Background

People from lower socioeconomic groups, and people living in rural locations, have poorer cancer survival. These differences are thought to be associated with longer time to help-seeking, and therefore later stage at diagnosis. Psychosocial factors, including low awareness of the severity of symptoms experienced, and holding negative beliefs about cancer, are known to increase the time to help-seeking. The purpose of this study was to assess associations between rurality, deprivation and anticipated time to help-seeking for two cancer symptoms: persistent cough (a vague symptom, potentially of lung cancer); and rectal bleeding (an ‘alarm’ symptom, potentially of colorectal cancer).

Method

A secondary analysis of cross-sectional data from the Welsh respondents of a 2011 International Cancer Benchmarking Partnership survey was undertaken (n=2298). Univariable chi-square analysis was used to examine the determinants of anticipated time to help-seeking, including demographic background factors, symptom awareness and cancer beliefs. Multivariable generalised linear modelling was used to further test the associations.

Results

In multivariable analysis, deprivation (p<0.05) and rurality (p<0.001) were statistically significantly associated with longer anticipated time to help-seeking for persistent cough, but not rectal bleeding. For both symptoms, younger age (p<0.001), higher educational attainment (p<0.05), perceived health (p<0.05), and lower symptom awareness (p<0.0001) were significantly associated with longer help-seeking intervals. There were no other statistically significant associations for either symptom.

Conclusion

Deprivation and rurality both act to significantly increase a patient’s time to help-seeking for a symptom of lung cancer, but not colorectal cancer. The differences between the two symptoms may be explained through reduced symptom awareness; a cough is non-specific and may not be perceived by patients as a possible sign of cancer.

Impact statement

Those from rurally deprived areas may delay help-seeking and therefore present at later stage of lung cancer; interventions should be developed and targeted at rurally deprived populations in order to increase symptom recognition and facilitate earlier diagnosis of lung cancer, thereby improving survival rates.