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3. Emotional responses to the experience of cancer ‘alarm’ symptoms

Author

Katriina Whitaker, Cromme S, Winstanley K, Renzi C, and Wardle J

Subjects
Paper, Adult, Male, Health Knowledge, Attitudes, Practice, Fear, Anxiety, Awareness, Middle Aged, Patient Acceptance of Health Care, Health Surveys, Interviews as Topic, Help-Seeking Behavior, Neoplasms, Papers, Humans, Female, Symptom Assessment, Qualitative Research
Abstract

Objective To qualitatively explore associations between emotional responses to experience of cancer ‘alarm’ symptoms and help‐seeking in a community sample of adults. Method Interviewees (n = 62) were recruited from a community sample (n = 2042) of adults aged ≥50 years, who had completed a health survey that included a list of cancer alarm symptoms. Participants who had reported an alarm symptom both at baseline and 3‐month follow‐up (n = 271), and who had consented to contact (n = 215), constituted the pool for invitations to interview. Results Over a third of participants (37%) described an emotional response to their symptom experience. In all these cases, there was evidence of awareness of the risk of cancer. Emotional responses were usually either classified as mild (‘worry’) or severe (‘fear’). Worry was often described in the context of a desire to seek medical help, either to rule out cancer or to minimise patient delay. In contrast, the ‘fear’ group described associations with death, the perceived incurability of cancer, and the consequence of a cancer diagnosis. Where the emotional reaction was fear, medical contact was seen as something to be avoided either because it had no value or because it was preferable not to be told a diagnosis. Conclusion In this community sample, worry about the possibility of cancer was associated with help‐seeking, either for reassurance or as part of a ‘sensible’ strategy to deal with the risk. In contrast, fear was associated with avoiding help‐seeking or even thinking about cancer, which could lead to prolonged help‐seeking intervals. © 2015 The Authors. Psycho‐Oncology published by John Wiley & Sons Ltd.

Published
2015

5. Unintended consequences of an 'all-clear' diagnosis for potential cancer symptoms: a nested qualitative interview study with primary care patients

Author

Renzi, C, Whitaker, KL, Winstanley, K, Cromme, S, and Wardle, J

Abstract

BACKGROUND: Nine out of 10 patients undergoing urgent cancer investigations receive an 'all-clear' diagnosis. AIM: A qualitative approach was used to evaluate the impact of investigations that did not result in cancer diagnosis on subsequent symptom attribution and help seeking for recurrent or new possible cancer symptoms. DESIGN AND SETTING: A survey of symptoms, help seeking, and past investigations was sent to 4913 individuals aged ≥50 years from four UK general practices. Of 2042 responders, 62 participants were recruited still reporting at least one cancer 'alarm' symptom in a 3-month follow-up survey for a nested in-depth interview study (ensuring variation in sociodemographic characteristics). METHOD: Framework analysis was used to examine the in-depth semi-structured interviews and identify themes related to previous health investigations. RESULTS: Interviewees were on average 65 years old, and 90% reported investigations within the previous 2 years. Most often they reported gastrointestinal, urinary, and respiratory symptoms, and 42% had waited ≥3 months before help seeking. Reassurance from a previous non-cancer diagnosis explained delays in help seeking even if symptoms persisted or new symptoms developed months or years later. Others were worried about appearing hypochondriacal or that they would not be taken seriously if they returned to the doctor. CONCLUSION: An all-clear diagnosis can influence help seeking for months or even years in case of new or recurrent alarm symptoms. Considering the increasing number of people undergoing investigations and receiving an all-clear, it is paramount to limit unintended consequences by providing appropriate information and support. Specific issues are identified that could be addressed.

