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Ip A, Black G, Vindrola-Padros C, Taylor C, Otter S, Hewish M, Bhuiya A, Callin J, Wong A, Machesney M, Fulop NJ, Taylor C, Whitaker KL. Socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19: a UK-wide qualitative interview study. Br J Gen Pract 2022; 72:e472-e482. [PMID: 35636968 PMCID: PMC9256043 DOI: 10.3399/bjgp.2021.0644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/24/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND COVID-19 has led to rapid changes in healthcare delivery, raising concern that these changes may exacerbate existing inequalities in patient outcomes. AIM To understand how patients' help-seeking experiences in primary care for colorectal cancer symptoms during COVID-19 were affected by their socioeconomic status (SES). DESIGN AND SETTING Qualitative semi-structured interviews with males and females across the UK, recruited using purposive sampling by SES. METHOD Interviews were carried out with 39 participants (20 higher SES; 19 lower SES) who contacted primary care about possible symptoms of colorectal cancer during COVID-19. Data were analysed using framework analysis followed by comparative thematic analysis to explore differences between groups. RESULTS Three themes were identified with differences between SES groups: 1) how people decided to seek medical help through appraisal of symptoms; 2) how people navigated services; and 3) impact of COVID-19 on how patients interacted with healthcare professionals. The lower SES group expressed uncertainty appraising symptoms and navigating services (in terms of new processes resulting from COVID-19 and worries about infection). There was also potential for increased disparity in diagnosis and management, with other methods of getting in touch (for example, email or 111) taken up more readily by higher SES patients. CONCLUSION The findings suggest that COVID-19 exacerbated disparities between higher and lower SES participants. This study raises awareness around challenges in help seeking in the context of the pandemic, which are likely to persist (post-COVID-19) as healthcare systems settle on new models of care (for example, digital). Recommendations are provided to reduce inequalities of care.
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Affiliation(s)
- Athena Ip
- School of Health Sciences, University of Surrey, Guildford
| | - Georgia Black
- Department of Applied Health Research, University College London, London
| | | | - Claire Taylor
- London North West University Healthcare NHS Trust, London
| | - Sophie Otter
- Royal Surrey County Hospital NHS Foundation Trust, Guildford
| | | | - Afsana Bhuiya
- University College London Hospitals NHS Foundation Trust, London
| | - Julie Callin
- Bart's Health NHS Trust, The Royal Hospital, London
| | - Angela Wong
- Bart's Health NHS Trust, The Royal Hospital, London
| | | | - Naomi J Fulop
- Department of Applied Health Research, University College London, London
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford
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Brewer HR, Hirst Y, Sundar S, Chadeau-Hyam M, Flanagan JM. Cancer Loyalty Card Study (CLOCS): protocol for an observational case-control study focusing on the patient interval in ovarian cancer diagnosis. BMJ Open 2020; 10:e037459. [PMID: 32900761 PMCID: PMC7484869 DOI: 10.1136/bmjopen-2020-037459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Ovarian cancer is the eighth most common cancer in women worldwide, and about 1 in 5 women with ovarian cancer do not receive treatment, because they are too unwell by the time they are diagnosed. Symptoms of ovarian cancer are non-specific or can be associated with other common conditions, and women experiencing these symptoms have been shown to self-manage them using over-the-counter medication. Results from a recent proof-of-concept study suggest there may be an increase in the purchases of painkillers and indigestion medication 10-12 months before ovarian cancer diagnosis. We propose a case-control study, as part of a larger project called the Cancer Loyalty Card Study (CLOCS), to investigate whether a significant change in medication purchases could be an indication for early signs of ovarian cancer, using data already collected through store loyalty cards. METHODS AND ANALYSIS Using a retrospective case-control design, we aim to recruit 500 women diagnosed with ovarian cancer (cases) and 500 women without ovarian cancer (controls) in the UK who hold a loyalty card with at least one participating high street retailer. We will use pre-existing loyalty card data to compare past purchase patterns of cases with those of controls. In order to assess ovarian cancer risk in participants and their purchase patterns, we will collect information from participants on ovarian cancer risk factors and clinical data including symptoms experienced before diagnosis from recruited women with ovarian cancer. ETHICS AND DISSEMINATION CLOCS was reviewed and approved by the North West-Greater Manchester South Research Ethics Committee (19/NW/0427). Study outcomes will be disseminated through academic publications, the study website, social media and a report to the research sites that support the study once results are published. TRIAL REGISTRATION NUMBER ISRCTN 14897082, CPMS 43323, NCT03994653.
