Background. Cancer is the fifth leading causes of death for young adults (age 20-39(. Young adults experience longer delays in diagnosis than children and older adults, which are associated with detrimental survival and quality of life. The purpose of our qualitative study was to use the Model of Pathways to Treatment as a framework to examine factors that delay young adult cancer diagnosis within three intervals: symptom appraisal (i.e., time from noticing a symptom to contacting a medical provider), help-seeking (i.e., time from contacting provider to first consultation), and diagnostic (i.e., time from consultation to diagnosis).
Methods. We conducted semi-structured interviews in January and February 2023 with individuals who were diagnosed with cancer between the ages of 20 and 39 years (N=30). Each interview began with a question asking the participant to describe what happened from the first physical change they noticed to the time they received a formal diagnosis. Follow-up questions asked about specific factors and processes impacting their appraisal of symptoms, decision to seek help for those symptoms, and healthcare encounters leading to diagnosis. Three independent coders used template analysis to code each interview transcript.
Results. We identified nine themes that characterized the factors influencing young adult time to diagnosis. Within the appraisal interval, most young adults misattributed symptoms to less serious causes which delayed perceiving a need for medical evaluation. Many participants believed symptoms were caused by uncontrollable external circumstances such as stressful life events; others had low perceived susceptibility to serious disease based on personal attributes such as lack of family cancer history, young age, and practicing healthy behaviors. Within the help-seeking interval, a few young adults delayed seeking care if they lacked the time to attend an appointment or had negative expectations about the care they would receive. Within the diagnostic interval, most participants experienced delays when their providers dismissed symptoms as nonserious and did not order clinical testing or investigate an underlying cause.
Conclusion. Young adults with cancer were aware of abnormal physical symptoms for months, sometimes years, before receiving a diagnosis. We identified multiple factors that influence diagnostic delays, including misattribution of symptoms as nonserious by both survivors and medical providers.