ORCA: Opportunities to Raise Cancer Awareness After Referral: Survey of Patient Views

In England, over 2 million patients are referred each year on urgent two-week wait (TWW) pathways to rule-out cancer of a single anatomical site. Referrals have increased by around 10% per year since 2015 (with the exception of 2020, due to the COVID-19 pandemic). The vast majority of those referred (93%) do not have cancer diagnosed. There is mounting evidence that patients who have previously experienced a symptom that after investigation turned out to be benign, often delay seeking help for subsequent symptoms. This is thought to occur because of over-reassurance from the previous 'all-clear' result leading to subsequent symptoms being interpreted as benign (extending the appraisal interval), concern about appearing hypochondriacal, not wanting to further bother the doctor or about the appropriate next actions. This is likely to be compounded by the impact of COVID-19 on help-seeking decisions and has implications for service provision. There may be scope to provide tailored support to those who are initially discharged without a cancer diagnosis to avoid missing cancers at other anatomical sites and to ensure subsequent cancers are diagnosed in a timely manner, at an early stage, or even prevented. For instance, patients could be offered information on common cancer signs, when/how to seek help for ongoing or new symptoms, facilitation to take part in cancer screening, and preventative advice. Indeed, referral for suspected cancer may be an under-utilised 'teachable moment' when people are more responsive and receptive to health information. There is currently a lack of support for those with a negative diagnosis after a TWW referral. Qualitative work indicates that there is currently no standardised approach to the information patients receive from healthcare professionals about future cancer risk or how to respond to new or recurring symptoms. It is important to assess feasibility and acceptability of interventions prior to evaluation of effectiveness. This allows implementation strategies to be incorporated into the design of interventions that will increase adoption and sustainment as well as being appropriate to the setting, providers and recipients. Yet at present it is not known what the feasibility and acceptability is of interventions linked to the TWW pathway. The objective of the proposed research is to obtain this information.

Inclusion criteria

• Adults >18 years old
• Referred through the two-week wait pathway for suspected cancer
• Received a negative diagnosis (i.e. informed of a 'ruling out of cancer' according to the new 28-day faster diagnosis standard) within the past 1-3 months

Exclusion criteria

• Adults who have been diagnosed with cancer
• Adults who have not yet been informed of their results from their urgent referral