Published
2016

6. Emotional responses to the experience of cancer 'alarm' symptoms

Author

Whitaker, KL, Cromme, S, Winstanley, K, Renzi, C, Wardle, J, Whitaker, KL, Cromme, S, Winstanley, K, Renzi, C, and Wardle, J

Abstract

Objective: To qualitatively explore associations between emotional responses to experience of cancer 'alarm' symptoms and help-seeking in a community sample of adults. Method: Interviewees (n=62) were recruited from a community sample (n=2042) of adults aged ≥50 years, who had completed a health survey that included a list of cancer alarm symptoms. Participants who had reported an alarm symptom both at baseline and 3-month follow-up (n=271), and who had consented to contact (n=215), constituted the pool for invitations to interview. Results: Over a third of participants (37%) described an emotional response to their symptom experience. In all these cases, there was evidence of awareness of the risk of cancer. Emotional responses were usually either classified as mild ('worry') or severe ('fear'). Worry was often described in the context of a desire to seek medical help, either to rule out cancer or to minimise patient delay. In contrast, the 'fear' group described associations with death, the perceived incurability of cancer, and the consequence of a cancer diagnosis. Where the emotional reaction was fear, medical contact was seen as something to be avoided either because it had no value or because it was preferable not to be told a diagnosis. Conclusion: In this community sample, worry about the possibility of cancer was associated with help-seeking, either for reassurance or as part of a 'sensible' strategy to deal with the risk. In contrast, fear was associated with avoiding help-seeking or even thinking about cancer, which could lead to prolonged help-seeking intervals.

Published
2015

10. Unintended consequences of an 'all-clear' diagnosis for potential cancer symptoms: a nested qualitative interview study with primary care patients.

Author

Renzi C, Whitaker KL, Winstanley K, Cromme S, and Wardle J

Subjects
Adult, Aged, Anxiety psychology, Delayed Diagnosis, Female, Health Care Surveys, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Neoplasm Recurrence, Local epidemiology, Neoplasm Recurrence, Local psychology, Neoplasms epidemiology, Neoplasms psychology, Patient Acceptance of Health Care psychology, Physician-Patient Relations, Qualitative Research, Review Literature as Topic, Symptom Assessment, Uncertainty, United Kingdom epidemiology, Anxiety epidemiology, Neoplasm Recurrence, Local diagnosis, Neoplasms diagnosis, Patient Acceptance of Health Care statistics & numerical data, Primary Health Care statistics & numerical data
Abstract

Background: Nine out of 10 patients undergoing urgent cancer investigations receive an 'all-clear' diagnosis., Aim: A qualitative approach was used to evaluate the impact of investigations that did not result in cancer diagnosis on subsequent symptom attribution and help seeking for recurrent or new possible cancer symptoms., Design and Setting: A survey of symptoms, help seeking, and past investigations was sent to 4913 individuals aged ≥50 years from four UK general practices. Of 2042 responders, 62 participants were recruited still reporting at least one cancer 'alarm' symptom in a 3-month follow-up survey for a nested in-depth interview study (ensuring variation in sociodemographic characteristics)., Method: Framework analysis was used to examine the in-depth semi-structured interviews and identify themes related to previous health investigations., Results: Interviewees were on average 65 years old, and 90% reported investigations within the previous 2 years. Most often they reported gastrointestinal, urinary, and respiratory symptoms, and 42% had waited ≥3 months before help seeking. Reassurance from a previous non-cancer diagnosis explained delays in help seeking even if symptoms persisted or new symptoms developed months or years later. Others were worried about appearing hypochondriacal or that they would not be taken seriously if they returned to the doctor., Conclusion: An all-clear diagnosis can influence help seeking for months or even years in case of new or recurrent alarm symptoms. Considering the increasing number of people undergoing investigations and receiving an all-clear, it is paramount to limit unintended consequences by providing appropriate information and support. Specific issues are identified that could be addressed., (© British Journal of General Practice 2016.)

Published
2016
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11. Clinical differences between benign and malignant pheochromocytomas.