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Affiliation(s)
| | - Yasemin Hirst
- Behavioural Science and Health, University College London, London, UK
| | - Sudha Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - Marc Chadeau-Hyam
- MRC Centre for Environment and Health, Imperial College London, London, UK
- Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Sarma EA, Rendle KA, Kobrin SC. Cancer symptom awareness in the US: Sociodemographic differences in a population-based survey of adults. Prev Med 2020; 132:106005. [PMID: 32004595 DOI: 10.1016/j.ypmed.2020.106005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 11/27/2019] [Accepted: 01/25/2020] [Indexed: 12/12/2022]
Abstract
Symptom awareness may improve cancer outcomes by prompting timely help-seeking and diagnosis. Research in the UK has shown lower symptom awareness among sociodemographic groups at higher risk of poor cancer outcomes; however, no population-based surveys in the US have assessed whether cancer symptom awareness varies across sociodemographic groups. We therefore examined associations between sociodemographic factors and recognition of 11 cancer symptoms using a novel population-based survey of US adults. We conducted telephone interviews in 2014 with a population-representative sample of English-speaking adults (aged 50 and older) in the US (N = 1425) using an adapted Awareness and Beliefs about Cancer (ABC) survey. Socioeconomic status (SES) was indexed by education. Additional sociodemographic factors included gender, age, marital status, and race. We used multivariable logistic regression models to examine the association between sociodemographic factors and recognition of each symptom, adjusting for cancer experience. Participants recognized an average of 8.43 symptoms as potential signs of cancer. In multivariable analyses, less education consistently predicted lower recognition across the symptoms. As socioeconomic inequalities in cancer mortality widen, it is increasingly important to understand factors that may contribute to these disparities. Our results suggest that US adults of lower SES have lower cancer symptom awareness across symptoms, findings that echo results from other developed countries. With low rates of cancer screening, another approach to reducing cancer burden and disparities may be through greater symptom awareness for symptoms with lower awareness, though additional work is needed to identify mechanisms through which awareness may have its effects on cancer outcomes.
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Affiliation(s)
- Elizabeth A Sarma
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda 20892, MD, USA; Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda 20892, MD, USA.
| | - Katharine A Rendle
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, 19104, PA, USA
| | - Sarah C Kobrin
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda 20892, MD, USA
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Flanagan JM, Skrobanski H, Shi X, Hirst Y. Self-Care Behaviors of Ovarian Cancer Patients Before Their Diagnosis: Proof-of-Concept Study. JMIR Cancer 2019; 5:e10447. [PMID: 30664464 PMCID: PMC6354198 DOI: 10.2196/10447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/30/2018] [Accepted: 11/02/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Longer patient intervals can lead to more late-stage cancer diagnoses and higher mortality rates. Individuals may delay presenting to primary care with red flag symptoms and instead turn to the internet to seek information, purchase over-the-counter medication, and change their diet or exercise habits. With advancements in machine learning, there is the potential to explore this complex relationship between a patient's symptom appraisal and their first consultation at primary care through linkage of existing datasets (eg, health, commercial, and online). OBJECTIVE Here, we aimed to explore feasibility and acceptability of symptom appraisal using commercial- and health-data linkages for cancer symptom surveillance. METHODS A proof-of-concept study was developed to assess the general public's acceptability of commercial- and health-data linkages for cancer symptom surveillance using a qualitative focus group study. We also investigated self-care behaviors of ovarian cancer patients using high-street retailer data, pre- and postdiagnosis. RESULTS Using a high-street retailer's data, 1118 purchases-from April 2013 to July 2017-by 11 ovarian cancer patients and one healthy individual were analyzed. There was a unique presence of purchases for pain and indigestion medication prior to cancer diagnosis, which could signal disease in a larger sample. Qualitative findings suggest that the public are willing to consent to commercial- and health-data linkages as long as their data are safeguarded and users of this data are transparent about their purposes. CONCLUSIONS Cancer symptom surveillance using commercial data is feasible and was found to be acceptable. To test efficacy of cancer surveillance using commercial data, larger studies are needed with links to individual electronic health records.
