ABSTRACT
OBJECTIVE: This study aimed to examine the effect of perceived diagnostic delay on cancer-related distress and determine whether fear of cancer-recurrence and quality of life mediate this relationship. METHODS: Cross-sectional study in which 311 colorectal cancer (CRC) survivors in Scotland completed a survey, which included questions on cancer-related distress (IES-R), perceived diagnostic delay, quality of life (trial outcome index of the FACT-C: FACT-C TOI) and fear of cancer recurrence. Fifteen patients withheld consent to data matching with medical records, leaving a sample size of 296. Participants were an average of 69 years old (range 56 to 81) and between 3.5 and 12 years post-diagnosis. Multiple regressions were used to test predictors of distress and regression and bootstrapping to test for mediation. RESULTS: Perceived diagnostic delay was correlated with higher cancer-related distress, while objective markers of diagnostic delay (disease stage at diagnosis and treatment received) were not. Some of the relationship between perceived diagnostic delay and cancer-related distress was mediated by quality of life, but not by fear of cancer recurrence. CONCLUSIONS: Perceived diagnostic delay was associated with higher cancer-related distress among CRC survivors. While poorer quality of life partly explained such associations, fear of cancer recurrence, stage at diagnosis and treatment did not. The exact features of diagnostic delay that are associated with cancer-related distress remain unclear. Future research should examine the experiences patients go through prior to diagnosis that may increase distress, in an effort to improve our understanding of the factors affecting emotional wellbeing among CRC survivors. Copyright © 2016 John Wiley & Sons, Ltd.
Subject(s)
Colorectal Neoplasms/psychology , Delayed Diagnosis/psychology , Quality of Life/psychology , Stress, Psychological/psychology , Aged , Aged, 80 and over , Cross-Sectional Studies , Fear/psychology , Female , Health Behavior , Health Status , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/psychology , Perception , ScotlandSubject(s)
Alcohol Drinking/adverse effects , Body Mass Index , Health Knowledge, Attitudes, Practice , Neoplasms/psychology , Smoking/adverse effects , Alcohol Drinking/psychology , Female , Humans , London , Male , Neoplasms/prevention & control , Risk Factors , Smoking/psychology , Surveys and Questionnaires , Young AdultABSTRACT
BACKGROUND: Screening using fecal occult blood testing (FOBt) reduces colorectal cancer mortality, but the test has low sensitivity. A "missed" cancer may cause psychologic harms in the screened population that partially counteract the benefits of early detection. METHODS: Three hundred and eleven people diagnosed with colorectal cancer (i) after a negative FOBt result (interval cancer), (ii) a positive result (screen-detected cancer), or (iii) in regions where screening was not offered, completed questions on quality of life (FACT-C), depression (CES-D), perceived diagnostic delay, and trust in the results of FOBt screening. Fifteen withheld consent to data matching with medical records, leaving a sample size of 296. RESULTS: Controlling for demographic and clinical variables, patients with an interval cancer reported poorer quality of life (difference in means = 6.16, P = 0.03) and more diagnostic delay (OR, 0.37; P = 0.02) than patients with screen-detected disease, with no differences in depression. No differences were observed between the interval cancer group and the group not offered screening on these measures. Patients with an interval cancer reported the lowest levels of trust in FOBt. CONCLUSIONS: An interval cancer has adverse effects on trust in FOBt, but does not result in worse psychologic outcomes compared with people diagnosed in areas with no screening program. People with an interval cancer report poorer quality of life than people with screen-detected disease. IMPACT: Improvements in test sensitivity could improve quality of life among people who complete an FOB test over and above any benefits already conferred by earlier detection.
Subject(s)
Anxiety/etiology , Colorectal Neoplasms/psychology , Early Detection of Cancer/psychology , Quality of Life , Aged , Colorectal Neoplasms/diagnosis , Cross-Sectional Studies , Early Detection of Cancer/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Occult Blood , Pilot Projects , Retrospective Studies , Surveys and QuestionnairesABSTRACT
AIM: This national survey sought to establish levels of awareness of cancer risk factors and awareness of what individuals could do to reduce their own risk status. METHOD: Cross-sectional interview data comprising a national representative sample of 4,233 individuals aged 15 years or over across Great Britain. RESULTS: There were high levels of awareness of the role of smoking in the development of cancer, but only modest awareness of alcohol intake, being overweight, physical inactivity and older age. Recognition of the role of viral infection in cancer risk was very poor. Although two-thirds of respondents thought that cancer risk could be modified through lifestyle changes, those most in need of making lifestyle changes were less likely to be aware of what they could do to reduce their cancer risk. CONCLUSION: This survey highlights the need to increase awareness of overweight, alcohol, infections and exercise in the development of cancer, particularly amongst younger people and those from more socio-economically deprived backgrounds.