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Galica J, Saunders S, Pan Z, Silva A, Ling HK. What do cancer survivors believe caused their cancer? A secondary analysis of cross-sectional survey data. Cancer Causes Control 2024; 35:875-886. [PMID: 38282044 DOI: 10.1007/s10552-023-01846-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Given that risk reduction and healthy lifestyles can prevent 4 in 10 cancers, it is important to understand what survivors believe caused their cancer to inform educational initiatives. METHODS In this secondary analysis, we analyzed cancer survivor responses on the Causes Subscale of the Revised Illness Perception Questionnaire, which lists 18 possible causes of illness and a free text question. We used descriptive statistics to determine cancer survivors' agreement with the listed causes and conducted separate partial proportional odds models for the top three causes to examine their associations with sociodemographic and clinical characteristics. Content analysis was used to examine free text responses. RESULTS Of the 1,001 participants, most identified as Caucasian (n = 764, 77%), female (n = 845, 85%), and were diagnosed with breast cancer (n = 656, 66%). The most commonly believed causes of cancer were: stress or worry (n = 498, 51%), pollution in the environment (n = 471, 48%), and chance or bad luck (n = 412, 42%). The associations of sociodemographic and clinical variables varied across the models. Free text responses indicated that hereditary and genetic causes (n = 223, 22.3%) followed by trauma and stress (n = 218, 21.8%) and bad luck or chance (n = 79, 7.9%) were the most important causes of cancer. CONCLUSIONS Study results illuminate cancer survivors' beliefs about varying causes of their cancer diagnosis and identify characteristics of survivors who are more likely to believe certain factors caused their cancer. Results can be used to plan cancer education and risk-reduction campaigns and highlight for whom such initiatives would be most suitable.
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Affiliation(s)
- Jacqueline Galica
- Queen's University School of Nursing, 92 Barrie Street, Kingston, ON, K7L 3N6, Canada.
| | | | - Ziwei Pan
- Department of Mathematics and Statistics, Queen's University, 48 University Avenue, Kingston, ON, K7L 3N6, Canada
| | - Amina Silva
- Faculty of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
| | - Hok Kan Ling
- Department of Mathematics and Statistics, Queen's University, 48 University Avenue, Kingston, ON, K7L 3N6, Canada
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Akbari P, Nemati S, Nahvijou A, Bolourinejad P, Forbes L, Zendehdel K. Survey of awareness and beliefs about cancer (ABC) in Tehran Province, Iran. BMC Cancer 2024; 24:579. [PMID: 38734656 PMCID: PMC11088007 DOI: 10.1186/s12885-024-12211-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/01/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Knowledge, attitudes, and practices are essential measures for planning and evaluating cancer control programs. Little is known about these in Iran. METHODS We conducted a population-based interview survey of adults aged 30-70 using the Farsi version of the Awareness and Beliefs about Cancer questionnaire in the capital province of Tehran, Iran, 2019. We calculated weighted estimates of levels of cancer knowledge, attitudes, and practices to allow for different selection probabilities and nonresponse. We used multivariate logistic regression to understand demographic factors associated with bowel, cervix, and breast screening practices. RESULTS We interviewed 736 men and 744 women. The mean number of recalled cancer warning signs was less than one; 57.7% could not recall any cancer warning signs. Participants recognized 5.6 out of 11 early cancer warning signs and 8.8 of 13 cancer risk factors. Most (82.7%) did not know that HPV infection was a cancer risk factor. Approximately, half had negative attitudes towards cancer treatment, but over 80% had positive attitudes towards the effectiveness of screening for improving survival. Colorectal, breast, and cervical screening rates were 24%, 42%, and 49%, respectively. Higher socioeconomic status increased the odds of taking up screening for cancer. Women aged 60-70 were less likely to report taking up breast and cervical screening than younger women. DISCUSSION The Iranian population has poor awareness and negative attitudes about cancer, and participation in screening programs is low. Public awareness and early detection of cancer should be promoted in Iran.
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Affiliation(s)
- Paria Akbari
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Nemati
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Nahvijou
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Paria Bolourinejad
- Student Research Committee, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Lindsay Forbes
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Al Bashir S, AlBarakat MM, Alabedalhalim KK, Al-Khalaileh A, Alassaf A, Saleh O, Ayyad AW, Alzoubi KH. Knowledge of cancer symptoms and risk factors: A cross-sectional study from a developing country. Medicine (Baltimore) 2024; 103:e37823. [PMID: 38608047 PMCID: PMC11018150 DOI: 10.1097/md.0000000000037823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/15/2024] [Indexed: 04/14/2024] Open
Abstract
The delayed presentation of cancer patients to healthcare facilities for diagnosis is a pressing issue, as late-stage cancer cases are often more challenging to treat effectively. In low-resource settings, such as those with limited access to healthcare facilities, the impact of inadequate awareness of cancer signs and symptoms can be particularly severe. Therefore, this study aimed to evaluate public knowledge of cancer signs and symptoms and risk factors in the context of Jordan. This cross-sectional study was conducted among participants from all settings. Data was obtained from an Arabic version of the cancer awareness measure (CAM), which was answered online. It described demographic data and knowledge of cancer prevalence, age-related risk, signs, symptoms, and risk factors in recall and recognition-type questions. Participants (n = 1998) completed the questionnaire with a Median age of 35 and an interquartile range of 24. About half (n = 1070) thought that cancer is unrelated to age. Most participants identified breast cancer as the most common cancer among women (81%). Awareness of cancer signs/symptoms significantly differed in the level of knowledge in favor of females. The symptom "unexplained weight loss" was most commonly recognized (66.3%) and "persistent difficulty swallowing" the least (42.6%). As for risk factors, "smoking" was the most identified (76.9%) and "eating less than 5 portions of fruits and vegetables a day" was the least (19%), and "doing <30 minutes of moderate physical activity 5 times a week" as a close second least (19.95%). Females identified "smoking," "passive smoking," "HPV infection," and "having a close relative with cancer" as risk factors significantly more than males. Those with good economic status were more aware that smoking is a cancer risk factor by 1.51 times compared to those with poor economic status. To enhance early diagnosis and presentation in Jordan, there is a need for increased public awareness of the signs, symptoms, and risk factors of cancer. One effective strategy to achieve this goal is to conduct targeted public campaigns that cater to different population groups, such as the youth, to improve their understanding and ensure that the message resonates.
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Affiliation(s)
- Samir Al Bashir
- Department of Pathology and Microbiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Majd M. AlBarakat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Ali Al-Khalaileh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Amer Alassaf
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Othman Saleh
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Asmaa W. Ayyad
- Branch of Otolaryngology - Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Karem H. Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, UAE
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Mirinezhad SK, Akbarzadeh-Khiavi M, Seyednejad F, Somi MH. Rectal cancer survival and prognostic factors in Iranian population: A retrospective cohort study. Cancer Treat Res Commun 2024; 39:100810. [PMID: 38599152 DOI: 10.1016/j.ctarc.2024.100810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 03/12/2024] [Accepted: 03/26/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Rectal cancer (RC) poses a significant global health challenge, causing substantial morbidity and mortality. This study aims to investigate the survival rates of RC patients and identify the factors that influence their survival. The study considers demographic characteristics, tumor features, and treatment received as the factors under consideration. METHODS A retrospective analysis was conducted on the medical records of 593 RC patients. Data were collected through a comprehensive review of medical records and conducting telephone interviews. Survival rates were estimated using the life table method, and subgroup comparisons were performed using the log-rank test. Cox regression analysis was utilized to assess the independent associations between RC survival time and various covariates. RESULTS The study cohort comprised 593 RC patients, with a predominantly male representation. The mean age at diagnosis was 58.18 years, and the majority of patients (78.6 %) underwent surgical interventions. The median age at symptom onset and diagnosis were 58 and 59 years, respectively. Survival rates at 1st, 3rd, 5th, and 10th years were estimated to be 85 %, 59 %, 47 %, and 36 %, respectively. Statistical analysis revealed several significant prognostic factors, including age, education, symptoms, and cancer stage. In the multivariate Cox proportional-hazards analysis, advanced regional stage (HR = 1.54, 95 % CI, 1.13-2.08), presence of metastasis (HR = 3.73, 95 % CI, 2.49-5.58), and age over 70 (HR = 1.65) were associated with a higher risk of mortality. CONCLUSION Given the alarming prognosis of RC observed in the study area and the significant delay between symptom onset and diagnosis, it is crucial to address this issue and potentially improve the survival rates of RC patients.