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Affiliation(s)
- James M Flanagan
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Hanna Skrobanski
- Institute of Epidemiology and Public Health, Research Department of Behavioural Science and Health, University College London, London, United Kingdom
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Xin Shi
- Business School, Manchester Metropolitan University, Manchester, United Kingdom
- School of Management, Shanghai University, Shanghai, China
- Karaganda State Medical University, Karaganda, Kazakhstan
| | - Yasemin Hirst
- Institute of Epidemiology and Public Health, Research Department of Behavioural Science and Health, University College London, London, United Kingdom
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Davies H, Marcu A, Vedsted P, Whitaker KL. Is lower symptom recognition associated with socioeconomic inequalities in help-seeking for potential breast cancer symptoms? Psychooncology 2018; 27:626-632. [PMID: 28940942 DOI: 10.1002/pon.4557] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/16/2017] [Accepted: 09/13/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Socioeconomic inequalities in recognising signs and symptoms of cancer may result in inequalities in timely help-seeking and subsequent prognosis of breast cancer. We explored the mediating role of symptom attribution and concern on the relationship between level of education and help-seeking for potential breast cancer symptoms. METHODS Women aged ≥47 years (n = 961) were purposively recruited (by education) to complete an online vignette-based survey that included nipple rash and axillary lump (in separate vignettes) as potential symptoms of breast cancer. Women completed questions relating to medical help-seeking (yes/no), cancer attribution, symptom concern, cancer avoidance, family history, and demographics. RESULTS Women with low education and mid education attributed nipple rash less often to cancer (26% and 27% mentioned cancer) than women with a degree or higher (40%). However, women with a degree or higher (63%) or mid education (64%) were less likely to anticipate seeking help for the nipple rash than women with no formal qualifications (73%). This association was statistically significant in the 60- to 69-year-old age group. There was no significant association between education and help-seeking for axillary lump. Mediation analysis adjusting for potential confounders confirmed that the association between education and help-seeking for nipple rash was fully mediated by symptom concern. CONCLUSIONS Socioeconomic inequalities in stage at diagnosis and survival of breast cancer may not always be explained by lower likelihood of suspecting cancer and subsequent impact on help-seeking. Reducing inequalities in stage at diagnosis will involve understanding a broader range of bio-psycho-social factors (eg, comorbidities and healthcare system factors).
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Affiliation(s)
- Hilary Davies
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Peter Vedsted
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Faculty of Health, Aarhus University, Aarhus, Denmark
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Hou SI, Liu LJ. Objective and Subjective Cancer Knowledge Among Faith-Based Chinese Adults. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2018; 38:47-56. [PMID: 29298633 DOI: 10.1177/0272684x17749567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined cancer knowledge between church-going younger versus older Chinese adults. Hou's 8-item validated cancer screening knowledge test (CSKT) and a new 14-item cancer warning signs test (CWST) were used to assess objective knowledge. Subjective knowledge was measured by one overall 5-point Likert scale item. A total of 372 Taiwanese and Chinese Americans from nine churches participated. Although there were no significant differences by age on either the CSKT scores (younger = 5.89 vs. older = 5.71; p = .297) or the CWST (younger = 6.27 vs. older = 5.86; p = .245), subjective knowledge was higher among older Chinese adults (younger = 2.44 vs. older = 3.05, p < .001). Older Chinese adults were also more likely to identify cancer warning signs correctly, while younger adults were more likely to identify false warning signs correctly. Results have implication on tailoring cancer knowledge type (subjective vs. objective) and content domain (screening vs. warning signs). Findings can help health educators better understand cancer education needs among Chinese adults.
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Affiliation(s)
- Su-I Hou
- 1 50616 College of Health and Public Affairs, University of Central Florida , Orlando, FL, USA
| | - Ling Jie Liu
- 2 Department of Health Promotion and Behavior, College of Public Health, 1355 University of Georgia , Athens, GA, USA
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Knowledge of cancer symptoms and anxiety affect patient delay in seeking diagnosis in patients with heterogeneous cancer locations. Curr Probl Cancer 2017; 41:64-70. [DOI: 10.1016/j.currproblcancer.2016.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/19/2016] [Indexed: 01/13/2023]
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Winstanley K, Renzi C, Smith CF, Wardle J, Whitaker KL. The impact of body vigilance on help-seeking for cancer 'alarm' symptoms: a community-based survey. BMC Public Health 2016; 16:1172. [PMID: 27871273 PMCID: PMC5117619 DOI: 10.1186/s12889-016-3846-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/15/2016] [Indexed: 12/19/2022] Open
Abstract
Background The act of detecting bodily changes is a pre-requisite for subsequent responses to symptoms, such as seeking medical help. This is the first study to explore associations between self-reported body vigilance and help-seeking in a community sample currently experiencing cancer ‘alarm’ symptoms. Methods Using a cross-sectional study design, a ‘health survey’ was mailed through primary care practices to 4913 UK adults (age ≥50 years, no cancer diagnosis), asking about symptom experiences and medical help-seeking over the previous three months. Body vigilance, cancer worry and current illness were assessed with a small number of self-report items derived from existing measures. Results The response rate was 42% (N = 2042). Almost half the respondents (936/2042; 46%) experienced at least one cancer alarm symptom. Results from logistic regression analysis revealed that paying more attention to bodily changes was significantly associated with help-seeking for cancer symptoms (OR = 1.44; 1.06-1.97), after controlling for socio-demographics, current illness and cancer worry. Being more sensitive to bodily changes was not significantly associated with help-seeking. Conclusions Respondents who paid attention to their bodily changes were more likely to seek help for their symptoms. Although the use of a cross-sectional study design and the limited assessment of key variables preclude any firm conclusions, encouraging people to be body vigilant may contribute towards earlier cancer diagnosis. More needs to be understood about the impact this might have on cancer-related anxiety.
