 GP practices (240 patients).

WP6(Y4-Y5): Development of a decision analytic model to explore the cost-effectiveness of the intervention and to extrapolate early diagnosis to the longer-term.

Anticipated Impact and Dissemination We anticipate the findings will change UK clinical guidelines, improve referral to secondary care and directly impact patient survival.

Findings should help to reduce the estimated 10,000 lives lost every year through late diagnosis and directly support the NHS target of 75% of cancers being diagnosed at early stage by 2028.

Dissemination activities aim to reach patients with long term conditions, those involved in their clinical care, charities, academics, policy makers, and the public and will include co-produced plain language evidence summaries, a stakeholder event, academic publications, conference presentations and dissemination through website, blogs, social media, and our multiple and extensive networks.