Risk factors for delayed presentation and referral of symptomatic cancer: Evidence for common cancers

Macleod, U.; Burgess, C.; Macdonald, S.; Mitchell, E. D.; Ramirez, A. J.

Abstract

Background:It has been suggested that the known poorer survival from cancer in the United Kingdom, compared with other European countries, can be attributed to more advanced cancer stage at presentation. There is, therefore, a need to understand the diagnostic process, and to ascertain the risk factors for increased time to presentation.Methods:We report the results from two worldwide systematic reviews of the literature on patient-mediated and practitioner-mediated delays, identifying the factors that may influence these.Results:Across cancer sites, non-recognition of symptom seriousness is the main patient-mediated factor resulting in increased time to presentation. There is strong evidence of an association between older age and patient delay for breast cancer, between lower socio-economic status and delay for upper gastrointestinal and urological cancers and between lower education level and delay for breast and colorectal cancers. Fear of cancer is a contributor to delayed presentation, while sanctioning of help seeking by others can be a powerful mediator of reduced time to presentation. For practitioner delay, ‘misdiagnosis’ occurring either through treating patients symptomatically or relating symptoms to a health problem other than cancer, was an important theme across cancer sites. For some cancers, this could also be linked to inadequate patient examination, use of inappropriate tests or failing to follow-up negative or inconclusive test results.Conclusion:Having sought help for potential cancer symptoms, it is therefore important that practitioners recognise these symptoms, and examine, investigate and refer appropriately. © 2009 Cancer Research UK All rights reserved.

Citation

Macleod, U., Burgess, C., Macdonald, S., Mitchell, E. D., & Ramirez, A. J. (2009). Risk factors for delayed presentation and referral of symptomatic cancer: Evidence for common cancers. The British Journal of Cancer, 101(S2), S92-S101. https://doi.org/10.1038/sj.bjc.6605398

• Journal Article Type: Article
• Online Publication Date: Dec 3, 2009
• Publication Date: Dec 3, 2009
• Deposit Date: Nov 13, 2014
• Publicly Available Date: Nov 13, 2014
• Journal: The British journal of cancer : supplement
• Print ISSN: 0007-0920
• Electronic ISSN: 1532-1827
• Publisher: Nature Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 101
• Issue: S2
• Pages: S92-S101
• DOI: https://doi.org/10.1038/sj.bjc.6605398
• Keywords: Delay; Diagnosis; Systematic review
• Public URL: https://hull-repository.worktribe.com/output/467324
• Publisher URL: http://www.nature.com/bjc/journal/v101/n2s/full/6605398a.html
• Additional Information: Copy of article first published in: The British journal of cancer : supplement, 2009, v.101.
• Contract Date: Nov 13, 2014