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Affiliation(s)
- Seyed Kazem Mirinezhad
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mostafa Akbarzadeh-Khiavi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farshad Seyednejad
- Department of Radiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Hossein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Liu Y, Jing L, Liu Y, Wang H, Yuan T, Yang J. Active for Life after Cancer: Association of Physical Activity with Cancer Patients' Interpersonal Competence, Quality of Life, and Survival Beliefs. Behav Sci (Basel) 2023; 13:449. [PMID: 37366701 DOI: 10.3390/bs13060449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
This study aimed to examine the relationship between physical activity and cancer patients' survival beliefs and constructed a mediation model involving the mediating effects of interpersonal competence and quality of life. We conducted 252 questionnaire surveys on multiple chat groups for cancer patients using the WeChat software, and assessed physical activity, survival beliefs, interpersonal competence, and quality of life using standard scales. Data were analyzed using SPSS and AMOS. There were positive correlations between physical activity and quality of life (β = 0.393, p < 0.001), physical activity and interpersonal competence (β = 0.385, p < 0.001), interpersonal competence and quality of life (β = 0.455, p < 0.001), and quality of life and survival beliefs (β = 0.478, p < 0.001). In addition, a significant mediating effect between physical activity and survival beliefs was observed between interpersonal competence and quality of life (standardized indirect effect = 0.384, p < 0.001). The study revealed that effective physical activity led to higher interpersonal competence, more excellent quality of life, and improved survival beliefs in cancer patients, and that the association of physical activity with improved survival beliefs was fully mediated through interpersonal competence and quality of life. The findings suggest that the relevant government should increase policy support and publicity to improve cancer patients' participation in physical activity.
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Affiliation(s)
- Ying Liu
- School of Physical Education, Hunan University of Science and Technology, Xiangtan 411201, China
- China Institute of Sports Science, Beijing 100061, China
| | - Longjun Jing
- School of Physical Education, Hunan University of Science and Technology, Xiangtan 411201, China
- China Athletics College, Beijing Sport University, Beijing 100061, China
| | - Yang Liu
- School of Business, Hunan University of Science and Technology, Xiangtan 411201, China
| | - Huilin Wang
- School of Business, Hunan University of Science and Technology, Xiangtan 411201, China
| | - Tinggang Yuan
- China Institute of Sports Science, Beijing 100061, China
| | - Jingyu Yang
- Department of Medical Bioinformatics, University of Göttingen, 37077 Göttingen, Germany
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Faury S, Aurouet P, Quintard B, Foucaud J. A Systematic Review on Reporting of Methods in National Surveys about Adults' Attitudes to Lifestyle and Environmental Risk Factors for Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095755. [PMID: 37174272 PMCID: PMC10177829 DOI: 10.3390/ijerph20095755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Abstract
The risks of developing cancer are significantly affected by our lifestyle and environment. While there are several uncontrollable risk factors, we can modify our lifestyle and our environment to reduce the increased threat of cancer. This systematic review aims to evaluate the methodological assessment used to evaluate attitudes about cancer risk factors among the general population. Two researchers independently screened the articles for inclusion and Critical Appraisal Skills Programme (CASP) checklists were used to assess the methodology of the included studies. Thirty-one manuscripts met the inclusion criteria with a majority of them focusing on attitudes to several cancer risk factors and six on specific cancer location risk factors. This systematic review highlights the diversity of notions used around attitudes and methods used in the method of administering the survey, as well as the format of the questions and the response scales. It is thus difficult to compare data between different countries. However, cancer is a global problem. Harmonizing methods could allow a comparison of data between countries. Recommendations to this effect are suggested.
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Affiliation(s)
- Stéphane Faury
- Institut National du Cancer (INCa), Research in Social & Human Sciences, Public Health and Epidemiology Department, 92100 Boulogne-Billancourt, France
- Laboratory of Psychology EA 4139, 33405 Bordeaux, France
| | - Philémon Aurouet
- Institut National du Cancer (INCa), Research in Social & Human Sciences, Public Health and Epidemiology Department, 92100 Boulogne-Billancourt, France
| | - Bruno Quintard
- Laboratory of Psychology EA 4139, 33405 Bordeaux, France
| | - Jérôme Foucaud
- Institut National du Cancer (INCa), Research in Social & Human Sciences, Public Health and Epidemiology Department, 92100 Boulogne-Billancourt, France
- Health Education and Practices Laboratory (LEPS EA 3412), Paris 13 University-UFR SMBH, 93017 Bobigny, France
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7
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He S, Li H, Cao M, Sun D, Yang F, Yan X, Zhang S, Xia C, Yu Y, Zhao L, Shi J, Li N, Yu XQ, Chen W, He J. Geographic, Demographic, and Socioeconomic Disparities and Factors Associated With Cancer Literacy in China: National Cross-sectional Study. JMIR Public Health Surveill 2023; 9:e43541. [PMID: 36800218 PMCID: PMC9985002 DOI: 10.2196/43541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Cancer literacy is associated with several health-related behaviors and outcomes. However, there is still a lack of nationwide surveys for cancer literacy in China. OBJECTIVE This study aims to evaluate cancer literacy in China, explore disparities, and provide scientific evidence for policy makers. METHODS A cross-sectional survey was conducted in mainland China in 2021 using the multistage probability proportional to the size sampling method. Both the reliability and validity of the questionnaire were evaluated. The awareness levels were adjusted by sampling weights and nonrepresentativeness weights to match the actual population distributions. The Rao-Scott adjusted chi-square test was applied to test geographic, demographic, and socioeconomic disparities. A generalized linear model was used to explore potential factors. RESULTS A total of 80,281 participants aged 15-74 years were finally enrolled from 21 provinces, with an overall response rate of 89.32%. The national rate of cancer literacy was 70.05% (95% CI 69.52%-70.58%). The rates were highest regarding knowledge of cancer management (74.96%, 95% CI 74.36%-75.56%) but were lowest regarding basic knowledge of cancer (66.77%, 95% CI 66.22%-67.33%). Cancer literacy was highest in East China (72.65%, 95% CI 71.82%-73.49%), Central China (71.73%, 95% CI 70.65%-72.81%), and North China (70.73%, 95% CI 68.68%-72.78%), followed by Northeast (65.38%, 95% CI 64.54%-66.22%) and South China (63.21%, 95% CI 61.84%-64.58%), whereas Southwest (59.00%, 95% CI 58.11%-59.89%) and Northwest China (57.09%, 95% CI 55.79%-58.38%) showed a need for improvement. Demographic and socioeconomic disparities were also observed. Urban dwellers, the Han ethnic group, and population with higher education level or household income were associated with prior knowledge. The questionnaire showed generally good internal and external reliability and validity. CONCLUSIONS It remains important for China to regularly monitor levels of cancer literacy, narrow disparities, and strengthen health education for dimensions with poor performance and for individuals with limited knowledge to move closer to the goal of Healthy China 2030.
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Affiliation(s)
- Siyi He
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - He Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Maomao Cao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dianqin Sun
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Yang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinxin Yan
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shaoli Zhang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changfa Xia
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiwen Yu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liang Zhao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jufang Shi
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ni Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue Qin Yu
- The Daffodil Centre - a joint venture with Cancer Council NSW, The University of Sydney, Sydney, Australia
| | - Wanqing Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie He
- Thoracic Surgery Department, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Petrova D, Pollán M, Garcia-Retamero R, Rodríguez-Barranco M, Catena A, Castillo Portellano L, Sánchez MJ. Cancer awareness in older adults: Results from the Spanish Onco-barometer cross-sectional survey. Int J Nurs Stud 2023; 140:104466. [PMID: 36871541 DOI: 10.1016/j.ijnurstu.2023.104466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND About half of all cancers are diagnosed in adults older than 65, making them the age group at highest risk of developing this disease. Nurses from different specialties can support individuals and communities in the prevention and early detection of cancer and should be aware of the common knowledge gaps and perceived barriers among older adults. OBJECTIVES The goal of the current research was to investigate personal characteristics, perceived barriers, and beliefs related to cancer awareness in older adults, with a special focus on perceptions about the influence of cancer risk factors, knowledge of cancer symptoms, and anticipated help-seeking. DESIGN Descriptive cross-sectional study. PARTICIPANTS Participants were 1213 older adults (≥65 years old) from the representative national Onco-barometer survey conducted in 2020 in Spain. METHODS Questions on the perceived influence of cancer risk factors, knowledge of cancer symptoms, and the Spanish version of the Awareness and Beliefs about Cancer (ABC) questionnaire were administered in computer-assisted telephone interviews. RESULTS Knowledge of cancer risk factors and symptoms was strongly related to personal characteristics and was limited among males and older individuals. Respondents from lower socio-economic background recognized fewer cancer symptoms. Having personal or family history of cancer had opposite effects on cancer awareness: It was related to more accurate symptom knowledge but also to lower perceptions about the influence of risk factors and more delayed help-seeking. Anticipated help-seeking times were strongly influenced by perceived barriers to help-seeking and beliefs about cancer. Worry about wasting the doctor's time (48% increase, 95% CI [25%-75%]), about what the doctor might find (21% increase [3%-43%]) and not having enough time to go to the doctor (30% increase [5%-60%]) were related to more delayed help-seeking intentions. In contrast, beliefs that reflected higher perceived seriousness of a potential cancer diagnosis were related to shorter anticipated help-seeking times (19% decrease [5%-33%]). CONCLUSIONS These results suggest that older adults could benefit from interventions informing them about how to reduce their cancer risk and addressing emotional barriers and beliefs associated with help-seeking delays. Nurses can contribute to educating this vulnerable group and are in a unique position to address some barriers to help-seeking. STUDY REGISTRATION Not registered.
