A mixed-methods study of attendance for suspected cancer investigations in people with anxiety and/or depression: an observational case-control study and pilot work for a subsequent discrete choice preference study

What is the problem?

Having anxiety or depression does not increase someone’s chances of developing cancer. However, current research at Exeter shows that having anxiety or depression may mean they are more likely to be diagnosed following an emergency, and less likely to live for at least 30 days after a cancer diagnosis.

What are we planning?

We plan to find out if people with anxiety or depression are less likely to go to hospital appointments after referral for suspected cancer. Delaying cancertests may mean that their cancer could grow and spread before it is diagnosed. We are going to take two approaches that, together, will give us a deeper insight into whether, and how, anxiety or depression affects people when deciding to attend appointments for cancer tests. We will study the medical records of thousands of people (whose personal details are removed) who were referred for cancer testing in the year before they were diagnosed with cancer.

For each cancer type we will look at whether having anxiety or depression is associated with attending an initial referral appointment. We will test for different effects based on the types of symptoms that people report to their family doctor. We will compare cancer outcomes between people who did and did not attend their first appointment for cancer testing to see if their cancer has spread and how long they live. This will show if these outcomes vary for people with anxiety or depression. This work will allow us to draw conclusions about whether people with anxiety or depression are less likely to attend their first referral appointment for cancer testing compared with people without these conditions.

Alongside this work, we will carry out in-depth interviews and workshopsto get a deeper understanding of the perspectives, needs, and priorities of people with or without anxiety or depression referred for cancer testing. The interviews will be informed by the medical records study, published studies, and our patient and public engagement partners. The findings from the in-depth interviews may suggest new analyses forthe medical records study. In this way, the two pieces of work will refine one another, resulting in a deeper insight into the issues than can be obtained by either approach alone.

Where will this lead?

We will draw up a list of things that are important to peoplewith anxiety or depression when they receive a letter asking them to attend their first hospital appointment for cancer testing. Our study will lay the foundations for future work that will show how we can make the referral process easier for people with anxiety or depression and increase their chances of attending their appointments, improving their experiences, and cancer outcomes. 

Amount awarded: £95,989