Journal
FAMILY PRACTICE
Volume 30, Issue 3, Pages 294-301Publisher
OXFORD UNIV PRESS
DOI: 10.1093/fampra/cms087
Keywords
Breast cancer; colorectal cancer; prostate cancer; lung cancer; primary care; rural health
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Funding
- Cancer Council of Western Australia
- National Health and Medical Research Council (NHMRC) [572765]
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Previous studies have focused on the treatment received by rural cancer patients and have not examined their diagnostic pathways as reasons for poorer outcomes in rural Australia. To compare and explore symptom appraisal and help-seeking behaviour in patients with breast, lung, prostate or colorectal cancer from rural Western Australia (WA). A mixed-methods study of people recently diagnosed with breast, lung, prostate or colorectal cancer from rural WA. The time from first symptom to diagnosis (i.e. total diagnostic interval, TDI) was calculated from interviews and medical records. Sixty-six participants were recruited (24 breast, 20 colorectal, 14 prostate and 8 lung cancer patients). There was a highly significant difference in time from symptom onset to seeking help between cancers (P 0.006). Geometric mean symptom appraisal for colorectal cancer was significantly longer than that for breast and lung cancers [geometric mean differences: 2.58 (95% confidence interval, CI: 0.644.53), P 0.01; 3.97 (1.636.30), P 0.001, respectively]. There was a significant overall difference in arithmetic mean TDI (P 0.046); breast cancer TDI was significantly shorter than colorectal or prostate cancer TDI [mean difference : 266.3 days (95% CI: 45.9486.8), P 0.019; 277.0 days, (32.1521.9), P 0.027, respectively]. These differences were explained by the nature and personal interpretation of symptoms, perceived as well as real problems of access to health care, optimism, stoicism, machismo, fear, embarrassment and competing demands. Longer symptom appraisal was observed for colorectal cancer. Participants defined core characteristics of rural Australians as optimism, stoicism and machismo. These features, as well as access to health care, contribute to later presentation of cancer.
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