Spreading Awareness of the Risk of Lung Cancer in Patients with COPD

Most patients with chronic obstructive pulmonary disease (COPD) require greater motivation to seek help when symptom changes occur and are unaware of their increased risk of developing lung cancer, according to a new, UK-based qualitative interview study in Psycho-Oncology. Researchers explored how COPD affects patient response to changes in their symptoms and sought to explain their reluctance toward help-seeking behaviors from medical professionals.

Researchers discovered that none of the patients in the study knew about the link between their condition and the potential onset of lung cancer. Results revealed patients often disregarded early signs of lung cancer and instead believed they were COPD-related. Various factors were considered to explain why patients avoided seeking medical treatment. Researchers acknowledged awareness to the risk of lung cancer, prompt diagnosis, and early treatment could prolong survival rates.

Between July 2016 and May 2017, interviews were completed with 40 patients with COPD aged 40 to 83 in Glasgow, Scotland. Researchers asked questions related to 4 different “circles of influence” regarding patient self-knowledge, his or her amount of social interaction, cultural attitudes, and social structure. The interviews were recorded, transcribed, and imported into the software package NVivo, version 11. Data were analyzed using a framework method, which allowed organization by key themes and concepts. Researchers were able to gather information on each patient’s symptom experience, interpretation, action, recognition, help-seeking tendencies, evaluation, and reevaluation.

Cultural influences had a dramatic effect on individuals’ reluctance to seek professional help. Many participants wanted to be considered “good patients.” Concern was expressed over wasting a physician’s time, which demonstrates mindfulness of a moral balance between responsible use of medical services and avoidance of needlessly sacrificing their health. Many patients emphasized they would only consult their physician in critical circumstances.

Stoicism and fatalism also deterred patients from seeking care. A number of individuals were pessimistic toward the idea of achieving improved symptoms.

In addition, social interaction was found to have a key influence on an individual’s likelihood to seek treatment. Family members and friends noticed worsening coughs or physical changes when patients failed to recognize any change themselves. Those who had the support of family or friends had a greater chance of attaining help than those who expressed feelings of isolation.

Social structure was also determined to be a major influencer on a patient’s tendency to seek help. Researchers inquired about barriers to healthcare, which included scheduling appointments beyond typical working hours, transportation or physical mobility issues, and social isolation. A number of patients admitted to purposefully avoiding social situations that could alert others to their condition, due to feelings of embarrassment. Those who stated they had few people in their lives also expressed little desire to pursue medical attention.

Researchers also sought to discover patients’ self-knowledge about COPD and their own bodies. Some patients demonstrated optimistic bias, assuming external factors, such as weather or illness, accounted for a change in their symptoms, rather than considering a more dire explanation.

Lung cancer is one of the most common cancers in the UK, causing more than 35,000 annual deaths. Nearly 60% of patients diagnosed at its earliest stage survive the disease for 5 years or more, compared to 10% when detection occurs at later stages. In addition, prevalence of lung cancer is 4 times higher in patients with COPD.

In their recommendations for the future, researchers expressed concern that informing patients of a link between COPD and cancer could be harmful and lead to increased fatalism, but they said that raising awareness of the relationship between COPD and lung cancer will enlighten patients to the benefits of early diagnosis.

“Healthcare professionals need to do more to educate those with COPD about their increased risk of developing lung cancer and be more vigilant when a patient with the illness presents changing symptoms,” said Kathyrn A. Robb, PhD, and senior lecturer at the University of Glasgow, in a statement.

Reference

Cunningham Y, Wyke S, Blyth K, et al. Lung cancer symptom appraisal among people with chronic obstructive pulmonary disease: A qualitative interview study [published online February 12, 2019]. Psychooncology. doi: 10.1002/pon.5005.