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Initial symptoms and delay in patients with penile carcinoma
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Urology, Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Urology, Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Urology, Örebro University Hospital, Örebro, Sweden.
Department of Urology, Örebro University Hospital, Örebro, Sweden.
2012 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 46, no 5, p. 319-325Article in journal (Refereed) Published
Abstract [en]

Objective: This study aimed to assess initial symptoms and factors associated with patients' and doctors' delay in penile carcinoma.

Material and methods: Fifty consecutive patients with penile carcinoma treated with an organ-sparing technique and nine with partial amputation were enrolled in a prospective study at the Department of Urology, Örebro University Hospital, between 2005 and 2009. Face-to-face structured interviews in combination with self-assessment forms were used for the patients' descriptions of clinical symptoms, treatment seeking and reasons for delay. Data were also extracted from the medical records confirming time-lag between GP assessment, specialist care and time for diagnosis.

Results: Erythema, rash and eczema were the most common initial symptoms (35%). In total, 65% had a patients' delay of more than 6 months, and among these there was a small, but not statistically significant, predominance for pT1 and pTis tumours. Living with a stable partner did not affect the delay. The most common reason for patients' delay was the feeling of embarrassment over symptoms localized in a sexual body area. Nine patients had a doctors' delay of more than 3 months from first special visit to diagnosis. Eight of these patients consulted dermatologists and were subjected to repeated biopsies, leaving premalignant results.

Conclusions: A considerable proportion of the patients had a patients' delay of more than 6 months, perhaps due to benign initial symptoms as erythema, rash or eczema. Psychological factors such as embarrassment and denial may also be involved, as well as insufficient awareness or knowledge. 

Place, publisher, year, edition, pages
London, United Kingdom: Informa Healthcare, 2012. Vol. 46, no 5, p. 319-325
Keywords [en]
Delay, doctors’ delay, initial symptoms, patients’ delay, penile carcinoma
National Category
Medical and Health Sciences Surgery Urology and Nephrology
Research subject
Surgery esp. Urology Specific
Identifiers
URN: urn:nbn:se:oru:diva-25774DOI: 10.3109/00365599.2012.677473ISI: 000308951000001PubMedID: 22989150Scopus ID: 2-s2.0-84866540090OAI: oai:DiVA.org:oru-25774DiVA, id: diva2:551273
Available from: 2012-09-10 Created: 2012-09-10 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Penile carcinoma: from first symptom to sexual function and life satisfaction following organ-sparing laser treatment
Open this publication in new window or tab >>Penile carcinoma: from first symptom to sexual function and life satisfaction following organ-sparing laser treatment
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to describe how patients with penile carcinoma experienced their symptoms, treatment seeking and the impact of the diagnosis and treatment on sexual function, sexual activity and life satisfaction. The thesis contains two studies of patients treated with organ-sparing laser therapy, a retrospective study (Papers II and III) of 46 patients treated between 1986-2000 and a prospective study (Papers I and IV) of 50 patients between 2005 and 2009 and additional 34 partners. In both studies face-to-face interviews were used with a structured questionnaire; and self-assessment instruments IIEF-5, LiSat-11, and HADS. An ad hoc comparator population of men aged 34–74 years from a nationally representative investigation of sexual life and life satisfaction in Swedes was chosen for some of the questions concerning sexuality and life satisfaction. We found a delay of more than 6 months in 37% of the patients in the retrospective study and 65% of the patients in the prospective study. The single most important reason for patients’ delay was embarrassment. Nine patients had a doctors’ delay of more than 3 months from first special visit until diagnosis. Eight of these patients consulted dermatologists and were subjected to repeated biopsies, leaving premalignant results (I, II). All patients younger than 75 years (34/46) in the retrospective study reported that they were sexual active before treatment, 80% of these had resumed their activity by the time of the interview. Furthermore, except for satisfaction with somatic health, similar—or even higher—proportions of patients than comparators were satisfied with life as a whole and with other domains of life including satisfaction with sexual life (III). We found that 21/29 couples were sexually active with intercourse before treatment and 17 couples resumed their activity. Two items differed markedly from the comparators; considerably fewer patients were satisfied with their somatic health, and satisfaction with sexual life (at 12 months follow-up). Couples with an active partner-related sexuality at 12 months follow-up, reported coherence in high satisfaction with life as a whole (IV).In conclusion, patients with penile carcinoma delay for a long time after identifying symptoms before seeking contact with the health care system. This delay is mainly caused by embarrassment in describing the symptom to health care personnel and deficient knowledge about the disease. Organ- sparing technique offers good, satisfying cosmetic results and the possibility of maintaining sexual activity and function to a great extent.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 101
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 73
Keywords
Penile carcinoma, sexuality, life satisfaction, treatment-seeking, sexual function, Sexual dysfunction, delay, organ-sparing
National Category
Medical and Health Sciences Cancer and Oncology Urology and Nephrology
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-24417 (URN)978-91-7668-891-5 (ISBN)
Public defence
2012-10-19, Wilandersalen, Universitetssjukhuset, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Note

Varierande stavning av förnamnet Elisabet förekommer.

Available from: 2012-08-24 Created: 2012-08-15 Last updated: 2017-10-17Bibliographically approved

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Skeppner, ElisabetAndersson, Swen-OlofJohansson, Jan-Erik

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