Covid -19; Cancer attitudes and Behaviour Study

Background: The impact of COVID-19 on UK public attitudes towards cancer is likely to be considerable, translating in to impact on the NHS from delayed referrals, missed screening and later-stage cancer diagnosis. Aim: To generate rapid evidence based on public views/response, informaing public health interventions to encourage timely symptom presentation, screening engagement and cancer- related health behaviours in the wake of the panedmic. Design: Prospective mixed-methods cohort study in the UK population. Methods: During June-August 2020, and again six months later, we will conduct a UK-Wide population survey of adults aged 18+ measuring attitudes and behaviour in the domains of cancer symptom presentation, screening, smoking, alcohol, diet and physical activity. We will sample from established online cohorts, supplemented with social media recruitment. Qualitative interviews will be conducted with survey participants to understand the contextual influences on cancer attitudes and behaviour. Using existing linked data, we will assess primary care referrals and investigations for suspected cancer symptoms, screening, smoking cessation and number/stage of new cancers diagnosed in the Welsh cohort. Analysis: Multivariable modelling will be used to assess determinants of symptom presentation (primary analysis), screening and health behaviours, and to identify longitudinal predictors of health service use and cancer outcomes. Qualitative data will be analysed thematically, with triangulation of data sources. Outputs: We will provide rapid recommendations to drive tailored public health initiatives for cancer early detection and prevention in the pandemic recovery period. Longer-term, the study will lay the foundations for assessing policy impact in response to future global health threats.