Knowledge of cancer symptoms among patients attending one-stop breast and rectal bleeding clinics

The value of health awareness days, weeks and months: A systematic review

OBJECTIVE

The aim of this systematic review was to analyze the value of awareness days, weeks, and months as found in peer-reviewed research and highlight any related trends.

METHODS

A systematic review was conducted across four electronic databases for articles published between 1970 and July 2020. The researchers reviewed articles which included awareness days, weeks, or months in the title or abstract and extracted articles which used quantitative analysis to assess the impact of such campaigns.

RESULTS

The 73 included articles were separated into categories based on outcome measure(s) with 12 articles included in more than one category. Of the 31 articles which examined online activity outcomes, the vast majority reported the awareness day, week, or month in question positively correlated with increased activity. Of the 14 articles focused on knowledge outcomes, those which focused on specific day, week, or month sub-interventions with targeted populations had relatively greater success. The 29 studies that examined the impact of awareness days, weeks, and months on health outcomes reported mixed results. Another twelve studies provided treatment insights based on convenience sample research conducted during awareness days, weeks, and months. The majority of articles across all outcome categories did not examine costs.

CONCLUSION

Although online activity seemed to generally increase during the awareness days, weeks, and months studied, the relationship between this increase and improved health behaviors and outcomes remains unclear. In addition, there is a paucity of research pertaining to the cost and cost effectiveness of such campaigns. Future research in this area needs to focus more on health outcome impacts and include an examination of cost effectiveness when possible.

The fecal occult blood test as a tool for improved outpatient qualification for colonoscopy. A single-center experience and 10-year follow-up survey

PURPOSE

Colonoscopy is not widely and easily available in all countries, even for symptomatic patients. This is one of the causes of tumors not being diagnosed until an advanced stage. The aim of this study was to estimate the efficacy of the fecal occult blood test (FOBT) in the diagnostic work-up of outpatients referred to a colorectal unit due to indistinct abdominal symptoms.

PATIENTS/METHODS

Among 10418 consecutive symptomatic individuals referred to the outpatient clinic, an immunochemical FOBT (Hem-Check 1^®) was recommended for 9432 patients with indistinct symptoms as a tool for qualifying them for colonoscopy. All the subjects were treated according to their diagnosis and followed-up for the next 10 years.

RESULTS

Colorectal cancer (CRC) was diagnosed in 535 individuals: 393/986 (39.9%) among patients with red-flag symptoms, and 142/951 (14.9%) of individuals with indistinct symptoms and a positive FOBT. In the latter group, less-advanced tumors, classed as such using Dukes' classification, were twice as common and more advanced CRC occurred twice as seldom than in the former. Cancer recurrence-free and overall survival periods after surgical treatment for CRC were significantly longer in patients with indistinct symptoms who qualified for diagnostic procedures on the basis of a positive FOBT.

CONCLUSIONS

Patients with symptoms suggesting organic colon disease had a worse prognosis compared to individuals with non-specific symptoms. If bowel endoscopy is not widely and easily available, qualification for colonoscopy on the basis of alarm symptoms and a positive FOBT seems to be an effective strategy in early CRC diagnosis.

Delay in Presentation, Diagnosis and Treatment for Colorectal Cancer Patients in Jordan

PURPOSE

Colorectal cancer (CRC) ranked first among cancers reported in males and second among cancers reported in females in Jordan in 2010. There has been no specific CRC-control programme in Jordan. Additionally, there has been no published study from Jordan or its neighbours on patient delays in presentation, diagnosis or treatment. Therefore, we conducted this study to assess these important quality indicators aiming to improve prognosis for CRC and to provide baseline data for future health promotion programmes for CRC in Jordan.

METHODS

This project was a cross-sectional study on CRC patients at Al Bashir Hospital, Ministry of Health, and at the Military Oncology Centre of the Jordanian Royal Medical Services.

RESULTS

The total number of participants was 189. The proportion of patients with presentation delay, diagnosis delay or treatment delay was 33.9, 68.1 and 32.6%, respectively. The main reasons reported for delay in presentation were lack of knowledge that symptoms were suggestive of cancer (58.5%), misdiagnosis by physicians or pharmacists (38.4%) or the patient did not want to visit a doctor (3.1%). Predictors of delay and mean time for presentation, diagnosis and treatment were identified.

