Factors Influencing Late Consultation Among Patients with Rectal Bleeding in University Kebangsaan Malaysia Medical Centre

Background: Patients’ delay in the presentation with rectal bleeding had been identified as a factor for latediagnosis of colorectal cancer. This study was conducted to determine the prevalence of delay in consulting amedical practitioner and identifying associated factors. Materials and Methods: A cross-sectional study of 80patients with rectal bleeding, aged 40 and above, was conducted between December 2008 and June 2009 inthe endoscopy unit, University Kebangsaan Malaysia Medical Centre. The self-administered questionnaireincluded data on sociodemographic, concern of rectal bleeding, whether patients sought initial advice, any selftreatment prior to medical consultation and patients’ opinion on causes of their own rectal bleeding. Results:The prevalence of delay in the presentation of rectal bleeding was 60%. Patients who were less worried (OR 9.6;95% CI 3.3-27.5), who did not seek anyone’s advice (OR 11.8; 95% CI 3.8-36.8) and took some treatment beforeseeking medical consultation (OR 5.0; 95% CI 1.0-24.1) were significantly more likely to delay. Multiple logisticregression revealed that less worry of rectal bleeding and not seeking anyone’s advice were important predictors(p < 0.05). The majority of patients attributed their bleeding to benign causes. Conclusion: A high proportion ofpatients with rectal bleeding in the high risk group delayed in seeking medical advice. Public education needsto focus on interventions to reduce the delay in presenting and diagnosis of colorectal carcinoma.     

Passive cancer detection and medical help seeking for cancer symptoms: (in)adequate behavior and psychosocial determinants.

The present study explored the performance and psychosocial determinants of passive cancer detection behavior, that is, attentiveness to cancer symptoms, and medical help seeking, and investigated potential dependency between these two behaviors. A detailed telephone survey was conducted among 459 respondents, aged 55 years or older. The survey assessed passive detection behavior and appropriately timed medical help seeking, regarding 14 cancer symptoms. Knowledge of cancer symptoms and various other psychosocial determinants were also measured. Knowledge of cancer symptoms and adequate passive detection behavior was low to moderate. Timely medical help-seeking behavior was low to moderate for urgent symptoms but relatively high for prolonged symptoms. Overall, women had higher knowledge levels, paid more attention to cancer symptoms, and performed more timely help seeking than men. Passive detection behavior was positively associated with premotivational awareness factors (knowledge and awareness), female gender, and perceived advantages. Timely medical help seeking was positively related to cognitive motivational factors (perceived advantages, self-efficacy expectations, and intention) and negatively related to educational level and perceived susceptibility to cancer. Furthermore, a strong positive association was found between the performance of passive detection behavior and timely medical help seeking. The suboptimal levels of knowledge and performance of early cancer detection behaviors found in this study emphasize a need for educational efforts in the area of early cancer detection. The effectiveness of these efforts may benefit from considering the distinct sets of determinants of passive detection behavior and medical help seeking.     

Random Cross-Sectional Determination of the Level of Awareness Among Female Saudi Patients About Breast Cancer

The purpose of this study was to randomly determine the level of awareness and knowledge among female Saudi patients about the risk factors and symptoms of breast cancer as well as any awareness about the practices for breast cancer self-examination. A random cross-sectional survey was conducted over 4 months at two private medical clinics in Riyadh, Saudi Arabia. The 4-month period was from December 2013 to March 2014. The survey instrument was a questionnaire that was both self-explanatory and user-friendly. Our study subjects included 174 randomly selected Saudi female patients with no medical history of breast cancer. These patients visited these private clinics for medical advice or for consultation on problems unrelated to breasts. Participants’ perception of risk factors regarding early menses showed only 47.1 %. The most common risk factor known by the participants was a family history of breast cancer (84 %). The most widely recognized symptoms of breast cancer were occurrence of breast lumps (86.2 %) and breast pain (93.7 %). Awareness of information regarding breast self-examination (BSE) was 81.6 % in general. Many were aware of the opinion that proper and assisted knowledge about BSE can help in early detection of breast cancer. The patients were also aware that BSE is the most widely used method of screening for breast cancer in clinics and hospitals. All the participants showed sufficient knowledge about the risk factors and symptoms of breast cancer. These baseline findings are encouraging for providing more self-explanatory information (to patients) and guidance to health authorities for developing effective breast health care programs in the entire Kingdom for the female population and not only for patients visiting health care clinics for advice on other medical issues.     

