A little anxiety can be a good thing when it comes to cancer symptoms according to researchers at Washington University School of Medicine in St. Louis. 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. I was curious about the psychology behind this," says Stephen Ristvedt, Ph.D., assistant professor of medical psychology in psychiatry and investigator at the Siteman Cancer Center. "Most people assume the explanation is fear or denial or a reluctance to hear the 'C-word' from a doctor. So, I was surprised to find those who are generally optimistic and unconcerned had the longest delays."
The study will be reported in the May 2005 issue of Psycho-Oncology and is currently 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 at Washington University School of Medicine. 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 also were asked to rate their overall health before the cancer diagnosis and to indicate whether they visited a doctor regularly and got cancer screenings.
The analysis showed that, regardless of 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 psychological tests of general anxiety. 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.