Psychological factors related to time to help-seeking for cancer symptoms: a meta-analysis across cancer sites

ABSTRACT

The time patients wait before seeking help for cancer symptoms is among the most important factors contributing to diagnostic delays in cancer. We reviewed the association between time to help-seeking and three psychological factors: symptom knowledge, symptom interpretation, and beliefs about cancer. Forty-seven studies met the inclusion criteria, providing data from 22 countries concerning seven cancer sites. Better symptom knowledge was related to lower odds of a long help-seeking interval in both studies with healthy populations (OR = .73, 95% CI [.63, .84], k = 19) and patients (OR = .40, 95% CI [.23, .69], k = 12), and so was interpreting experienced symptoms as cancer-related (OR = .52, 95% CI [.36, .75], k = 13 studies with patients). More positive beliefs about cancer (i.e., that cancer is treatable) were associated with lower odds of a long help-seeking interval in both studies with healthy populations (OR = .70, 95% CI [.52, .92], k = 11) and with patients (OR = .51, 95% CI [.32, .82], k = 7). Symptom knowledge, interpretation, and beliefs about cancer are likely to be universal predictors of help-seeking and should be incorporated into theoretical models of patient help-seeking and interventions aiming to reduce delays.

KEYWORDS:

• Cancer
• patient interval
• time to help-seeking
• diagnostic delay
• beliefs
• symptoms
• knowledge

Acknowledgements

DP conceived the research, collected, analysed, and interpreted the data, and wrote the first draft of the manuscript. YO collected, analysed, and interpreted the data, and revised the manuscript for critical content. ESF and SDL collected and interpreted the data, and revised the manuscript for critical content. MJS conceived the research, interpreted the data and revised the manuscript for critical content. MRB revised the analysis and interpreted the data and revised the manuscript for critical content. All authors approved the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Availability of data and materials

Data and materials are available on the Open Science Framework (DOI: 10.17605/OSF.IO/95CVF).

ORCID

Dafina Petrova http://orcid.org/0000-0002-0346-6776

Yasmina Okan http://orcid.org/0000-0001-7963-1363

Notes

1 Whereas such high heterogeneity is common in meta-analyses aiming to answer broader questions, it is important that it be properly addressed and discussed (Schroll, Moustgaard, & Gøtzsche, 2011). On one hand, the OR is highly sensitive to variation in the base event rate (e.g., the proportion of patients with long help-seeking intervals among those who do not think of cancer), which was highly variable across studies and could explain some of the variation in effect sizes (Higgins & Green, 2011). On the other hand, the I² statistic tends towards 100% for meta-analyses based on studies with large sample sizes (Li et al., 2015; Rücker, Schwarzer, Carpenter, & Schumacher, 2008), as was the case in the current research, so it is not a fully reliable measure of variability between studies.

Additional information

Funding

Dafina Petrova is supported by a Juan de la Cierva Fellowship (FJCI-2016-28279) from the Spanish Ministry of Science, Innovation, and Universities. María José Sánchez, Miguel Rodríguez Barranco, and Dafina Petrova are members of the ‘Health, Brain, and Behavior’ [Salud, Cerebro y Comportamiento, SC²] Scientific Excellence Unit of the University of Granada funded by ‘Plan Propio’ of the University of Granada and Consejería de Conocimiento, Investigación y Universidad de Granada, Junta de Andalucía (SOMM17/6103/UGR). Yasmina Okan’s time was supported by a Population Research Fellowship awarded by Cancer Research UK (reference C57775/A22182). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.