Breast cancer awareness among older women

The aim of this study was to elicit the level of breast cancer awareness in older women. A cross-sectional study-specific questionnaire survey of 712 British women aged 67-73 years (response rate 83.8%), assessing knowledge of symptoms and risk and confidence to detect a change, was conducted. Over 85% of respondents were aware that a lump was a symptom of breast cancer but knowledge of non-lump symptoms was limited. Knowledge of risk was poor; 50% believed that the lifetime risk of developing breast cancer was less than 1 in 100 women and 75% were not aware that age is a risk factor. Thirty-one percent of women reported low levels of confidence to detect a breast change and 19% rarely or never checked their breasts. Those with fewer educational qualifications had poorer knowledge of symptoms, less awareness of lifetime and age-related risks, but were more likely to check their breasts than more highly educated women. This national survey demonstrates a significant lack of the prerequisite knowledge and confidence to detect a breast change. Raising breast cancer awareness and promoting early presentation among older women is important, as they are more at risk of breast cancer and more likely to delay seeking help with breast cancer symptoms than younger women.     

Patient factors influencing symptom appraisal and subsequent adjustment to oesophageal cancer: A qualitative interview study

Oesophageal cancer (EC) is characterised by vague symptoms and is often diagnosed at an advanced stage, leading to poor outcomes. Therefore, we aimed to investigate whether there might be any patient factors contributing to delay in EC diagnosis, and focused on the symptom appraisal and help‐seeking strategies of people diagnosed with EC in the UK. Semi‐structured interviews were conducted with 14 patients aged >18 years with localised EC at point of diagnosis. Purposive sampling was used to include patients from 1 to 9 months post‐diagnosis. Analysis of the interviews identified three main themes: Interpreting symptoms, Triggers to seeking help and Making sense of an unfamiliar cancer. Findings suggested that participants normalised symptoms or used previous health experiences as a means to interpret their symptoms. The majority of participants were not alarmed by their symptoms, mainly because they had very little knowledge of EC specific symptoms. Lack of knowledge also influenced participants’ sense‐making of their diagnosis. The findings highlight that the process of symptom appraisal in EC is likely to be inaccurate, which may hinder early presentation and thus diagnosis. Public health campaigns communicating EC specific symptoms, however, could shorten the appraisal period and lead to earlier diagnosis.     

Knowledge of cancer symptoms among patients attending one-stop breast and rectal bleeding clinics.

AIM AND METHOD: The aim of this questionnaire study was to identify knowledge of breast and colorectal cancer symptoms among 100 patients attending one-stop breast clinics and rectal bleeding clinics and to determine the source of the information. RESULTS: Seventy-five breast clinic (mean age 46 years, all female) and 78 colorectal clinic patients (mean age 59 years, 51% male) responded. Knowledge of breast was significantly greater than bowel cancer in both groups (P<0.0001, McNemar's chi(2)). There was no difference in knowledge of symptoms of breast cancer or bowel cancer between patients attending either clinic. There was a positive association between cancer knowledge, family history and female gender but no association with age. Knowledge of Bowel Cancer Awareness Week was positively associated with colorectal cancer knowledge. CONCLUSION: Knowledge of colorectal cancer is much less than breast cancer in clinic attenders. Seventy-five per cent of women attending breast clinic could name a breast cancer symptom whereas only 37% of patients attending colorectal clinic could name a bowel cancer symptom. These findings have implications when considering patients' anxiety, expectations of a cancer diagnosis and breaking bad news.     