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Affiliation(s)
- Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública (EASP), Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Marina Pollán
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; National Center for Epidemiology, Health Institute Carlos III, Madrid, Spain
| | | | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública (EASP), Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Lucia Castillo Portellano
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; University Hospital Virgen de las Nieves, Granada, Spain
| | - Maria-José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública (EASP), Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Richards MA, Hiom S, Hamilton W. Diagnosing cancer earlier: what progress is being made? Br J Cancer 2023; 128:441-442. [PMID: 36725918 PMCID: PMC9890414 DOI: 10.1038/s41416-023-02171-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 02/03/2023] Open
Affiliation(s)
- M. A. Richards
- grid.11485.390000 0004 0422 0975Cancer Research UK, London, UK
| | - Sara Hiom
- Cancer Intelligence, GRAIL Europe, London, UK
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10
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Morgan E, Arnold M, Gini A, Lorenzoni V, Cabasag CJ, Laversanne M, Vignat J, Ferlay J, Murphy N, Bray F. Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimates from GLOBOCAN. Gut 2023; 72:338-344. [PMID: 36604116 DOI: 10.1136/gutjnl-2022-327736] [Citation(s) in RCA: 258] [Impact Index Per Article: 258.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/29/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Colorectal cancer (CRC) is the third most common cancer worldwide. The geographical and temporal burden of this cancer provides insights into risk factor prevalence and progress in cancer control strategies. We examine the current and future burden of CRC in 185 countries in 2020 and 2040. METHODS Data on CRC cases and deaths were extracted from the GLOBOCAN database for the year 2020. Age-standardised incidence and mortality rates were calculated by sex, country, world region and Human Development Index (HDI) for 185 countries. Age-specific rates were also estimated. The predicted number of cases and deaths in 2040 were calculated based on global demographic projections by HDI. RESULTS Over 1.9 million new CRC cases and 930 000 deaths were estimated in 2020. Incidence rates were highest in Australia/ New Zealand and European regions (40.6 per 100 000, males) and lowest in several African regions and Southern Asia (4.4 per 100 000, females). Similar patterns were observed for mortality rates, with the highest observed in Eastern Europe (20.2 per 100 000, males) and the lowest in Southern Asia (2.5 per 100 000, females). The burden of CRC is projected to increase to 3.2 million new cases and 1.6 million deaths by 2040 with most cases predicted to occur in high or very high HDI countries. CONCLUSIONS CRC is a highly frequent cancer worldwide, and largely preventable through changes in modifiable risk factors, alongside the detection and removal of precancerous lesions. With increasing rates in transitioning countries and younger adults, there is a pressing need to better understand and act on findings to avert future cases and deaths from the disease.
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Affiliation(s)
- Eileen Morgan
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Melina Arnold
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - A Gini
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - V Lorenzoni
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - C J Cabasag
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Mathieu Laversanne
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Jerome Vignat
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Jacques Ferlay
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Neil Murphy
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
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Aye PS, Win SS, Tin Tin S, Elwood JM. Comparison of Cancer Mortality and Incidence Between New Zealand and Australia and Reflection on Differences in Cancer Care: An Ecological Cross-Sectional Study of 2014-2018. Cancer Control 2023; 30:10732748231152330. [PMID: 37150819 PMCID: PMC10170599 DOI: 10.1177/10732748231152330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Despite many background similarities, New Zealand showed excess cancer deaths compared to Australia in previous studies. This study extends this comparison using the most recent data of 2014-2018. METHODS This study used publicly available cancer mortality and incidence data of New Zealand Ministry of Health and Australian Institute of Health and Welfare, and resident population data of Statistics New Zealand. Australian cancer mortality and incidence rates were applied to New Zealand population, by site of cancer, year, age and sex, to estimate the expected numbers, which were compared with the New Zealand observed numbers. RESULTS For total cancers in 2014-2018, New Zealand had 780 excess deaths in women (17.1% of the annual total 4549; 95% confidence interval (CI) 15.8-18.4%), and 281 excess deaths in men (5.5% of the annual total 5105; 95% CI 4.3-6.7%) compared to Australia. The excess was contributed by many major cancers including colorectal, melanoma, and stomach cancer in both sexes; lung, uterine, and breast cancer in women, and prostate cancer in men. New Zealand's total cancer incidences were lower than those expected from Australia's in both women and men: average annual difference of 419 cases (-3.6% of the annual total 11 505; 95% CI -4.5 to -2.8%), and 1485 (-11.7% of the annual total 12 669; 95% CI -12.5 to -10.9%), respectively. Comparing time periods, the excesses in total cancer deaths in women were 15.1% in 2000-07, and 17.5% in 1996-1997; and in men 4.7% in 2000-2007 and 5.6% in 1996-1997. The differences by time period were non-significant. CONCLUSION Excess mortality from all cancers combined and several common cancers in New Zealand, compared to Australia, persisted in 2014-2018, being similar to excesses in 2000-2007 and 1996-1997. It cannot be explained by differences in incidence, but may be attributable to various aspects of health systems governance and performance.
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Affiliation(s)
- Phyu Sin Aye
- Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Shwe Sin Win
- Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Sandar Tin Tin
- Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - J Mark Elwood
- Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
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12
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Nemati S, Saeedi E, Lotfi F, Nahvijou A, Mohebbi E, Ravankhah Z, Rezaeianzadeh A, Yaghoobi-Ashrafi M, Pirnejad H, Golpazir A, Dolatkhah R, Alvand S, Ahmadi-Tabatabaei SV, Cheraghi M, Weiderpass E, Bray F, Coleman MP, Etemadi A, Khosravi A, Najafi F, Mohagheghi MA, Roshandel G, Malekzadeh R, Zendehdel K. National surveillance of cancer survival in Iran (IRANCANSURV): Analysis of data of 15 cancer sites from nine population-based cancer registries. Int J Cancer 2022; 151:2128-2135. [PMID: 35869869 DOI: 10.1002/ijc.34224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 03/25/2024]
Abstract
Cancer survival is a key indicator for the national cancer control programs. However, survival data in the East Mediterranean region (EMR) are limited. We designed a national cancer survival study based on population-based cancer registries (PBCRs) from nine provinces in Iran. The current study reports 5-year net survival of 15 cancers in Iranian adults (15-99 years) during 2014 to 2015 in nine provinces of Iran. We used data linkages between the cancer registries and the causes of death registry and vital statistics and active follow-up approaches to ascertain the vital status of the patients. Five-year net survival was estimated through the relative survival analysis. We applied the international cancer survival standard weights for age standardization. Five-year survival was highest for prostate cancer (74.9%, 95% CI 73.0, 76.8), followed by breast (74.4%, 95% CI 72.50, 76.3), bladder (70.4%, 95% CI 69.0, 71.8) and cervix (65.2%, 95% CI 60.5, 69.6). Survival was below 25% for cancers of the pancreas, lung, liver, stomach and esophagus. Iranian cancer patients experience a relatively poor prognosis as compared to those in high-income countries. Implementation of early detection programs and improving the quality of care are required to improve the cancer survival among Iranian patients. Further studies are needed to monitor the outcomes of cancer patients in Iran and other EMR countries.
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Affiliation(s)
- Saeed Nemati
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elnaz Saeedi
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- Biostatistics Research Group, Department of Health Science, University of Leicester, Leicester, UK
| | - Fereshte Lotfi
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Nahvijou
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Mohebbi
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ravankhah
- Esfahan Cancer Registry, Esfahan University of Medical Sciences, Esfahan, Iran
| | | | | | - Habbiballah Pirnejad
- Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Arash Golpazir
- Kermanshah Cancer Registry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roya Dolatkhah
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saba Alvand
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maria Cheraghi
- Cancer Registry Section, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Freddie Bray
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Arash Etemadi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ardeshir Khosravi
- Deputy of Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Farid Najafi
- Department of Epidemiology and Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Ali Mohagheghi
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
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13
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Vedsted P, Weller D, Zalounina Falborg A, Jensen H, Kalsi J, Brewster D, Lin Y, Gavin A, Barisic A, Grunfeld E, Lambe M, Malmberg M, Turner D, Harland E, Hawryluk B, Law RJ, Neal RD, White V, Bergin R, Harrison S, Menon U. Diagnostic pathways for breast cancer in 10 International Cancer Benchmarking Partnership (ICBP) jurisdictions: an international comparative cohort study based on questionnaire and registry data. BMJ Open 2022; 12:e059669. [PMID: 36521881 PMCID: PMC9756230 DOI: 10.1136/bmjopen-2021-059669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES A growing body of evidence suggests longer time between symptom onset and start of treatment affects breast cancer prognosis. To explore this association, the International Cancer Benchmarking Partnership Module 4 examined differences in breast cancer diagnostic pathways in 10 jurisdictions across Australia, Canada, Denmark, Norway, Sweden and the UK. SETTING Primary care in 10 jurisdictions. PARTICIPANT Data were collated from 3471 women aged >40 diagnosed for the first time with breast cancer and surveyed between 2013 and 2015. Data were supplemented by feedback from their primary care physicians (PCPs), cancer treatment specialists and available registry data. PRIMARY AND SECONDARY OUTCOME MEASURES Patient, primary care, diagnostic and treatment intervals. RESULTS Overall, 56% of women reported symptoms to primary care, with 66% first noticing lumps or breast changes. PCPs reported 77% presented with symptoms, of whom 81% were urgently referred with suspicion of cancer (ranging from 62% to 92%; Norway and Victoria). Ranges for median patient, primary care and diagnostic intervals (days) for symptomatic patients were 3-29 (Denmark and Sweden), 0-20 (seven jurisdictions and Ontario) and 8-29 (Denmark and Wales). Ranges for median treatment and total intervals (days) for all patients were 15-39 (Norway, Victoria and Manitoba) and 4-78 days (Sweden, Victoria and Ontario). The 10% longest waits ranged between 101 and 209 days (Sweden and Ontario). CONCLUSIONS Large international differences in breast cancer diagnostic pathways exist, suggesting some jurisdictions develop more effective strategies to optimise pathways and reduce time intervals. Targeted awareness interventions could also facilitate more timely diagnosis of breast cancer.
