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Coping With Prediagnosis Symptoms of Colorectal Cancer

A Study of 244 Individuals With Recent Diagnosis

Rogers, Heather L. PhD, MPH; Siminoff, Laura A. PhD; Longo, Daniel R. ScD; Thomson, Maria D. PhD

doi: 10.1097/NCC.0000000000000361

Background: Colorectal cancer (CRC) symptoms are often vague and vary in severity, intensity, type, and timing. Receipt of medical care is dependent on symptom recognition and assessment, which may impede timely diagnosis.

Objective: The aim of this study was to describe and categorize how CRC patients coped with symptoms prior to seeking medical care, examine sociodemographic differences in these coping strategies, and determine the strategies associated with time to seek medical care and overall time to diagnosis.

Methods: Two hundred forty-four white and African American patients in Virginia and Ohio who received a diagnosis of CRC and who experienced symptoms prior to diagnosis were administered a semistructured interview and the Brief COPE questionnaire.

Results: Eighty-three percent used more than 1 coping strategy. Common symptom-specific coping strategies were to “wait-and-see,” self-treat, and rationalize symptoms. Males were more likely to wait and see (P < .001); African Americans and Medicaid recipients were more likely to self-treat via lifestyle changes (P’s < .01). Younger individuals (<50 years old) had higher Brief COPE reframing, planning, and humor scores; those with lower education and income had higher denial scores (P’s < .01). Using more symptom-specific coping strategies and engaging in avoidance/denial were associated with longer time to seek medical care and overall time to diagnosis (P’s < .01).

Conclusions: Individuals experiencing CRC symptoms use multiple, diverse coping strategies that are influenced by sociodemographic characteristics. Denial is particularly relevant for delay in seeking care and timely diagnosis.

Implications for Practice: Public health campaigns could focus on secondary prevention of CRC by targeting at-risk groups such as males, African Americans, or Medicaid recipients, who choose waiting or self-treatment in response to initial symptoms.

Author Affiliations: Department of Methodology and Experimental Psychology, University of Deusto, Bilbao, Spain (Dr Rogers); College of Public Health, Temple University, Philadelphia, Pennsylvania (Dr Siminoff); and Departments of Family Medicine and Population Health (Dr Longo) and Social and Behavioral Health (Dr Thomson), Virginia Commonwealth University, Richmond.

This study was funded by National Institutes of Health/National Cancer Institute grant R01 CA134280.

The authors have no conflicts of interest to disclose.

Correspondence: Heather L. Rogers, PhD, MPH, Department of Methodology and Experimental Psychology, University of Deusto, Avenida de las Universidades 24, Bilbao, Spain 48007 (

Accepted for publication January 4, 2016.

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