Exeter Collaboration for Academic Primary Care (APEx) Blog
Exeter Collaboration for Academic Primary Care (APEx) Blog
Posted by ma403
6 May 2026
Every now and again you do a piece of work that you think is really important, but the journals just won’t bite. This happened to me 11 years ago with a paper where we were looking at the health and healthcare experiences of gay, lesbian and bisexual patients. This paper went to all the big journals and got rejected by them all. It did get published eventually here and has gone on to be cited nearly 200 times. More recently the flagship paper from the early work in our SPOtting Cancer among Comorbidities (SPOCC) programme has had a similar fate. After over 2-years of hawking it around the big, and not so big journals, it has finally been published here and my hopes for impact and citations are even higher for this paper.
One of the reasons that we found it so hard to get this paper published may be that it challenges the perceived wisdom that pre-existing conditions are bad when it comes to diagnosing cancer. In fact we found quite the opposite. It was those patients without pre-existing conditions that were most likely to be diagnosed with late stage disease. Changing the narrative on a subject can be hard and people don’t always want to be challenged. With a current NHS policy focussed on prevention and identifying those patients most at risk of poor health outcomes, we need to be careful we don’t design out the forgotten fit. If primary care focuses too much on those with long-term conditions we could well see more issues diagnosing cancer in those who don’t have such conditions.
Another reason that might have hindered us in getting this work published is that what we did is not simple. We did not just consider stage at diagnosis as an outcome, but also whether people were diagnosed as an emergency, or through an urgent suspected cancer referral, or whether they died within 30-days. The findings here were more nuanced, and nuance is always a hard sell. Those with a high morbidity burden were the most likely to be diagnosed as an emergency or die within 30 days of their diagnosis, but they were not followed by those with a medium or low morbidity burden, but by those who did not have long term conditions. This again indicates that the lack of long-term conditions is likely bad for diagnosing cancer. The high rate of emergencies and early death in those with a high morbidity burden may well reflect those conditions rather than the cancer. Cancer may have been found during an emergency admission for something else, or the burden or morbidity may make the cancer more consequential. We could have solved this complexity problem by publishing multiple papers, but actually the power of the analysis is in bringing the whole story together.
Only time will tell whether the work is well received, but I certainly believe it should be.
Finally, if you want to know more we are holding a series of webinars for people to find out more about the findings of SPOCC for non-academic audiences. The webinars are targeting different audiences; clinicians, patients and the public, policy and third sector, and commissioners of services. Sign up at the links below and do spread the word.
Clinicians – Tuesday 2 June 12:30 PM – 1:30 PM – https://www.eventbrite.com/e/1988073403066?aff=oddtdtcreator
Policy – Thursday 4 June 12:30 PM – 1:30 PM – https://www.eventbrite.com/e/1988553963435?aff=oddtdtcreator
Public & Patients – Tuesday 9 June 12:30 PM – 1:30 PM – https://www.eventbrite.com/e/1988554125921?aff=oddtdtcreator
Service Commissioners – Wednesday 10 June 12:30 PM – 1:30 PM – https://www.eventbrite.com/e/1988554386701?aff=oddtdtcreator
Wiering B, Mounce LTA, Price SJ, Shotter D, Valderas JM, Merriel SWD, Moore S, Farmer L, Wagner CV, Payne RA, Renzi C, Lyratzopoulos G, Hamilton W, Abel GA. The impact of morbidity burden on cancer diagnosis; a retrospective cohort study in England. Cancer Epidemiol. 2026 Feb 27;102:103027. doi: 10.1016/j.canep.2026.103027. Epub ahead of print. PMID: 41764785.