Patient delay in presenting symptoms of breast cancer in women in the Czech Republic
Authors:
Mgr. Černíková Anna Kristýna; PhDr. Kráčmarová Klůzová Lucie, Ph.D.; Mgr. Pešoutová Markéta; Mgr. Tavel Peter, Ph.D.
Authors place of work:
Institut sociálního zdraví, Cyrilometodějská teologická fakulta, UP Olomouc
Published in the journal:
Klin Onkol 2021; 34(1): 40-48
Category:
Original Articles
doi:
https://doi.org/10.48095/ccko202140
Summary
Background: Presenting breast cancer symptoms and seeking medical help is a key element in the diagnosis and treatment of this disease. Early presentation of symptoms increases the likelihood of recovery. However, some women do not seek medical attention as soon as they find a symptom and delay a visit to the physician.
Material and methods: This study is part of a project based on DIPEx qualitative methodology focused on experience of women with breast cancer. The aim of this article is to explore reasons for the delay of the presentation of breast cancer symptoms to a physician. Fifty-three interviews with women were collected across the Czech Republic. Aiming for maximum variation of the sample, the women represent different age groups, education level, marital status, stages of illness and types of treatment. The DIPEx qualitative methodology was used. The first part of the interview is narrative, followed by a semi-structured part. The interviews were verbatim transcribed for the analysis. The data were analysed using NVivo10 software. Open coding was applied from which the categories were constructed and the themes emerged. We used the OSOP (one sheet of paper) method for a thematic analysis.
Results: Delay in presenting symptoms to a physician is mainly caused by wrong symptom interpretation, and not considering symptom as serious. In some cases, defence mechanisms are activated and women tend to downplay the symptom. Cognitive distortion is triggered in some women who have experience with such a symptom. Other women tend to prioritize various life events over seeing a physician. Screening tests were perceived positively.
Conclusions: Bearing the results in mind, we recommend aiming educational campaigns not only at symptom recognition and the importance of seeking medical help, but also the subsequent steps that need to be taken.
Keywords:
breast cancer – patient – Health care – health psychology –psycho-oncology – patient delay
Zdroje
1. Burgess C, Hunter MS, Ramirez AJ. A qualitative study of delay among women reporting symptoms of breast cancer. Br J Gen Pract 2001; 51 (473): 967–971.
2. Khakbazan Z, Taghipour A, Roudsari RL et al. Help seeking behavior of women with self-discovered breast cancer symptoms: a meta-ethnographic synthesis of patient delay. Plos One 2014; 9 (12): 24. doi: 10.1371/journal.pone.0110262.
3. Richards MA, Smith P, Ramirez AJ et al. The influence on survival of delay in the presentation and treatment of symptomatic breast cancer. Br J Cancer 1999; 79 (5–6): 858–864. doi: 10.1038/sj.bjc.6690137.
4. Ústav zdravotnických informací a zdravotnictví ČR. Novotvary, 2015. [online]. Dostupné z: http: //www.uzis.cz/katalog/zdravotnicka-statistika/novotvary.
5. Skovajsová M, Májek O, Daneš J et al. Results of the Czech National Breast Cancer screening programme. Klin Onkol 2014; 27 (Suppl 2): 2S69–2S78.
6. Smith LK, Pope C, Botha JL. Patients‘ help-seeking experiences and delay in cancer presentation: a qualitative synthesis. Lancet 2005; 366 (9488): 825–883. doi: 10.1016/s0140-6736 (05) 67030-4.
7. Stamatovic L, Vasovic S, Trifunovic J et al. Factors influencing time to seeking medical advice an onset of treatment in women who are diagnosed with breast cancer in Serbia. Psychooncology 2018; 27 (2): 576–582. doi: 10.1002/pon.4551.
8. Hansen RP, Vedsted P, Sokolowski I et al. Time intervals from first symptom to treatment of cancer: a cohort study of 2,212 newly diagnosed cancer patients. BMC Health Services Research 2011; 11: 284. doi: 10.1186/1472-6963-11-284.
9. Leon-Rodriguez E, Molina-Calzada C, Rivera-Franco MM et al. Breast self-exam and patient interval associate with advanced breast cancer and treatment delay in Mexican women. Clin Transl Oncol 2017; 19 (10): 1276–1282. doi: 10.1007/s12094-017-1666-6.
