Evaluation of an online intervention to encourage early help-seeking for lung cancer symptoms

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.

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Engaging high-risk groups in early lung cancer diagnosis: a qualitative study of symptom presentation and intervention preferences among the UK’s most deprived communities

BMJ Open ◽

10.1136/bmjopen-2018-025902 ◽

2019 ◽

Vol 9 (5) ◽

pp. e025902 ◽

Cited By ~ 3

Author(s):

Grace McCutchan ◽

Julia Hiscock ◽

Kerenza Hood ◽

Peter Murchie ◽

Richard D Neal ◽

...

Keyword(s):

Lung Cancer ◽

High Risk ◽

Qualitative Study ◽

Focus Groups ◽

Cancer Diagnosis ◽

Help Seeking ◽

Symptom Presentation ◽

Cancer Symptoms ◽

Early Lung Cancer ◽

Intervention Preferences

ObjectivesPeople at high-risk for lung cancer—current/former smokers, aged 40+ years, with serious lung comorbidity (ie, chronic obstructive pulmonary disease) and living in highly deprived areas—are more likely to delay symptom presentation. This qualitative study aimed to understand the influences on early presentation with lung cancer symptoms in high-risk individuals and intervention preferences.MethodsSemi-structured qualitative interviews with 37 high-risk individuals (without a cancer diagnosis), identified through seven GP practices in socioeconomically deprived areas of England, Scotland and Wales (most deprived 20%). A symptom attribution task was used to explore lung symptom perception and help seeking, developed using Leventhal’s Common Sense Model. Four focus groups with 16 high-risk individuals and 12 local stakeholders (healthcare professionals and community partners) were conducted to explore preferences for an intervention to promote early lung cancer symptom presentation. Data were synthesised using Framework analysis.ResultsIndividual and area level indicators of deprivation confirmed that interview participants were highly deprived.Interviews.Preoccupation with managing ‘treatable’ short-term conditions (chest infections), led to avoidance of acting on ‘inevitable and incurable’ long-term conditions (lung cancer). Feeling judged and unworthy of medical help because of their perceived social standing or lifestyle deterred medical help seeking, particularly when difficult life circumstances and traumatic events led to tobacco and alcohol addiction.Focus groups. Participants recommended multifaceted interventions in community venues, with information about lung cancer symptoms and the benefits of early diagnosis, led by a trained and non-judgemental facilitator.ConclusionsThis study was novel in engaging a high-risk population to gain an in-depth understanding of the broader contextual influences on lung cancer symptom presentation. Perceived lack of health service entitlement and complex lives facilitated avoidance of recognising and presenting with lung cancer symptoms. Community-based interventions have the potential to empower disadvantaged populations to seek medical help for lung symptoms.

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Evaluation of a web-based, tailored intervention to encourage help-seeking for lung cancer symptoms: a randomised controlled trial

Digital Health ◽

10.1177/2055207620922381 ◽

2020 ◽

Vol 6 ◽

pp. 205520762092238

Author(s):

Julia Mueller ◽

Alan Davies ◽

Caroline Jay ◽

Simon Harper ◽

Chris Todd

Keyword(s):

Lung Cancer ◽

Help Seeking ◽

Controlled Trial ◽

Cancer Symptoms ◽

Factorial Anova ◽

Presenting Symptoms ◽

Help Seeking Behaviour ◽

Seeking Help ◽

Randomised Controlled ◽

Mixed Factorial Anova

Background People with lung cancer often wait for several months before presenting symptoms to health services. Some patients report seeking information online to help them appraise symptoms. No research has evaluated whether websites about lung cancer present information in an optimal manner to encourage help-seeking. Objective To evaluate the effectiveness of an online, tailored, theory-based intervention in encouraging help-seeking behaviour among people with potential lung cancer symptoms. Methods The intervention consisted of a specialised website which provided tailored information about lung cancer and included a component to address beliefs about help-seeking, based on the Theory of Planned Behaviour (TPB-component). Individuals with undiagnosed symptoms were randomised to receive information about lung cancer in a factorial design (tailored/untailored × TPB-component/no TPB-component). Pre and post viewing webpages, participants reported perceived likelihood of seeking help. Data were analysed using robust mixed factorial ANOVA. Results Data from 253 participants (73.9% female) were analysed. No effect for the TPB-component was found ( p = 0.16), nor for tailoring ( p = 0.27). Self-reported likelihood of seeking help increased significantly from pre to post ( p < 0.001), regardless of tailoring and TPB-components. Conclusion Self-reported likelihood of seeking help for potential lung cancer symptoms may increase after viewing information online. This does not appear to be affected by information tailoring and components to address beliefs. However, intentions remained unchanged in the majority of the sample. This suggests further efforts are needed to improve lung cancer websites if they are to be a useful resource for those seeking advice about their symptoms.

