Contributing Factors to Delays in Diagnosis, Treatment Initiation of Cancers in Men – Oncology Nurse Advisor

Some people may be surprised to hear that cancer is diagnosed in men at higher rates than in women. In the United States, more than 40% of men can expect to receive a cancer diagnosis in their lifetime.¹ The leading cancer diagnoses for men include prostate, lung, and colorectal cancers, which make up 46% of the total diagnoses. Worldwide, cancers are increasingly at advanced stages when diagnosed, which has led to poorer survival outcomes and requires increased research on why diagnosis and treatment initiation are lagging.²

Factors important to improving earlier diagnosis, treatment, and survivorship rates include recognition of the signs of cancer in men, availability of social and support services for men, and closing the gaps in research focusing on men’s health-related behaviors that may help them seek earlier diagnosis and participate in their treatment.

When cancer is diagnosed in any person, it may come with symptoms. Symptoms that could indicate a possible cancer diagnosis are commonly ignored by men. For example, men are likely to ignore difficulty urinating or urinating frequently, potential indicators of prostate cancer.³ Chronic coughing also is a commonly ignored symptom that can become a lung cancer diagnosis later as it may be confused with other illnesses, especially in men at an atypical age for the disease.³ Blood in the stool may indicate presence of colorectal cancer.³

Other common symptoms that may indicate cancer include unexplained bleeding; difficulty swallowing; change in bowel or bladder habits; sores that do not heal; unexplained pain, cough, or hoarseness; unexplained lump or swelling; swelling or sores on the testicles or penis; sores in the mouth; stomach pain or nausea; changes in mole appearance; skin changes; fatigue; and unexplained weight loss.^3,4

Men are more likely to ignore their symptoms. They also are more prone to experience symptoms due to high-risk lifestyle behaviors such as smoking, alcohol consumption, eating fatty foods, and exposure to workplace hazards such as chemicals, molds, and other environmental factors that increase risk of cancers.³ Despite the risks and lack of symptom recognition, support may help men to be more involved in their health and treatment decisions.

Support for people with cancer can be found in both formal and informal settings. Formal supports include cancer support groups; individual counseling; peer matching support; workshops; and meetings with treatment team members such as doctors, nurses, patient navigators, psychiatrists, nutritionists, and more. Informal sources of support include friends, family members, neighbors, colleagues, and members of the patient’s faith community. Patients with strong social and emotional supports have been found to be more protective of their health.⁵ Research is ongoing in the hope of finding underlying reasons that could support future interventions.

Reamer and colleagues reported thatwhen men consulted with friends about their prostate cancer diagnosis, they were more likely to seek a curative form of treatment.⁶ However, consulting with informal supports can increase difficulty with treatment decisions due to differing opinions and desired outcomes. Having both formal and informal supports in place can be helpful to men making treatment decisions.

To understand why men experience delays in cancer treatment and lower survival rates than women, consider the gaps in health-related behaviors. The first point of contact for a cancer diagnosis is likely a person’s primary care physician; however, many people do not have a primary care physician or have other barriers to care. Additionally, 80% of people present to their primary care physician with nonspecific symptoms, making a diagnosis of cancer difficult without further appointments, tests, and visits to specialists.⁴

Disparity in health care is another gap. Specific attention should be shown to those who identify as members of LGBTQIA+ community. Kamen and colleagues found that gay men showed a higher likelihood of alcohol use and smoking, spent less time exercising, and experienced more psychological distress than heterosexual men. Gay men also are at greater risk for lung, colorectal, anal, and esophageal cancers.⁷ HIV-positive gay men are at lower risk of HIV-related cancers due to antiretroviral treatments, but at increased risk for non-HIV related cancers such as Hodgkin disease, anal cancer, lung cancer, and testicular germ cell cancer.⁸

Despite the known gaps and challenges, the greater risk of cancer for men and dying from their cancer has known ways to be addressed. To bridge the gaps in research and in care, men should build a support system and become familiar with the signs and symptoms of cancer. Formal supports in the medical setting should have a working knowledge of signs and symptoms of cancer in men, as well as support and information available for men in all communities including LGBTQIA+ and minority communities.

Addressing the known gaps in care and ensuring support for patients can lead us on the path to finding other gaps and closing the span of time to diagnosis and treatment of cancer in men.

References

1. Eldridge L. Top 10 cancers causing death in men in the U.S. Verywell Health. Updated October 7, 2021. Accessed October 26, 2021. https://www.verywellhealth.com/top-cancers-causing-death-in-men-2248874
2. Macleod U, Mitchell ED, Burgess C, Macdonald S, Ramirez AJ. Risk factors for delayed presentation and referral of symptomatic cancer: evidence for common cancers. Br J Cancer. 2009;101 Suppl 2(Suppl 2):S92–S101. doi:10.1038/sj.bjc.6605398
3. Men and cancer. Cancer Treatment Centers of America. Accessed October 26, 2021. https://www.cancercenter.com/men-and-cancer
4. Al-Azri MH. Delay in cancer diagnosis: causes and possible solutions. Oman Med J. 2016;31(5):325–326. doi:10.5001/omj.2016.65
5. Reblin M, Uchino BN. Social and emotional support and its implication for health. Curr Opin Psychiatry. 2008;21(2):201-205. doi:10.1097/YCO.0b013e3282f3ad89
6. Reamer E, Yang F, Holmes-Rovner M, Liu J, Xu J. Influence of men’s personality and social support on treatment decision-making for localized prostate cancer. BioMed Res Int. 2017;2017:1467056. doi:10.1155/2017/1467056
7. Kamen C, Palesh O, Gerry AA, et al. Disparities in health risk behavior and psychological distress among gay versus heterosexual male cancer survivors. LGBT Health. 2014;1(2):86-94. doi:10.1089/lgbt.2013.0022
8. The Effect of Cancer on the LGBT Community. New York, NY: The LGBT Cancer Project; 2007.