Author

Glodny B, Winde G, Herwig R, Meier A, Kühle C, Cromme S, and Vetter H

Subjects
Abdominal Pain, Adolescent, Adrenal Gland Neoplasms diagnosis, Adrenal Gland Neoplasms pathology, Adrenal Gland Neoplasms surgery, Adult, Aged, Back Pain, Catecholamines metabolism, Child, Child, Preschool, Diagnosis, Differential, Female, Headache, Humans, Hypertension, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Metastasis, Pallor, Pheochromocytoma pathology, Pheochromocytoma surgery, Prognosis, Retrospective Studies, Sweating, Tachycardia, Weight Loss, Pheochromocytoma diagnosis
Abstract

Most pheochromocytomas can be cured by resection. In view of the unfavourable prognosis for surgical therapy in cases of late tumour detection and malignant tumours, the aim of the present study is to differentiate between typical signs and symptoms of malignant versus benign pheochromocytomas. We investigated the records of 133 patients retrospectively (1967-1998). In cases of benign tumours (104 of 133, mean age 42+/-15.8 years) tumour size was 5.9+/-3.4 cm, and history was 47.4+/-75.4 months. 7.7% of the tumours were extraadrenal, and 77% had paroxysmal manifestations. The other 29 patients (mean age: 39.2+/-21.9 years) had malignant lesions (tumour size: 9.4+/-5.9 cm (p=0.0022); history: 7.4+/-5.6 months (p=0.0137); extraadrenal: 24.1% (p=0.0219); paroxysmal: 37.9% (p=0.0012)). Symptoms of patients with benign tumours were hypertension (80%), headaches (42.3%), sweating (30.8%), tachycardia (26%) and pallor (24%) (Malignant: Hypertension 46%, p=0.0873; headaches 11%, p=0.0008; sweating 11%, p=0.0196; tachycardia 14%, p=0.1961 and pallor 0%, p=0.0010). Abdominal pain and dorsalgia occurred more frequently in malignant pheochromocytomas (26% versus 7%, p=0.0014). Unusually short histories and extraadrenal localization appear to be suspicious for malignancy. The "typical" clinical signs and symptoms occur more frequently in patients with benign tumours and can therefore be regarded as typical signs of benign pheochromocytomas.

Published
2001
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12. An assessment of diagnostic procedures preparatory to retroperitoneoscopic removal of adenoma in cases of primary hyperaldosteronism.

Author

Glodny B, Kühle C, Cromme S, Brockmann J, and Winde G

Subjects
Adenoma pathology, Adrenal Gland Neoplasms pathology, Adrenal Glands blood supply, Adrenal Glands pathology, Adult, Aldosterone biosynthesis, False Negative Reactions, False Positive Reactions, Female, Humans, Hyperaldosteronism pathology, Hyperplasia, Iodine Radioisotopes, Male, Middle Aged, Retrospective Studies, Tomography, X-Ray Computed, Ultrasonography, Veins, Adenoma diagnosis, Adenoma surgery, Adrenal Gland Neoplasms diagnosis, Adrenal Gland Neoplasms surgery, Hyperaldosteronism surgery, Laparoscopy, Retroperitoneal Space
Abstract

The goal of this study was to improve assessment of diagnostic measures for lateral localization of aldosterone-producing adrenal adenomas preparatory to retroperitoneoscopic removal, in view of the fact that this technique allows for only unilateral access. A retrospective study was carried out of the medical records of 64 patients (38 women, 26 men, average age 46.8+/-11.2) who underwent surgery at University Hospital, Münster, between 1969 and 1998. Seventeen of the 64 patients presented with hyperplasia and 47 had adrenal adenoma. In cases of hyperplasia, computerized tomography imaged a false-positive unilateral tumor 10 times, a false-negative 3 times, and a unilateral hyperplasia 1 time (ultrasonography: tumor 2 times, false-negative 3 times; 131I-Iodomethylnorcholesterol scintigraphy: tumor 5 times, false-negative 1 time, correct 1 time). In cases of adenoma, computerized tomography yielded accurate results 40 times, imaged a false-negative 2 times, and indicated the incorrect side 1 time (Ultrasonography: false-negative 12 times, correct side 9 times, incorrect side 1 time; 131I-Iodomethylnorcholesterol scintigraphy: correct side 19 times, false-positive (both sides) 5 times, negative 3 times, incorrect side 2 times). Venous sampling, which was carried out seven times, yielded accurate results six times, and failed technically one time. Venous sampling appears to be the method of choice for preoperative lateral localization. Thus, retroperitoneoscopic treatment of Conn's syndrome should not be carried out unless venous sampling is carried out first.

Published
2000
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