996 Understanding symptom appraisal and help-seeking in people with symptoms suggestive of endometrial cancer: a mixed methods study

Introduction/Background Endometrial cancer is the most common gynaecological cancer within the UK. One in five women are diagnosed with advanced-stage disease, associated with poor prognosis. An understanding of pathways to diagnosis is imperative to improve outcomes. This study explores symptom appraisal and help-seeking among patients referred with symptoms suggestive of endometrial cancer. Methodology Patients with suspected or confirmed endometrial cancer attending a gynaecological cancer centre in North-West England were eligible for inclusion. A cross sectional survey was undertaken for patients referred from October 2020 to November 2023. Semi-structured interviews of a purposive sample based on age, socioeconomic status, time to presentation and diagnosis were conducted. Data were analysed using a thematic approach informed by the Model of Pathways to Treatment. Results In total, 160 participants were recruited with suspected (n=129) or confirmed (n=31) endometrial cancer. Time from first symptom/s to presentation in primary care ranged from 1 day to 243 days, mean 23 days. Ten interviews were conducted. Questionnaire responses Presence of post-menopausal or heavy vaginal bleeding was the stimulus to seeking help for most patients. Associated symptoms, like pain, were more likely to initiate help-seeking. Half of respondents with endometrial cancer reported that changes in or worsening of symptoms prompted initial contact with primary care. Interviews Symptoms were normalised more frequently in younger patients who attributed them to use of hormonal replacement therapy or menopause. Patients who waited more than 3 months to seek help and women from socio-economically deprived communities had less awareness of cancer as a potential diagnosis. Discussion with family was positively associated with help-seeking. Conclusion Increased awareness of endometrial cancer in younger patients and those from high levels of deprivation may lead to more timely presentation. Strategies to improve awareness of symptoms of endometrial cancer are needed to reduce time to presentation and subsequent stage at diagnosis. Disclosures This study is funded by the NIHR Doctoral Research Fellowship DRF-2018–11-ST2–054. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.