The Welsh Cancer Intelligence and Surveillance Unit (WCISU) reports that lung cancer is responsible for the greatest number of cancer deaths in Wales accounting for over two in ten deaths overall (WCISU 2018) and risk factors such as smoking contribute toward the relatively high incidence rate in Wales (Macmillan Cancer Support 2013 www.macmillan.org.uk). The National Survey for Wales lifestyle trends for 2018 reports that 17% of adults reported themselves to be current smokers (National Survey for Wales 2018-2019). It was also reported in 2014 that 20% of adults living within the Betsi Cadwaladr University Health board catchment area identified themselves as current smokers (Welsh Health Survey 2014).
As almost all cases of lung cancer are attributable to smoking smokers are at a significant risk for developing the disease (Parkin 2011). Whilst there are many campaigns encouraging smoking cessation, there is also a need to provide a high standard of care for those who suffer smoking related symptoms and to encourage them to present early by making it clear to patients that they will not be judged or blamed for their condition.
Some evidence has been shown that delays in diagnosis can seriously influence the operability of lung cancer and patients are often inoperable at the time of diagnosis, additionally, smokers with chest symptoms are likely to delay seeing their doctor (Tod et al 2007; Corner et al 2005). The patient interval is defined as the time between the onset of noticeable symptoms and the first presentation in primary care (Weller et al 2012). As survival is compromised by longer patient intervals it is important to seek out the reasons for these delays and to address concerns which may discourage smokers from seeing their GP. It has also been postulated that healthcare providers express a negative attitude toward smokers and especially lung cancer patients who ignore advice and continue to smoke (Lebel et al 2013). It may be of benefit to healthcare providers to have a deeper understanding of patient hesitancy to present in order to minimise feelings of responsibility and blameworthiness often felt by those who suffer ‘self-inflicted’ cancer (Chapple et al 2004).
This study employed a qualitative methodology to explore this area in-depth and examined the reasons behind delayed presentation in smokers.