Promoting Early Cancer Presentation Group
Nature and duration of symptoms of stomach cancer
Fiona Warburton, Farhana Haseen, Amanda Ramirez, Lindsay...
Fiona Warburton, Farhana Haseen, Amanda Ramirez, Lindsay Forbes, March 2014
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Introduction The 2010 Cancer Patient Experience Survey included 465 patients with pancreatic cancer and 763 patients with stomach cancer who agreed they could be recontacted for further research. One hundred and eighty one (38.9%) of pancreatic cancer patients and 425 (55.7%) stomach cancer patients were known to be alive at the start of survey fieldwork (9 Nov 2011). Two hundred patients with pancreatic cancer and 200 patients with stomach cancer were randomly selected from these and sent a questionnaire about the nature and duration of their symptoms. One hundred and thirteen (56.5%) pancreatic cancer patients and 140 (70.0%) stomach cancer patients returned a completed questionnaire. Eighty nine (78.8%) pancreatic cancer patients had been diagnosed in the year before the 2010 Cancer Patient Experience Survey, 22 (19.5%) between 1 and 5 years previously and 2 (1.8%) more than 5 years previously. All stomach cancer patients had been diagnosed in the year before the 2010 Cancer Patient Experience Survey.
Demographic characteristics of patients Stomach cancer One hundred and four (74.9%) were male. Ethnicity was available for 129 (92%) of patients, of whom 97% reported that they were of White ethnic group. Age at diagnosis was available for 133 (95%) patients. The mean age at diagnosis was 67 years, range 42 to 87. Quintile of index of multiple deprivation (IMD) was available for 139 (99%) respondents. Thirty three (23.7%) respondents were in the least deprived quintile of deprivation (according to the distribution of IMD in England) and 18 (13%) were in the most deprived quintile.
Route to diagnosis Stomach cancer One hundred and sixteen (85.3%) of patients had been referred to hospital by their GP, 8 (5.9%) had presented via A&E, and 12 (8.8%) via an unspecified route. Route to diagnosis was missing for 4 (2.9%) of patients.
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Nature of symptoms that led to diagnosis Table 1 shows the symptoms reported by the 137 stomach cancer patients who reported any symptoms Table 1. Reported symptoms by symptom type Symptom
n (%)
Other symptoms
95 (69.3)
Indigestion or heartburn
60 (43.8)
Feeling of food getting stuck on way down
46 (33.6)
Feeling sick or vomiting
33 (24.1)
Feeling unusually full after food
24 (17.5)
Systemic Symptoms
65 (47.4)
Extreme fatigue or tiredness
40 (29.2)
Unexpected weight loss
30 (21.9)
Loss of appetite
26 (19.0)
Breathlessness
4 (2.9)
Other systemic
3 (2.2)
Pain symptoms
43 (31.4)
Pain and discomfort in tummy
32 (23.4)
Pain and discomfort in back
10 (7.3)
Other pain
3 (2.2)
Bowel symptoms
6 (4.4)
Black stool
5 (3.6)
Blood in stool
1 (0.7)
Fifty five (39.3%) stomach cancer patients with symptoms reported one symptom only; of these commonly reported symptom was indigestion or heartburn (7; 12.7%).
