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Article History

Accepted: 28 June 2022

First Online: 22 July 2022

Declarations

:

: This paper presents independent research commissioned by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research Programme, funded by the Department of Health and Social Care (study reference 14/46/19). NJF is an NIHR Senior Investigator. CVP and NJF are in part supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Bart’s Health NHS Trust. KPJ was funded by UCLPartners Academic Health Science Network as Cancer Programme Director and as Chief Medical Officer of London Cancer from 2011 to 2016 when the latter funding reverted to the National Cancer Vanguard programme held locally by the University College London Hospitals (UCLH) Cancer Collaborative on behalf of all acute provider trusts in North Central and North East London and West Essex. London Cancer received funding from National Health Service (NHS) England (London Region). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

: Besides the funding received by authors’ institutions from the NIHR for this work as mentioned in the ‘Funding’ section, KPJ was Chief Medical Officer for London Cancer during the period of the changes described in this paper. MT has received payment or honoraria for teaching and educational events from Boston Scientific Corporation, grants from the NIHR paid to her institution, and payment for expert testimony as an external clinical advisor from the Parliamentary ombudsman for health services, and is a Trustee of Kidney Cancer UK and Governor of Royal Free London NHS Foundation Trust. DCS has received grants or contracts from CRUK for the ACED project, regarding research into early detection of cancer (A27859), and held a director role in the Greater Manchester Cancer Alliance (a NHS England cancer alliance). NJF has received grants or contracts from The Health Foundation and THIS Institute paid to her institution, and holds the role of Non-Executive Director, Whittington Health NHS Trust, and is a Trustee of Health Services Research UK. AIGR is also a Trustee of Health Services Research UK. All other authors have nothing to disclose.

: The datasets generated and analysed during the current study are not shareable due to confidentiality.

: This study was reviewed and approved by the Proportionate Review Subcommittee of the NRES Committee Yorkshire and the Humber—Leeds (reference number 15/YH/0359).

: CSC led the analysis, design and interpretation and wrote the first draft of the paper; MMe, AIGR, CVP, DCS, SM, NJF and RMH conceived of the initial study design; MMe, SM and RMH assisted in the analysis; AIGR, CVP, SM, NJF and RMH interpreted the results; RB, AB, JH, MMu, KPJ and MT provided clinical and health services input; CL provided health services input; NJF led the overall RESPECT-21 mixed methods programme of research. All authors contributed to the drafting of the paper and approved the final version.

: Not applicable as this analysis used anonymised routinely collected data.

: Not applicable.

: Analysis code can be made available on request to the authors.