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年轻结直肠癌幸存者的诊断前症状、归因原因和医疗保健寻求资产。

Pre-diagnosis Symptoms, Attributed Causes, and Healthcare Seeking Assets of Younger Colorectal Cancer Survivors.

机构信息

Department of Health Behavior and Policy, School of Population Health, Virginia Commonwealth University, Richmond, VA, USA.

Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA.

出版信息

J Cancer Educ. 2023 Dec;38(6):1932-1938. doi: 10.1007/s13187-023-02363-z. Epub 2023 Sep 16.

Abstract

Younger onset colorectal cancer (CRC) rates continue to rise. Survivors younger than the requisite age of population-based screening guidelines experience adverse symptoms, longer appraisal delays, and more advanced-stage diagnoses. This secondary analysis of interviews with n=252 recently diagnosed CRC survivors was completed to compare younger and older survivors' symptoms, attributed causes, and healthcare seeking assets. The original transcripts and quantitative data were divided into two survivor classifications, younger (age <50 years) (N=64) and older (N=188). Bivariate analyses assessed differences between younger and older survivors for symptoms, attributed causes, and seeking healthcare assets. Multiple logistic regression models adjusting for race, sex, income, education, and stage of diagnosis were conducted for significant bivariate findings. An α level .05 was used to detect significance. Bleeding (𝛘=3.8, p =0.05) and loss of appetite/weight differed between survivors (𝛘=5.3, p=0.02) but not after controlling for sex and race respectively. Younger survivors were more likely to report being too young/healthy to have cancer (𝛘=7.8, p<0.01) and social support encouragement to seek healthcare (𝛘=6.4, p=0.01). Having a regular healthcare provider was more common among older survivors (𝛘=6.4, p=0.01). Logistic regression models also detected age as a significant predictor for all healthcare seeking assets. Clinical and public health practice can benefit from understanding that CRC symptoms may present similarly but assets that facilitate seeking healthcare appraisal differ based upon age. Expanding knowledge of CRC risk factors and symptoms across healthcare professionals and the general public could promote earlier appraisal regardless of age and improve outcomes for younger survivors.

摘要

年轻型结直肠癌(CRC)的发病率持续上升。不符合基于人群的筛查指南年龄要求的年轻 CRC 幸存者会经历不良症状、更长的评估延迟和更晚期的诊断。对 n=252 名最近诊断出的 CRC 幸存者的访谈进行了二次分析,以比较年轻和年长幸存者的症状、归因原因和寻求医疗保健的资产。原始转录本和定量数据被分为两个幸存者分类,年轻组(年龄<50 岁)(N=64)和年长组(N=188)。双变量分析评估了年轻和年长幸存者在症状、归因原因和寻求医疗保健资产方面的差异。对具有统计学意义的双变量发现进行了调整种族、性别、收入、教育和诊断分期的多变量逻辑回归模型分析。采用α水平.05 来检测显著性。出血(𝛘=3.8,p=0.05)和食欲不振/体重减轻在幸存者之间存在差异(𝛘=5.3,p=0.02),但分别在控制性别和种族后则不存在差异。年轻幸存者更有可能报告自己太年轻/健康而不会患有癌症(𝛘=7.8,p<0.01),并且更有可能获得社会支持鼓励他们寻求医疗保健(𝛘=6.4,p=0.01)。年长幸存者更有可能拥有常规医疗保健提供者(𝛘=6.4,p=0.01)。逻辑回归模型还检测到年龄是所有寻求医疗保健资产的重要预测因素。临床和公共卫生实践可以从了解 CRC 症状可能表现相似但促进寻求医疗保健评估的资产因年龄而异中受益。扩大医疗保健专业人员和公众对 CRC 风险因素和症状的认识,可以促进无论年龄大小的早期评估,并改善年轻幸存者的结局。

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