Skip to main content
NCBI home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 2004 Jan;54(498):25–32.

Qualitative study of men's perceptions of why treatment delays occur in the UK for those with testicular cancer.

Alison Chapple 1, Sue Ziebland 1, Ann McPherson 1
PMCID: PMC1314774  PMID: 14965403

Abstract

BACKGROUND: Many studies (but not all) have shown that for men with testicular cancer a longer treatment delay is associated with additional treatments, greater morbidity, and shorter survival. AIM: This paper explores patients' perspectives on why treatment delays occur. DESIGN: Qualitative study using narrative interviews SETTING: Interviews in patient's homes throughout the United Kingdom (UK). METHOD: Interviews with a maximum variation sample of 45 men with testicular cancer, recruited through general practitioners (GPs), urologists, support groups, and charities. RESULTS: Those who sought help relatively quickly responded to symptoms, had heard about testicular cancer in the media, had seen leaflets in GPs' surgeries, or knew others with this disease. Men delayed because they did not recognise signs and symptoms; feared appearing weak, a hypochondriac, or lacking in masculinity; recalled past illness or painful examinations; were embarrassed; feared the consequences of treatment; or lacked time to consult their doctors. Beliefs about symptoms and pessimistic associations with cancer also led to delay. Treatment delays also resulted from misdiagnosis or waiting lists. CONCLUSION: Whether or not men should be taught to examine themselves routinely to check for testicular cancer is much debated. This study suggests that it is important that men are aware of the normal shape and feel of their testicles, and may benefit from information about signs and symptoms of testicular cancer and the excellent cure rate. Information, provided in surgeries where men feel welcome, might encourage men to seek help promptly when a problem arises. Our study also suggests that GPs may need to accept a low threshold for ultrasound investigation of testicular symptoms and that the ultrasound service needs to be improved. These measures may further reduce mortality and morbidity.

