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Background: It has been suggested that the known poorer survival from cancer in the United Kingdom, compared with other European countries, can be attributed to more advanced cancer stage at presentation. There is, therefore, a need to understand the diagnostic process, and to ascertain the risk factors for increased time to presentation.Methods: We report the results from two worldwide systematic reviews of the literature on patient-mediated and practitioner-mediated delays, identifying the factors that may influence these.Results: Across cancer sites, non-recognition of symptom seriousness is the main patient-mediated factor resulting in increased time to presentation. There is strong evidence of an association between older age and patient delay for breast cancer, between lower socio-economic status and delay for upper gastrointestinal and urological cancers and between lower education level and delay for breast and colorectal cancers. Fear of cancer is a contributor to delayed presentation, while sanctioning of help seeking by others can be a powerful mediator of reduced time to presentation. For practitioner delay, 'misdiagnosis' occurring either through treating patients symptomatically or relating symptoms to a health problem other than cancer, was an important theme across cancer sites. For some cancers, this could also be linked to inadequate patient examination, use of inappropriate tests or failing to follow-up negative or inconclusive test results.Conclusion: Having sought help for potential cancer symptoms, it is therefore important that practitioners recognise these symptoms, and examine, investigate and refer appropriately. [ABSTRACT FROM AUTHOR]

In the World Health Organization's International Classification of Functioning, Disability and Health, participation restriction--the social and personal consequences of health conditions and their environment--is an important component of the concept of disability. The cross-sectional associations between perceived participation restriction and health, demographic and socio-economic factors were examined in 7,878 community-dwelling adults aged 50 years and over in North Staffordshire, UK who responded to a postal survey. All health conditions, impairments, activity limitations, demographic and socio-economic factors were associated with participation restriction, after adjusting for age and gender in a logistic regression analysis. Health and disability factors most strongly and independently associated with participation restriction in a multivariate analysis were the number of peripheral joint pains, the number of health conditions, cognitive impairment, anxiety, depression, and activity limitation. Perceived adequacy of income, employment status and occupational class were also significantly associated with participation restriction after adjusting for health and disability factors. In conclusion, perceived participation restriction is associated with a range of health and socio-economic factors. Although further prospective research is needed to identify the direction of causal association, these factors represent potential targets for intervention to prevent or reduce participation restriction in older adults in the community. [ABSTRACT FROM AUTHOR]