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Affiliation(s)
- Peter Vedsted
- Department for Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
| | - David Weller
- General Practice, University of Edinburgh, Edinburgh, UK
| | - Alina Zalounina Falborg
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
| | - Henry Jensen
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
| | - Jatinderpal Kalsi
- Gynaecological Cancer Research Centre, University College London, London, UK
| | - David Brewster
- Scottish Registry, Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Yulan Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Anna Gavin
- N Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | | | - Eva Grunfeld
- Department of Family and Community Medicine, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Mats Lambe
- University Hospital, Regional Cancer Centre of Central Sweden, Uppsala, Sweden
| | - Martin Malmberg
- Department of Oncology, Lund University Hospital, Lund, Sweden
| | - Donna Turner
- Population Oncology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Harland
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Breann Hawryluk
- Patient Navigation, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Rebecca-Jane Law
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | | | - Victoria White
- CBRC, Cancer Council Victoria, Melbourne, Victoria, Australia
- Deakin University Faculty of Health, Burwood, Victoria, Australia
| | - Rebecca Bergin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | | | - Usha Menon
- Women's Cancer, University College London, London, UK
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14
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Deane J, Norris R, O’Hara J, Patterson J, Sharp L. Who Presents Where? A Population-Based Analysis of Socio-Demographic Inequalities in Head and Neck Cancer Patients' Referral Routes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16723. [PMID: 36554605 PMCID: PMC9779534 DOI: 10.3390/ijerph192416723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
Head and neck cancers (HNC) are often late stage at diagnosis; stage is a major determinant of prognosis. The urgent cancer referral pathway (two week wait; 2WW) within England's National Health Service aims to reduce time to diagnosis. We investigated factors associated with HNC route to diagnosis. Data were obtained from the English population-based cancer registry on 66,411 primary invasive HNCs (ICD C01-14 and C31-32) diagnosed 2006-2014. Multivariable logistic regression determined the likelihood of different diagnosis routes by patients' demographic and clinical characteristics. Significant socio-demographic inequalities were observed. Emergency presentations declined over time and 2WW increased. Significant socio-demographic inequalities were observed. Non-white patients, aged over 65, residing in urban areas with advanced disease, were more likely to have emergency presentations. White males aged 55 and older with an oropharynx cancer were more likely to be diagnosed via 2WW. Higher levels of deprivation were associated with both emergency and 2WW routes. Dental referral was more likely in women, with oral cancers and lower stage disease. Despite the decline over time in emergency presentation and the increased use of 2WW, socio-demographic variation is evident in routes to diagnosis. Further work exploring the reasons for these inequalities, and the consequences for patients' care and outcomes, is urgently required.
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Affiliation(s)
- Jennifer Deane
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE1 4LP, UK
| | - Ruth Norris
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE1 4LP, UK
| | - James O’Hara
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE1 4LP, UK
- Freeman Hospital, Newcastle upon Tyne Hospitals, Newcastle-upon-Tyne NE7 7DN, UK
| | - Joanne Patterson
- School of Health Sciences, Institute of Population Health, University of Liverpool, Liverpool L69 7ZX, UK
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE1 4LP, UK
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15
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Diao B, Bagayogo NA, Carreras NP, Halle M, Ruiz-Alzola J, Ungi T, Fichtinger G, Kikinis R. The use of 3D digital anatomy model improves the communication with patients presenting with prostate disease: The first experience in Senegal. PLoS One 2022; 17:e0277397. [PMID: 36454858 PMCID: PMC9714841 DOI: 10.1371/journal.pone.0277397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/26/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES We hypothesized that the use of an interactive 3D digital anatomy model can improve the quality of communication with patients about prostate disease. METHODS A 3D digital anatomy model of the prostate was created from an MRI scan, according to McNeal's zonal anatomy classification. During urological consultation, the physician presented the digital model on a computer and used it to explain the disease and available management options. The experience of patients and physicians was recorded in questionnaires. RESULTS The main findings were as follows: 308 patients and 47 physicians participated in the study. In the patient group, 96.8% reported an improved level of understanding of prostate disease and 90.6% reported an improved ability to ask questions during consultation. Among the physicians, 91.5% reported improved communication skills and 100% reported an improved ability to obtain patient consent for subsequent treatment. At the same time, 76.6% of physicians noted that using the computer model lengthened the consultation. CONCLUSION This exploratory study found that the use of a 3D digital anatomy model in urology consultations was received overwhelmingly favorably by both patients and physicians, and it was perceived to improve the quality of communication between patient and physician. A randomized study is needed to confirm the preliminary findings and further quantify the improvements in the quality of patient-physician communication.
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Affiliation(s)
- Babacar Diao
- Department of Urology, Ouakam Military Hospital, Dakar, Senegal
- Faculty of Medicine Sheikh Anta Diop University, Dakar, Senegal
- * E-mail:
| | | | - Nayra Pumar Carreras
- Research Institute in Biomedical and Health Science, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Michael Halle
- Department of Radiology, Surgical Planning Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Juan Ruiz-Alzola
- Research Institute in Biomedical and Health Science, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Tamas Ungi
- Laboratory for Percutaneous Surgery, School of Computing, Queen’s University, Kingston, Canada
| | - Gabor Fichtinger
- Laboratory for Percutaneous Surgery, School of Computing, Queen’s University, Kingston, Canada
| | - Ron Kikinis
- Department of Radiology, Surgical Planning Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
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16
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Elshami M, Usrof FD, Alser M, Al-Slaibi I, Okshiya HM, Ghithan RJ, Shurrab NRS, Ismail IO, Mahfouz II, Fannon AA, Qawasmi MAM, Hawa MRM, Giacaman N, Ahmaro M, Zaatreh RK, AbuKhalil WA, Melhim NK, Madbouh RJ, Abu Hziema HJ, Lahlooh RAA, Ubaiat SN, Jaffal NA, Alawna RK, Abed SN, Abuzahra BNA, Abu Kwaik AJ, Dodin MH, Taha RO, Alashqar DM, Mobarak RAAF, Smerat T, Abu-El-Noor N, Bottcher B. Awareness of Palestinian Women About Breast Cancer Risk Factors: A National Cross-Sectional Study. JCO Glob Oncol 2022; 8:e2200087. [PMID: 36508704 PMCID: PMC10166356 DOI: 10.1200/go.22.00087] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This study aimed to assess awareness of Palestinian women about breast cancer (BC) age-related and lifetime risks and its risk factors and to identify factors associated with good awareness. MATERIALS AND METHODS Adult women were recruited from government hospitals, primary health care centers, and public spaces in 11 governorates in Palestine. Recognition of 14 BC risk factors was assessed using a translated-into-Arabic version of the validated BC awareness measure. The level of BC risk factor awareness was determined on the basis of the number of risk factors recognized: poor (0-4), fair (5-9), and good (10-14). RESULTS Of 6,269 potential participants approached, 5,434 agreed and completed the questionnaire (response rate = 86.7%). A total of 5,257 questionnaires were included: 2,706 from the West Bank and Jerusalem and 2,551 from the Gaza Strip. Only 173 participants (3.3%) recognized the age-related risk of BC. More than one quarter (n = 1,465; 27.9%) recognized the lifetime risk of BC. The most recognized modifiable risk factor was not breastfeeding (n = 4,937; 93.9%), whereas the least recognized was having children later on in life or not at all (n = 1,755; 33.4%). The most recognized nonmodifiable risk factor was radiation exposure (n = 4,579; 87.1%), whereas the least recognized was starting the periods at an early age (n = 1,030; 19.6%). In total, 2,024 participants (38.4%) demonstrated good BC risk factor awareness. Participants from the Gaza Strip had a higher likelihood than participants from the West Bank and Jerusalem to have good awareness (42.0% v 35.2%). Age ≥ 40 years, postsecondary education, and visiting hospitals and primary health care centers were all associated with an increase in the likelihood of having good BC risk factor awareness. CONCLUSION The awareness of BC risk factors was suboptimal. These findings highlight the need for implementing health education programs combined with consistent use of ad hoc opportunities to raise awareness by health care providers.
