Background
Aims and objectives
Methods
Participants
Recruitment and sampling
Interviews
Analysis
Results
Patient interviews
Sex/ Age range | FPC Diagnosis | Mode of Detection | Time Interval FPC /SPC | SPC Diagnosis | Mode of Detection | Self-Reported Co-morbidities/ Treatment Complications | |
---|---|---|---|---|---|---|---|
1★ | M, 70–74 | Bowel | GP consult | 20 years | Prostate | Incidental | Atrial fibrillation, B12 deficiency |
2 | F / 65–69 | Bowel | Incidental | 19 years | Breast | Nurse Consult | Ileostomy problems for 7 years+, C. difficile |
3 | F / 40–44 | Cervical | Screening | 15 years | Breast | GP consult | RTx damage to bowel, early menopause |
4 | M / 60–64 | Kidney | GP consult | 24 years | Prostate | GP consult | Cirrhosis, E. coli |
5 | F / 60–64 | Melanoma | GP consult | 16 years | Bowel | GP consult | High blood pressure |
6 | F / 70–74 | Breast | GP consult | 3 years | Bowel | Screening | High blood pressure, seroma |
7(8) | F / 70–74 | Breast | Incidental | 34 years | Bowel | GP consult | Peripheral neuropathy, asthma |
8(9) | F / 65–69 | Pancreatic | GP consult | 10 years | Breast | Screening | Chronic fatigue syndrome, fibromyalgia |
9(11) | F / 70–74 | Breast | Screening | 7 years | Lung | GP non-cancer | Osteoporosis |
10(13) | F / 60–64 | Endometrial | GP consult | 20 years | Colorectal | GP consult | RTx damage, bladder problems, MRSA |
11(14) | F / 60–64 | Lymphoma | GP consult | 9 years | Lung | Incidental – via FPC | Arthritis |
12(15) | M / 70–74 | Larnyx | Incidental | 3 years | Prostate | GP consult | Back pain |
13(16) | M / 75–79 | Prostate | Diabetes check-up | 1 year | Lung | Incidental – via FPC | Diabetes, Macular degeneration |
14(17) | F / 75–79 | NHL | Incidental | 5 years | Bowel | Secondary care consult | Heart condition |
15(18) | F / 80–84 | NHL | Emergency | 5 years | Breast | Breast clinic | COPD |
16(19) | F / 60–64 | Breast | Screening | 6 years | Colon | GP consult | Underactive thyroid, peripheral neuropathy |
17(20) | F / 60–64 | Melanoma | GP consult | 21 years | Breast | Screening | Restless leg syndrome, IBS, depression |
18(21) | F / 45–49 | Lymphoma | GP consult | 8 years | Breast | GP consult | Early menopause |
19(22) | M / 65–69 | Bladder | GP consult | 1 year | Prostate | Incidental – via FPC | Diabetes, high blood pressure, high cholesterol |
20(23) | F / 50–54 | Melanoma | GP consult | 22 years | Breast, then Thyroid | Incidental | Thyroid problems |
Themes | Supporting quotes |
---|---|
Awareness of SPC | “Interviewer: Did anybody ever mention to you about the risk of a second primary cancer or was it ever on your mind…? P16: Never, no, no, I didn’t think at all. “P13 “I just completely forgot. […], It’s because of having no problems with the...after the first one that I just forgot all about it, I really did.” P14 |
Symptom appraisal and help-seeking | “…Very tired, […] I’m sitting at nine o’clock sleeping, and I thought this is not normal. So, I went to see my GP and they took blood tests and then sent me for an X-ray, and that’s when they discovered that I had a tumour in my lung.” P1 “I’m probably less inclined to just sit on something and not go to the GP, as a result.” P18 |
Pathways to diagnosis of SPC | “I will be absolutely frank, I never thought, oh goodness, that’s the second time I’ve had cancer […].[…]. That wasn’t the first thing that came to my mind. I would say it took me quite a long time to kind of clock that actually, that means I’ve had cancer twice. It just wasn’t top of my list of priorities to be perfectly honest.” P5 |
Navigating the healthcare system | “I go to that urology clinic, it’s packed, it’s absolutely mobbed. It’s a really busy place […]. When I went to the kidney clinic, when I first got it, there was only me, you know, there wasn’t a big queue or nothing.” P4 |
Impact of SPC | “Interviewer: Have they ever mentioned your first cancer, the melanoma or was that kind of never discussed? P5: Not really discussed, I mean they knew, but it wasn’t linked and nobody kind of majored on it.” P5 |
Cumulative burden of SPC | “I thought, oh, no, here we go again.” P8 |
Awareness of SPC
“It was totally unexpected because I didn’t realise that you could have two cancers running at the same time.” P11
Symptom appraisal and help-seeking
“..If this was a completely isolated, never had breast cancer before, I think I would have reacted the same way. I think I would have had that feeling of, something’s not quite right here.” P16
“But, men don’t bother as much as, […] I don’t think.” P1
“The last thing with my history is to leave it.” P2
