Background One year cancer survival is poor in the UK compared with similar developed countries. Poor one year survival may be due to delay in symptomatic presentation leading to advanced stage at diagnosis. Much of the research to date has focussed on risk factors for delayed presentation for people with specific cancers. To inform public health approaches to promoting early symptomatic presentation of across all cancer types, we aimed to identify the most common symptoms of cancer and risk factors for delay in presentation of those symptoms in a UK population of cancer patients.
Methods We surveyed 2,923 cancer patients who had been diagnosed after symptomatic presentation, using a self-complete questionnaire asking about nature and duration of symptoms and barriers to symptomatic presentation (response rate 79%). We weighted percentages reporting each symptom by the incidence of each cancer site to ensure representativeness of the general population of cancer patients. We considered patients reporting more than three months from first noticing the symptom to first seeing a doctor to have delayed presentation.
Results The four commonest symptoms were pain (30%), systemic symptoms (23% [fatigue 17%, weight loss 8%]), bleeding (20%) and lump (17%). 69% had experienced one or more of these symptoms. Delay in presentation was reported by one fifth of cancer patients and was most common among patients with prostate and rectal cancer and malignant melanoma and among more socioeconomically deprived people. Change of bowel habit and urinary symptoms (in men only) were the symptoms most likely to be associated with delay in presentation. Among 48% of the patients who reported that anything had put them off going to the doctor with their cancer symptoms, 58% reported that they had not recognised that their symptom was serious; 32% of these had delayed presentation. Worry about wasting the doctor’s time was reported by 12% of patients; 33% of these had delayed presentation. Worry about what the doctor might find (7%) and embarrassment were less common (3%), but were frequently associated with delay in presentation (47% of those who reported worry about what the doctor might find and 60% of those who reported embarrassment).
Conclusion These unique data on the nature of the most common symptoms of cancer and risk factors for delayed symptomatic presentation among a representative sample of cancer patients can inform public health approaches to promoting diagnosis of cancer at an early stage and contribute to improving cancer survival.
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