Non-cancer diagnoses and their potential for missed opportunities in symptomatic cancer diagnosis: a mixed methods study

What is the problem?

Cancer can be difficult to diagnose, especially when its symptoms could be caused by other diseases. Family doctors might start with a non-cancer diagnosis that matches the symptoms. In people who are later diagnosed with cancer, we call these “interim” diagnoses. Sometimes interim diagnoses are good clinical practice, considering what was known at the time. Sometimes, they may be missed opportunities to test for cancer, leading to delayed diagnosis and poorer outcomes.

What are we planning?

Our research will help us to understand when interim diagnoses represent missed opportunities to diagnose cancer.
We will study the medical records of thousands of people whose personal details have been removed. We will look for patterns of interim diagnoses before a cancer diagnosis, and the consequences for patients. For example, are people more likely to be diagnosed after an emergency and less likely after being referred for urgent testing? Is their cancer more likely to have spread? Does it alter someone’s chances of living for at least one year after diagnosis? We will also explore the financial impacts of interim diagnoses for the NHS.

We will gain an in-depth understanding of interim diagnoses as possible missed opportunities from the perspectives of patients and healthcare providers. We will analyse existing interviews with patients and carry out new interviews with 40 healthcare professionals and non-clinical staff (for example receptionists) to find out:

(1) How do interim diagnoses happen, and how do they change over time?

(2) How are interim diagnoses recorded in the medical record, and why?

(3) What are the impacts of interim diagnoses on the chances that patients go back to their doctor and on their ongoing care?

(4) What could be done to reduce potential delays?

We will also explore what prompts healthcare professionals to move away from the interim diagnosis and consider cancer. This will help us to recognise situations where delays might occur and whether there are opportunities to reduce or avoid them.
The results will be shared at a consultation event with stakeholders, including patients and carers, healthcare professionals and policy makers. We will include groups that our research suggests are prone to these types of missed opportunities. Together, we will create a list of situations that could be the target for future interventions for reducing delays in cancer diagnosis.

Where will this lead?

We will follow-up this research with studies to develop and evaluate interventions to reduce the time from an interim non-cancer diagnosis to cancer diagnosis.

Amount awarded: £537,123