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An open structure questionnaire on reasons for delay in presentation: a study of patients attending clinic with red flag symptoms of head and neck cancer

  • Head and Neck
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European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Reasons for delayed presentation in cancer are reported as patient or professional delays. Studies have examined patient demographic factors associated with presentation delay, but it is currently unknown why patients feel they delayed presenting.

Methods

Questionnaire study of consecutive patients attending an urgent suspicion of cancer clinic at a tertiary referral centre in Glasgow over a 3-month period.

Results

395 patients were included. 53 (13%) patients waited 0–7 days, 164 (41%) patients 1–4 weeks, 139 (35%) 1–12 months and 31 (8%) waited longer than 12 months, before presenting. 8 (3%) did not state length of time before presentation. 123 (31%) patients were not worried about their symptoms. 5 of the 13(38%) patients diagnosed with head and neck cancer, waited up to 12 months. 5 (38%) cancer patients delayed presentation because they were not worried about symptoms.

Conclusion

Patients with head and neck cancer are not worried about their symptoms and delay their presentation, possibly contributing towards later stage diagnosis.

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References

  1. Foot C, Harrison T (2011) How to improve cancer survival: Explaining England’s relatively poor rates. The King's Fund https://www.kingsfund.org.uk/sites/default/files/How-to-improve-cancer-survival-Explaining-England-poor-rates-Kings-Fund-June-2011. Accessed 3 Feb 2020

  2. Allgar VL, Neal RD (2005) Delays in the diagnosis of six cancers: analysis of data from the National Survey of NHS Patients. Br J Cancer 92(11):1959–1970

    Article  CAS  Google Scholar 

  3. Simon AE, Waller J, Robb K, Wardle J (2011) Europe PMC Funders Group Patient delay in presentation of possible cancer symptoms: the contribution of knowledge and attitudes in a UK population sample. Cancer Epidemiol Biomarkers Prev 19(9):2272–2277

    Article  Google Scholar 

  4. Thomson CS, Forman D (2009) Cancer survival in England and the influence of early diagnosis: what can we learn from recent EUROCARE results ? Br J Cancer [Internet] 101(S2):S102–S109. https://doi.org/10.1038/sj.bjc.6605399

    Article  Google Scholar 

  5. Scottish Government (2019) Scottish referral guidelines for suspected cancer. https://www.gov.scot/publications/scottish-referral-guidelines-suspected-cancer-january-2019/. Accessed 3 Feb 2020

  6. Zeitler M,  Fingland P, Tikka T, Douglas CM, Montgomery J (2018) Deprivation in relation to urgent suspicion of head and neck cancer referrals in Glasgow. Clin Otolaryngol  43(3):861–867

    Article  CAS  Google Scholar 

  7. Mckie C, Ahmad UA, Fellows S, Meikle D, Stafford FW, Thomson PJ et al (2008) The 2-week rule for suspected head and neck cancer in the United Kingdom: referral patterns, diagnostic efficacy of the guidelines and compliance. OraOncol 4(9):851–856

    Article  CAS  Google Scholar 

  8. Scott SE, Grunfeld EA, Auyeung V, Mcgurk M (2009) Barriers and triggers to seeking help for potentially malignant oral symptoms : implications for interventions. J Public Heal Dent 69(1):34–40

    Article  Google Scholar 

  9. Health Research Authority (2018) HRA Decision Tool. http://www.hra-decisiontools.org.uk/research/. Acessed 3 Feb 2020

  10. Stangroom J (2020) Social Science Statistics. https://www.socscistatistics.com/tests/chisquare2/default2.aspx. Acessed 3 Feb 2020

  11. Drinkaware (2019) What is an alcohol unit? https://www.drinkaware.co.uk/alcohol-facts/alcoholic-drinksunits/what-is-an-alcohol-unit/. Accessed 28 Feb 2020

  12. Department of Health and Social Care (2016) New alcohol guidelines show increased risk of cancer. https://www.gov.uk/government/news/new-alcohol-guidelines-show-increased-risk-of-cancer. Accessed 28 Feb 2020

  13. Baughan P, Keatings J, Neill BO (2011) Urgent suspected cancer referrals from general practice. Br J Gen Pract 61(592):e700–e706

    Article  Google Scholar 

  14. Clouston SA, Manganello JARM (2016) A life course approach to health literacy: the role of gender, educational attainment and lifetime cognitive capability. Age Ageing 46(3):493–499

    PubMed Central  Google Scholar 

  15. Kickbusch IS (2001) Health literacy: addressing the health and education divide. Health Promot Int 16(3):289–297

    Article  CAS  Google Scholar 

  16. Jansen T, Rademakers J, Waverijn G, Verheij R, Osborne R, Heijmans M (2018) The role of health literacy in explaining the association between educational attainment and the use of out-of-hours primary care services in chronically ill people: a survey study. BMC Health Serv Res 18(394):1–13

    Google Scholar 

  17. Fingland P, Carswell V, Tikka T, Douglas CM, Montgomery J (2018) The value of chest X-ray in the Scottish Referral Guidelines for suspected head and neck cancer in 2144 patients. J Laryngol Otol 2019(132):434–438

    Article  Google Scholar 

  18. Williams P, Murchie P, Bond C (2019) Patient and primary care delays in the diagnostic pathway of gynaecological cancers. Br J Gen Pract 69(679):e106–111

    Article  Google Scholar 

  19. Pedersen AF, Forbes L, Brain K, Hvidberg L, Wulff CN, Lagerlund M et al (2018) Negative cancer beliefs, recognition of cancer symptoms and anticipated time to help-seeking: an international cancer benchmarking partnership (ICBP) study. BMC Cancer 18(363):1–10

    Google Scholar 

  20. Tromp DM, Brouha X, Hordijk G, Am J, De LJRJ (2005) Patient factors associated with delay in primary care among patients with head and neck carcinoma: a case-series analysis. Fam Pract 22(5):554–559

    Article  Google Scholar 

  21. Mccutchan GM, Wood F, Edwards A, Richards R, Brain KE (2015) Influences of cancer symptom knowledge, beliefs and barriers on cancer symptom presentation in relation to socioeconomic deprivation: a systematic review. BMC Cancer 15:1000

    Article  Google Scholar 

  22. Montgomery J, Douglas CM, Begbie F, Hitchings A, MacKenzie K (2019) ‘Urgent suspicion of cancer’ referrals to a head and neck clinic—what do patients expect? J Laryngol Otol 1–6 [Epub ahead of print]

  23. Purayastha M, McMahon AD, Gibson J, Conway DI (2016) Trends of oral cavity, oropharyngeal and laryngeal cancer incidence in Scotland 1975–2012)—a socioeconomic perspective. Oral Oncol. 61:70–75

    Article  Google Scholar 

  24. Lannin DR, Mathews HF, Mitchell J, Swanson MS, Swanson FH, Edwards MS (1998) Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer. JAMA 279(22):1801–1807

    Article  CAS  Google Scholar 

  25. Tromp DM, Brouha XDR, Leeuw JRJWJ (2004) Psychological factors and patient delay in patients with head and neck cancer. Eur J Cancer 40(10):1509–1516

    Article  CAS  Google Scholar 

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Correspondence to Alison E. Lim.

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Lim, A.E., Douglas, C.M. & Montgomery, J. An open structure questionnaire on reasons for delay in presentation: a study of patients attending clinic with red flag symptoms of head and neck cancer. Eur Arch Otorhinolaryngol 277, 1801–1806 (2020). https://doi.org/10.1007/s00405-020-05897-w

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  • DOI: https://doi.org/10.1007/s00405-020-05897-w

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