Risk factors for delay in symptomatic presentation: a survey of cancer patients

Background:

Delay in symptomatic presentation leading to advanced stage at diagnosis may contribute to poor cancer survival. To inform public health approaches to promoting early symptomatic presentation, we aimed to identify risk factors for delay in presentation across several cancers.

Methods:

We surveyed 2371 patients with 15 cancers about nature and duration of symptoms using a postal questionnaire. We calculated relative risks for delay in presentation (time from symptom onset to first presentation >3 months) by cancer, symptoms leading to diagnosis and reasons for putting off going to the doctor, controlling for age, sex and deprivation group.

Results:

Among 1999 cancer patients reporting symptoms, 21% delayed presentation for >3 months. Delay was associated with greater socioeconomic deprivation but not age or sex. Patients with prostate (44%) and rectal cancer (37%) were most likely to delay and patients with breast cancer least likely to delay (8%). Urinary difficulties, change of bowel habit, systemic symptoms (fatigue, weight loss and loss of appetite) and skin symptoms were all common and associated with delay. Overall, patients with bleeding symptoms were no more likely to delay presentation than patients who did not have bleeding symptoms. However, within the group of patients with bleeding symptoms, there were significant differences in risk of delay by source of bleeding: 35% of patients with rectal bleeding delayed presentation, but only 9% of patients with urinary bleeding. A lump was a common symptom but not associated with delay in presentation. Twenty-eight percent had not recognised their symptoms as serious and this was associated with a doubling in risk of delay. Embarrassment, worry about what the doctor might find, being too busy to go to the doctor and worry about wasting the doctor''s time were also strong risk factors for delay, but were much less commonly reported (<6%).

Interpretation:

Approaches to promote early presentation should aim to increase awareness of the significance of cancer symptoms and should be designed to work for people of the lowest socioeconomic status. In particular, awareness that rectal bleeding is a possible symptom of cancer should be raised.     

Relationships between a sign of rectal bleeding and the results of an immunochemical occult blood test, and colorectal cancer.

A cross-sectional study based on medical check-up was carried out to investigate the association between signs of rectal bleeding and colorectal cancer, and the results of an immunochemical faecal occult blood test. The 9625 patients received both an immunochemical faecal occult blood test using a two-consecutive-day method and colonoscopy. They were then divided into two groups, according to the results of a self-completed questionnaire on the signs of rectal bleeding. The positivity rate of the immunochemical faecal occult blood test as well as the positive predictive value for colorectal cancer were determined in these two groups. The faecal occult blood test was positive in 9.3% of patients with rectal bleeding and in 4.4% of patients without rectal bleeding, and the positive predictive value for colorectal cancer was 0.79 and 0.27 in patients with and without rectal bleeding, respectively. This indicates a significant difference in the positivity rate (P < 0.001) as well as the positive predictive value (P < 0.05) between these two groups. The results suggest that there are positive associations between the signs of rectal bleeding and the results of immunochemical faecal occult blood test, and between the patients presenting with rectal bleeding and colorectal cancer.     

Oral Cancer Awareness in Sudan: Assessment of Knowledge,Attitude and Treatment Seeking Behavior

Objective: This study was aimed to assess oral cancer awareness among a selected Sudanese population and to evaluate their knowledge and treatment seeking behavior. Methods: A questionnaire- based survey was performed on the general population who attended the oral cancer awareness campaigns carried between 2015 and 2016 in different geographic areas of the Sudan. It was focusing on general awareness of oral cancer, oral cancer risk factors, oral cancer clinical signs/symptoms and treatment seeking behavior. Data were entered by Microsoft excel 2007 and analyzed by SPSS (version 20) using chi square test with P value Result: There were 1,370 participants, 634(46.3%) were males and 736(53.7%) were females. The responses of participants revealed that 66.6% have heard about oral cancer and the media was the common source of information (75.7%). Of all participants only 45.3% mentioned that they don’t have enough knowledge on oral cancer. Some participants believe that oral cancer is treatable (66.5%) whilst 30.4% respond by I don’t know. More than 80% of the respondents were aware that smokeless tobacco (toombak) is a risk factor for oral cancer. While 60.1% were aware of alcohol as a risk factor and 66.2% were aware of smoking as a risk factor. When qui square test was done, smokers were found to be the least to seek help in comparison to non-smokers. The same result was obtained from alcohol consumers but it was different in snuff dippers, as the latter response was similar to that of the non-snuff dippers. Conclusion: This study revealed a level of around 66.6% of oral cancer awareness in different states of Sudan. Counseling sessions should be conducted when necessary with further investigations to find out the reasons behind the continued practice of high risk habits, despite knowledge.     