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Affiliation(s)
- Mohamedraed Elshami
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH.,Ministry of Health, Gaza, Palestine
| | - Faten Darwish Usrof
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, Islamic University of Gaza, Gaza City, Palestine
| | | | | | | | | | | | | | | | | | | | | | | | - Manar Ahmaro
- Faculty of Medicine, Al-Quds University, Palestine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tasneem Smerat
- Faculty of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, Palestine
| | | | - Bettina Bottcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
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17
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Sætre LMS, Rasmussen S, Balasubramaniam K, Søndergaard J, Jarbøl DE. A population-based study on social inequality and barriers to healthcare-seeking with lung cancer symptoms. NPJ Prim Care Respir Med 2022; 32:48. [PMID: 36335123 PMCID: PMC9637082 DOI: 10.1038/s41533-022-00314-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/17/2022] [Indexed: 11/08/2022] Open
Abstract
Healthcare-seeking with lung cancer symptoms is a prerequisite for improving timely diagnosis of lung cancer. In this study we aimed to explore barriers towards contacting the general practitioner (GP) with lung cancer symptoms, and to analyse the impact of social inequality. The study is based on a nationwide survey with 69,060 individuals aged ≥40 years, randomly selected from the Danish population. The survey included information on lung cancer symptoms, GP contacts, barriers to healthcare-seeking and smoking status. Information about socioeconomics was obtained by linkage to Danish Registers. Descriptive statistics and multivariate logistic regression model were used to analyse the data. “Being too busy” and “Being worried about wasting the doctor’s time” were the most frequent barriers to healthcare-seeking with lung cancer symptoms. Individuals out of workforce and individuals who smoked more often reported “Being worried about what the doctor might find” and “Being too embarrassed” about the symptoms. The social inequality in barriers to healthcare-seeking with lung cancer symptoms is noticeable, which emphasises the necessity of focus on vulnerable groups at risk of postponing relevant healthcare-seeking.
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Affiliation(s)
- Lisa Maria Sele Sætre
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sanne Rasmussen
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kirubakaran Balasubramaniam
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorte Ejg Jarbøl
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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18
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Variation in suspected cancer referral pathways in primary care: comparative analysis across the International Benchmarking Cancer Partnership. Br J Gen Pract 2022; 73:e88-e94. [PMID: 36127155 PMCID: PMC9512411 DOI: 10.3399/bjgp.2022.0110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/12/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND International variations in cancer outcomes persist and may be influenced by differences in the accessibility and organisation of cancer patient pathways. More evidence is needed to understand to what extent variations in the structure of primary care referral pathways for cancer investigation contribute to differences in the timeliness of diagnoses and cancer outcomes in different countries. AIM To explore the variation in primary care referral pathways for the management of suspected cancer across different countries. DESIGN AND SETTING Descriptive comparative analysis using mixed methods across the International Cancer Benchmarking Partnership (ICBP) countries. METHOD Schematics of primary care referral pathways were developed across 10 ICBP jurisdictions. The schematics were initially developed using the Aarhus statement (a resource providing greater insight and precision into early cancer diagnosis research) and were further supplemented with expert insights through consulting leading experts in primary care and cancer, existing ICBP data, a focused review of existing evidence on the management of suspected cancer, published primary care cancer guidelines, and evaluations of referral tools and initiatives in primary care. RESULTS Referral pathway schematics for 10 ICBP jurisdictions were presented alongside a descriptive comparison of the organisation of primary care management of suspected cancer. Several key areas of variation across countries were identified: inflexibility of referral pathways, lack of a managed route for non-specific symptoms, primary care practitioner decision-making autonomy, direct access to investigations, and use of emergency routes. CONCLUSION Analysing the differences in referral processes can prompt further research to better understand the impact of variation on the timeliness of diagnoses and cancer outcomes. Studying these schematics in local contexts may help to identify opportunities to improve care and facilitate discussions on what may constitute best referral practice.
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Morris M, Seguin M, Landon S, McKee M, Nolte E. Exploring the Role of Leadership in Facilitating Change to Improve Cancer Survival: An Analysis of Experiences in Seven High Income Countries in the International Cancer Benchmarking Partnership (ICBP). Int J Health Policy Manag 2022; 11:1756-1766. [PMID: 34380203 PMCID: PMC9808244 DOI: 10.34172/ijhpm.2021.84] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 07/12/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The differences in cancer survival across countries and over time are well recognised, with progress varying even among high-income countries with comparable health systems. Previous research has examined several possible explanations, but the role of leadership in systems providing cancer care has attracted little attention. As part of the International Cancer Benchmarking Partnership (ICBP), this study looked at diverse aspects of leadership to identify drivers of change and opportunities for improvement across seven high-income countries. METHODS Key informants in 13 jurisdictions were interviewed: Australia (2 states), Canada (3 provinces), Denmark, Ireland, New Zealand, Norway and United Kingdom (4 countries). Participants represented a range of stakeholders at different tiers of the system. They were recruited through a combination of purposive and 'snowball' strategies and participated in semi-structured telephone interviews. Interview transcripts were analysed thematically drawing on the World Health Organization (WHO) health systems framework and previous work analysing national cancer control programmes (NCCPs). RESULTS Several facets of leadership were perceived as important for improving outcomes. These included political leadership to initiate and maintain progress, intellectual leadership to support those engaged in local implementation of national policies and drive change, and a coherent vision from leaders at different levels of the system. Clinical leadership was also viewed as vital for translating policy into action. CONCLUSION Certain aspects of cancer care leadership emerged as underpinning and sustaining improvements, such as appointing a central agency, involving clinicians at every stage, ensuring strong leadership of cancer care with a consistent political mandate. Improving cancer outcomes is challenging and complex, but it is unlikely to be achieved without effective leadership, both political and clinical.
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Affiliation(s)
- Melanie Morris
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
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20
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Sociodemographic and Clinical Characteristics Associated With Worst Pain Intensity Among Cancer Patients. Pain Manag Nurs 2022; 23:424-429. [PMID: 35227646 PMCID: PMC9308655 DOI: 10.1016/j.pmn.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 10/17/2021] [Accepted: 11/19/2021] [Indexed: 02/02/2023]
Abstract
AIMS Patients with cancer have pain due to their cancer, the cancer treatment and other causes, and the pain intensity varies considerably between individuals. Additional research is needed to understand the factors associated with worst pain intensity. Our study aim was to determine the association between worst pain intensity and sociodemographics and cancerspecific factors among patients with cancer. DESIGN A total of 1,280 patients with cancer recruited from multiple cancer centers over 25 years in the United States were asked to complete a questionnaire that collected respondents' demographic, chronic pain, and cancer-specific information. SETTINGS Worst, least, and current pain intensities were captured using a modified McGill Pain Questionnaire (pain intensity measured on 0-10 scale). A generalized linear regression analysis was utilized to assess the associations between significant bivariate predictors and worst pain intensity scores.Our study sample was non-Hispanic White (64.5%), non-Hispanic Black (28.3%), and Hispanic (7.2%). On average, participants were 59.4 (standard deviation = 14.4) years old. The average worst pain intensity score was 6.6 (standard deviation = 2.50). After controlling for selected covariates, being Hispanic (β = 0.6859), previous toothache pain (β = 0.0960), headache pain (β = 0.0549), and stomachache pain (β = 0.0577) were positively associated with worse cancer pain. Notably, year of enrollment was not statistically associated with pain. CONCLUSIONS Our study sample was non-Hispanic White (64.5%), non-Hispanic Black (28.3%), and Hispanic (7.2%). On average, participants were 59.4 (standard deviation = 14.4) years old. The average worst pain intensity score was 6.6 (standard deviation = 2.50). After controlling for selected covariates, being Hispanic (β = 0.6859), previous toothache pain (β = 0.0960), headache pain (β = 0.0549), and stomachache pain (β = 0.0577) were positively associated with worse cancer pain. Notably, year of enrollment was not statistically associated with pain. Findings identified being Hispanic and having previous severe toothache, stomachache, and headache pain as significant predictors of worst pain intensity among patients with cancer. After controlling for selected covariates, we did not note statistical differences in worst pain during a 25-year period. Therefore,studies focused on improving the management of pain among patients with cancer should target interventions for those with Hispanic heritage and those with past history of severe common pain.
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21
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Merriel SWD, Ball S, Bright CJ, Mak V, Gildea C, Paley L, Hyde C, Hamilton W, Elliss-Brookes L. A prospective evaluation of the fourth national Be Clear on Cancer 'Blood in Pee' campaign in England. Eur J Cancer Care (Engl) 2022; 31:e13606. [PMID: 35570375 PMCID: PMC9539495 DOI: 10.1111/ecc.13606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 01/03/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
Abstract
Objective To assess the impact of the fourth Be Clear on Cancer (BCoC) ‘Blood in Pee’ (BiP) campaign (July to September 2018) on bladder and kidney cancer symptom awareness and outcomes in England. Methods In this uncontrolled before and after study, symptom awareness and reported barriers to GP attendance were assessed using panel and one‐to‐one interviews. The Health Improvement Network (THIN), National Cancer Registration and Analysis Service (NCRAS) and NHS Cancer Waiting Times (CWT) data were analysed to assess the impact on GP attendances, urgent cancer referrals, cancer diagnoses and 1‐year survival. Analyses used Poisson, negative binomial and Cox regression. Results Symptom awareness and intention to consult a GP after one episode of haematuria increased following the campaign. GP attendance with haematuria (rate ratio (RR) 1.17, 95% confidence interval (CI): 1.07–1.28) and urgent cancer referrals (RR 1.18 95% CI: 1.08–1.28) increased following the campaign. Early‐stage diagnoses increased for bladder cancer (difference in percentage 2.8%, 95% CI: −0.2%–5.8%), but not for kidney cancer (difference −0.6%, 95% CI: −3.2%–2.1%). Conclusions The fourth BCoC BiP campaign appears to have been effective in increasing bladder cancer symptom awareness and GP attendances, although long‐term impacts are unclear.