10. Leydon GM, Bynoe-Sutherland J, Coleman MP. The journey towards a cancer diagnosis: the experiences of people with cancer, their family and carers. Eur J Cancer Care 2003; 12 (4): 317–326. doi: 10.1046/j.1365-2354.2003.00418.x.
11. Forbes LJ, Warburton F, Richards MA et al. Risk factors for delay in symptomatic presentation: a survey of cancer patients. Br J Cancer 2014; 111 (3): 581–588. doi: 10.1038/bjc.2014.304.
12. Bairati I, Fillion L, Meyer FA et al. Women‘s perceptions of events impeding or facilitating the detection, investigation and treatment of breast cancer. Eur J Cancer Care (Engl) 2006; 15 (2): 183–193. doi: 10.1111/j.1365-2354.2005.00635.x.
13. Lund-Nielsen B, Midtgaard J, Rorth M et al. An avalanche of ignoring-a qualitative study of health care avoidance in women with malignant breast cancer wounds. Cancer Nurs 2011; 34 (4): 277–285. doi: 10.1097/NCC.0b013e3182025020.
14. Gozum S, Tuzcu A. Elapsed time between the first symptoms of breast cancer and medical help-seeking behavior and the affecting factors. Cancer Nursing 2018; 41 (3): E21–E29. doi: 10.1097/ncc.0000000000000 498.
15. Hvidberg L, Wulff CN, Pedersen AF et al. Barriers to healthcare seeking, beliefs about cancer and the role of socio-economic position. A Danish population-based study. Prev Med 2015; 71: 107–113. doi: 10.1016/j.ypmed.2014.12.007.
16. Bish A, Ramirez A, Burgess C et al. Understanding why women delay in seeking help for breast cancer symptoms. J Psychosom Res 2005; 58 (4): 321–326. doi: 10.1016/j.jpsychores.2004.10.007.
17. Burgess CC, Potts HW, Hamed H et al. Why do older women delay presentation with breast cancer symptoms? Psychooncology 2006; 15 (11): 962–968. doi: 10.1002/pon.1030.
18. Macleod U, Mitchell ED, Burgess C et al. Risk factors for delayed presentation and referral of symptomatic cancer: evidence for common cancers. Br J Cancer 2009; 101 (Suppl 2): S92–S101. doi: 10.1038/sj.bjc.6605 398.
19. Nosarti C, Crayford T, Roberts JV et al. Delay in presentation of symptomatic referrals to a breast clinic: patient and system factors. Br J Cancer 2000; 82 (3): 742–748. doi: 10.1054/bjoc.1999.0990.
20. Murphy PJ, Marlow LA, Waller J et al. What is it about a cancer diagnosis that would worry people? A population-based survey of adults in England. BMC Cancer 2018; 18 (1): 86. doi: 10.1186/s12885-017-3963-4.
21. Bourdeanu L, Luu T, Baker N et al. Barriers to treatment in patients with locally advanced breast cancer. J Natl Compr Canc Netw 2013; 11 (10): 1193–1198. doi: 10.6004/jnccn.2013.0141.
22. O‘Mahony M, Hegarty J, McCarthy G. Women‘s help seeking behaviour for self discovered breast can19cer symptoms. Eur J Oncol Nurs 2011; 15 (5): 410–418. doi: 10.1016/j.ejon.2010.10.011.
23. Agustina E, Dodd RH, Waller J et al. Understanding middle-aged and older adults‘ first associations with the word „cancer“: A mixed methods study in England. Psychooncology 2018; 27 (1): 309–315. doi: 10.1002/pon. 4569.
24. Meechan G, Collins J, Petrie KJ. The relationship of symptoms and psychological factors to delay in seeking medical care for breast symptoms. Prev Med 2003; 36 (3): 374–378. doi: 10.1016/s0091-7435 (02) 00 053-1.
25. Weingart SN, Saadeh MG, Simchowitz et al. Process of care failures in breast cancer diagnosis. J Gen Intern Med 2009; 24 (6): 702–709. doi: 10.1007/s11606-009- 0982-0.
26. O‘Mahony M, McCarthy G, Corcoran P et al. Shedding light on women‘s help seeking behaviour for self discovered breast symptoms. Eur J Oncol Nurs 2013; 17 (5): 632–639. doi: 10.1016/j.ejon.2013.03.012.
27. Harirchi I, Ghaemmaghami F, Karbakhsh M et al. Patient delay in women presenting with advanced breast cancer: an Iranian study. Public Health 2005; 119 (10): 885–891. doi: 10.1016/j.puhe.2004.11.005.