Factors triggering medical consultation for symptoms of colorectal cancer and perceptions surrounding diagnosis

RAMOS M., ARRANZ M., TALTAVULL M., MARCH S., CABEZA E. & ESTEVA M. (2010) European Journal of Cancer Care 19 , 192–199
Factors triggering medical consultation for symptoms of colorectal cancer and perceptions surrounding diagnosis This study aims to find out how the presenting symptoms of colorectal cancer are interpreted by those who get them, to identify the main triggering factors that lead someone with colorectal cancer symptoms to consult a doctor, and to describe how those affected perceive the process of being diagnosed with colorectal cancer. It is a qualitative study performed within the theoretical framework of symbolic interactionism and from a gender perspective. Grounded theory has been used for the analysis. Semi‐structured interviews were conducted. Twelve individuals with colorectal cancer – seven men and five women – were interviewed. At first, both the men and women attributed their symptoms to trivial causes. Changes in symptoms or the persistence of symptoms trigger medical consultation. Close relatives, especially the closest female family members, can trigger medical consultation, particularly among men. The women said nothing to their families until they had already gone to the doctor. Knowledge about colorectal cancer could be a factor triggering medical consultation. The time between consulting the family doctor and seeing a specialist feels drawn out. Gender‐related differences have been observed in respect to help‐seeking in colorectal cancer. Health education programmes focusing on knowledge about cancer are needed.     

Delayed Presentation of Self-discovered Breast Cancer Symptoms in Iranian Women: A Qualitative Study

Background: Delayed presentation of symptomatic breast cancer is a public health issue in Iran, making amajor contribution to low survival. Despite the importance of this problem, current knowledge is insufficient toinform interventions to shorten patient delay. The aim of this study was to explore factors influencing patient delayin Iranian women with self-discovered breast cancer symptom. Materials and Methods: This qualitative studywas conducted during 2012-2013. Purposeful sampling was used to recruit 20 Iranian women with self-discoveredsymptoms of breast cancer who attended the Cancer Institute of Tehran University of Medical Sciences, Tehran,Iran. Data were collected through semi-structured in-depth audiotaped interviews, which were transcribed andanalyzed using conventional content analysis with MAXqda software version 10. Findings: Content analysis of thedata revealed four main themes related to the delay in seeking medical help including: 1) attributing symptomsto the benign conditions; 2) conditional health behavior; 3) inhibiting emotional expression; and 4) barriers toaccess to health care systems. Conclusions: These results suggest that patient delay is influenced by complexand multiple factors. Effective intervention to reduce patient delay for breast cancer should be developed byfocusing on improvement of women’s medical knowledge, managing patients’ emotional expression and reformof the referral system.     

Risk of colorectal cancer in general practice patients presenting with rectal bleeding, change in bowel habit or anaemia

The aim was to use data routinely collected in general practice to assess the absolute risk of colorectal cancer in patients newly presenting to their general practitioner (GP) with relevant symptoms. Three cohorts were identified from patients attending a sample of UK general practices. Patients with new symptoms of rectal bleeding, changes in bowel habit or anaemia were identified, and their incident rate for colorectal cancer and the positive predictive value (PPV) of each symptom in the following 12 months were calculated by age and gender. The total population over the age of 40 years was 2.8 million, and 9143 incident cases of colorectal cancer were identified. A total of 67,164 patients (28% men) were identified with anaemia, 27,524 (40% men) with changes in bowel habit and 44,741 (48% men) with rectal bleeding. For each cohort, the absolute risk rose with increasing age, and men were twice as likely to develop colorectal cancer. The PPV for developing colorectal cancer in the subsequent 12 months in those aged 60-69 years with anaemia was 3.02% for men, 1.38% for women; with changes in bowel habit 6.89% for men, 2.42% for women; and with rectal bleeding was 5.99% for men, 3.50% for women. A combination of any two signs and symptoms doubled the risk of an underlying cancer. In UK general practice, men are less likely to present with symptoms and signs of colorectal cancer compared with women, but after investigation are much more likely to have a colorectal cancer diagnosed. This should be taken into account in guidelines for referral.     

