Appraisal of emerging symptoms of colorectal cancer: associations with dispositional, demographic, and tumor characteristics.

The time it takes for individuals to realize that their emerging colorectal cancer (CRC) symptoms are serious is often an impediment to expeditious help-seeking. Tailored educational efforts to hasten symptom appraisal time would benefit from knowledge of the characteristics of individuals who tend to neglect their symptoms as well as the nature of symptoms that are most often neglected. In a sample of 112 CRC patients, we investigated associations between duration of symptom appraisal and: (1) trait anxiety, and (2) tumor location, which affects symptomatology. Symptom appraisal duration was associated with a sex-by-anxiety interaction (p = 0.007). The longest times (in weeks) were among high anxiety females (Mdn = 26.0) and low anxiety males (Mdn = 17.0), with shorter times among low anxiety females (Mdn = 9.0) and high anxiety males (Mdn = 2.0). Symptom appraisal times were also longer for patients with distal (vs. proximal) tumors (p = 0.036).

Endogenous testosterone levels are associated with assessments of unfavourable health information.

The purpose of this study was to investigate whether participants' assessments of unfavourable health information are associated with individual differences in basal testosterone. Testosterone has previously been related to assessments of threat in social and other domains. 52 undergraduate males were tested for a minor, fictitious medical condition thioamine acetylase deficiency ('TAA deficiency') in a paradigm that was developed to examine the thoughts and behaviours of individuals who have just received unfavourable medical news. In a variation on the classic paradigm, all participants were told that they had 'TAA deficiency,' after which they rated the seriousness and prevalence of that condition as well as 19 other actual conditions. Higher testosterone levels were significantly correlated with lower estimates of both the seriousness and prevalence of TAA deficiency as well as lower median seriousness and prevalence estimates of the 19 actual conditions. Findings are discussed in light of current research in the field of behavioural endocrinology. This study provides preliminary evidence that individual differences in assessments of threatening health information may be associated with neurobiological characteristics.

Trait anxiety as an independent predictor of poor health-related quality of life and post-traumatic stress symptoms in rectal cancer.

OBJECTIVES: To determine the influence of trait anxiety on patient reports of health-related quality of life (HRQoL) and post-traumatic stress symptoms (PTSS) in a sample of rectal cancer survivors. DESIGN: Eighty patients who had been diagnosed with rectal cancer were assessed at two points in time in a longitudinal study. METHODS: At Time 1, soon after initial treatment, participants completed the State-Trait Anxiety Inventory and the Temperament and Character Inventory Harm Avoidance scale, which were combined into a composite measure of trait anxiety. At Time 2, 2-5 years following Time 1, participants were assessed for HRQoL using the Functional Assessment of Cancer Therapy-Colorectal scale (FACT-C) and for PTSS using the Impact of Event Scale-Revised (IES-R). RESULTS: HRQoL and PTSS were generally favourable on average, although many of the patients reported faring poorly. Higher levels of trait anxiety were predictive of poorer scores on all of the FACT-C and the IES-R total and subscale measures. More severe faecal incontinence was associated with poorer scores on the FACT Emotional well-being subscale, the FACT-Colorectal Cancer Scale, and all of the IES-R scales. Males were more likely than females to have poorer scores on the FACT Social well-being subscale, and those patients who were further out from active treatment had more favourable scores on the FACT-Colorectal Cancer Scale. The presence of a colostomy did not impact HRQoL or PTSS. CONCLUSION: Trait anxiety had a significant influence on HRQoL and PTSS several years following diagnosis and treatment of rectal cancer.

Sex differences in responding to rectal cancer symptoms.

Many people who develop cancer symptoms wait inordinate amounts of time before seeking medical attention. Studies have found that symptom appraisal time--the time that passes before the individual concludes that their symptoms could be serious--accounts for most of the total delay time across subjects. It is thus important to understand the individual characteristics associated with slow recognition of dangerous symptoms. In this study, 62 patients (38 males) recently diagnosed with rectal cancer answered questions regarding the development of symptoms as well as their decisions and behaviors prior to seeking help. One subgroup of patients--males with the lowest scores on a measure of trait anxiety--took significantly longer to recognize the seriousness of their symptoms as compared to all other patients. This finding is discussed in the context of recent studies where the interaction of sex and negative affect is related to symptom reporting and other health-related behaviors.

Delayed treatment for rectal cancer.

