Smith Lauren, Von Wagner Christian, Kaushal Aradhna, Rafiq Meena, Lyratzopoulos Georgios, Renzi Cristina
Research Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK.
Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne 3052, Australia.
Cancers (Basel). 2023 Mar 8;15(6):1668. doi: 10.3390/cancers15061668.
Type 2 diabetes is associated with a higher risk of colorectal cancer (CRC) and advanced-stage cancer diagnosis. To help diagnose cancer earlier, this study aimed at examining whether diabetes might influence patient symptom attribution, help-seeking, and willingness to undergo investigations for possible CRC symptoms.
A total of 1307 adults (340 with and 967 without diabetes) completed an online vignette survey. Participants were presented with vignettes describing new-onset red-flag CRC symptoms (rectal bleeding or a change in bowel habits), with or without additional symptoms of diabetic neuropathy. Following the vignettes, participants were asked questions on symptom attribution, intended help-seeking, and attitudes to investigations.
Diabetes was associated with greater than two-fold higher odds of attributing changes in bowel habits to medications (OR = 2.48; 95% Cl 1.32-4.66) and of prioritising diabetes-related symptoms over the change in bowel habits during medical encounters. Cancer was rarely mentioned as a possible explanation for the change in bowel habits, especially among diabetic participants (10% among diabetics versus 16% in nondiabetics; OR = 0.55; 95% CI 0.36-0.85). Among patients with diabetes, those not attending annual check-ups were less likely to seek help for red-flag cancer symptoms (OR = 0.23; 95% Cl 0.10-0.50).
Awareness of possible cancer symptoms was low overall. Patients with diabetes could benefit from targeted awareness campaigns emphasising the importance of discussing new symptoms such as changes in bowel habits with their doctor. Specific attention is warranted for individuals not regularly attending healthcare despite their chronic morbidity.
2型糖尿病与结直肠癌（CRC）风险升高及晚期癌症诊断相关。为了更早地诊断癌症，本研究旨在探讨糖尿病是否会影响患者对症状的归因、寻求帮助的行为以及对可能的结直肠癌症状进行检查的意愿。
共有1307名成年人（340名患有糖尿病，967名未患糖尿病）完成了一项在线 vignette 调查。参与者阅读了描述新发的结直肠癌警示症状（直肠出血或排便习惯改变）的 vignette，这些症状伴有或不伴有糖尿病神经病变的其他症状。阅读 vignette 后，参与者被问及有关症状归因、预期寻求帮助的行为以及对检查的态度等问题。
糖尿病与将排便习惯改变归因于药物的几率高出两倍多相关（OR = 2.48；95% CI 1.32 - 4.66），并且在就医时将糖尿病相关症状置于排便习惯改变之上的几率也更高。癌症很少被提及为排便习惯改变的可能原因，尤其是在糖尿病参与者中（糖尿病患者中为10%，非糖尿病患者中为16%；OR = 0.55；95% CI 0.36 - 0.85）。在糖尿病患者中，未参加年度体检的患者因癌症警示症状寻求帮助的可能性较小（OR = 0.23；95% CI 0.10 - 0.50）。
总体而言，对可能的癌症症状的认识较低。糖尿病患者可能会从有针对性的宣传活动中受益，这些活动强调与医生讨论诸如排便习惯改变等新症状的重要性。对于尽管患有慢性病但未定期就医的个体，应给予特别关注。
