Risk factors and time to symptomatic presentation in leukaemia, lymphoma and myeloma.
BACKGROUND
UK policy aims to improve cancer outcomes by promoting early diagnosis, which for many haematological malignancies is particularly challenging as the pathways leading to diagnosis can be difficult and prolonged.


METHODS
A survey about symptoms was sent to patients in England with acute leukaemia, chronic lymphocytic leukaemia (CLL), chronic myeloid leukaemia (CML), myeloma and non-Hodgkin lymphoma (NHL). Symptoms and barriers to first help seeking were examined for each subtype, along with the relative risk of waiting >3 months' time from symptom onset to first presentation to a doctor, controlling for age, sex and deprivation.


RESULTS
Of the 785 respondents, 654 (83.3%) reported symptoms; most commonly for NHL (95%) and least commonly for CLL (67.9%). Some symptoms were frequent across diseases while others were more disease-specific. Overall, 16% of patients (n=114) waited >3 months before presentation; most often in CML (24%) and least in acute leukaemia (9%). Significant risk factors for >3 months to presentation were: night sweats (particularly CLL and NHL), thirst, abdominal pain/discomfort, looking pale (particularly acute leukaemias), and extreme fatigue/tiredness (particularly CML and NHL); and not realising symptom(s) were serious.


CONCLUSIONS
These findings demonstrate important differences by subtype, which should be considered in strategies promoting early presentation. Not realising the seriousness of some symptoms indicates a worrying lack of public awareness.
Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York YO10 5DD, UK.
Debra A
DA
Howell
Kings College London Promoting Early Cancer Presentation Group, 4th Floor, Capital House, 42, Weston Street, London SE1 3QD, UK.
Fiona
F
Warburton
Kings College London Promoting Early Cancer Presentation Group, 4th Floor, Capital House, 42, Weston Street, London SE1 3QD, UK.
Amanda-Jane
AJ
Ramirez
Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York YO10 5DD, UK.
Eve
E
Roman
Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York YO10 5DD, UK.
Alexandra G
AG
Smith
Kings College London Promoting Early Cancer Presentation Group, 4th Floor, Capital House, 42, Weston Street, London SE1 3QD, UK.
Lindsay J L
LJ
Forbes
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D007938:Leukemia / Q000175:diagnosis*; D008223:Lymphoma / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis*; D012307:Risk Factors; D063189:Symptom Assessment; D061665:Time-to-Treatment; D006113:United Kingdom; D055815:Young Adult