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Affiliation(s)
| | - Susan Ball
- NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Chloe Jayne Bright
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Vivian Mak
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Carolynn Gildea
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Lizz Paley
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Chris Hyde
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - William Hamilton
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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22
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Knowledge and awareness of leukaemia and its risks among the population of Saudi Arabia. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.100971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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23
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Moriarty Y, Lau M, Sewell B, Trubey R, Quinn-Scoggins H, Owen S, Padgett L, Kolovou V, Hepburn J, Buckle P, Playle R, Townson J, Robling M, Gilbert S, Dimitropoulou P, Edwards A, Mitchell C, Matthews M, Smits S, Wood F, Neal RD, Brain K. Randomised controlled trial and economic evaluation of a targeted cancer awareness intervention for adults living in deprived areas of the UK. Br J Cancer 2021; 125:1100-1110. [PMID: 34453114 PMCID: PMC8391006 DOI: 10.1038/s41416-021-01524-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 07/06/2021] [Accepted: 08/11/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cancer outcomes are poor in socioeconomically deprived communities, with low symptom awareness contributing to prolonged help-seeking and advanced disease. Targeted cancer awareness interventions require evaluation. METHODS This is a randomised controlled trial involving adults aged 40+ years recruited in community and healthcare settings in deprived areas of South Yorkshire and South-East Wales. INTERVENTION personalised behavioural advice facilitated by a trained lay advisor. CONTROL usual care. Follow-up at two weeks and six months post-randomisation. PRIMARY OUTCOME total cancer symptom recognition score two weeks post-randomisation. RESULTS Two hundred and thirty-four participants were randomised. The difference in total symptom recognition at two weeks [adjusted mean difference (AMD) 0.6, 95% CI: -0.03, 1.17, p = 0.06] was not statistically significant. Intervention participants reported increased symptom recognition (AMD 0.8, 95% CI: 0.18, 1.37, p = 0.01) and earlier intended presentation (AMD -2.0, 95% CI: -3.02, -0.91, p < 0.001) at six months. "Lesser known" symptom recognition was higher in the intervention arm (2 weeks AMD 0.5, 95% CI: 0.03, 0.97 and six months AMD 0.7, 95% CI: 0.16, 1.17). Implementation cost per participant was £91.34, with no significant between-group differences in healthcare resource use post-intervention. CONCLUSIONS Improved symptom recognition and earlier anticipated presentation occurred at longer-term follow-up. The ABACus Health Check is a viable low-cost intervention to increase cancer awareness in socioeconomically deprived communities. CLINICAL TRIAL REGISTRATION ISRCTN16872545.
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Affiliation(s)
- Yvonne Moriarty
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - Mandy Lau
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Bernadette Sewell
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Rob Trubey
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Harriet Quinn-Scoggins
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Louise Padgett
- Department of Health Sciences, University of York, York, UK
| | - Vasiliki Kolovou
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Julie Hepburn
- Public Involvement Community, Health and Care Research Wales Support Centre, Cardiff, UK
| | | | - Rebecca Playle
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | | | - Adrian Edwards
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Caroline Mitchell
- Academic Unit of Primary Medical Care, University of Sheffield, Northern General Hospital, Sheffield, UK
| | | | - Stephanie Smits
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Fiona Wood
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kate Brain
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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24
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Quinn-Scoggins HD, Cannings-John R, Moriarty Y, Whitelock V, Whitaker KL, Grozeva D, Hughes J, Townson J, Osborne K, Goddard M, McCutchan GM, Waller J, Robling M, Hepburn J, Moore G, Gjini A, Brain K. Cancer symptom experience and help-seeking behaviour during the COVID-19 pandemic in the UK: a cross-sectional population survey. BMJ Open 2021; 11:e053095. [PMID: 34531224 PMCID: PMC8449845 DOI: 10.1136/bmjopen-2021-053095] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/11/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To understand self-reported potential cancer symptom help-seeking behaviours and attitudes during the first 6 months (March-August 2020) of the UK COVID-19 pandemic. DESIGN UK population-based survey conducted during August and September 2020. Correlates of help-seeking behaviour were modelled using logistic regression in participants reporting potential cancer symptoms during the previous 6 months. Qualitative telephone interviews with a purposeful subsample of participants, analysed thematically. SETTING Online UK wide survey. PARTICIPANTS 7543 adults recruited via Cancer Research UK online panel provider (Dynata) and HealthWise Wales (a national register of 'research ready' participants) supplemented with social media (Facebook and Twitter) recruitment. 30 participants were also interviewed. MAIN OUTCOME MEASURES Survey measures included experiences of 15 potential cancer symptoms, help-seeking behaviour, barriers and prompts to help-seeking. RESULTS Of 3025 (40.1%) participants who experienced a potential cancer symptom, 44.8% (1355/3025) had not contacted their general practitioner (GP). Odds of help-seeking were higher among participants with disability (adjusted OR (aOR)=1.38, 95% CI 1.11 to 1.71) and who experienced more symptoms (aOR=1.68, 95% CI 1.56 to 1.82), and lower among those who perceived COVID-19 as the cause of symptom(s) (aOR=0.36, 95% CI 0.25 to 0.52). Barriers included worries about wasting the doctor's time (1158/7543, 15.4%), putting strain on healthcare services (945, 12.6%) and not wanting to make a fuss (907, 12.0%). Interviewees reported reluctance to contact the GP due to concerns about COVID-19 and fear of attending hospitals, and described putting their health concerns on hold. CONCLUSIONS Many people avoided healthcare services despite experiencing potential cancer symptoms during the COVID-19 pandemic. Alongside current help-seeking campaigns, well-timed and appropriate nationally coordinated campaigns should signal that services are open safely for those with unusual or persistent symptoms. TRIAL REGISTRATION NUMBER ISRCTN17782018.
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Affiliation(s)
- Harriet D Quinn-Scoggins
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | | | | | | | | | | | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Mark Goddard
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Grace M McCutchan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Michael Robling
- Centre for Trials Research, Cardiff University, Cardiff, UK
- DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Julie Hepburn
- Public Involvement Community, Health and Care Research Wales Support Centre, Cardiff, UK
| | - Graham Moore
- DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Ardiana Gjini
- Public Health Wales, Cardiff, UK
- Cardiff University, Cardiff, UK
| | - Kate Brain
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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25
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Zomerdijk N, Jongenelis M, Yuen E, Turner J, Huntley K, Smith A, McIntosh M, Short CE. Experiences and needs of people with haematological cancers during the COVID-19 pandemic: A qualitative study. Psychooncology 2021; 31:416-424. [PMID: 34500498 PMCID: PMC8646676 DOI: 10.1002/pon.5819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/30/2022]
Abstract
Objective Haematological cancer patients are particularly vulnerable to the effects of COVID‐19. In addition to being immunocompromised, pandemic‐related travel restrictions have impacted access to treatments and overseas stem cell donations for patients requiring transplantation. Given this vulnerability, people with haematological cancers are at risk of experiencing heightened distress during the pandemic. This study aimed to explore haematological cancer patients' experiences and needs. Methods Twenty‐four Australian haematological cancer patients completed semi‐structured interviews exploring their concerns and worries during the pandemic, impact of pandemic on management of disease, access to information and support, lifestyle changes, and attitudes towards emerging models of healthcare during the pandemic. Interview transcripts were thematically analysed. Results Four themes reflecting the experiences of haematological cancer patients during the pandemic were identified: ‘Fears about contracting COVID‐19' (behaviour changes to protect health, impact on daily routine and habits, annoyance at dismissive attitude of others toward COVID‐19); ‘Reduced sense of connection and support’ (reduced social support and access to external support services); ‘New challenges’ (increased financial hardship, worsened health), and; ‘Underlying system and communication issues' (access to trusted information, satisfaction/dissatisfaction with care, navigating telehealth). Participants expressed a need for improved access to support services and trusted information. Conclusions The findings emphasise the additional challenges experienced by haematological cancer patients during the COVID‐19 pandemic and their impact on daily life. Results point to the importance of validation of increased distress during periods of uncertainty; reinforcing recommendations about high‐quality sources of information; and facilitating access to support services when face‐to‐face care is limited.