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Reasons for not going to the doctor Of the 137 stomach cancer patients who reported at least 1 symptom, 66 (48.2%) reported that something had put them off going to the doctor. The most common reason (34; 24.8%) was not realising the symptom was serious. Among these:
28 had other symptoms o 16 had indigestion or heartburn o 12 were feeling of food getting stuck on way down o 7 were feeling unusually full after food o 7 were feeling sick or vomiting 14 had systemic symptoms o 7 had loss of appetite o 6 experienced extreme fatigue or tiredness o 5 had unusual weight loss o 1 had breathlessness 10 had pain symptoms o 7 had pain or discomfort in tummy o 4 had pain or discomfort in back 1 had black stool
Table 2 shows the frequency of reporting for each of specific barriers to symptomatic presentation. Stomach cancer patients rarely reported that anything might put them off to see the doctors when they had symptoms. Table 2: Reported barriers to symptomatic presentation in stomach cancer patients who have had at least 1 symptom Barrier reported
n (%)
I found my doctor difficult to talk to
3 (2.2)
I had too many other things to worry about at the time
3 (2.2)
I was too busy to make time to go to the doctor
3 (2.2)
I was worried about wasting the doctor’s time
2 (1.5)
I was too worried about what the doctor might find
2 (1.5)
It was difficult to make an appointment with the doctor
1 (0.7)
I didn't feel confident talking about my symptoms with the doctor
1 (0.7)
I was too scared to go and see the doctor
1 (0.7)
I was too embarrassed to go to see the doctor
0 (0.0)
It was difficult to arrange transport to the doctor’s
0 (0.0)
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Duration of symptoms For the 137 patients with stomach cancer who reported any symptoms, duration of symptoms was calculated using the question “How long was it from the time you noticed these MAIN health problems or symptoms and first seeing a GP or hospital doctor?” For patients for whom this information was not available (n=17) we used the time between the symptom first starting and seeing a GP or presenting at accident and emergency, where a full date had been given at both time points, to calculate duration of symptoms. We were able to calculate duration of symptoms for 121 out of the 137 patients who reported any symptoms (88.3%). In total, 25 (20.7%) stomach cancer patients had duration of symptoms’ greater than 3 months. Table 3 shows the reported duration of symptoms. Some of the numbers are small and therefore the percentages should be treated with caution. Table 3: Reported duration of symptoms –stomach cancer patients, by symptom Symptoms 4 weeks but 3 months
missing
Other symptoms
42 (44.2)
26 (27.4)
22 (23.2)
5 (5.3)
Indigestion or heartburn
24 (40.0)
16 (26.7)
17 (28.3)
3 (5.0)
Feeling of food getting stuck on way down
19 (41.3)
16 (34.8)
10 (21.7)
1 (2.2)
Feeling sick or vomiting
12 (36.4)
11 (33.3)
8 (24.2)
2 (6.1)
Feeling unusually full after food
11 (45.8)
8 (33.3)
4 (16.7)
1 (4.2)
Systemic Symptoms
31 (47.7)
18 (27.7)
14 (21.5)
2 (3.1)
Extreme fatigue or tiredness
22 (55.0)
9 (22.5)
8 (20.0)
1 (2.5)
Unexpected weight loss
14 (46.7)
9 (30.0)
6 (20.0)
1 (3.3)
Loss of appetite
11 (42.3)
9 (34.6)
5 (19.2)
1 (3.8)
Breathlessness
1 (25.0)
2 (50.0)
1 (25.0)
0 (0.0)
Other systemic
3 (100.0)
0 (0.00)
0 (0.0)
0 (0.0)
Pain symptoms
19 (44.2)
8 (18.6)
13 (30.2)
3 (7.0)
Pain and discomfort in tummy
15 (46.9)
4 (12.5)
10 (31.2)
3 (9.4)
Pain and discomfort in back
5 (50.0)
3 (30.0)
2 (20.0)
0 (0.0)
Other pain
1 (33.3)
1 (33.3)
1 (33.3)
0 (0.0)
Bowel symptoms
6 (100.0)
0 (0.0)
0 (0.0)
0 (0.0)
Black stool
5 (100.0)
0 (0.0)
0 (0.0)
0 (0.0)
Blood in stool
1 (100.0)
0 (0.0)
0 (0.0)
0 (0.0)
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Risk factors for duration of symptoms >3 months Table 4 shows the demographic characteristics of those patients who delayed. Table 4: Demographic characteristics of patients whose duration of symptoms was >3months n (%) Age Group Gender IMD
3 months by symptom and whether or not they realised the symptom was serious. Only symptoms reported by at least 20 patients are included. It was not possible to calculate relative risks adjusted for age, sex and IMD because of small numbers. Indigestion or heartburn (RR , 2.39 95% CI 1.12-5.10) pain symptoms (RR 2.19, 95% CI1.10-4.36), especially pain and discomfort in tummy (RR 2.12, 95% CI 1.07-4.19) were significantly related to delaying. In addition, not realising the symptom was serious was significantly related to delay (RR 2.01, 95% CI 1.06-4.14). We did not look at the relationship between duration of symptoms >3 months and barriers to symptomatic presentation because of the small number of participants reporting any barriers.
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Table 5: Risk factors for delay in symptomatic presentation among stomach cancer patients reporting any symptoms Delay in presentation
n
Unadjusted Relative risk for delay in presentation (95% CI)
