"Almost everyone has heard about people who had cancer symptoms long before they sought help. I was curious about the psychology behind this," says Stephen Ristvedt, Ph.D., assistant professor of medical psychology in psychiatry and investigator at the Siteman Cancer Center. "Most people assume the explanation is fear or denial or a reluctance to hear the 'C-word' from a doctor. So, I was surprised to find those who are generally optimistic and unconcerned had the longest delays."
The study will be reported in the May 2005 issue of Psycho-Oncology and is currently available online at the journal's web site.
The study examined 69 patients diagnosed with rectal tumors and treated in the Section of Colon and Rectal Surgery at Washington University School of Medicine. The patients were asked to indicate the length of two time periods: how much time passed between when they first experienced a symptom and when they realized it was potentially serious--the symptom appraisal time--and the time between that realization and the time they contacted a doctor--the action appraisal time.
In addition, each patient was assessed with standardized psychological tests to measure their sensitivity to threat and disposition toward anxiety. Individuals who score low on these tests tend to be confident, relaxed, optimistic, carefree, uninhibited, and outgoing. Those who score high are usually cautious, tense, apprehensive, fearful, inhibited, and shy.
The patients also were asked to rate their overall health before the cancer diagnosis and to indicate whether they visited a doctor regularly and got cancer screenings.
The analysis showed that, regardless of psychological profile, 71 percent of the patients did not at first believe their rectal bleeding or other symptoms were signs of cancer. They attributed the symptoms to hemorrhoids, diet, physical injury, stress or ulcers.
Among all the patients, the symptom appraisal time ranged from less than a week to around two years, with a median of seven weeks. Sixteen patients took six months or more to conclude their symptoms might be serious.
The longest symptom appraisal times were associated with those who scored low on the psychological tests of general anxiety. By one measure, the low scorers took a median of 30 weeks to appraise their symptoms as serious; high scorers took less than half that long.
"We found that people who are typically less responsive to threatening things take longer to seek medical attention, and they tend not to go in for routine screening because they just are not concerned enough," Ristvedt says. "They rate their overall health better, even though in these cases they were seriously ill."
The study found little difference in symptom appraisal times between men and women, but younger people took slightly longer than older patients to decide their symptoms were serious, as did those with fewer years of education compared to those with more education.
Action appraisal time was considerably shorter than symptom appraisal time among all the patients, having a median of one week. Action appraisal time was not affected by the patients' psychological profiles or other parameters measured. It appeared that once most patients decided the symptoms were signs of serious illness, they quickly sought medical help.
Ristvedt's findings suggest a different approach will be needed to ensure that carefree people pay attention to signs of disease. "We would like to figure out how to reach these people and get them to understand that their positive attitude may actually interfere with healthy behaviors," Ristvedt says.
Next, Ristvedt plans to extend his study to both colon and rectal cancers to see if the correlation between personality traits and symptom recognition can be replicated in larger groups and for the less-defined set of symptoms characteristic of colon cancer.
Ristvedt SL, Trinkaus KM. Psychological factors related to delay in consultation for cancer symptoms. Psycho-Oncology, May 2005.
A Research Development Award from the Alvin J. Siteman Cancer Center and funding from the National Cancer Institute supported this research.
Washington University School of Medicine's full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked second in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.
Journal
Psycho-Oncology