28. Foretová L, Navrátilová M, Svoboda M et al. Recommendations for preventive care for women with rare genetic cause of breast and ovarian cancer. Klin Onkol 2019; 32 (Suppl 2): 2S6–2S13. doi: 10.14735/amko2019S6.
29. Claes K, Mikova M, Házová J et al. Twenty years of BRCA1 and BRCA2 molecular analysis at MMCI – current developments for the classification of variants. Klin Onkol 2019; 32 (Suppl 2): 2S51–2S71. doi: 10.14735/amko2019 S51.
30. Chojnacka-Szawlowska G, Majkowicz M, Basinski K et al. Knowledge of cancer symptoms and anxiety affect patient delay in seeking diagnosis in patients with heterogeneous cancer locations. Curr Probl Cancer 2017; 41 (1): 64–70. doi: 10.1016/j.currproblcancer.2016.10.001.
31. Innos K, Padrik P, Valvere V et al. Identifying women at risk for delayed presentation of breast cancer: a cross-sectional study in Estonia. BMC Public Health 2013; 13: 947. doi: 10.1186/1471-2458-13-947.
32. De Nooijer J, Lechner L, De Vries H. Help-seeking behaviour for cancer symptoms: perceptions of patients and general practitioners. Psychooncology 2001; 10 (6): 469–478. doi: 10.1002/pon.535.
33. Ziebland S, McPherson A. Making sense of qualitative data analysis: an introduction with illustrations from DIPEx (personal experiences of health and illness). Med Educ 2006; 40 (5): 405–414. doi: 10.1111/j.1365-2929.2006.02467.x
34. Chapple A, Ziebland S, McPherson A. Qualitative study of men‘s perceptions of why treatment delays occur in the UK for those with testicular cancer. Br J Gen Pract 2004; 54 (498): 25–32.
35. Sutton S, Bickler G, Sanchoaldridge J et al. Prospective-study of predictors of attendance for breast screening in inner London. J Epidemiol Community Health 1994; 48 (1): 65–73. doi: 10.1136/jech.48.1.65.
36. Ministerstvo zdravotnictví ČR.Vyhláška 70/2012 Sb. o preventivních prohlídkách. [online]. Dostupné z: https: //www.zakonyprolidi.cz/cs/2016-317.
37. Pedersen AF, Olesen F, Hansen RP et al. Coping strategies and patient delay in patients with cancer. J Psychosoc Oncol 2013; 31 (2): 204–218. doi: 10.1080/07347332.2012.761319.
38. Breuning M, Lucius-Hoene G, Burbaum C et al. Patient experiences and patient centeredness. The website project DIPEx Germany. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz 2017; 60 (4): 453–461. doi: 10.1007/s00103-017-2524-y.
39. Herxheimer A, McPherson A, Miller R et al. Database of patients‘ experiences (DIPEx): a multi-media approach to sharing experiences and information. Lancet 2000; 355 (9214): 1540–1543. doi: 10.1016/s0140-6736 (00) 02 174-7.
40. Tavel P, Klůzová Kráčmarová L, Půžová Z et al. Metodika DIPEx ČR. Certifikovaná metodika MPSV č.j.: 2015/70065-312. [online]. Dostupné z: https: //oushi.upol.cz/public/certifikovana-metodika/.
41. Coyne IT. Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear boundaries? J Adv Nurs 1997; 26 (3): 623–630. doi: 10.1046/j.1365-2648.1997.t01-25-00999.x.
42. Cameron L, Leventhal EA, Leventhal H. Symptom representations and affect as determinants of care seeking in a community-dwelling, adult sample population. Health Psychol 1993; 12 (3): 171–179. doi: 10.1037//0278-6133.12.3.171.
Štítky
Paediatric clinical oncology Surgery Clinical oncologyČlánok vyšiel v časopise
Clinical Oncology
2021 Číslo 1
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole vs. Tramadol in Postoperative Analgesia
- Spasmolytic Effect of Metamizole
- Possibilities of Using Metamizole in the Treatment of Acute Primary Headaches
- Current Insights into the Antispasmodic and Analgesic Effects of Metamizole on the Gastrointestinal Tract
Najčítanejšie v tomto čísle
- Breast cancer rehabilitation
- Germline mutations in RAD51C and RAD51D and hereditary predisposition to ovarian cancer
- Droplet digital PCR as a novel diagnostic tool
- Squamous cell rectal cancer in a young woman