CONCLUSIONS

Our results revealed that CRC patients in Jordan experience delays in presentation, Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation diagnosis, and, to a lesser degree, in treatment. This could justify the advanced stages at diagnosis and poor outcomes for CRC patients. Our findings provide baseline information for future CRC-control programmes in Jordan. We recommend that CRC prevention programmes in Jordan focus on early detection of CRC and target both patients and physicians.

Assessment of knowledge among patients of surgical wards regarding clinical symptoms and diagnostics of the most common malignant tumors

Aim of the study

The aim of this work was to evaluate the knowledge of symptoms and prophylaxis among hospitalized patients.

Material and methods

The research was carried in the Provincial Hospital in Bydgoszcz (i.e. general surgery, gynecology and obstetrics, urology, breast surgery and thoracic surgery). 250 hospitalized patients took part in the tests, as well as 50 healthy people. The scientific method used was a specially designed questionnaire. The Bioethics Committee of Collegium Medicum of Mikołaj Kopernik University in Bydgoszcz approved these tests.

Results

Patients from the Breast Diseases Ward had better knowledge about cancers than the control group. Symptoms of lung cancer were known to both groups to the same extent. Patients from the Clinical Ward of Thoracic Surgery were very knowledgeable about lung cancer, but they did not know anything about other malignant types of cancer. Patients from Gynecology and Obstetrics wards are better than the control group only at knowledge about symptoms and screening of cervix cancer. Patients from the Urology Ward have the best knowledge about screening of prostate cancer and colon cancer. Those hospitalized at the Surgery Ward do not know symptoms of colon cancer, but they have knowledge about its screening.

Conclusions

Patients from the Clinical Ward of Thoracic and Cancer Surgery and the Clinical Surgery Ward had the least knowledge about malignant tumors.

Patients from Urology, Gynecology and Obstetrics wards have better knowledge about malignant tumors treated there.

Women's awareness of cancer symptoms: a review of the literature

Improvements in cancer detection and treatment have led to consistent declines in mortality from many cancers. However, many patients present for treatment at a point where more invasive treatment is required and/or treatment outcomes are less than optimal. One factor that has been consistently shown to be associated with late diagnosis and treatment is delay in seeking help for symptoms. This paper reviews the literature on women's awareness of cancer symptoms and aims to identify knowledge gaps that need to be addressed in order to improve help-seeking behaviors. The discovery of substantial gaps in awareness suggest a need for improved community education regarding cancer symptoms.

Socioeconomic position and participation in colorectal cancer screening

BACKGROUND

Colorectal cancer (CRC) screening with faecal occult blood test (FOBT) has the potential to reduce the incidence and mortality of CRC. Screening uptake is known to be inferior in people with low socioeconomic position (SEP) when compared with those with high position; however, the results of most previous studies have limited value because they are based on recall or area-based measures of socioeconomic position, and might thus be subject to selective participation and misclassification. In this study we investigated differences in CRC screening participation using register-based individual information on education, employment, and income to encompass different but related aspects of socioeconomic stratification. Also, the impact of ethnicity and cohabiting status was analysed.

METHODS

A feasibility study on CRC screening was conducted in two Danish counties in 2005 and 2006. Screening consisted of a self-administered FOBT kit mailed to 177 114 inhabitants aged 50-74 years. Information on individual socioeconomic status was obtained from Statistics Denmark.

RESULTS

A total of 85 374 (48%) of the invited returned the FOBT kits. Participation was significantly higher in women than in men (OR=1.58 (1.55-1.61)), when all socioeconomic and demographic variables were included in the statistical model. Participation also increased with increasing level of education, with OR=1.38 (1.33-1.43) in those with a higher education compared with short education. Also, participation increased with increasing income levels, with OR=1.94 (1.87-2.01) in the highest vs lowest quintile. Individuals with a disability pension, the unemployed and self-employed people were significantly less likely to participate (OR=0.77 (0.74-0.80), OR=0.83 (0.80-0.87), and OR=0.85 (0.81-0.89), respectively). Non-western immigrants were less likely to participate (OR=0.62 (0.59-0.66)) in a model controlling for age, sex, and county; however, this difference might be attributed to low SEP in these ethnic groups ((OR=0.93 (0.87-0.99), when adjusting for SEP indicators).