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Affiliation(s)
- Nienke Zomerdijk
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Comprehensive Cancer Centre Alliance, Melbourne, Victoria, Australia
| | - Michelle Jongenelis
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, Melbourne Centre for Behaviour Change, University of Melbourne, Melbourne, Victoria, Australia
| | - Eva Yuen
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Institute for Health Transformation Deakin University, Melbourne, Victoria, Australia.,School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Victoria, Australia.,School of Psychology and Public Health, Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria, Australia.,Psycho-Oncology Research Unit, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Jane Turner
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | | | - Andrew Smith
- Leukaemia Foundation, Brisbane, Queensland, Australia
| | - Megan McIntosh
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
| | - Camille E Short
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, Melbourne Centre for Behaviour Change, University of Melbourne, Melbourne, Victoria, Australia.,School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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26
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Balasubramaniam K, Rasmussen S, Haastrup PF, Suadicani K, Søndergaard J, Jarbøl DE. Women's barriers for contacting general practice when experiencing gynecological cancer symptoms: a population-based study. BMC FAMILY PRACTICE 2021; 22:167. [PMID: 34399693 PMCID: PMC8369740 DOI: 10.1186/s12875-021-01518-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 07/31/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND A prerequisite for general practitioners (GPs) being able to refer patients with gynecological cancer alarm symptoms for further investigations is that individuals present the symptoms to the GP. Not all symptoms are presented to the GP, and knowledge of barriers for healthcare-seeking is sparse. The aim of this study was to analyze associations between age, socioeconomic status, and common barriers ("being too embarrassed", "being too busy", "worried about wasting the doctors time" and "worried what the GP might find") towards GP contact with gynecological alarm symptoms. METHODS Nationwide population-based study in Denmark based on a random sample of 51 090 women aged 20 years or older. A web-based questionnaire regarding experience of four predefined alarm symptoms of gynecological cancer, decisions about contact to GPs, and barriers towards GP contact was distributed. Information about socioeconomic status was collected from Statistics Denmark. RESULTS A total of 26 466 women (54.5%) completed the questionnaire. The proportion of women with no contact to the GP varied between 64.6% and 78.1% for postmenopausal bleeding and pain during intercourse, respectively. Between 32.3% (bleeding during intercourse) and 45.3% (postmenopausal bleeding) of the women reported no barriers for GP contact. The proportions of reported barriers ranged from 7.5% for being too embarrassed (pelvic pain) to 26.8% for being too busy (bleeding during intercourse). Women aged 40-59 years had lower odds of reporting "being too embarrassed" and "worried about wasting the GP´s time", while women aged 60 + years of age had lower odds of reporting "being too busy" compared to the youngest age group. Women in the highest income groups had lower odds of reporting "being too embarrassed" and "wasting the GP´s time" compared to those with a low income, while those with high educational level had lower odds of reporting "being too embarrassed" and "worried what the GP might find" compared to those with low educational level. CONCLUSIONS More than half of the respondents with no contact to the GP, reported one or more barriers towards GP contact. Lower age and socioeconomic status were significantly associated with higher odds of reporting barriers. As this may explain the differences in healthcare seeking behavior, healthcare planners, policy makers and clinicians should be aware of these findings.
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Affiliation(s)
- Kirubakaran Balasubramaniam
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark.
| | - Sanne Rasmussen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Peter Fentz Haastrup
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | | | - Jens Søndergaard
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Dorte Ejg Jarbøl
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
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27
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Miller J, Maeda Y, Au S, Gunn F, Porteous L, Pattenden R, MacLean P, Noble CL, Glancy S, Dunlop MG, Din FVN. Short-term outcomes of a COVID-adapted triage pathway for colorectal cancer detection. Colorectal Dis 2021; 23:1639-1648. [PMID: 33682302 PMCID: PMC8250907 DOI: 10.1111/codi.15618] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/16/2021] [Accepted: 03/01/2021] [Indexed: 12/29/2022]
Abstract
AIM The dramatic curtailment of endoscopy and CT colonography capacity during the coronavirus pandemic has adversely impacted timely diagnosis of colorectal cancer (CRC). We describe a rapidly implemented COVID-adapted diagnostic pathway to mitigate risk and maximize cancer diagnosis in patients referred with symptoms of suspected CRC. METHOD The 'COVID-adapted pathway' integrated multiple quantitative faecal immunochemical tests (qFIT) to enrich for significant colorectal disease with judicious use of CT with oral contrast to detect gross pathology. Patients reporting 'high-risk' symptoms were triaged to qFIT+CT and the remainder underwent an initial qFIT to inform subsequent investigation. Demographic and clinical data were prospectively collected. Outcomes comprised cancer detection frequency. RESULTS Overall, 422 patients (median age 64 years, 220 women) were triaged using this pathway. Most (84.6%) were referred as 'urgent suspicious of cancer'. Of the 422 patients, 202 (47.9%) were triaged to CT and qFIT, 211 (50.0%) to qFIT only, eight (1.9%) to outpatient clinic and one to colonoscopy. Fifteen (3.6%) declined investigation and seven (1.7%) were deemed unfit. We detected 13 cancers (3.1%), similar to the mean cancer detection rate from all referrals in 2017-2019 (3.3%). Compared with the period 1 April-31 May in 2017-2019, we observed a 43% reduction in all primary care referrals (1071 referrals expected reducing to 609). CONCLUSION This COVID-adapted pathway mitigated the adverse effects on diagnostic capacity and detected cancer at the expected rate within those referred. However, the overall reduction in the number of referrals was substantial. The described risk-mitigating measures could be a useful adjunct whilst standard diagnostic services remain constrained due to the ongoing pandemic.
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Affiliation(s)
- Janice Miller
- Department of Colorectal SurgeryWestern General HospitalEdinburghUK
- Clinical SurgeryRoyal Infirmary of EdinburghUniversity of EdinburghEdinburghUK
| | - Yasuko Maeda
- Department of Colorectal SurgeryWestern General HospitalEdinburghUK
- Clinical SurgeryRoyal Infirmary of EdinburghUniversity of EdinburghEdinburghUK
| | - Stephanie Au
- Department of Colorectal SurgeryWestern General HospitalEdinburghUK
| | - Frances Gunn
- Department of Colorectal SurgeryWestern General HospitalEdinburghUK
| | - Lorna Porteous
- Lead GP for Cancer and Palliative CareNHS LothianEdinburghUK
| | | | - Peter MacLean
- Department of RadiologyWestern General HospitalEdinburghUK
| | - Colin L. Noble
- Department of GastroenterologyWestern General HospitalEdinburghUK
| | - Stephen Glancy
- Department of RadiologyWestern General HospitalEdinburghUK
| | - Malcolm G. Dunlop
- Department of Colorectal SurgeryWestern General HospitalEdinburghUK
- Clinical SurgeryRoyal Infirmary of EdinburghUniversity of EdinburghEdinburghUK
- Edinburgh CRUK Cancer Research CentreEdinburghUK
- Institute if Genetics and Molecular MedicineEdinburghUK
| | - Farhat V. N. Din
- Department of Colorectal SurgeryWestern General HospitalEdinburghUK
- Clinical SurgeryRoyal Infirmary of EdinburghUniversity of EdinburghEdinburghUK
- Edinburgh CRUK Cancer Research CentreEdinburghUK
- Institute if Genetics and Molecular MedicineEdinburghUK
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28
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Freer-Smith C, Harvey-Kelly L, Mills K, Harrison H, Rossi SH, Griffin SJ, Stewart GD, Usher-Smith JA. Reasons for intending to accept or decline kidney cancer screening: thematic analysis of free text from an online survey. BMJ Open 2021; 11:e044961. [PMID: 34006549 PMCID: PMC8137225 DOI: 10.1136/bmjopen-2020-044961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/17/2021] [Accepted: 04/15/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Kidney cancer has been identified as a disease for which screening might provide significant benefit for patients. The aim of this study was to understand in detail the facilitators and barriers towards uptake of a future kidney cancer screening programme, and to compare these across four proposed screening modalities. DESIGN An online survey including free-text responses. SETTING UK PARTICIPANTS: 668 adults PRIMARY AND SECONDARY OUTCOME MEASURES: The survey assessed participants' self-reported intention to take-up kidney cancer screening with four different test methods (urine test, blood test, ultrasound scan and low-dose CT). We conducted thematic analysis of 2559 free-text comments made within the survey using an inductive approach. RESULTS We identified five overarching themes that influenced screening intention: 'personal health beliefs', 'practicalities', 'opinions of the test', 'attitudes towards screening' and 'cancer apprehension'. Overall, participants considered the tests presented as simple to complete and the benefits of early detection to outweigh any drawbacks to screening. Dominant facilitators and barriers varied with patterns of intention to take up screening across the four tests. Most intended to take up screening by all four tests, and for these participants, screening was seen as a positive health behaviour. A significant minority were driven by practicalities and the risks of the tests offered. A smaller proportion intended to reject all forms of screening offered, often due to fear or worry about results and unnecessary medical intervention or a general negative view of screening. CONCLUSIONS Most individuals would accept kidney cancer screening by any of the four test options presented because of strong positive attitudes towards screening in general and the perceived simplicity of the tests. Providing information about the rationale for screening in general and the potential benefits of early detection will be important to optimise uptake among uncertain individuals.
