Academic journal article International Journal of Men's Health

Studying Help-Seeking for Testicular Cancer: Some Lessons from the Literature (Part 2)

Academic journal article International Journal of Men's Health

Studying Help-Seeking for Testicular Cancer: Some Lessons from the Literature (Part 2)

Article excerpt

When patients delay seeking medical attention after noticing symptoms of cancer there may be consequences in terms of the eventual staging of the disease at diagnosis, its prognosis and their survival. This review focuses on the psychosocial factors influencing help-seeking behaviour, hoping to draw lessons for testicular cancer in particular. Although the majority of studies have focussed on breast cancer, there is increased attention on other cancers including testicular cancer. This review outlines the methodology and terminology of "patient delay" and some of its consequences, before considering the range of influences of potential relevance to testicular cancer from a wide range of studies. It makes specific recommendations concerning the measurement of delay and methodology generally. Both psychological factors such as symptom interpretation, denial, avoidance, and distress as well as social factors are highlighted when studying the process by which men come to consult physicians.

Keywords: men, help-seeking behaviour, testicular cancer, patient delay, physicians

Although commonly considered a single disease, cancer is a term that is used to describe more than two hundred different diseases (Nezu, Nezu, Friedman, Faddis, & Houts, 1998). The most common cancers in men are lung and skin cancers (accounting for more than a third of the cases), and in women breast and skin cancers account for a similar proportion of cases (Rees, Goodman, & Bullimore, 1993). Rees et al. (1993) state that over their lifespan approximately three out of 10 people will develop cancer and two thirds of these will die as a result of the disease (or one in five of the population). It is a disease that generally affects an older age group with 75% of cancers registered in people over the age of 60. Although these aspects inform lay perceptions of cancer in general, testicular cancer does not fit the "general picture," occurring as it does in younger men with a high survival rate when treated appropriately. However, one should note the significant gap between men's and women's attendance at health centres, with men attending less often (Watson, 2000), and that men suffer increased mortality. The Department of Health and Human Services (Courtenay, 2000) noted that in the United States men's death rates for cancer are one and a half times greater than for women. These two factors have led to the common adage in health literature that "women are sicker, but men die quicker" (Lahelma, Martikainen, Rahkonen, & Silventoinen, 1999, p. 7).

The United Kingdom census (Quinn, Babb, Brock, Kirby, & Jones, 2001) identified around 1,400 cases of testicular cancer in 1997, forming just over 1% of all male cancer. Incidence was highest (13 per 100,000) in 30-34 year olds, and more than half of all cases were under 35. It appears that the incidence of testicular cancer is increasing in the western world (Chilvers, Saunders, Bliss, Nicholls, & Horwich, 1989; Dearnaley, Huddart, & Horwich, 2001). However, the prognosis for testicular cancer has steadily improved, and it is estimated (Gascoigne & Whitear, 1999) that deaths in England and Wales fell by 40% between the late 1970s and 1980s. This is probably due to improved detection and treatment, the introduction of serum markers, and the use of chemotherapy since the mid-1970s. However, one review of epidemiological and histological evidence across several regions in Europe and Asia (Forman & Moller, 1994) suggested that both the increase and variability in incidence point to environmental influences such as environmental estrogenic compounds. Although the cause of testicular cancer is unknown, intra-organismic suggestions include genetic factors, undescended testicles, and infantile hernia (Dearnaley et al., 2001).

Several decades of cancer research have focused on what have become known as "patient delay" and the factors involved in the time between first noticing symptoms and first seeking medical help. …

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