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An Online Intervention for Lung Cancer Caregivers Buffers Negative Mood in Bereavement

PsycEXTRA Dataset ◽

10.1037/e575782013-001 ◽

2013 ◽

Author(s):

Lori L. DuBenske ◽

David Gustafson ◽

Kang Namkoong ◽

Ming-Yuan Chih ◽

Amy Atwood ◽

...

Keyword(s):

Lung Cancer ◽

Negative Mood ◽

Online Intervention ◽

Cancer Caregivers

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Anticipated help-seeking for cancer symptoms before and after the coronavirus pandemic: results from the Onco-barometer population survey in Spain

British Journal of Cancer ◽

10.1038/s41416-021-01382-1 ◽

2021 ◽

Author(s):

Dafina Petrova ◽

Marina Pollán ◽

Miguel Rodriguez-Barranco ◽

Dunia Garrido ◽

Josep M. Borrás ◽

...

Keyword(s):

Poisson Regression ◽

Help Seeking ◽

Regression Models ◽

Population Survey ◽

Waiting Times ◽

Perceived Barriers ◽

Older Individuals ◽

Cancer Symptoms ◽

Before And After ◽

Diagnostic Delays

Abstract Background The patient interval—the time patients wait before consulting their physician after noticing cancer symptoms—contributes to diagnostic delays. We compared anticipated help-seeking times for cancer symptoms and perceived barriers to help-seeking before and after the coronavirus pandemic. Methods Two waves (pre-Coronavirus: February 2020, N = 3269; and post-Coronavirus: August 2020, N = 1500) of the Spanish Onco-barometer population survey were compared. The international ABC instrument was administered. Pre–post comparisons were performed using multiple logistic and Poisson regression models. Results There was a consistent and significant increase in anticipated times to help-seeking for 12 of 13 cancer symptoms, with the largest increases for breast changes (OR = 1.54, 95% CI 1.22–1–96) and unexplained bleeding (OR = 1.50, 1.26–1.79). Respondents were more likely to report barriers to help-seeking in the post wave, most notably worry about what the doctor may find (OR = 1.58, 1.35–1.84) and worry about wasting the doctor’s time (OR = 1.48, 1.25–1.74). Women and older individuals were the most affected. Conclusions Participants reported longer waiting times to help-seeking for cancer symptoms after the pandemic. There is an urgent need for public interventions encouraging people to consult their physicians with symptoms suggestive of cancer and counteracting the main barriers perceived during the pandemic situation.

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Psychosocial influences on help-seeking behaviour for cancer in low-income and lower middle-income countries: a mixed-methods systematic review

BMJ Global Health ◽

10.1136/bmjgh-2020-004213 ◽

2021 ◽

Vol 6 (2) ◽

pp. e004213

Author(s):

Grace McCutchan ◽

Bahr Weiss ◽

Harriet Quinn-Scoggins ◽

Anh Dao ◽

Tom Downs ◽

...

Keyword(s):

