Poster Presentation COSA-IPOS Joint Scientific Meeting 2012

Diagnosing cancer in the bush: a mixed methods study of diagnostic intervals in people with cancer from rural Western Australia. (#769)

Jon Emery 1 , Fiona M Walter 2 , Vicky Gray 1 , Craig Sinclair 1 , Caroline Bulsara 1 , Max Bulsara 3 , Kirsten Auret 1 , Anna Nowak 1 , Christobel Saunders 1 , D'Arcy Holman 1
  1. General Practice and Primary Health Care Academic Centre, The University of Melbourne, Melbourne, VIC, Australia
  2. Department of Primary Care, University of Cambridge, Cambridge, UK
  3. Notre Dame University, Fremantle, WA, Australia

Objectives: To compare and explore diagnostic intervals in patients with breast, lung, prostate or colorectal cancer from rural Western Australia (WA).
Design, setting and participants: Mixed methods study of people recently diagnosed with breast, lung, prostate or colorectal cancer from the Goldfields and Great Southern Regions of WA. Recruitment occurred from March 2009 to April 2010 through rural cancer nurse coordinators and the WA Cancer Registry.
Main outcome measures: Total Diagnostic Interval  and its sub-components. Qualitative interviews exploring factors underlying differences observed in these intervals.
Results: 66 participants were recruited (24 breast, 20 colorectal, 14 prostate and 8 lung cancers). There were significant differences between cancers in time from: symptom onset to deciding to seek help (p=0.006); presentation in general practice to referral (p=0.045), referral to seeing a specialist (p=0.010) and first specialist appointment to diagnosis (p=<0.001). There was a significant overall difference in mean Total Diagnostic Interval (p=0.046): breast cancer was significantly shorter than colorectal or prostate cancer (mean difference (95% CI): 266.3 days (45.9-486.8) p=0.019; 277.0 days (32.1-521.9) p=0.027 respectively). Differences in symptom appraisal and help-seeking by patients were explained by several factors including the nature and personal interpretation of symptoms, fear, embarrassment, competing demands and the core rural Australian characteristics of optimism, stoicism and machismo. Breast cancer was diagnosed more quickly because its symptoms are often more specific and better recognised by consumers, and due to good access to diagnostic tests and specialist one-stop clinics.
Conclusions: This study could inform the development of targeted interventions in rural Australia to promote earlier presentation and investigation of symptoms suggestive of cancer, particularly for colorectal and prostate cancer.