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Survey Finds Gaps in Awareness of Childhood Cancer Symptoms

Just one in three UK adults said they felt confident in recognising symptoms of possible childhood cancer, according to results of a survey published online in the journal Archives of Disease in Childhood

Researchers from the University of Nottingham said the findings demonstrated the need for initiatives to plug this gap in knowledge.

Childhood cancer is the leading cause of death in children over the age of 12 months, and a major cause of acquired disability, the study authors noted. Around 3755 new cases are diagnosed every year in children and young people under the age of 24 in the UK. Concerningly, survival rates are reported to lag behind those of the rest of Europe, they added.

The researchers highlighted that cancer symptoms in young people usually mimic more common ailments. Because of this, practitioners wait for evidence of symptom persistence or progression to evolving symptom clusters before initiating further investigations. However, this approach delivered "life-threatening and disabling" presentations at diagnosis due to characteristically rapidly advancing disease.

Given that childhood cancers are not preventable and screening tests are currently unavailable, public and professional awareness to ensure early diagnosis and treatment are the favoured way to close the gap and improve the outcome, the authors said.

Six Questions on Perceived Risk

The observational study assessing public awareness of the risks and symptoms of cancer in children, teenagers, and young adults aged under 18 years in Great Britain.

A cross-sectional opinion survey was conducted by Ipsos MORI in May 2019 via face-to-face computer-assisted interviews with 1000 adults. The survey consisted of six questions around perceived risk, overall confidence in recognising cancer signs and symptoms, information sources, whether symptoms merited discussion with a doctor, and knowledge of symptoms indicative of cancer in a child/teenager.

Of the adult cohort, 32% had children aged under 16 years in the household, and 13% were aged between 18 and 24 years.

The researchers found that only one in three (32%) felt confident about identifying the tell-tale signs and symptoms of childhood cancer. Those who had children were 50% more likely to not feel confident about this than participants without children – 42% versus 27%. 

Childhood cancer symptom awareness in the survey ranged from 10% to 46%, which was significantly lower than that in an adult awareness survey where the percentage ranged between 63% and 94%.

On average, respondents identified only around one in four (10.6 out of 42) classical signs and symptoms of cancer. The most recognised symptoms included a lump or swelling in the pelvis, testicle, or breast (46%), blood in urine or stool (44%), changes to moles (43%), a lump/swelling in the chest wall or armpits (41%), and weight loss (40%). 

The least recognised symptoms were early/late puberty (10%), developmental delay in infants (11%), and slow growth (13%), with 8%, 2%, and 6%, respectively, perceiving no need to discuss these symptoms with a doctor.

A significant proportion of respondents said they would wait 3 months — or not seek medical advice at all — for persistent/recurrent sore throat or hoarse voice (43%) and slow recovery after bone or joint injury (43%).

More than half of the respondents assessed seizures/fits, blood in urine or stool, and persistent vomiting as symptoms requiring medical assessment within 48 hours. by over half the participants included.

The research also revealed lower symptom awareness in participants from ethnic minorities and those from less affluent backgrounds.

Need to Boost Symptom Awareness

"Perceived rarity of cancer in children is a key barrier to early diagnosis," underlined the authors. "While the number of cases may be small compared with adult cancers, the cumulative risk from birth to early adulthood is comparable to that of other childhood illnesses," they pointed out. This was something that needed to be "communicated with the public", as parents usually associated common symptoms with common childhood ailments, but not cancer.

Accelerating childhood cancer diagnosis enabled identification of cancers at lower stages and also prevented further lifelong disabilities, they stressed.

"The survey findings show that the public is unaware of childhood cancer risk, has a lack of confidence in recognising signs and symptoms, and has low knowledge of childhood cancer symptoms," alerted the authors.

Targeted awareness activities was necessary to plug these gaps, they stressed.

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