Carefree people more apt to ignore cancer symptoms

A little anxiety can be a good thing when it comes to cancer symptoms, according to University researchers.

They report that people with low overall anxiety levels were more apt to ignore symptoms of rectal cancer for long periods of time, thereby delaying treatment.

In contrast, people with at least moderate levels of anxiety tended to quickly recognize symptoms, such as rectal bleeding, as a sign of serious illness.

“Almost everyone has heard about people who had cancer symptoms long before they sought help,” said Stephen L. Ristvedt, Ph.D., assistant professor of medical psychology in psychiatry and Siteman Cancer Center investigator. “Most people assume the explanation is fear or denial or a reluctance to hear the ‘C-word’ from a doctor. I was surprised to find those who are generally optimistic and unconcerned had the longest delays.”

The study will be reported in the May issue of Psycho-Oncology and is available online at the journal’s Web site.

The study examined 69 patients diagnosed with rectal tumors and treated in the Section of Colon and Rectal Surgery. The patients were asked to indicate the length of two time periods: How much time passed between when they first experienced a symptom and when they realized it was potentially serious — the symptom appraisal time — and the time between that realization and the time they contacted a doctor — the action appraisal time.

In addition, each patient was assessed with standardized psychological tests to measure their sensitivity to threat and disposition toward anxiety. Individuals who score low on these tests tend to be confident, relaxed, optimistic, carefree, uninhibited and outgoing.

Those who score high are usually cautious, tense, apprehensive, fearful, inhibited and shy.

The patients were also asked to rate their overall health before the cancer diagnosis and to indicate whether they visited a doctor regularly and underwent cancer screenings.

The analysis showed that, regardless of their psychological profile, 71 percent of the patients did not at first believe their rectal bleeding or other symptoms were signs of cancer. They attributed the symptoms to hemorrhoids, diet, physical injury, stress or ulcers.

Among all the patients, the symptom appraisal time ranged from less than a week to around two years, with a median of seven weeks. Sixteen patients took six months or more to conclude their symptoms might be serious.

The longest symptom appraisal times were associated with those who scored low on the general anxiety psychological tests. By one measure, the low scorers took a median of 30 weeks to appraise their symptoms as serious; high scorers took less than half that long.

“We found that people who are typically less responsive to threatening things take longer to seek medical attention, and they tend not to go in for a routine screening because they just are not concerned enough,” Ristvedt said. “They rate their overall health better, even though in these cases they were seriously ill.”

The study found little difference in symptom appraisal times between men and women, but younger people took slightly longer than older patients to decide their symptoms were serious, as did those with fewer years of education compared with those with more education.

Action appraisal time was considerably shorter than symptom appraisal time among all the patients, having a median of one week. Action appraisal time was not affected by the patients’ psychological profiles or other parameters measured. It appeared that once most patients decided the symptoms were signs of serious illness, they quickly sought medical help.

Ristvedt’s findings suggest a different approach will be needed to ensure that carefree people pay attention to signs of disease.

“We would like to figure out how to reach these people and get them to understand that their positive attitude may actually interfere with healthy behaviors,” he said.