Mismatch between cancer symptom knowledge and symptom attribution in daily life: A population-based study


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Katriina Whitaker1, Una Macleod3, Alice Simon4, Suzanne Scott2, Jane Wardle1
1University College London, London, UK, 2King's College London, London, UK, 3Hull York Medical School, Hull, UK, 4City University, London, UK

Background

Failure to recognise symptom seriousness is a common reason given for delay in cancer presentation. However, recent studies have demonstrated that the public has good knowledge of warning signs for cancer; indicating that delay cannot be due to lack of knowledge per se. We collected symptom data in a population-based sample to investigate whether formal knowledge that a symptom is a ‘warning sign' for cancer was related to making a cancer attribution when the symptom was experienced.

Method

A postal survey was sent to 4931 adults (>50 years, no cancer diagnosis), from 3 General Practices in England, asking about recent experience (past 3 months) of 17 symptoms, including 10 ‘cancer warning signs' symptoms. The survey was presented as a health survey to avoid cancer focus. Follow-up questions asked about perceived cause and perceived seriousness for each reported symptom. Knowledge of warning signs was assessed with items from the CAM1, embedded among questions about other illnesses.

Results

Over half the respondents (915/1724: 53%) reported at least one ‘cancer warning sign' symptom. However, only 23 (1.3%) spontaneously mentioned cancer as a possible cause. A higher proportion (40%) thought the symptom might be serious, ranging from 28% (18/64) of respondents with unexplained weight loss to 62% (154/247) for unexplained pain. Multiple regression analyses on a symptom-by-symptom basis showed that ‘knowledge' of that item on the CAM did not predict a cancer attribution or perceived seriousness, except for unexplained bleeding where knowledge was associated with higher perceived seriousness (beta=0.25, p<.05).

Conclusion

When asked about ‘real-time' symptom experience, theoretical knowledge of cancer warning signs did not translate to making a cancer attribution, or to higher perceived seriousness. Further work is needed to understand why cancer schema are not activated when people engage in symptom appraisal.