Systematic Review ◽

Mixed Methods ◽

Cancer Treatment ◽

Help Seeking ◽

Middle Income ◽

Cancer Symptoms ◽

Middle Income Countries ◽

Help Seeking Behaviour ◽

Psychosocial Influences

IntroductionStarting cancer treatment early can improve outcomes. Psychosocial factors influencing patients’ medical help-seeking decisions may be particularly important in low and lower middle-income countries (LMIC) where cancer outcomes are poor. Comprehensive review evidence is needed to understand the psychosocial influences on medical help-seeking for cancer symptoms, attendance for diagnosis and starting cancer treatment.MethodsMixed-methods systematic review registered on PROSPERO (CRD42018099057). Peer-reviewed databases were searched until April 2020 for studies assessing patient-related barriers and facilitators to medical help-seeking for cancer symptoms, diagnosis and treatment in adults (18+ years) living in LMICs. Quality of included studies was assessed using the Critical Appraisal Skills Programme tool. Data were synthesised using meta-analytic techniques, meta-ethnography or narrative synthesis as appropriate.ResultsOf 3963 studies identified, 64 were included. In quantitative studies, use of traditional, complementary and alternative medicine (TCAM) was associated with 3.60 higher odds of prolonged medical help-seeking (95% CI 2.06 to 5.14). Qualitative studies suggested that use of TCAM was a key barrier to medical help-seeking in LMICs, and was influenced by causal beliefs, cultural norms and a preference to avoid biomedical treatment. Women face particular barriers, such as needing family permission for help-seeking, and higher stigma for cancer treatment. Additional psychosocial barriers included: shame and stigma associated with cancer such as fear of social rejection (eg, divorce/disownment); limited knowledge of cancer and associated symptoms; and financial and access barriers associated with travel and appointments.ConclusionDue to variable quality of studies, future evaluations would benefit from using validated measures and robust study designs. The use of TCAM and gender influences appear to be important barriers to help-seeking in LMIC. Cancer awareness campaigns developed with LMIC communities need to address cultural influences on medical help-seeking behaviour.

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Initial Evaluation of the Patient With Lung Cancer: Symptoms, Signs, Laboratory Tests, and Paraneoplastic Syndromes

CHEST Journal ◽

10.1378/chest.07-1358 ◽

2007 ◽

Vol 132 (3) ◽

pp. 149S-160S ◽

Cited By ~ 88

Author(s):

Stephen G. Spiro ◽

Michael K. Gould ◽

Gene L. Colice

Keyword(s):

Lung Cancer ◽

Laboratory Tests ◽

Paraneoplastic Syndromes ◽

Initial Evaluation ◽

Cancer Symptoms

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Symptoms of Posttraumatic Stress Disorder and Associated Risk Factors in Patients With Lung Cancer: A Longitudinal Observational Study

Integrative Cancer Therapies ◽

10.1177/1534735418807970 ◽

2018 ◽

Vol 17 (4) ◽

pp. 1195-1203 ◽

Cited By ~ 3

Author(s):

Jun Ni ◽

Jian Feng ◽

Linda Denehy ◽

Yi Wu ◽

Liqin Xu ◽

...

Keyword(s):

Lung Cancer ◽

Posttraumatic Stress Disorder ◽

Observational Study ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Ptsd Symptoms ◽

Newly Diagnosed ◽

Cancer Symptoms ◽

Longitudinal Observational Study ◽

Prospective Longitudinal

Purpose. This study aimed to measure symptoms of posttraumatic stress disorder (PTSD) in Chinese patients following a new diagnosis of lung cancer. Secondary aims were to explore factors at diagnosis that may predict PTSD symptoms at 6 months. Methods. This was a prospective longitudinal observational study that included 93 patients with newly diagnosed lung cancer. PTSD symptomology was assessed using the PTSD Checklist Civilian Version (PCL-C) and health-related quality of life (HRQoL) was assessed with the European Organisation for the Research and Treatment of Cancer questionnaire. Measures were completed at diagnosis and 6 months. Results. No patient had PTSD at baseline or 6 months as measured by a score of ⩾50 in the PCL-C. However, at diagnosis, 44% of patients had “mild” symptoms of PTSD. At 6 months, 64% of patients had “mild” and 8% had “moderate” PTSD symptoms. PTSD symptom scores significantly worsened over 6 months (mean difference [95% CI] = 7.2 [5.4 to 9.0]). Six months after diagnosis, higher PTSD scores were seen in people who at diagnosis were younger ( P = .003), had a lower smoking pack history ( P = .012), displayed less sedentary behavior ( P < .005), or initially had worse cancer symptoms, including fatigue ( P = .001) and poorer HRQoL ( P = .004). Conclusions. Mild PTSD symptoms are common in patients with lung cancer 6 months after treatment; however, a full diagnosis of PTSD is uncommon. Screening for PTSD symptoms may be considered for at-risk patients with newly diagnosed lung cancer.

