Abstract

This paper discusses about the living realities and problems of oncology patients – clients of social work. The approach is interpreted in the social-epidemiological- theoretical framework in the context of early vs. late cancer diagnoses. Late cancer detection is the main cause of high cancer mortality in Estonia. In this paper, the social determinants that potentially play a role in delayed detection of cancer are dealt with.
In 2001–2005, 1442 client cases were documented by the social worker. The documentation included, in addition to medical data (e.g. date of diagnosis, type of cancer and stage at diagnosis, and case-specific information), also the client’s demographic data (date of birth, gender, address, education, status in the labour market/ occupation, family composition and/or other sources of social support), formal reason for turning to the social worker, comments about the specific characteristics of the case, the realities of life that the client wished to share at the meeting. Time of death was included in the case of persons who had died by the time of data analysis.
Results. Considering all cancer sites, cancer was more likely to be diagnosed in the later stage in persons with lower education (p<0.01). There were no significant  differences in the cancer stages for men and women by education, except for participants with technical education acquired at higher school. Men with after higher school technical education were more likely to be diagnosed with the late stage cancer than women with a similar education (p<0.05). By the end of 2005 35.9% (n = 517) of the clients of social work had died. Among those who died, late stage at diagnosis meant more likely less lived years after cancer diagnosis in comparison to early stage diagnosis (p<0.000). Among those who died, men lived less years after cancer diagnosis than women (p<0.000).
Conclusions. Of the cancer patients clients of social work, 50% (n = 721) shared their problems with the social worker beyond formal reasons for referral already at the first meeting. Their worries were real, often lasting for a longer period of life, at present being aggravated by cancer: distress, economic hardships, adverse social relations, perceived lack of trust and control over life. As a consequence, their ability to act as informed patients and their motivation to meet the expectations of the society and the health care organization were reduced.