This article is more than 5 years old. Information may no longer be current.
Cancer fear limits colorectal cancer screening uptake
Click Here to Manage Email Alerts
Adults who worry about cancer are more likely to want to get screened for colon cancer, but those who are uncomfortable about the thought of the disease makes them less willing to actually follow through with screening, according to study results.
How men and women deal with their fear and discomfort about cancer likely dictates their participation in screening, researchers wrote.
Charlotte Vrinten
Charlotte Vrinten, research psychologist at the Cancer Research UK Health Behaviour Research Centre at University College London, and colleagues conducted a prospective study to examine the association between cognitive, biological and behavioral aspects of cancer fear and the likelihood that adults would express the intent to screen or actually get screened for colorectal cancer.
“Cancer fear is still very common in the U.K. and the U.S.,” Vrinten told HemOnc Today. “Over half our sample said they feared cancer more than other diseases, and that they felt uncomfortable thinking about it. This can cost someone their life if it stops them [from] going for screening or getting medical help for symptoms. We need to help people understand that cancer outcomes are improving and there is no need for it to be the great dread it used to be.”
The analysis included 13,351 participants in the U.K. Flexible Sigmoidoscopy Trial, a multicenter randomized controlled trial that assessed the effect of once-only flexible sigmoidoscopy screening in adults aged 55 to 64 years on colorectal cancer incidence and mortality.
All participants had never undergone colorectal cancer screening as it was not standard practice in the U.K. at the time of the study.
Participants received a baseline questionnaire designed to assess demographic, health and psychological factors.
The questionnaire also assessed patients’ fears. Patients read three statements and were asked to choose which of five responses — “strongly agree,” “agree,” “disagree,” “strongly disagree” or “not sure” — best described their feelings toward each statement.
The statements were:
- “Of all the diseases there are, I am most afraid of cancer.”
- “I worry a lot about cancer.”
- “It makes me uncomfortable to think about cancer.”
Sixty percent (n = 7,971) of participants responded. Overall, 59% indicated they were more afraid of cancer than other diseases, 53% indicated they were uncomfortable thinking about cancer and 25% indicated they worried about cancer.
More than 7,600 respondents had complete, valid responses to all key questions, and 82% of them (n=6,299) indicated they would “definitely” (29%) or “probably” (53%) undergo screening if invited.
Eighty-six percent of respondents who indicated cancer was their greatest health fear expressed an intention to undergo screening, compared with 74% who indicated cancer was not their greatest health fear and 79% of those who answered “not sure.”
Eighty-nine percent of those who indicated they worry about cancer expressed an intention to undergo screening, compared with 79% of those who did not worry about cancer and 83% who answered “not sure.”
Respondents who indicated they were uncomfortable thinking about cancer indicated they were less likely to attend a screening (80%) than those who indicated they were not uncomfortable thinking about cancer (83%) or those who answered “not sure” (85%).
From the group of patients who indicated they would “definitely” or “probably” undergo screening if invited, researchers randomly assigned about one-third (31.6%; n = 1,995) to be invited for screening. About 71% of those patients attended their appointment.
Those who indicated they “definitely” would undergo screening if invited were more likely to attend their assigned screening than those who indicated they “probably” would accept the invitation (80% vs. 54%).
Screening uptake was similar between those who identified cancer as their biggest health fear and those who did not (70% vs. 72%). Respondents who indicated they didn’t worry about cancer were more likely to attend screening than those who indicated they worry a lot about cancer (72% vs. 65%). Respondents who indicated they were comfortable thinking about cancer were more likely to attend screening than those who indicated they were uncomfortable thinking about it (77% vs. 68%).
Multivariable analysis adjusted for age, sex, education, ethnicity and marital status showed only one measure of fear — feeling uncomfortable when thinking about cancer — had an effect on screening attendance (OR = 0.72; 95% CI, 0.56-0.91).
“Our study helps explain why cancer fear motivates some people to get checked up and why others are put off, and why people don’t always follow through on their intentions — a phenomenon known as the ‘intention-behavior gap,’” Vrinten said. “ [The data shows] 82% of our sample said they would attend for colon cancer screening, but only 71% of this group actually turned up for the test when they were invited. By looking at different aspects of cancer fear, we are better able to predict who will go for screening and who is put off by their fear. This information can help in designing effective public health messages about cancer screening.” – by Anthony SanFilippo
For more information:
Charlotte Vrinten can be reached at Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, UK, WC1E 6BT; email: c.vrinten@ucl.ac.uk
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopSanja Percac-Lima, MD
Vrinten and colleagues examined the association between three aspects of cancer fear and screening colonoscopy. Prior to implementing a patient navigator program for colorectal cancer screening at Massachusetts General Hospital Chelsea Heath Center, we performed a qualitative study to explore barriers to colonoscopy in our patients. The fear of cancer diagnosis was one of the main barriers mentioned by participants, as this quote illustrates: “What I do not know won’t hurt me. No, I want nothing to do with cancer. Not even to test or screen for it … nothing.”Using the data obtained in this study, we trained our navigators to help patients overcome their specific barriers to screening and navigate them to obtain colonoscopy.
The 9-month study showed significantly higher colonoscopy rates in the navigated group compared with the usual care group (20.8% and 9.6%; P < .001) and the program improved the equity in colorectal cancer prevention. Vrinten’s study revealed that different aspects of cancer fear could have different effects on intention and uptake of colonoscopy. Understanding these differences could help us modify navigator training and further improve cancer prevention.
References:
Green AR, et al. J Gen Intern Med. 2008;doi:10.1007/s11606-008-0572-6.NCI. Culturally tailored navigator intervention program for colorectal cancer screening. Available at: rtips.cancer.gov/rtips/programDetails.do?programId=1493683. Accessed on March 12, 2015.
Percac-Lima S, et al. J Gen Intern Med. 2009;doi:10.1007/s11606-008-0864-x.
Percac-Lima S, et al. Cancer. 2014;doi:10.1002/cncr.28682.
Click Here to Manage Email Alerts