title: The Association between Fatalistic Beliefs and Late Stage at Diagnosis of Lung and Colorectal Cancer.
abstract: BACKGROUND
  Fatalistic beliefs may be implicated in longer help-seeking intervals, and consequently, greater risk of advanced stage at cancer diagnosis.
  
  
  METHODS
  We examined associations between fatalism and stage at diagnosis in a population-based cohort of 4,319 U.S. patients with newly diagnosed lung or colorectal cancer participating in the Cancer Care Outcomes and Research Surveillance (CanCORS) study. Fatalistic beliefs were assessed with an established measure. A fatalism score (range, 4-16) was created by summing Likert scale responses to four items. Cancer stage at diagnosis was abstracted from medical records by trained staff. Logistic regression was used to assess the association between fatalism score and advanced stage at diagnosis (IV vs. I-III), adjusting for sociodemographic and clinical characteristics.
  
  
  RESULTS
  Overall, 917 (21%) patients had stage IV cancers (lung: 28%, colorectal: 16%). The mean fatalism score was 10.7 (median = 11; interquartile range, 9-12). In adjusted analyses, a higher fatalism score was associated with greater odds of stage IV diagnosis (OR per unit increase in fatalism = 1.05; 95% confidence interval 1.02-1.08; P = 0.003). Patients with the highest fatalism score had an adjusted 8.9% higher frequency of stage IV diagnosis compared with patients with the lowest score (25.4% vs. 16.5%).
  
  
  CONCLUSIONS
  In this large and socioeconomically, geographically, and ethnically diverse population of patients with lung and colorectal cancer, fatalistic beliefs were associated with higher risk of advanced stage at diagnosis. Longitudinal studies are needed to confirm causation.
  
  
  CONCLUSIONS
  These findings support the value of incorporating information about the curability of early-stage cancers in public education campaigns.
authors: Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, Institute of Public Health, Cambridge, United Kingdom. Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, United Kingdom. gl290@medschl.cam.ac.uk.
authors: Georgios
authors: G
authors: Lyratzopoulos
authors: Harvard Medical School, Department of Health Care Policy, Boston, Massachusetts.
authors: Michael Pang-Hsiang
authors: MP
authors: Liu
authors: Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, Institute of Public Health, Cambridge, United Kingdom.
authors: Gary A
authors: GA
authors: Abel
authors: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, United Kingdom.
authors: Jane
authors: J
authors: Wardle
authors: Harvard Medical School, Department of Health Care Policy, Boston, Massachusetts. Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Nancy L
authors: NL
authors: Keating
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058443:Catastrophization / Q000523:psychology*; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012306:Risk; D055815:Young Adult
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