Awareness of Risk Factors,Symptoms and Time to Seek Medical Help of Ovarian Cancer amongst Omani Women Attending Teaching Hospital in Muscat Governorate,Oman

Background: Ovarian cancer has been regarded as most deadly gynaecological cancer in the world. In Oman,ovarian cancer is the third most prevalent gynaecological cancer affecting Omani women. The awareness of risk factors,symptoms and seeking early medical care play a role in the improvement of survival rates. The aim of this study is toexplore knowledge, risk factors, symptoms and the time taken to seek early medical help for ovarian cancer amongOmani women attended Sultan Qaboos University Hospital. Methods: The ovarian Cancer Awareness and Measure(CAM) questionnaire (translated into Arabic) was used to collect data. Results: A total of 499 women participated.The most recognised risk factors were having ovarian cysts (71.3%), smoking (67.5%) and having close relative withovarian cancer (63.5%); the least recognised were having in vitro fertilization (25.5%), having children (26.3%) andusing talcum powder in the genital area (31.5%). The most recognised symptoms were persistent pain in the pelvis(67.7%), persistent pain in the abdomen (60.3%) and extreme fatigue (56.5%); the least recognised were feeling fullpersistently (22.8%), passing more urine than usual (31.1%) and changes in bowel habits (32.1%). Multinomial logisticregression showed recognition of risk factors and symptoms were associated with a higher level of education, a higherincome, increased age, higher number of pregnancies, a longer duration of marriage and having a family history ofovarian cancer. Most of the barriers to seeking medical help were for several emotional, practical and healthcare servicereasons. Conclusion: The overall level of recognition of risk factors and symptoms of ovarian cancer among Omaniwomen were low with several emotional, practical and service barriers preventing them from seeking early medicalhelp. More measures to raise national cancer awareness levels are needed, and support for women to overcome thesebarriers to minimized delays in the presentation.     

Health-Seeking Behaviour and Delayed Presentation of Oral Cancer Patients in a Developing Country: A Qualitative Study based on the Self-Regulatory Model

Background: The aim of this study was to explore reasons for delayed health-seeking for late stage oral cancerpatients. Methods: Semi-structured in-depth interviews were conducted with 35 oral cancer patients with TNM stageIII to IV disease, who were treated at six tertiary regional centres managing oral cancer throughout Malaysia. Interviewswere audio-recorded, transcribed verbatim, coded using NVivo (version 10.0) qualitative software and analysedusing framework analysis. Results: Participants interpreted their early symptoms as a minor condition and did notconsider it as requiring immediate attention. Four types of coping strategies causing delayed help-seeking emerged:1) self-remedy 2) self-medication 3) seeking traditional healers and 4) consulting general medical practitioners (GPs)instead of dentists. Socio-economic factors, cultural beliefs and religious practices have some influence on diagnosticdelay. Conclusion: Low levels of public knowledge and awareness regarding early signs and symptoms of oral canceras well as GPs’ misdiagnosis of early lesions results in delayed diagnosis.     