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Help-seeking behaviour in smokers and ex-smokers with symptoms of lung cancer. The application of an integrated model

Journal of Epidemiology & Community Health ◽

10.1136/jech.2009.096719s ◽

2009 ◽

Vol 63 (Suppl 2) ◽

pp. 45-45 ◽

Cited By ~ 1

Author(s):

S. Smith ◽

S. Wyke ◽

U. Macleod ◽

S. Ziebland ◽

N. Campbell

Keyword(s):

Lung Cancer ◽

Help Seeking ◽

Integrated Model ◽

Help Seeking Behaviour

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Patient-reported outcomes (PRO) from the phase 2 CodeBreaK 100 trial evaluating sotorasib in KRAS p.G12C mutated non-small cell lung cancer (NSCLC).

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.9057 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 9057-9057

Author(s):

Alexander I. Spira ◽

Frederick Hugh Wilson ◽

Geoffrey Shapiro ◽

Christophe Dooms ◽

Alessandra Curioni-Fontecedro ◽

...

Keyword(s):

Lung Cancer ◽

Health Status ◽

Chest Pain ◽

Global Health ◽

Physical Functioning ◽

Global Health Status ◽

Phase 2 ◽

Cancer Symptoms ◽

Eortc Qlq C30 ◽

Eortc Qlq

9057 Background: In the registrational phase 2 CodeBreaK 100 trial, sotorasib demonstrated a response rate of 37.1% with median duration of 10.0 months, a median progression-free survival of 6.8 months, and a tolerable safety profile in patients with pretreated KRAS p.G12C mutated NSCLC. Patients received a median of 2 prior lines of therapy. Here, we report PRO measures of health-related quality of life (QoL), physical functioning, and key lung cancer symptoms from this trial. Methods: Eligible patients had KRAS p.G12C mutated advanced NSCLC and received prior standard therapies. Sotorasib was given at an oral daily dose of 960 mg with 21-day treatment cycles until disease progression. Disease-related symptoms and health-related QoL were evaluated as exploratory endpoints on day 1 of each cycle from baseline to discontinuation, using the European Organization for Research and Treatment of Cancer Quality-of-life Questionnaire Core 30 (EORTC QLQ-C30) and its lung cancer module, EORTC QLQ-LC13. The single item, 5-point scale GP5, of the Functional Assessment of Cancer Therapy-General version was used to evaluate the impact of side effects. Predefined analyses included change from baseline using descriptive statistics and mixed model for repeated measures for global health status/QoL, physical functioning, and key lung cancer symptoms of cough, dyspnea and chest pain. Results: Of 126 patients enrolled, compliance rates for each of the questionnaires were high throughout the study ( > 70%). Data up to cycle 11 (where n > 20) are presented. EORTC QLQ-C30 global health status/QoL and physical functioning were maintained over time (least-square mean changes ranged from -3.5 to 0.2 and 0.1 to 3.9, respectively). EORTC QLQ-C30 symptoms of fatigue, nausea/vomiting, pain, dyspnea, insomnia, appetite loss, and constipation were stable or improved. Similarly, key lung cancer-related symptoms, as measured by EORTC QLQ-LC13, remained stable or improved from baseline, with the greatest least-square mean change of -11.2 (95% Cl: -16.2, -6.1) for cough, -4.9 (95% Cl: -10.3, 0.4) for chest pain, and -3.4 (95% Cl: -7.8, 1.0) for dyspnea. Most patients reported on the GP5 that they were “not at all” (54.2%-79.2%) or “a little bit” (8.3%-33.3%) bothered by side effects from sotorasib, with 0%-7.4% reporting being bothered as “quite a bit” and 0% as “very much”. Conclusions: In patients from the single-arm phase 2 trial of sotorasib, PRO measures suggested maintenance or improvement of global health status/QoL, physical functioning, and the severity of key lung cancer-related symptoms, including cough, dyspnea, and chest pain. Self-reported side effect bother was minimal. These data, together with the encouraging efficacy and safety profiles, strongly support the use of sotorasib in this population. Clinical trial information: NCT03600883.

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