“I noticed the lump. And I was due to see the nurse a few days later to take bloods. And I said to her, look what do you think? And she said, I think you should be seeing the doctor. […] It was a doctor I’d never met before […] But she said, right I’m referring you straight to the breast clinic at the [HOSPITAL].” P2
“I think because I’ve had cancer before that when I get appointments in the hospital they’re pretty quick.” P4
Pathways to diagnosis of SPC
“So I reacted quite quickly and I got an appointment with my GP and my GP was excellent. They did an internal […] and she sent me for an urgent colonoscopy and I got that the following week.” P16
“I didn’t have time to worry about it ‘cause it was always… my ileostomy [as a result of first primary bowel cancer] that takes over. And I have to just live my life to keep that working properly without worrying whether my breast cancer is going to come back again or not.” P2
Navigating the healthcare system
“But as I say, I think because of previous experiences and knowing the system and everything, I was able to just rationalise it pretty quickly and say, this is stupid. […] I could apply colorectal to the problem, but obviously it wasn’t exactly the same. But it gave me, sort of, insight and, you know…so that I wasn’t so worried […].” P2
“I feel really disappointed […] I think it’s just changing times, isn’t it? […] When I was going through all the pancreas things, for a long time after, my GP was amazing. She insisted I went to see her. […] This GP I’ve got now hasn’t even acknowledged that I’ve had breast cancer.” P8
Impact of SPC
“They operated the next day, and they took out a tumour which turned out to be a Dukes’ A. […] I convalesced for about two weeks and then I went back to work. […] It was just straightforward, in for the operation, and I had a stoma, and it wasn’t too bad, you know. It wasn’t too bad because I never had chemo, this time.” P14
“No, they’re separate events, definitely. I definitely feel they’re separate events but I still feel…I still worry about the pancreatic cancer. That’s never, ever left me, that worrying about that. Yes, I would say I am worried about the breast cancer but, yes, it’s two different worries, isn’t it?” P8
“No, it’s still just a massive blow when you’re told and you still go through the same shock, horror, why me, and surely this can’t be happening, not for a second time.” P15
“I thought, you know, you’re quite blasé about it, you’re not expecting to get a second one. That really takes the wind from you. […] Quite devastating.” P10
“It does make you more aware of everything, you know. […] It does…which I wasn’t a worried person before, and it does make me more, everything now, oh gosh, what’s this, you know.” P6
“I try to protect them from it because I felt that they’d had enough. Yes, in some ways I feel like it’s been…if this had been the first time…this second cancer had been the first time I had had cancer, I think that everybody’s attitudes would be a lot different.” P8
“No. I mean, it’s made me think about it now, now that I know, you know, I’m maybe a bit paranoid if you like, oh, I’ve had it twice, is it going to come back again, you know.” P17
GP interviews
GP identifier | Years’ experience | Health Board/ relevant practice characteristics |
---|---|---|
GP 1 | Under 5 years | Lothian, large practice, 6 GPs |
GP 2 | 21–25 years | Tayside, large urban practice |
GP 3 | Unknown | Lothian, large semi-rural practice |
GP 4 | 16–20 years | Lothian, small, semi-rural, some deprivation. |
GP 5 | 21–25 years | Lothian, urban practice |
GP 6 | 6–10 years | Tayside, small rural practice |
GP 7 | 31–35 years | Borders, mid-size practice, semi-rural |
Experience and knowledge of SPC
“First we would probably think, is this a recurrence of the primary cancer [..], rather than a new diagnosis of another type of cancer.” GP6, 6–10 years’ experience
“I would say it’s very rare. I mean we might not even identify that they’ve had a previous cancer; it might not be relevant.” GP 1, Under 5 years’ experience
“It’s just a little lightbulb moment for everybody and, I guess, raising awareness of it... if nobody says anything out loud then it maybe just doesn’t occur to a lot of us.” GP2, 21–25 years’ experience
Decision-making and referrals
“I mean hopefully we refer people all fairly urgently” GP 7, 31–35 years’ experience
“So it’s more decided on presenting symptoms rather than what happened in the past.” GP3, unknown experience
“I mean I think the two are probably related; I think they have the same sort of impact upon people’s kind of psyche and things. So I mean I wouldn’t necessarily associate the causality between the two of them, but I think from the patient’s perspective, they’ve got cancer, it doesn’t really matter whether it’s one or two.” GP5, 21–25 years’ experience