Koo, Minjoung Monica Koo;
(2018)
The presenting symptoms of cancer patients and associations with diagnostic timeliness.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Diagnosing cancer earlier is an important strand of cancer control. Interventions promoting early diagnosis such as awareness campaigns and fast-track clinical pathways are increasingly commonplace in England and other countries, but their theoretical underpinning is limited. Cancer symptoms are critical components of such interventions, but evidence regarding the presenting symptoms of individuals diagnosed with cancer and measures of diagnostic timeliness remains sparse. I sought to address this evidential gap using data from the first English National Audit of Cancer Diagnosis in Primary Care on a large and representative cohort of cancer patients. Using symptom status (ascertained through the coding of free-text information on presenting symptoms), I identified and described a group of atypically diagnosed cancer patients before proceeding to examine the nature and frequency of presenting symptoms and associated diagnostic timeliness among symptomatic cancer patients. I profiled the broad range of presenting symptoms beyond breast lump among women diagnosed with breast cancer, and found that non-lump symptoms were associated with longer intervals to presentation and referral. I also described variation in diagnostic timeliness among cancer patients who presented with abdominal symptoms, and the case-mix of cancers they were subsequently diagnosed with. The relative length of time to presentation and referral varied by abdominal symptom. A considerable proportion of cancer patients who presented with abdominal symptoms were diagnosed with other solid tumours or haematological cancers, particularly for non-specific abdominal symptoms. Lastly, I examined the association between alarm symptoms and stage at diagnosis among cancer patients who had presented promptly. While most alarm symptoms at presentation were associated with early stage disease, the extent of the association was highly variable compared to patients with other symptomatic presentations. This thesis provides exemplar evidence regarding the epidemiology of presenting symptoms among cancer patients and associated diagnostic timeliness. Together with other evidence, the findings could contribute to the design and evaluation of symptom awareness campaigns and healthcare interventions that expedite the investigation and diagnosis of cancer.
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