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Cancer Symptom Recognition and Anticipated Delays in Seeking Care Among U.S. Adults
Introduction: Early stage diagnosis strongly predicts cancer survival. Recognition of potential symptoms of cancer may improve survival by reducing time to seeking care.
Methods: Telephone interviews with a population-representative sample of English-speaking adults (aged ≥50 years) in the U.S. (N=1,425) were conducted in 2014 using an instrument adapted from the International Cancer Benchmarking Partnership Awareness and Beliefs about Cancer sur-vey. Anticipated time to seeking care for four cancer symptoms (persistent cough, rectal bleeding, Ascorbic acid changes, and breast changes) was assessed, and delay was defined as waiting >2 weeks. Recog-nition of symptoms as potential cancer signs was assessed dichotomously. Multivariate logistic regression models were used to assess associations between symptom recognition and anticipated delay, adjusting for demographics, cancer experience, self-reported health, and healthcare access. Analyses were weighted and conducted in 2017.
Conclusions: Lack of symptom recognition was associated with anticipated delay in seeking care for some cancer symptoms. Differences in recognition and delays by symptom could be driven partly by screening messaging or by ambiguity and functional impact of each symptom.
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INTRODUCTION E arly stage at diagnosis is a strong predictor of sur-vival for most cancer types.1 Population-based screening programs are designed to detect cancers before the onset of symptoms and therefore play a key role
in the early detection of cancer. However, even in countries such as the U.S. and the United Kingdom (UK) with popu-lation-based screening, most cancers are not detected through screening.2,3 Many adults do not receive adequate screening and, even among those who are screened, cancers go undetected and interval cancers occur. Consequently, most diagnoses are made incidentally or following symp-tomatic presentation by the patient. To the extent that
From the 1Department of Family Medicine and Community Health, Perel-man School of Medicine, University of Pennsylvania, Philadelphia, Penn-sylvania; 2Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland; 3Department of Behavioral Science and Health, University College London, London, England; 4Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and 5Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
Address correspondence to: Katharine A. Rendle, PhD, MSW, MPH, Department of Family Medicine and Community Health, University of Pennsylvania, Perelman School of Medicine, PPMC, Mutch Building, 51 N. 39th Street, Philadelphia PA 19104. E-mail: [email protected]
most cancers are not symptomatic until later stages, diag-noses resulting from symptomatic presentation often have worse prognoses.2,4 Ensuring prompt care seeking is there-fore key to reducing cancer morbidity and mortality, yet delays in presentation are common and have been linked to individual, social, and structural factors, including age, education, marital status, and failure to recognize early warning signs of cancer.5−7 Several international studies have sought to understand the relationship between cancer symptom awareness and care-seeking behaviors at the individual and population level.8−10 As part of the International Cancer Benchmark-ing Partnership (ICBP), the Awareness and Beliefs about Cancer (ABC) survey was administered in 2011 across six countries to investigate how individuals’ symptom aware-ness, cancer beliefs, and care-seeking behaviors might
contribute to international differences in cancer sur-vival.11,12 This work expanded upon studies from the UK