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Affiliation(s)
- Kelly Winstanley
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Cristina Renzi
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Claire Friedemann Smith
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Katriina L Whitaker
- School of Health Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK.
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McCutchan G, Wood F, Smits S, Edwards A, Brain K. Barriers to cancer symptom presentation among people from low socioeconomic groups: a qualitative study. BMC Public Health 2016; 16:1052. [PMID: 27729048 PMCID: PMC5057256 DOI: 10.1186/s12889-016-3733-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in cancer survival can in part be explained by long patient intervals among people from deprived groups; however, the reasons for this are unclear. This qualitative study explores the actual and anticipated barriers to cancer symptom presentation in the context of socioeconomic deprivation. METHODS Thirty participants were recruited through the International Cancer Benchmarking Partnership Welsh database (n = 20), snowball sampling (n = 8) and community partners (n = 2). Semi-structured qualitative interviews were conducted with symptomatic and asymptomatic adults over the age of 50 years, who were identified as being from a low socioeconomic group based on multiple individual and group level indicators. Transcripts were analysed using a Framework approach based on the COM-B model (Capability, Opportunity, Motivation-Behaviour). RESULTS There was evidence of poor awareness of non-specific cancer symptoms (Capability), fearful and fatalistic beliefs about cancer (Motivation), and various barriers to accessing an appointment with the family physician (Opportunity) and full disclosure of symptoms (Capability). These in combination were associated with a lengthened patient interval among participants. Social networks (Opportunity) were influential on the formation of knowledge and beliefs about cancer. Participants' behavioural and normative beliefs were usually formed and reinforced by people they knew with cancer, and such beliefs were considered to lengthen the patient interval. Discussing symptoms with a family member or friend before a visit to the family physician was the norm, and could act as a barrier or facilitator depending on the quality of advice given (Opportunity). Economic hardship meant fulfilling basic day-to-day needs such as finding money for food were prioritised over medical help seeking (Opportunity). CONCLUSIONS The complex interaction between individual characteristics and socio-environmental factors is important for understanding cancer symptom presentation behaviour, especially in the context of socioeconomic deprivation. Interventions targeted at deprived communities should take into account the wider social influences on symptom presentation behaviour.
