Abstract
Failure to recognize symptoms which signal cancer may delay contact with the medical care system, thus decreasing the chances of diagnosis at an early stage of disease. We investigated the determinants of cancer symptom recognition and delay in seeking medical care in a population-based sample of 625 newly diagnosed lung, breast and colorectal cancer patients. Although the majority (79.5%) of patients reported noticing symptoms prior to diagnosis, one quarter of these patients (24.7%) delayed longer than three months in seeking medical care. Contrary to the findings of research based on clinic samples, logistic regression analysis revealed that no demographic or social support factors were predictive of symptom recognition or delay, with the exception that older colorectal cancer patients were less likely to notice symptoms, but also less likely to delay. Lung and colorectal patients diagnosed with advanced disease were more likely to notice symptoms than patients with local disease.
Results of a content analysis of patients' remarks indicate that breast cancer patients were significantly more likely than lung or colorectal cancer patients to attribute their symptoms to cancer (p<.001). Symptoms common to lung and colorectal cancer appear to be attributed to other, less serious causes. Given the lack of demographic predictors of symptom recognition and delay in seeking care, we suggest that education programs address risk groups for specific cancers, rather than the general public as a whole, grouping together all cancers and cancer symptomatology.
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References
American Cancer Society: Cancer Facts and Figures-1988. New York, NY:American Cancer Society, Inc. 1988.
Mechanic, D: The epidemiology of illness behavior and its relationship to physical and psychological distress. In D. Mechanic (Ed.),Symptoms, Illness Behavior, and Help-Seeking. New York: Prodist, 1982, pp 1–24.
Leventhal, EA, & Prohaska, T, Age, symptom interpretation, and health behavior.J Am Geriatr Soc, 34: 185–191, 1986.
Berkanovic, E, Seeking care for cancer relevant symptoms.J Chronic Dis, 35: 727–734, 1982.
Pack, GT & Gallo, JS, The culpability for delay in the treatment of cancer.Am J Cancer, 33: 443–462, 1938.
Antonovsky, A & Hartman, H, Delay in the detection of cancer: A review of the literature.Health Educ Monogr, 2: 98–128, 1974.
Cobb, B, Clark, RL, McGuire, C & Howe, CD, Patient responsible delay of treatment in cancer: A social psychological study.Cancer, 7: 920–926, 1954.
Henderson, JG, Wittkower, ED & Lougheed, MN, A psychiatric investigation of the delay factor in patient to doctor presentation in cancer.J Psychosom Res, 3: 27–41, 1958.
Goldsen, RK, Patient delay in seeking cancer diagnosis: Behavioral aspects.J Chronic Dis, 16: 427–436, 1963.
Hackett, TP, Cassem, NH, & Raker, JW, Patient delay in cancer.N Engl J Med, 289(1): 14–20, 1973.
Worden, JW & Weisman, AD, Psychosocial components of lagtime in cancer diagnosis.J Psychosom Res, 19:69–79, 1975.
MacArthur, C & Smith, A, Factors associated with speed of diagnosis, referral, and treatment in colorectal cancer.J Epidemiol Community Health, 38: 122–126, 1984.
Samet, JM, Hunt, WC, Lerchen, ML, Goodwin, JS, Delay in seeking care for cancer symptoms: a population-based study of elderly New Mexicans.J Natl Cancer Inst, 80: 432–438, 1988.
Mor, V., Guadagnoli, E., Masterson-Allen, S., et al., The Brown University cancer and aging study: A statewide cooperative investigation.RI Med J, 71: 379–386, 1988.
Wool, MS: Understanding denial in cancer patients. In RJ Goldberg (Ed.),Psychiatric Aspects of Cancer. Basil: Karger, 1988, pp 37–53.
Wool, MS, Extreme denial in breast cancer patients and capacity for object relations.Psychother Psychosom, 46: 196–204, 1986.
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Vincent Mor, Ph.D. is Director at the Brown University Center for Gerontology and Health Care Research; Susan Masterson-Allen, M.A. is Sr. Project Coordinator at the Brown University Center for Gerontology and Health Care Research; Richard Goldberg, M.D. is Psychiatrist-in-Chief in the Department of Psychiatry, Rhode Island Hospital; Edward Guadagnoli, Ph.D. is Assistant Professor at the Brown University Center for Gerontology and Health Care Research; Margaret S. Wool, Ph.D. is Clinical Assistant Professor in the Department of Psychiatry, Rhode Island Hospital
Supported in part by grant number CA 36560 from the National Cancer Institute
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Mor, V., Masterson-Allen, S., Goldberg, R. et al. Pre-diagnostic symptom recognition and help seeking among cancer patients. J Community Health 15, 253–266 (1990). https://doi.org/10.1007/BF01350291
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DOI: https://doi.org/10.1007/BF01350291