Study explores why patients skip appointments for suspected cancer

Men, the elderly and people from deprived areas are among the patients most likely to miss an urgent referral appointment for suspected cancer, a study led by the University of York has found.

The study, funded by Yorkshire Cancer Research, involved researchers interviewing GPs and patients who had missed their appointment in order to understand the factors that contributed to their non-attendance.

The researchers found that some patients were let down by flaws in the appointment system and in some cases referral letters arrived too late due to the fast-paced nature of the referral process.


For others, more complicated factors were involved, including patients’ fear of the diagnosis or procedures they may have to undergo, with anxiety leading to hesitation and avoidance.

Patients from deprived areas also reported struggling to negotiate time away from work and finding the money for transport costs as well as complications arising from other health problems and wider life struggles.

Earlier in the year, research by the same authors found that around 5-7 percent of patients miss or cancel urgent referrals. Of the patients who skipped their appointment, those who later discovered they had cancer were 12 percent more likely to die within a year of diagnosis.

The authors of the study say that more support is needed for patients at risk of non-attendance.

Concerns about procedures

Dr. Peter Knapp from the Department of Health Sciences at the University of York and Hull York Medical School, said: “Non-attendance at urgent referral appointments for suspected cancer involves a minority of patients, but happens in somewhat predictable groups.

“To understand these issues, we obtained in-depth accounts of the experiences of both patients and GPs. We found multiple and complex reasons why patients don’t attend. For example, patients with suspected gastrointestinal cancer were among the most likely to skip an appointment—this may be due to concerns about unpleasant or embarrassing procedures or wanting to protect themselves from the stress of a potential diagnosis in the face of significant other demands.

“Our research suggests that more could be done to identify individuals at risk of non-attendance and offer extra support.”

Challenging life circumstances

Dr. Laura Jefferson from the Department of Health Sciences at the University of York added: “Some of our findings relate to difficulties in the system which may be relatively straightforward to overcome, such as streamlining timings of bookings and helping patients navigate the booking system (particularly elderly patients and those from deprived backgrounds, who struggle with this more).

“However, other issues were more complex and related to patients’ beliefs around the referral—for example, some didn’t understand they were being referred for suspected cancer, or challenging life circumstances meant attending a referral appointment was not a priority.

“Some patients expressed feelings of guilt and concern that non-attendance would be noted as a ‘black mark’ on their health records.”


The NHS’s “Two Week Wait” policy aims to ensure that a consultant sees patients with suspected cancer within two weeks of an urgent GP referral.

More than 1.9 million Two Week Wait referrals are made annually. While almost half of all cancers are identified through this route, for 92 percent of patients referral will exclude cancer.

Although there is more awareness around the issues of ignored cancer screening invitations and the waste of resources incurred from missed GP appointments, the research team is the first to focus on non-attendance of symptomatic patients referred due to suspected cancer.

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