J R Soc Med 2005;98:415
doi:10.1258/jrsm.98.9.415
© 2005 Royal Society of Medicine
Unfounded worries about cancer in patients attending a routine otolaryngology clinic
Safina Ali MB MRCS
B J G Bingham MB FRCS
Department of Otolaryngology, Southern General Hospital, Glasgow G51 4TK,
Scotland, UK
Correspondence to: Miss Safina Ali
E-mail:
safinaali{at}doctors.org.uk
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SUMMARY
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To investigate a suspicion that many ear, nose and throat patients
have
unfounded concerns about cancer, we questioned 50 patients
who had attended a
routine clinic after screening-out of those
with possibly cancer-related
features. None of the 50 proved
to have cancer. 15 (30%) had been worried
about cancer and 7
of these were still worried despite the consultation.
Unwarranted
fears about cancer are best dealt with by the referring clinician,
especially
when the wait for an appointment will be long. Such fears also
need
to be recognized and addressed by the specialist.
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INTRODUCTION
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In Scotland as elsewhere in the UK, Government targets require
that
patients with possible cancer are seen by an appropriate
specialist within a
narrow time limit.
1
Consultants in otolaryngology
therefore examine outpatient referral letters
and give priority
to patients whose symptoms are compatible with head or neck
cancer.
For those not categorized as ‘urgent’ the wait for
a
routine appointment can be as long as six months. The present
pilot study was
prompted by a suspicion that, even in the non-urgent
groups, many patients
have concerns about cancer—perhaps
generated or worsened by consultation
of internet sources. So
they have a long wait before such fears can be allayed
by an
expert.
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METHOD
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A questionnaire was given to 50 consecutive new patients who
had been seen
at a ‘routine’ ear, nose and throat
clinic (i.e. designated by the
consultant as unlikely to have
cancer). They were asked whether, before the
consultation, they
had been concerned that they might have cancer and whether
this
concern persisted after the consultation. The answers were yes
or no. We
reviewed all the case notes to determine principal
symptoms and eventual
outcomes. Approval by our local ethics
committee is not required for studies
of this kind.
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RESULTS
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All 50 patients completed the questionnaire—22 men, 28
women (age
range 18-77 years). None proved to have cancer. 15
(30%) said they had worried
that their principal symptom might
be due to cancer, and 7 had not lost this
fear after the consultation.
Fear of cancer was most prevalent in patients
with neck symptoms
(5/6) and least in those with ear symptoms (1/13).
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DISCUSSION
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On the evidence of this small survey, many patients attending
routine ear,
nose and throat clinics have a hidden cancer worry.
Referring clinicians need
to be aware of such anxieties and
address them early, so as to prevent
needless worry during the
wait for an appointment. Moreover, specialists need
to be aware
of these seemingly unwarranted fears and deal with them. The
senior
author was greatly troubled by the finding that only half his
patients
had their cancer concern lifted by the consultation.
In consequence, we now
ask most patients directly whether they
are worried about cancer and reassure
them categorically whenever
possible.
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REFERENCES
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- Cancer in Scotland: Action for Change
[www.scotland.gov.uk]
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SUMMARY
INTRODUCTION
