20 Feb Over-reassurance after a cancer false alarm may delay help-seeking for future symptoms
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Renzi: Only a minority of symptomatic individuals undergoing cancer investigations are diagnosed with cancer and more than 80% receive an ‘all-clear’ or non-cancer diagnosis (here called a ‘false alarm’). This makes it important to consider the possible unintended consequences of a false alarm.
Several studies have shown that investigations for a suspected cancer can have negative psychological effects, even for individuals ultimately diagnosed with a benign condition. In addition, an association between false alarms and subsequent delayed diagnosis has been reported for various cancers, with both patients and healthcare providers contributing to delays.
Our review published by BMJ Open focused on 19 research papers which reported information on false alarms and subsequent symptom attribution or help-seeking. By integrating the available evidence from qualitative, quantitative and mixed methods studies this review allowed us to identify areas that need to be addressed in order to reduce the risk of delayed help-seeking after a previous false alarm. In particular, over-reassurance and under-support of patients can be an unintended consequence of a false alarm leading to delays in help-seeking, even years later, if patients notice possible symptoms of the disease again.
The review, funded by Cancer Research UK, looked only at adult patients who had a false alarm after raising concerns about their symptoms; the effect of a false alarm might be different in patients who are investigated for suspected cancer following cancer screening.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Renzi: Our study suggested that patients may delay seeking help for new or recurrent symptoms if they feel over-reassured following a previous false alarm or felt under-supported at the time by the healthcare system. In particular, over-reassurance from the previous ‘all-clear’ diagnosis can lead to subsequent symptoms being interpreted as benign. Our review has also shown that under-supporting patients receiving an all-clear diagnosis can negatively impact future symptom interpretation and help-seeking. The perception that symptoms were previously dismissed as unimportant was a relevant theme explaining subsequent delays, most often because of not wanting to appear hypochondriacal. Several studies also reported that insufficient explanation or advice at the time of the false alarm, on possible causes of the symptoms or the next steps, left patients feeling that doctors could not help them, and unsure about what to do next. Many of the studies reported on prolonged delays, suggesting that the effects of a false alarm can be long-lasting, and may generalize beyond recurrence of the original symptom to new symptoms appearing some time later. In the case of breast symptoms, a benign diagnosis appeared to give some women a false sense of security persisting for many years.
Providing appropriate, balanced information to patients who have a cancer false alarm, including making sure they don’t feel foolish about having sought help, might encourage them to check out any future symptoms earlier. A clinical encounter providing information before and after diagnostic investigations may be valuable to ensure that bodily sensations are not dismissed following negative examinations, and to discuss next steps in the case of recurrent or new symptoms. It’s important that patients don’t have a false sense of security and understand they should still seek help if they notice any potential cancer symptoms even after an all-clear diagnosis.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Renzi: The evidence on the effects of a false alarm is limited as the majority of studies are based on qualitative data collection methods and are limited by small sample size, retrospective design and lack of control groups. More prospective studies are needed, also including information provided by healthcare professionals.
The majority of studies were conducted in English-speaking countries, mainly the UK and the USA, with a few from Northern Europe. More international comparisons, including central and southern European countries could provide a different perspective on common issues.
Prospective studies are needed to identify the appropriate forms of patient-information to avoid unintended consequences of false alarms on subsequent symptom attribution and help-seeking.
Renzi, K. L. Whitaker, J. Wardle. Over-reassurance and undersupport after a ‘false alarm’: a systematic review of the impact on subsequent cancer symptom attribution and help seeking. BMJ Open, 2015; 5 (2): e007002 DOI: 10.1136/bmjopen-2014-007002
MedicalResearch.com Interview with: Dr Cristina Renzi (2015). Reassurance After False Alarms May Delay Future Cancer Screenings MedicalResearch.com