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

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

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<b>Background</b>: 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. <b>Methods</b>: 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. <b>Results</b>: 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. <b>Conclusion</b>: Having sought help for potential cancer symptoms, it is therefore important that practitioners recognise these symptoms, and examine, investigate and refer appropriately.

Item Type:Articles
Glasgow Author(s) Enlighten ID:MacLeod, Dr Una and Mitchell, Dr Elizabeth and Macdonald, Professor Sara
Authors: MacLeod, U., Mitchell, E.D., Burgess, C., Macdonald, S., and Ramirez, A.J.
Subjects:R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Clinical Specialities
Journal Name:British Journal of Cancer
ISSN (Online):1532-1827
Published Online:03 December 2009

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
309001Factors influencing patient and primary care delay in the diagnosis of cancer: a database of existing research and its implications for...Una MacleodDepartment of Health (DOH-R&D)1217522RI HEALTH & WELLBEING