CANCER-RELATED SYMPTOMS: DO CONCERNS OVER TIME, DOCTORS' REACTION, OR OTHER PATIENT WORRIES IMPACT THE DECISION TO SEEK CARE?

Purpose: To examine the prevalence and impact of patient-reported concerns on the decision to seek care for cancer-related symptoms in the United States.

Methods: We conducted a population-based survey with English-speaking adults (aged 50 or older) using an adapted Awareness and Beliefs about Cancer (ABC) instrument. Respondents were asked if they viewed the following concerns as a potential reason to delay seeking care: 1) too embarrassed; 2) worries about wasting doctor's time; 3) worries about what the doctor might find; 4) too busy; 5) cost; and 6) worries that doctor would not take symptom seriously. Anticipated time to seeking care was assessed by asking respondents how long it would take them to see a doctor for the following cancer-related symptoms: persistent cough, rectal bleeding, mole changes, and breast changes. We categorized “delay” as expecting to wait two weeks or longer. Multivariate logistic regression models were used to examine the association between delay for each cancer symptom and the six perceived barriers (adjusted odds ratio=aOR; CI=95% confidence interval), adjusting for sociodemographic factors and health status. All analyses were weighted for complex survey sampling.

Results: For persistent cough, we found a positive relationship between expected delay and being too busy (aOR=2.34, CI: 1.61, 3.39). For rectal bleeding, we found a positive association between delay and embarrassment (aOR=2.22, CI: 1.05, 4.73), and worries that the doctor would not take the symptom seriously (aOR=1.90, CI: 1.01, 3.57). For breast changes, we found a positive relationship between delay and concerns over what the doctor may find (aOR=1.69, CI: 1.01, 2.85), and being too busy (aOR=3.45, CI: 1.93, 6.06).  For mole changes, we found a positive association between delay and the following barriers: embarrassment (aOR=1.75, CI: 1.06, 2.90), concerns over wasting doctor's time (aOR=2.11, CI: 1.27, 3.53), being too busy (aOR=2.13, CI: 1.49, 3.07), and cost (aOR=1.78, CI: 1.25, 2.53).  

Conclusions: Although many cancer cases are identified through screening prior to symptom presentation, not all cancers have reliable screening methods. Even when there is a reliable screening test, many patients do not routinely receive cancer screening. As such, while our results begin to document the impact of patient-reported concerns on anticipated delay, more studies are needed to identify effective ways to ensure patients with potential cancer-related symptoms are seeking care quickly.