Why Patients Ignore Cancer 'Alarm' Symptoms

Ricki Lewis, PhD

January 27, 2015

The finding that people are often aware of "alarm" symptoms of cancer but avoid or delay consulting their primary care provider might explain the poor 1-year cancer survival rates in the United Kingdom, a Cancer Research UK survey suggests.

"We know that in the United Kingdom there is worse survival from cancer than in other high-income countries with similar healthcare systems," said Katriina Whitaker, PhD, senior lecturer in the School of Health Sciences at the University of Surrey.

"We wanted to do some community-level research to understand how people interpret and respond to symptoms that could give an early warning sign of cancer in real life, without imposing a cancer perspective," Dr Whitaker told Medscape Medical News.

In results were published in the February issue of the British Journal of General Practice.

Dr Whitaker's team developed and sent a health survey to 4858 people older than 50 years who attended one of three general practices in London during a 3-month period in 2012. The 1-year survival rates in London are among the lowest in the United Kingdom.

The survey did not use the word "cancer," but listed 17 symptoms from the Cancer Awareness Measures.

Of the 1724 respondents, 915 reported having at least one cancer-associated symptom, and 482 gave their consent to be contacted by the researchers.

The team chose 48 participants for in-depth interviews; 38 were conducted in person and 10 were conducted over the phone.

Many of the participants recognized their symptoms as being associated with cancer, which some referred to as "the big C" or "the bogeyman."

However, 45% of the participants did not contact a primary care physician about their symptoms. Reasons for not doing so included the intermittent nature of the symptoms, not wanting to bother a physician or waste National Health Service resources, the perception that frequently consulting a doctor is a sign of weakness, and the attribution of the symptoms to aging.

Some of the participants consulted a physician only after exposure to a cancer awareness campaign or on the advice of a friend or family member, Dr. Whitaker reported. One awareness campaign cited involved TV and radio spots describing the symptoms of colon cancer; an "alarm symptom" that often provoked others to push a friend or relative to seek help was persistent coughing (highlighted in a health campaign as a potential symptom of lung cancer).

The researchers identified some circumstances under which people do seek help: unresolved symptoms, a feeling that something is wrong, and awareness or fear of cancer. However, fear of cancer kept some individuals from taking action, and others delayed mention of the symptom until they visited a primary care physician for another reason.

Some people became accustomed to the symptom and began to think of it as normal. For many participants, fear centered around the effect of cancer on daily life. Some reported a distrust of the healthcare system, and some cited difficulty making an appointment and the short times allotted for medical exams.

The researchers attribute the propensity of some participants to endure considerable discomfort, such as persistent difficulty swallowing and bloody bowel movements, to the British characteristic of a "stiff upper lip."

"International comparisons have shown that in the United Kingdom, we are more worried about wasting the doctor's time than in other countries, such as Australia, Canada, Denmark, Norway, and Sweden," Dr. Whitaker explained. "There's also been research looking into patient delay for signs of stroke and heart disease, so I think the findings have more general application beyond cancer."

"Spotting and treating cancer early means that patients have a far better chance of beating the disease, so it's important we understand why some people with potential symptoms decide not to get them checked out straight away," said Sara Hiom, director of early diagnosis at Cancer Research UK.

"This study gives us valuable insight into the decision-making process, and could help us find ways to encourage everyone with worrying symptoms to seek help as early as possible," Hiom explained.

Limitations of this study include the qualitative nature of the investigation, the small sample size, and the fact that the interviews provided only glimpses of each participant's attitude toward following-up on symptoms that could indicate cancer.

Dr Whitaker and Ms Hiom have disclosed no relevant financial relationships.

Br J Gen Pract. 2015;65(631):e96-e105. Abstract

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