Full Text

The Full Text of this article is available as a PDF (53.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Banks I. No man's land: men, illness, and the NHS. BMJ. 2001 Nov 3;323(7320):1058–1060. doi: 10.1136/bmj.323.7320.1058. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Blaxter M. The causes of disease. Women talking. Soc Sci Med. 1983;17(2):59–69. doi: 10.1016/0277-9536(83)90356-8. [DOI] [PubMed] [Google Scholar]
  3. Bosl G. J., Vogelzang N. J., Goldman A., Fraley E. E., Lange P. H., Levitt S. H., Kennedy B. J. Impact of delay in diagnosis on clinical stage of testicular cancer. Lancet. 1981 Oct 31;2(8253):970–973. doi: 10.1016/s0140-6736(81)91165-x. [DOI] [PubMed] [Google Scholar]
  4. Burgess C., Hunter M. S., Ramirez A. J. A qualitative study of delay among women reporting symptoms of breast cancer. Br J Gen Pract. 2001 Dec;51(473):967–971. [PMC free article] [PubMed] [Google Scholar]
  5. Chilvers C. E., Saunders M., Bliss J. M., Nicholls J., Horwich A. Influence of delay in diagnosis on prognosis in testicular teratoma. Br J Cancer. 1989 Jan;59(1):126–128. doi: 10.1038/bjc.1989.25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Coyne I. T. Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear boundaries? J Adv Nurs. 1997 Sep;26(3):623–630. doi: 10.1046/j.1365-2648.1997.t01-25-00999.x. [DOI] [PubMed] [Google Scholar]
  7. De Nooijer J., Lechner L., De Vries H. Help-seeking behaviour for cancer symptoms: perceptions of patients and general practitioners. Psychooncology. 2001 Nov-Dec;10(6):469–478. doi: 10.1002/pon.535. [DOI] [PubMed] [Google Scholar]
  8. Dearnaley D., Huddart R., Horwich A. Regular review: Managing testicular cancer. BMJ. 2001 Jun 30;322(7302):1583–1588. doi: 10.1136/bmj.322.7302.1583. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Dyer Owen. London hospital slated for "chaotic" ultrasound service. BMJ. 2002 Nov 23;325(7374):1193–1193. doi: 10.1136/bmj.325.7374.1193. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gascoigne P., Mason M. D., Roberts E. Factors affecting presentation and delay in patients with testicular cancer: results of a qualitative study. Psychooncology. 1999 Mar-Apr;8(2):144–154. doi: 10.1002/(SICI)1099-1611(199903/04)8:2<144::AID-PON349>3.0.CO;2-P. [DOI] [PubMed] [Google Scholar]
  11. Hernes E. H., Harstad K., Fosså Changing incidence and delay of testicular cancer in southern Norway (1981-1992). Eur Urol. 1996;30(3):349–357. doi: 10.1159/000474195. [DOI] [PubMed] [Google Scholar]
  12. Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet. 2001 Aug 11;358(9280):483–488. doi: 10.1016/S0140-6736(01)05627-6. [DOI] [PubMed] [Google Scholar]
  13. Mor V., Masterson-Allen S., Goldberg R., Guadagnoli E., Wool M. S. Pre-diagnostic symptom recognition and help seeking among cancer patients. J Community Health. 1990 Aug;15(4):253–266. doi: 10.1007/BF01350291. [DOI] [PubMed] [Google Scholar]
  14. Moul J. W., Paulson D. F., Dodge R. K., Walther P. J. Delay in diagnosis and survival in testicular cancer: impact of effective therapy and changes during 18 years. J Urol. 1990 Mar;143(3):520–523. doi: 10.1016/s0022-5347(17)40007-3. [DOI] [PubMed] [Google Scholar]
  15. Moynihan C. Men, women, gender and cancer. Eur J Cancer Care (Engl) 2002 Sep;11(3):166–172. doi: 10.1046/j.1365-2354.2002.00348.x. [DOI] [PubMed] [Google Scholar]
  16. Moynihan C. Testicular cancer: the psychosocial problems of patients and their relatives. Cancer Surv. 1987;6(3):477–510. [PubMed] [Google Scholar]
  17. Oliveria S. A., Christos P. J., Halpern A. C., Fine J. A., Barnhill R. L., Berwick M. Patient knowledge, awareness, and delay in seeking medical attention for malignant melanoma. J Clin Epidemiol. 1999 Nov;52(11):1111–1116. doi: 10.1016/s0895-4356(99)00083-9. [DOI] [PubMed] [Google Scholar]
  18. Pill R. Issues in lifestyles and health: lay meanings of health and health behaviour. WHO Reg Publ Eur Ser. 1991;37:187–211. [PubMed] [Google Scholar]
  19. Pope C., Ziebland S., Mays N. Qualitative research in health care. Analysing qualitative data. BMJ. 2000 Jan 8;320(7227):114–116. doi: 10.1136/bmj.320.7227.114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Power D. A., Brown R. S., Brock C. S., Payne H. A., Majeed A., Babb P. Trends in testicular carcinoma in England and Wales, 1971-99. BJU Int. 2001 Mar;87(4):361–365. doi: 10.1046/j.1464-410x.2001.00078.x. [DOI] [PubMed] [Google Scholar]
  21. Smith E. M., Anderson B. The effects of symptoms and delay in seeking diagnosis on stage of disease at diagnosis among women with cancers of the ovary. Cancer. 1985 Dec 1;56(11):2727–2732. doi: 10.1002/1097-0142(19851201)56:11<2727::aid-cncr2820561138>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  22. Steele Jeremy P. C., Oliver R. Timothy D. Testicular cancer: perils of very late presentation. Lancet. 2002 May 11;359(9318):1632–1633. doi: 10.1016/S0140-6736(02)08544-6. [DOI] [PubMed] [Google Scholar]
  23. Summerton Nicholas. Cancer recognition and primary care. Br J Gen Pract. 2002 Jan;52(474):5–6. [PMC free article] [PubMed] [Google Scholar]
  24. Toklu C., Ozen H., Sahin A., Rastadoskouee M., Erdem E. Factors involved in diagnostic delay of testicular cancer. Int Urol Nephrol. 1999;31(3):383–388. doi: 10.1023/a:1007134421608. [DOI] [PubMed] [Google Scholar]
  25. Westlake S. J., Frank J. W. Testicular self-examination: an argument against routine teaching. Fam Pract. 1987 Jun;4(2):143–148. doi: 10.1093/fampra/4.2.143. [DOI] [PubMed] [Google Scholar]
  26. Wishnow K. I., Johnson D. E., Preston W. L., Tenney D. M., Brown B. W. Prompt orchiectomy reduces morbidity and mortality from testicular carcinoma. Br J Urol. 1990 Jun;65(6):629–633. doi: 10.1111/j.1464-410x.1990.tb14834.x. [DOI] [PubMed] [Google Scholar]
  27. Zola I. K. Pathways to the doctor-from person to patient. Soc Sci Med. 1973 Sep;7(9):677–689. doi: 10.1016/0037-7856(73)90002-4. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES