The role of chronic conditions in influencing symptom attribution and anticipated help-seeking for potential lung cancer symptoms: a vignette-based study.

Aradhna Kaushal,Christian Von Wagner,Katriina Whitaker,Cristina Renzi,Georgios Lyratzopoulos,Sonja Kummer,Aishwarya Puri,Jo Waller

doi:10.3399/bjgpopen20x101086

Abstract

BackgroundVery little is known about the influence of chronic conditions on symptom attribution and help-seeking for potential cancer symptoms.AimTo determine if symptom attribution and anticipated help-seeking for potential lung cancer symptoms is influenced by pre-existing respiratory conditions (often referred to as comorbidity), such as asthma or chronic obstructive pulmonary disease (COPD).Design & settingA total of 2143 adults (1081 with and 1062 without a respiratory condition) took part in an online vignette survey.MethodThe vignette described potential lung cancer symptoms (persistent cough and breathlessness) after which questions were asked on symptom attribution and anticipated help-seeking.ResultsAttribution of symptoms to cancer was similar in participants with and without respiratory conditions (21.5% and 22.1%, respectively). Participants with respiratory conditions, compared with those without, were more likely to attribute the new or changing cough and breathlessness to asthma or COPD (adjusted odds ratio [OR] = 3.64, 95% confidence interval [CI] = 3.02 to 4.39). Overall, 56.5% of participants reported intention to seek help from a GP within 3 weeks if experiencing the potential lung cancer symptoms. Having a respiratory condition increased the odds of prompt help-seeking (OR = 1.25, 95% CI = 1.04 to 1.49). Regular healthcare appointments were associated with higher odds of anticipated help-seeking.ConclusionOnly one in five participants identified persistent cough and breathlessness as potential cancer symptoms, and half said they would promptly seek help from a GP, indicating scope for promoting help-seeking for new or changing symptoms. Chronic respiratory conditions did not appear to interfere with anticipated help-seeking, which might be explained by regular appointments to manage chronic conditions.

Highlights

IntroductionOne hypothesis is that pre-e xisting conditions could affect symptom attribution (that is, the perceived cause of symptoms) and help-seeking, when cancer and comorbidity have overlapping symptomatology
The majority of patients diagnosed with cancer have a pre-e xisting condition; it is important to examine the potential influence of chronic conditions on the timeliness of cancer diagnoses.[3,4,5]
Some studies focused on their possible effect on the diagnostic interval, but relatively little is known about how chronic conditions may influence the patient interval.[8,9,10,11]

Summary

Introduction

One hypothesis is that pre-e xisting conditions could affect symptom attribution (that is, the perceived cause of symptoms) and help-seeking, when cancer and comorbidity have overlapping symptomatology This could lead to longer patient intervals with delays in cancer diagnoses, but the evidence is heterogeneous and dependent on the specific chronic condition and cancer site.[12,13,14] In the case of lung cancer symptoms, such as persistent cough, when patients have a pre-e xisting respiratory condition this could provide a plausible ‘alternative explanation’, with patients underestimating the need for prompt help-seeking. Aim: To determine if symptom attribution and anticipated help-seeking for potential lung cancer symptoms is influenced by pre-e xisting respiratory conditions (often referred to as comorbidity), such as asthma or chronic obstructive pulmonary disease (COPD). Chronic respiratory conditions did not appear to interfere with anticipated help-s eeking, which might be explained by regular appointments to manage chronic conditions

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Conclusion