Patient symptom experience prior to a diagnosis of oesophageal or gastric cancer: a multi-methods study

Abstract

BackgroundLate stage diagnosis of oesophageal and gastric cancer is common, which limits treatment options and contributes to poor survival.AimTo explore patients' understanding, experience and presentation of symptoms before a diagnosis of oesophageal or gastric cancer.Design & settingBetween May 2016 and October 2017, all patients newly diagnosed with oesophageal or gastric cancer were identified at weekly multidisciplinary team meetings at two large hospitals in England. A total of 321 patients were invited to participate in a survey and secondary care medical record review; 127 (40%) participants responded (102 patients had oesophageal cancer and 25 had gastric cancer). Of these, 26 participated in an additional face-to-face interview.MethodSurvey and medical record data were analysed descriptively. Interviews were analysed using thematic analysis, informed by the Model of Pathways to Treatment.ResultsParticipants experienced multiple symptoms before diagnosis. The most common symptom associated with oesophageal cancer was dysphagia (n = 66, 65%); for gastric cancer, fatigue or tiredness (n = 20, 80%) was the most common symptom. Understanding of heartburn, reflux and indigestion, and associated symptoms differed between participants and often contrasted with clinical perspectives. Bodily changes attributed to personal and/or lifestyle factors were self-managed, with presentation to primary care prompted when symptoms persisted, worsened, or impacted daily life, or were notably severe or unusual. Participants rarely presented all symptoms at the initial consultation.ConclusionThe patient interval may be lengthened by misinterpretation of key terms, such as heartburn, or misattribution or non-recognition of important bodily changes. Clearly defined symptom awareness messages may encourage earlier help-seeking, while eliciting symptom experience and meanings in primary care consultations could prompt earlier referral and diagnosis.

The Lived Experiences of Esophageal Cancer Patients With The Concept of Uncovering Pathways to Seeking Treatment and Follow-Up: A Qualitative Study in Arsi Zone, Oromia, Ethiopia

“…In this study, experiences of survival with EC were designated as problems associated with food intakes, treatment side effects, reduced quality of life, psychological and physical impairments. The nding is in line with studies that recounted experiences of severe malnutrition, a sense of despair, and lack of psychological support among cancer patients (1,2). Studies have shown that the local effect of the tumor itself, host response, hypermetabolism, impaired organ function, therapy-related symptoms, and radiation enteritis results in a high prevalence of malnutrition among patients who undergo palliative cancer care (31)(32)(33).…”

“…In this study, EC patients experienced various vague gastrointestinal disturbances and advanced symptoms characterized by dysphagia and weight loss but none of the early GI disturbances were considered as the symptoms that are associated with esophageal cancer. A previous study demonstrated the experience of imprecise early symptoms among EC patients (1). Failure to associate the minor symptoms with E C maybe because of the similarities of such symptoms to non-cancer conditions at the early stages of the illness (21).…”

“…Esophageal cancer(EC) patients often experience several gastrointestinal (GI) symptoms (1), undergo invasive investigations, suffer from fear of being diagnosed with cancer (2). Furthermore, studies demonstrated multifaceted challenges including reduced physical activity, economic constraints (2,3), loss of appetite, anxiety, and depression (4).…”

The Pathways to Seeking Treatment, Diagnose and Follow Up of Esophageal Cancer Patients in Arsi Zone, Oromia, Ethiopia: Qualitative Phenomenological Study

“…However, except for dysphagia, none of the GI disturbances were considered as the symptoms that are associated with esophageal cancer. A previous study demonstrated the experience of imprecise early symptoms among EC patients (1). Failure to associate the minor symptoms with E C maybe because of the similarities of such symptoms to non-cancer conditions at the early stages of the illness (24).…”

A Predictive Nomogram for Early Death of Metastatic Gastric Cancer: A Retrospective Study in the SEER Database and China

“…Gastric cancer remains one of the most common malignancies all over the world, particularly in Asia 1 - 3 . Most patients are diagnosed with advanced stages on account of unspecific symptoms 4 , 5 . There are still no curable treatments but only approved treatments like chemotherapy and immunotherapy for metastatic gastric cancer patients currently 6 .…”