Symptom Perceptions and Help-Seeking Behaviours of Omani Patients Diagnosed with Late-Stage Colorectal Cancer: A Qualitative Study

Objective: Colorectal cancer (CRC) is the fourth leading cause of mortality in Oman, with most patients diagnosed at advanced stages. Early diagnosis of CRC improves prognosis and survival rate. The aim of this study was to explore the symptom perceptions and help-seeking behaviours (HSBs) of Omani patients diagnosed with late-stage CRC. Methods: Semi-structured individual interviews were conducted with 16 patients. Results: Four main themes emerged, including normalisation and ignorance (patients felt healthy, perceived symptoms as not being serious and related to dietary habits, concealed them or prioritised work and family commitments), self-empowerment and self-management (patients were stubborn, employed ‘wait and see’ approach, used symptomatic or herbal treatments), disclosure and seeking help (patients disclosed symptoms to family members or friends, sought medical help only when symptoms worsened, visited faith healers or travelled abroad for treatment) and healthcare professionals (patients attributed treatment or diagnosis delays to lack of continuity of care, loss of trust in doctors or delays in referral). Conclusion: Patients attributed delays in CRC diagnosis to several factors based on their perceptions of symptoms. Most HSBs driven by sociocultural and emotional causes. Increased awareness of CRC symptoms and modifying HSBs can encourage early diagnosis. Prompting patients to disclose CRC-related symptoms may aid referral decisions.     

The influence of social factors on help‐seeking for people with lung cancer

While there has been no clear consensus on the potential for earlier diagnosis of lung cancer, recent research has suggested that the time between symptom onset and consultation can be long enough to plausibly affect prognosis. In this article, we present a review of the literature concerning help‐seeking delays in lung cancer presentation, and more specifically, the role and influence that social factors may play in determining when and how people decide to seek medical help. We also consider how these factors contribute to patients’ understanding of symptoms and illness indicators. We suggest that while there is research highlighting the importance of psychosocial influences on the general help‐seeking behaviour of people with concerns about cancer, existing studies are mainly retrospective, and very little work has focused on identifying triggers and barriers specific to lung cancer. Further, we propose that while there have been a number of recent initiatives to raise awareness of the early signs of lung cancer, aimed at both patients and health professionals, little information provision has been targeted specifically at the formal and informal network level. This may be a useful avenue to pursue in future initiatives.     

Causes of Delay in Seeking Treatment in Patients with Breast Cancer in Iran: a Qualitative Content Analysis Study

Background: In the Middle East, including Iran, breast cancer is the most frequent malignancy among women.Without treatment, a malignant breast tumor advances in stage, diminishing a woman’s chances of survival. Inthis study we aimed to gain insight into the causes of delay in seeking treatment in patients with breast cancer.Methods: The participants in this qualitative, content analysis study were 10 women in whom a diagnosis ofbreast cancer in the stages of II b, III or IIV had been made. They were selected from patients of a major oncologyclinic in Kerman, Iran. Data were collected by means of semi-structured interviews that lasted between 20 to30 minutes. Sampling was discontinued when data saturation was achieved. Content analysis was conductedby classifying the data into themes and sub-themes. Results: The results of our study revealed several factorsthat interfered with patients’ professional consultation seeking and prompt treatment. These factors included;lack of knowledge, fear of being diagnosed with cancer, not seeing oneself at risk, mental preoccupation andwrong diagnosis by physicians. Conclusions: This study suggests that women and even physicians need furtherinformation about breast cancer symptoms. Women need encouragement to seek medical advice when theyencounter suspicious symptoms. Additionally, women may benefit from awareness of the pros of early detectionand reassurance about the improvements in the success of breast cancer treatment.     

Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer

Background:

Rectal bleeding is a recognised early symptom of colorectal cancer. This study aimed to assess the diagnostic accuracy of symptoms, signs and diagnostic tests in patients with rectal bleeding in relation to risk of colorectal cancer in primary care.

Methods:

Diagnostic accuracy systematic review. Medline (1966 to May 2009), Embase (1988 to May 2009), British Nursing Index (1991 to May 2009) and PsychINFO (1970 to May 2009) were searched. We included cohort studies that assessed the diagnostic utility of rectal bleeding in combination with other symptoms, signs and diagnostic tests in primary care. An eight-point quality assessment tool was produced to assess the quality of included studies. Pooled positive likelihood ratios (PLRs), sensitivities and specificities were calculated.