PURPOSE: Reports of the relationship between length of delay before diagnosis of rectal cancer and stage of the disease have been mixed. The present study documented the magnitude and medical ramifications of delay in diagnosing rectal cancer. METHODS: One hundred twenty patients who had been recently diagnosed with rectal cancer provided information regarding history of symptoms and initial perceptions of those symptoms. Patients also estimated the time elapsed from onset of symptoms until their first consultation with a physician, as well as time elapsed from consultation until the diagnosis of rectal cancer was made. Stage information was gathered from patient charts. RESULTS: For 106 of the patients, the first sign of rectal cancer was in the form of symptoms, and the most common first symptom was rectal bleeding. For the remaining 14 patients, their cancer was first discovered through routine examination. Over 75 percent of patients with symptoms did not initially believe that they were caused by cancer or any other serious problem, and over 50 percent attributed their symptoms to hemorrhoids. There was a clear trend, albeit statistically nonsignificant, toward worsening disease with longer delays. Median delay times in weeks were Stage I (10.0 weeks), Stage II (14.0 weeks), Stage III (18.5 weeks), and Stage IV (26.0 weeks). CONCLUSIONS: Delayed diagnosis for rectal cancer remains a significant problem, with instances of delay attributable to both patient and physician. Delayed diagnosis can result in more serious disease and, when attributable to the physician, can result in damaged trust and sometimes legal action.

Psychological factors related to delay in consultation for cancer symptoms.

This research investigated psychological characteristics associated with delay in seeking help for symptoms of rectal cancer. Sixty nine subjects reconstructed pivotal events beginning with symptom onset and ending with medical consultation, and completed the Temperament and Character Inventory (TCI) and the State-Trait Anxiety Inventory (STAI). The mean delay time was around 6 months, with about 1 out of 6 subjects waiting one year or more. Subjects estimated the lengths of two sequential segments of total time to consultation: (1) Symptom Appraisal time (from symptom onset to recognition of possible seriousness), and (2) Action Appraisal time (from recognition of seriousness to medical consultation). Symptom Appraisal time accounted for over two-thirds of total time and was associated with low scores on the TCI Harm Avoidance scale (TCI-HA), indicating dispositional insensitivity to threat, and marginally associated with less education and younger age. Action Appraisal time was not associated with any demographic or psychological variables. Low TCI-HA scores were also associated with lower likelihood of previous cancer screening, and with better judgments of premorbid health. Low STAI Trait scores were associated with better judgments of premorbid health and fewer doctor visits. Results are discussed regarding the importance of understanding dispositional characteristics related to health behavior.

Patient care in multidisciplinary cancer clinics: does attention to psychosocial needs predict patient satisfaction?

Satisfaction with treatment is an important early indicator of medical outcome for cancer patients. This study examined patient satisfaction with treatment-planning and follow-up appointments among 58 recently diagnosed ENT and GI cancer patients seen at a multidisciplinary cancer clinic. Patients reported which medical specialties they saw, whether adjuvant treatment was planned, and whether they had a chance to discuss their feelings about the diagnosis. Patients also rated the attention paid by staff to several psychosocial issues considered relevant to cancer. These included how the patient was coping, support services available, and the issue of common emotional reactions to cancer. Patients then rated their overall satisfaction with their clinic visits. Overall satisfaction was predicted by younger age, female gender, and greater attention to how patients were coping with their illness. Having a chance to discuss one's feelings about the diagnosis, and staff attention to other psychosocial issues, also predicted patient satisfaction. The relationship of these psychosocial issues to patient satisfaction did not vary by gender. Results suggest that patient satisfaction may be enhanced when hospital staff attend to and provide for the psychosocial needs engendered by a diagnosis of cancer.

Patient preferences for CT colonography, conventional colonoscopy, and bowel preparation.

OBJECTIVES: The aim of this study was to determine patient pre-examination expectations and postexamination appraisals for CT colonography, conventional colonoscopy and bowel preparation. METHODS: Prospective evaluation of 120 patients at defined risk for colorectal neoplasia was performed with CT colonography followed by colonoscopy on the same day. Subjects were stratified by age and sex (67 women and 53 men) and were randomized to receive either manual air (n = 61) or CO(2) (n = 59) insufflation during CT colonography. Patients' expectations were assessed just before the two examinations, and appraisals were assessed 2 to 3 days afterward regarding pain/discomfort, embarrassment, difficulty, overall assessment, preference for future testing, and bowel preparation. RESULTS: No significant differences were found in appraisals of manual air versus CO(2) insufflation techniques. For both CT colonography and colonoscopy, patients' appraisals after the procedure were significantly more positive than prior expectations. Patients expressed more favorable appraisals of colonoscopy for pain (p < 0.001) and embarrassment (p < 0.001), with most responses being "none" to "a little" for both examinations. Overall appraisals of the tests were favorable and similar between CT and colonoscopy: patients mainly expressed "not unpleasant" to "a little unpleasant" (95%, 114/120 for both examinations). Overall, appraisal of the bowel preparation was the most negative. Preferences for future testing were more favorable toward CT: of the patients, 58% (69/120) preferred CT, 14% (17/120) preferred colonoscopy, and 28% (34/120) had no preference. CONCLUSIONS: Overall appraisals were similar and positive for both CT colonography and colonoscopy, with less favorable appraisals of the bowel preparation. Most patients stated that they would prefer CT for future evaluation.