CONCLUSION

This study based on individual information on several socioeconomic dimensions in a large, unselected population allowed for identification of several specific subgroups within the population with low CRC screening participation. Improved understanding is needed on the effect of targeted information and other strategies in order to reduce socioeconomic inequalities in screening.

Australian women's awareness of breast cancer symptoms and responses to potential symptoms

OBJECTIVES

Poor awareness of breast cancer symptoms has been associated with patient delay in seeking help; thus reduced survival, more aggressive treatment, and fewer treatment choices. The aim of this study was to develop a representative picture of Australian women's knowledge of symptoms, experienced potential symptoms, and behavioral responses.

METHODS

A general population sample of approximately 3,000 women aged 30-69 completed a telephone survey; results were compared to previous surveys conducted in 1996 and 2003.

RESULTS

The most commonly cited potential symptom of breast cancer was a lump in the breast, identified by 86% of respondents (an increase from 75% in 2003). Other commonly mentioned symptoms were discharge from the nipple, pain/soreness, skin puckering, or dimpling; and a change in breast shape. The proportion unable to name any potential symptoms of breast cancer decreased from one in ten in 2003 to approximately one in twenty in 2007. The primary reason for not seeking medical advice in response to a potential symptom was the belief that breast cancer was not present.

CONCLUSIONS

Health promotion efforts need to continue to aim at increasing community understanding of potential breast cancer symptoms and encouraging women to act on potential symptoms by seeking medical advice.

A colorectal cancer patient focus group develops an information package

INTRODUCTION

In order to deliver high quality care and empower cancer patients in decision-making, good quality information and communication are essential. We describe the development of an information booklet.

PATIENTS AND METHODS

A total of 22 colorectal cancer patients (12 male; median age, 72 years, range, 40-86 years) met on 3 occasions. Patients were asked to define their information needs and score them (1-4) according to importance. The information document was written. The second meeting involved feedback on the booklet. The modified booklet was reviewed/approved by the group before submission for local ethics committee approval prior to its distribution to other patients.

RESULTS

All participants felt the project a good idea. Essential information included the surgeon's individual morbidity, mortality, survival, recurrence data and details of adjuvant therapies (score = 4). Also important were type of surgery, complications and postoperative recovery (score = 3). Simple anatomical drawings were also considered important.

CONCLUSIONS

The booklet is now used to personalise information for all our patients and serves, in part, as a record of the key issues discussed during the consultation. The booklet has been evaluated in a randomised trial.

Reported symptoms, diagnostic delay and stage of colorectal cancer: a population-based study in Denmark

OBJECTIVE

The primary prognostic factor for colorectal cancer (CRC) is stage. Any association between symptoms, diagnostic delay and stage may have implications for the clinical course of the disease. We examined the association between symptoms and diagnostic delay and between symptoms and stage, and assessed whether the associations differed for colon cancer (CC) and rectal cancer (RC).

PATIENTS AND METHODS

Population-based prospective observational study based on 733 Danish CRC patients. Diagnostic delay and patients' reported symptoms were determined through questionnaire-interviews. Dukes' stage was obtained from medical records and pathology forms. Diagnostic delay was categorized into three delay groups: < or = 60, 61-150 and > 150 days. Stage was classified into nonadvanced (Dukes' A and B) or advanced (Dukes' C and D) cancers. We calculated the frequency of the most frequently reported initial symptom or symptom complex for CC and RC patients, and evaluated the frequency of patients with different initial symptoms/symptom complexes in the three delay groups. For the most frequent initial symptoms/symptom complexes, we calculated the frequencies according to stage, and estimated the relative risk of having an advanced stage, with 95% confidence intervals.

RESULTS

The most frequent initial symptoms/symptom complexes were very vague symptoms for CC and rectal bleeding for RC. For both CC and RC, rectal bleeding was significantly associated with nonadvanced stage. The relative risk of having an advanced cancer was 0.6 for monosymptomatic rectal bleeding and 0.7 for rectal bleeding combined with other symptoms.

CONCLUSIONS

Initial symptoms of CC were often very vague, making it difficult to identify a precise start date. The most frequent initial symptom/symptom complex for RC - rectal bleeding - was better defined. Rectal bleeding was significantly associated with nonadvanced CC and RC and a significantly decreased relative risk of having an advanced cancer.