Results:

Eight studies incorporating 2323 patients were included. Average weighted prior probability of colorectal cancer was 7.0% (range: 3.3–15.4%, median: 8.1%). Age ⩾60 years (pooled PLR: 2.79, 95% confidence interval (CI) 2.00–3.90), weight loss (pooled PLR: 1.89, 95% CI: 1.03–3.07) and change in bowel habit (pooled PLR: 1.92, 95% CI: 0.54–3.57) raise the probability of colorectal cancer into the range of referral to secondary care but do not conclusively ‘rule in'' the diagnosis. Presence of severe anaemia has the highest diagnostic value (pooled PLR: 3.67, 95% CI: 1.30–10.35), specificity 0.95 (95% CI: 0.93–0.96), but still only generates a post-test probability of 21.6%.

Conclusions:

In patients with rectal bleeding who present to their general practitioner, additional ‘red flag'' symptoms have modest diagnostic value. These findings have implications in relation to recommendations contained in clinical practice guidelines.     

Factors affecting presentation and delay in patients with testicular cancer: results of a qualitative study

A qualitative study was undertaken with men treated for testicular tumours, to ascertain how they interpreted their symptoms and the factors which influenced a decision to consult a physician. The research was undertaken with six men who had been diagnosed as having testicular tumours. Interviews were also conducted with four wives and one mother. The findings showed that giving men information on testicular cancer may not guarantee early presentation. Symptoms were not generally attributed to cancer and the one patient who practised self‐examination had delayed seeking help for 6 months. The extent to which symptoms affected the patient's lifestyle was also a factor in the decision‐making process, as was the checking of symptoms with other family members. Wives were often pivotal in persuading men to seek help. The discovery of testicular symptoms produced emotional responses which included embarrassment and fear of both cancer and castration. There was evidence of strong feelings of masculine identity bound up with the appearance of ‘normal’ genitals. Provider‐delay was identified in four cases and was associated with misattribution of symptoms by physicians and the failure to initiate specialist referral. Delay was under‐recorded in the hospital notes in all cases where presentation was not immediate. Copyright © 1999 John Wiley & Sons, Ltd.     

Knowledge of Cancer Risk Factors,Symptoms, and Barriers to Seeking Medical Help among Omani Adolescents

Objective: Raising cancer awareness among adolescents should lead to early diagnosis and improve their survival rate into adulthood. This study aims to identify knowledge of cancer risk factors, symptoms and barriers to seek medical help among Omani adolescents. Methods: A cross-sectional study with Omani adolescents (aged 15-17 years) has been conducted in six schools in Muscat, the capital of Oman. The general Cancer Awareness Measure questionnaire was used to collect the data. Results: A total of 481 adolescents participated. The average recognition of cancer risk factors and symptoms was low (36.8% and 39.6%, respectively). Cancer risk factors and/or symptoms significantly recognised more in girls compared to boys (χ2 = 10.136; Odds ratio [OR] = 2.13 ; 95% confidence interval [CI]= 0.33-3.41; P = 0.001); older (age 17 year) versus younger (aged 15 and 16 years) (χ2 = 6.075; OR = 11.68; 95% CI: 1.11-2.53; P = 0.014); those with existing co-morbidities compared to those without (χ2 = 4.955; OR = 0.41; 95% CI: 0.18-0.92; P = 0.026); and those who knew someone with cancer compared to those who did not (χ2 = 15.285; OR 2.70; 95% CI: 1.62-4.49; P <0.001). The majority of adolescents (88.8%) would seek medical help within the first two weeks of noting cancer symptoms. The most notable barriers to seek medical help were “emotional”. Girls were experienced “emotional barriers” significantly more than the boys (χ2 = 11.617; OR = 1.89; 95% CI: 1.31-2.72; P = <0.001). Conclusion: Adolescents in Oman showed poor cancer awareness with several “emotional” barriers. There is a need to establish and integrate effective cancer educational programs in school curriculums to raise the cancer awareness, address emotional barriers and encourage seeking early medical help. The program could potentially have a life-long impact on encouraging early cancer diagnosis and improving the cancer survival rate.