為何病患會忽略癌症的警告症狀


  【24drs.com】英國癌症研究調查認為,人們通常會警覺到一些癌症警告症狀,卻避免或延後與他們的主要照護提供者諮商,或許這正是英國一年癌症存活率不佳的原因。
  
  Surrey大學健康科學院資深講師Katriina Whitaker博士表示,我們知道,英國的癌症存活率比其他有類似健康照護系統的高所得國家還要糟糕。
  
  Whitaker博士表示,我們想要執行一些以社區為基礎的研究,藉以瞭解人們在實際生活中,在不知道可能是癌症下,對於初期癌症警訊是如何詮釋與回應。
  
  這些結果發表於2月的英國一般醫學期刊。
  
  Whitaker博士的團隊發出一份健康調查給4,858名50歲以上、在2010年某3個月期間內於倫敦三個一般開業機構之一就診者;倫敦的一年存活率是英國最低的。
  
  調查並未使用癌症這個語詞,而是列出癌症防治意識所提及的17症狀。
  
  回覆的1,724人中,915人表示至少有一項癌症相關症狀,482同意與研究人員聯絡;研究團隊選擇48人進行深度訪談,38人是面談,10人是電話訪談。
  
  有許多研究對象知道他們的症狀與癌症有關,其中一些症狀被視為「沒有明天」或「惡魔」。
  
  不過,有45%的研究對象並未與主治醫師連絡告知症狀,理由包括:症狀間歇出現、不想打擾醫師或浪費國家健康服務資源、認為經常找醫師諮商是代表虛弱、認為症狀是因為老化。
  
  Whitaker博士報告指出,有些研究對象與醫師諮商是因為接觸到癌症警覺活動、或者是接受親友的建議。癌症警覺活動包括:從電視和廣播節目得知結腸癌的症狀;讓其他人催促親友尋求幫助的「警告症狀」是持續咳嗽(健康活動強調這是肺癌的潛在症狀) 。
  
  研究人員發現,在一些情況下人們會尋求幫助:懸而未決的症狀、感覺到哪裡有問題、擔心是癌症,不過,擔心是癌症的想法會使有些人反而不採取行動,其他人會延遲到因為其他原因就醫時才告訴醫師這些症狀。
  
  有些人會變得習慣這些症狀而開始認為這是正常的,另外有許多研究對象,整天都陷於擔憂癌症的影響,有些人是對醫療系統不信任,有些人表示難以預約、分配給體檢的時間太短。
  
  研究者認為,有些研究對象傾向會忍耐相當程度的不適,例如持續吞嚥困難、腸道蠕動出血,這是英國人「咬緊牙關」的特色。
  
  Whitaker博士解釋,國際比較研究發現,英國比其他國家如澳大利亞、加拿大、丹麥、挪威和瑞典更擔心會浪費醫師的時間。另外有研究發現病人會延遲中風和心臟疾病的跡象,所以我認為,我們的研究結果不只適用於癌症,而且能更廣泛應用。
  
  英國癌症研究、及早診斷小組負責人Sara Hiom表示,及早確定和治療癌症表示病患有更好的機會對抗疾病,所以,我們瞭解為何有些有潛在症狀的人決定不立即檢查是很重要的。
  
  Hiom解釋,這篇研究讓我們深入了解患者的決策過程,可幫助我們找到鼓勵有症狀者盡早尋求協助的方法。
  
  研究限制包括,質性研究的本質、樣本少,有關研究對象對於可能代表癌症症狀之追蹤態度的訪談資料只有一點點。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7156&x_classno=0&x_chkdelpoint=Y
  

Why Patients Ignore Cancer 'Alarm' Symptoms

By Ricki Lewis, PhD
Medscape Medical News

The finding that people are often aware of "alarm" symptoms of cancer but avoid or delay consulting their primary care provider might explain the poor 1-year cancer survival rates in the United Kingdom, a Cancer Research UK survey suggests.

"We know that in the United Kingdom there is worse survival from cancer than in other high-income countries with similar healthcare systems," said Katriina Whitaker, PhD, senior lecturer in the School of Health Sciences at the University of Surrey.

"We wanted to do some community-level research to understand how people interpret and respond to symptoms that could give an early warning sign of cancer in real life, without imposing a cancer perspective," Dr Whitaker told Medscape Medical News.

In results were published in the February issue of the British Journal of General Practice.

Dr Whitaker's team developed and sent a health survey to 4858 people older than 50 years who attended one of three general practices in London during a 3-month period in 2012. The 1-year survival rates in London are among the lowest in the United Kingdom.

The survey did not use the word "cancer," but listed 17 symptoms from the Cancer Awareness Measures.

Of the 1724 respondents, 915 reported having at least one cancer-associated symptom, and 482 gave their consent to be contacted by the researchers.

The team chose 48 participants for in-depth interviews; 38 were conducted in person and 10 were conducted over the phone.

Many of the participants recognized their symptoms as being associated with cancer, which some referred to as "the big C" or "the bogeyman."

However, 45% of the participants did not contact a primary care physician about their symptoms. Reasons for not doing so included the intermittent nature of the symptoms, not wanting to bother a physician or waste National Health Service resources, the perception that frequently consulting a doctor is a sign of weakness, and the attribution of the symptoms to aging.

Some of the participants consulted a physician only after exposure to a cancer awareness campaign or on the advice of a friend or family member, Dr. Whitaker reported. One awareness campaign cited involved TV and radio spots describing the symptoms of colon cancer; an "alarm symptom" that often provoked others to push a friend or relative to seek help was persistent coughing (highlighted in a health campaign as a potential symptom of lung cancer).

The researchers identified some circumstances under which people do seek help: unresolved symptoms, a feeling that something is wrong, and awareness or fear of cancer. However, fear of cancer kept some individuals from taking action, and others delayed mention of the symptom until they visited a primary care physician for another reason.

Some people became accustomed to the symptom and began to think of it as normal. For many participants, fear centered around the effect of cancer on daily life. Some reported a distrust of the healthcare system, and some cited difficulty making an appointment and the short times allotted for medical exams.

The researchers attribute the propensity of some participants to endure considerable discomfort, such as persistent difficulty swallowing and bloody bowel movements, to the British characteristic of a "stiff upper lip."

"International comparisons have shown that in the United Kingdom, we are more worried about wasting the doctor's time than in other countries, such as Australia, Canada, Denmark, Norway, and Sweden," Dr. Whitaker explained. "There's also been research looking into patient delay for signs of stroke and heart disease, so I think the findings have more general application beyond cancer."

"Spotting and treating cancer early means that patients have a far better chance of beating the disease, so it's important we understand why some people with potential symptoms decide not to get them checked out straight away," said Sara Hiom, director of early diagnosis at Cancer Research UK.

"This study gives us valuable insight into the decision-making process, and could help us find ways to encourage everyone with worrying symptoms to seek help as early as possible," Hiom explained.

Limitations of this study include the qualitative nature of the investigation, the small sample size, and the fact that the interviews provided only glimpses of each participant's attitude toward following-up on symptoms that could indicate cancer.

Dr Whitaker and Ms Hiom have disclosed no relevant financial relationships.

Br J Gen Pract. 2015;65(631):e96-e105.

    
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