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Affiliation(s)
- Grace McCutchan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
| | - Fiona Wood
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Stephanie Smits
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Marcu A, Lyratzopoulos G, Black G, Vedsted P, Whitaker KL. Educational differences in likelihood of attributing breast symptoms to cancer: a vignette-based study. Psychooncology 2016; 25:1191-1197. [PMID: 27218858 DOI: 10.1002/pon.4177] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/06/2016] [Accepted: 05/17/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Stage at diagnosis of breast cancer varies by socio-economic status (SES), with lower SES associated with poorer survival. We investigated associations between SES (indexed by education), and the likelihood of attributing breast symptoms to breast cancer. METHOD We conducted an online survey with 961 women (47-92 years) with variable educational levels. Two vignettes depicted familiar and unfamiliar breast changes (axillary lump and nipple rash). Without making breast cancer explicit, women were asked 'What do you think this […..] could be?' After the attribution question, women were asked to indicate their level of agreement with a cancer avoidance statement ('I would not want to know if I have breast cancer'). RESULTS Women were more likely to mention cancer as a possible cause of an axillary lump (64%) compared with nipple rash (30%). In multivariable analysis, low and mid education were independently associated with being less likely to attribute a nipple rash to cancer (OR 0.51, 0.36-0.73 and OR 0.55, 0.40-0.77, respectively). For axillary lump, low education was associated with lower likelihood of mentioning cancer as a possible cause (OR 0.58, 0.41-0.83). Although cancer avoidance was also associated with lower education, the association between education and lower likelihood of making a cancer attribution was independent. CONCLUSION Lower education was associated with lower likelihood of making cancer attributions for both symptoms, also after adjustment for cancer avoidance. Lower likelihood of considering cancer may delay symptomatic presentation and contribute to educational differences in stage at diagnosis. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Georgios Lyratzopoulos
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Georgia Black
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Peter Vedsted
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Faculty of Health, Aarhus University, Denmark
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Whitaker KL, Smith CF, Winstanley K, Wardle J. What prompts help-seeking for cancer 'alarm' symptoms? A primary care based survey. Br J Cancer 2016; 114:334-9. [PMID: 26794277 PMCID: PMC4742581 DOI: 10.1038/bjc.2015.445] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/25/2015] [Accepted: 11/30/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Encouraging prompt help-seeking for cancer symptoms can help shorten the patient interval and improve timely diagnosis. We explored factors associated with help-seeking in a primary care sample reporting 'alarm' symptoms. METHODS A questionnaire was mailed to 9771 adults (⩾ 50 years of age and no cancer diagnosis) and 3766 (39%) returned it. Our sample included 1732 adults reporting at least one cancer 'alarm' symptom; with a total of 2726 symptoms. Respondents completed questions relating to help-seeking, demographic and symptom characteristics (e.g., type, knowledge, concern, interference and attribution). RESULTS Over a third of people who reported a cancer 'alarm' symptom in the past 3 months had not sought help from a doctor. An unexplained lump (odds ratio (OR) 2.46, 1.42-4.26) and persistent unexplained pain (OR 1.79, 1.19-2.69) were associated with increased likelihood of help-seeking. Symptom concern (OR 3.10, 2.19-4.39) and interference (OR 3.06, 2.15-4.36) were associated with an increased likelihood of seeking help independently of symptom type. People who were not working (OR 1.41, 1.09-1.83), were married/cohabiting rather than single (OR 1.38, 1.10-1.74) and were older (60-69 years) rather than younger (50-59 years; OR 1.33, 1.02-1.75) were more likely to have sought help. CONCLUSIONS Our findings highlighted symptom type and symptom characteristics as key drivers of help-seeking. We also found that there may be specific demographic groups where encouraging help-seeking might be warranted.
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Affiliation(s)
- K L Whitaker
- School of Health Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - C Friedemann Smith
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - K Winstanley
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - J Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
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12
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McCutchan GM, Wood F, Edwards A, Richards R, Brain KE. Influences of cancer symptom knowledge, beliefs and barriers on cancer symptom presentation in relation to socioeconomic deprivation: a systematic review. BMC Cancer 2015; 15:1000. [PMID: 26698112 PMCID: PMC4688960 DOI: 10.1186/s12885-015-1972-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 12/03/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND People from lower socioeconomic groups have worse survival outcomes for cancer, which in part reflects later-stage disease at diagnosis. The mechanisms underlying delayed cancer symptom presentation in lower socioeconomic groups are not well understood. METHODS Systematic review of studies of actual or anticipated symptom presentation across all tumour sites. Included studies measured socioeconomic group, symptom presentation and one or more of the following variables: cancer symptom knowledge, beliefs about cancer, barriers/facilitators to symptom presentation. RESULTS A total of 60 studies was included. Symptom knowledge overall was lowest and actual presentation time was longest in lower socioeconomic groups. Knowledge for specific symptoms such as lumps and bleeding was good and encouraged timely symptom presentation, in contrast to non-specific symptoms which were not well recognised. The combination of fearful and fatalistic beliefs was typically associated with later presentation, especially in lower socioeconomic groups. Emotional barriers such as 'worry what the doctor might find' were more frequently reported in lower socioeconomic groups, and there was evidence to suggest that disclosing symptoms to family/friends could help or hinder early presentation. CONCLUSIONS Poor symptom knowledge, fearful and fatalistic beliefs about cancer, and emotional barriers combine to prolong symptom presentation among lower socioeconomic groups. Targeted interventions should utilise social networks to improve knowledge of non-specific symptoms, challenge negative beliefs and encourage help-seeking, in order to reduce avoidable delays and minimise socioeconomic group inequalities.
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Affiliation(s)
- Grace M McCutchan
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Fiona Wood
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Adrian Edwards
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Rebecca Richards
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Kate E Brain
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
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