Psychosocial factors involved in delayed consultation by patients with head and neck cancer.
BACKGROUND
In the north of France, a delay in primary consultation has been noted among patients with head and neck cancer. This group is often correlated with lower socioeconomic status and a lack of medical information. Therefore, the choice to seek consultation is often influenced by symptoms such as pain and change in the size of tumors in the neck. We studied this delay in seeking consultation, focusing on psychosocial variables such as professional and social background, the involvement of a spouse/partner, and the presence of anxiety and depression.


METHODS
Two rating scales were administered to 50 patients with large tumors (T3/T4) and 50 patients with small tumors (T1/T2), and the results were compared. These rating scales were as follows: (1) a 17-item questionnaire assessing sociodemographic data, presenting symptoms, factors generating the consultation, and reasons for delay; and (2) the Hospital Anxiety and Depression Scale (HADS).


RESULTS
Both groups were predominantly male and working-class. Significant differences were observed in time since symptom onset and in conscious delay in seeking medical attention. The group with large tumors was characterized by lower involvement of a spouse/partner, conscious delay before first consultation, greater social isolation, fewer medical visits, and lower HADS anxiety scores. The group with small tumors sought consultation sooner and was characterized by greater involvement of a spouse/partner, correlated with significant anxiety. Depression was not a factor influencing delay within either group.


CONCLUSIONS
The interpersonal relationship with a spouse/partner seemed to be essential in the dynamics surrounding consultation. Anxiety, rather than socioeconomics status, was a discriminating factor in the delay in seeking consultation.
Rozniatowski
Olivier
O
Psycho-oncology Unit, Centre Oscar Lambret, BP 307, 59020 Lille Cedex, France.
Reich
Michel
M
Mallet
Yann
Y
Penel
Nicolas
N
Fournier
Charles
C
Lefebvre
Jean-Louis
JL
D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D001294:Attitude to Health; D003863:Depression / Q000523:psychology; D004522:Educational Status; D005260:Female; D006258:Head and Neck Neoplasms / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009790:Occupations; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011322:Primary Prevention; D012017:Referral and Consultation; D012737:Sex Factors; D012923:Social Class; D012934:Social Isolation; D018454:Spouses / Q000523:psychology; D013997:Time Factors