Risk factors for delayed presentation and referral of symptomatic cancer: evidence for common cancers

Abstract

Background:It has been suggested that the known poorer survival from cancer in the United Kingdom, compared with other European countries, can be attributed to more advanced cancer stage at presentation. There is, therefore, a need to understand the diagnostic process, and to ascertain the risk factors for increased time to presentation.Methods:We report the results from two worldwide systematic reviews of the literature on patient-mediated and practitioner-mediated delays, identifying the factors that may influence these.Results:Across cancer sites, non-recognition of symptom seriousness is the main patient-mediated factor resulting in increased time to presentation. There is strong evidence of an association between older age and patient delay for breast cancer, between lower socio-economic status and delay for upper gastrointestinal and urological cancers and between lower education level and delay for breast and colorectal cancers. Fear of cancer is a contributor to delayed presentation, while sanctioning of help seeking by others can be a powerful mediator of reduced time to presentation. For practitioner delay, ‘misdiagnosis' occurring either through treating patients symptomatically or relating symptoms to a health problem other than cancer, was an important theme across cancer sites. For some cancers, this could also be linked to inadequate patient examination, use of inappropriate tests or failing to follow-up negative or inconclusive test results.Conclusion:Having sought help for potential cancer symptoms, it is therefore important that practitioners recognise these symptoms, and examine, investigate and refer appropriately.

Non-Practice of Breast Self Examination and Marital Status are Associated with Delayed Presentation with Breast Cancer

“…Most said the lump was not present all the time and could be felt on and off, raising doubts as to whether there was a lump in the first place and strengthening the belief that the lump was benign. Non-recognition of symptom seriousness is a common theme in patient delay (Burgess et al, 2001;McLeod et al, 2009;Lam et al, 2009). Absence of pain is usually assumed to indicate benign disease and therefore does not warrant a visit to the doctor (Burgess et al, 2001;McLeod et al, 2009;Lam et al, 2009).…”

“…Non-recognition of symptom seriousness is a common theme in patient delay (Burgess et al, 2001;McLeod et al, 2009;Lam et al, 2009). Absence of pain is usually assumed to indicate benign disease and therefore does not warrant a visit to the doctor (Burgess et al, 2001;McLeod et al, 2009;Lam et al, 2009). All this can be avoided if women have better knowledge of signs and symptoms of breast cancer, perform breast self examination correctly and have proactive help-seeking behavior.…”

Cancer patients need better care, not just more technology

“…Everywhere, a lack of education and awareness, affordability and availability of treatment are the main factors preventing patients from being diagnosed early enough 7,8 . Given all this, it is alarming that many low-and middle-income countries are devoting more of their meagre cancer-care budgets to technology, especially through the private sector.…”

“…The core technology is electronics that stretch -elastronics -made from soft plastic circuits thinner than paper that can deform without tearing, biodegrade and even heal themselves (see go.nature.com/2vtutzz). Elastronic sensors respond to touch, pressure, temperature, humidity and light, as well as to chemical and biological signals [2][3][4][5][6][7][8][9][10] .…”

How potentially serious symptom changes are talked about and managed in COPD clinical review consultations: A micro-analysis

“…The possible influence of delays in diagnosis on survival and the risk factors for delay in patients with cancer have been the subject of considerable interest and controversy for many years (Macleod et al, 2009). Survival from cancer in the United Kingdom is poorer than that of other European countries, and it has been suggested that this can be attributed to more advanced disease stage at presentation (Cancer Research UK, 2009).…”