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Affiliation(s)
| | - Laragh Harvey-Kelly
- School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Katie Mills
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Hannah Harrison
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Sabrina H Rossi
- Department of Oncology, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Simon J Griffin
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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29
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Petrova D, Pollán M, Rodriguez-Barranco M, Garrido D, Borrás JM, Sánchez MJ. Anticipated help-seeking for cancer symptoms before and after the coronavirus pandemic: results from the Onco-barometer population survey in Spain. Br J Cancer 2021; 124:2017-2025. [PMID: 33854210 PMCID: PMC8044659 DOI: 10.1038/s41416-021-01382-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/11/2021] [Accepted: 03/25/2021] [Indexed: 12/21/2022] Open
Abstract
Background The patient interval—the time patients wait before consulting their physician after noticing cancer symptoms—contributes to diagnostic delays. We compared anticipated help-seeking times for cancer symptoms and perceived barriers to help-seeking before and after the coronavirus pandemic. Methods Two waves (pre-Coronavirus: February 2020, N = 3269; and post-Coronavirus: August 2020, N = 1500) of the Spanish Onco-barometer population survey were compared. The international ABC instrument was administered. Pre–post comparisons were performed using multiple logistic and Poisson regression models. Results There was a consistent and significant increase in anticipated times to help-seeking for 12 of 13 cancer symptoms, with the largest increases for breast changes (OR = 1.54, 95% CI 1.22–1–96) and unexplained bleeding (OR = 1.50, 1.26–1.79). Respondents were more likely to report barriers to help-seeking in the post wave, most notably worry about what the doctor may find (OR = 1.58, 1.35–1.84) and worry about wasting the doctor’s time (OR = 1.48, 1.25–1.74). Women and older individuals were the most affected. Conclusions Participants reported longer waiting times to help-seeking for cancer symptoms after the pandemic. There is an urgent need for public interventions encouraging people to consult their physicians with symptoms suggestive of cancer and counteracting the main barriers perceived during the pandemic situation.
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Affiliation(s)
- Dafina Petrova
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Marina Pollán
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,National Center for Epidemiology, Health Institute Carlos III, Madrid, Spain
| | - Miguel Rodriguez-Barranco
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain. .,Escuela Andaluza de Salud Pública (EASP), Granada, Spain. .,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
| | | | - Josep M Borrás
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain.,Bellvitge Biomedical Research Institute, Hospitalet, Spain.,NHS Cancer Strategy, Ministry of Health, Hospitalet, Spain
| | - Maria-José Sánchez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
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30
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Bernhardson BM, Tishelman C, Rasmussen BH, Hajdarevic S, Malmström M, Overgaard Hasle TL, Locock L, Eriksson LE. Sensations, symptoms, and then what? Early bodily experiences prior to diagnosis of lung cancer. PLoS One 2021; 16:e0249114. [PMID: 33780498 PMCID: PMC8007036 DOI: 10.1371/journal.pone.0249114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 03/11/2021] [Indexed: 11/26/2022] Open
Abstract
Lung cancer (LC) generally lacks unique core symptoms or signs. However, there are a multitude of bodily sensations that are often non-specific, not easily understood, and many times initially not recognized as indicative of LC by the affected person, which often leads to late diagnosis. In this international qualitative study, we inductively analyzed retrospective accounts of 61 people diagnosed with LC in Denmark, England and Sweden. Using the bodily sensations they most commonly spoke about (tiredness, breathlessness, pain, and cough), we constructed four sensation-based cases to understand the pre-diagnostic processes of reasoning and practice triggered by these key indicators of LC. We thereafter critically applied Hay's model of sensations to symptoms transformation, examining its central concepts of duration, disability and vulnerability, to support understanding of these processes. We found that while duration and disability are clearly relevant, vulnerability is more implicitly expressed in relation to perceived threat. Tiredness, even when of long duration and causing disability, was often related to normal aging, rather than a health threat. Regardless of duration, breathlessness was disturbing and threatening enough to lead to care-seeking. Pain varied by location, duration and degree of disability, and thus also varied in degree of threat perceived. Preconceived, but unmet expectations of what LC-related cough and pain would entail could cause delays by misleading participants; if cough lasted long enough, it could trigger health care contact. Duration, disability, and sense of threat, rather than vulnerability, were found to be relevant concepts for understanding the trajectory to diagnosis for LC among these participants. The process by which an individual, their family and health care providers legitimize sensations, allowing them to be seen as potential symptoms of disease, is also an essential, but varying part of the diagnostic processes described here.
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Affiliation(s)
- Britt-Marie Bernhardson
- Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Carol Tishelman
- Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services (SLSO), Stockholms County Council (SLL), Stockholm, Sweden
| | - Birgit H. Rasmussen
- Department of Health Sciences, Lund University, Lund, Sweden
- The Institute for Palliative Care, Lund University and Region, Skåne, Sweden
| | | | - Marlene Malmström
- Department of Health Sciences, Lund University, Lund, Sweden
- The Institute for Palliative Care, Lund University and Region, Skåne, Sweden
| | - Trine Laura Overgaard Hasle
- Department of Public Health, Research Centre for Cancer, Diagnosis in Primary Care, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
- Nuffield Department of Primary Care Health Sciences, Health Experiences Research Group, University of Oxford, Oxford, United Kingdom
| | - Lars E. Eriksson
- Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- School of Health Sciences, University of London, London, United Kingdom
- Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
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31
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Lai J, Mak V, Bright CJ, Lyratzopoulos G, Elliss-Brookes L, Gildea C. Reviewing the impact of 11 national Be Clear on Cancer public awareness campaigns, England, 2012 to 2016: A synthesis of published evaluation results. Int J Cancer 2021; 148:1172-1182. [PMID: 32875560 DOI: 10.1002/ijc.33277] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 12/23/2022]
Abstract
The Be Clear on Cancer (BCoC) campaigns have run in England since 2010. They aim to raise awareness of possible cancer symptoms, encouraging people to consult a general practice with these symptoms. Our study provides an overview of the impact of 11 national campaigns, for bowel, lung, bladder and kidney, breast and oesophago-gastric cancers. We synthesised existing results for each campaign covering seven clinical metrics across the patient pathway from primary care attendances to one-year net survival. For each metric, "before" and "after" periods were compared to assess change potentially related to the campaign. Results show that primary care attendances for campaign-related symptoms increased for 9 of 10 campaigns and relevant urgent referrals for suspected cancer increased above general trends for 9 of 11 campaigns. Diagnostic tests increased for 6 of 11 campaigns. For 7 of 11 campaigns, there were increases in cancer diagnoses resulting from an urgent referral for suspected cancer. There were sustained periods where more cancers were diagnosed than expected for 8 of 10 campaigns, with higher than expected proportions diagnosed at an early stage for sustained periods for 4 of 10 campaigns. There was no impact on survival. In summary, there is evidence that the BCoC campaigns impact help-seeking by patients and referral patterns by general practitioners, with some impact on diagnosis (incidence and stage). There was no clear evidence of impact on survival.
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Affiliation(s)
- Jennifer Lai
- National Cancer Registration and Analysis Service (NCRAS), Public Health England, London, UK
| | - Vivian Mak
- National Cancer Registration and Analysis Service (NCRAS), Public Health England, London, UK
| | - Chloe J Bright
- National Cancer Registration and Analysis Service (NCRAS), Public Health England, London, UK
| | - Georgios Lyratzopoulos
- National Cancer Registration and Analysis Service (NCRAS), Public Health England, London, UK
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - Lucy Elliss-Brookes
- National Cancer Registration and Analysis Service (NCRAS), Public Health England, London, UK
| | - Carolynn Gildea
- National Cancer Registration and Analysis Service (NCRAS), Public Health England, London, UK
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Boban S, Downs J, Codde J, Cohen PA, Bulsara C. Women Diagnosed with Ovarian Cancer: Patient and Carer Experiences and Perspectives. PATIENT-RELATED OUTCOME MEASURES 2021; 12:33-43. [PMID: 33623464 PMCID: PMC7896761 DOI: 10.2147/prom.s272688] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/15/2020] [Indexed: 01/04/2023]
Abstract
Purpose By directly engaging with women diagnosed with ovarian cancer, this study aimed to explore and identify their view of the health symptoms and outcomes that matter most to them as they traverse their disease pathway. Background Patient-reported outcome measures in ovarian cancer have tended to focus on physical symptoms rather than the more complex psychosocial aspects of living with the disease. Using a "ground-up approach", this study sought to comprehensively understand the health concerns that matter most to women with ovarian cancer as a first step in generating items for development into an ovarian cancer-specific patient-reported outcome measure. Patients and Methods Following an extensive literature review, we sought to capture the "patient voice" through a qualitative descriptive approach including a community conversation with ovarian cancer patients, their carers and clinicians, and interviews and focus groups with women with ovarian cancer. Thirteen women were interviewed individually, and two focus groups were conducted. A template thematic analysis was used to analyze the data. Results Key themes included challenges related to clinical diagnosis, treatment phase, altered relationships with family/friends, financial issues, relationships with health professionals and coping strategies. Within each key theme, several sub-themes emerged that were identified as various challenges experienced by participants. Diagnostic delay, chemotherapy and surgery-related challenges, negative impact of sexual well-being on partner relationship, communicational challenges with health professionals were among the few issues identified. In addition, self-empowerment was identified as a coping mechanism among participants. Conclusion By identifying priorities for women diagnosed with ovarian cancer we have highlighted the need for strategies to reduce diagnostic delays and improve quality of life for these women. Data will inform the development of an ovarian cancer-specific patient-reported outcome measure.
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Affiliation(s)
- Sharolin Boban
- School of Health Sciences, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Jenny Downs
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Jim Codde
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Division of Obstetrics and Gynecology, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Paul A Cohen
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Division of Obstetrics and Gynecology, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Caroline Bulsara
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Al-Azri M, Al-Baimani K, Al-Awaisi H, Al-Mandhari Z, Al-Khamayasi J, Al-Lawati Y, Panchatcharam SM. Knowledge of symptoms, time to presentation and barriers to medical help-seeking among Omani women diagnosed with breast cancer: a cross-sectional study. BMJ Open 2021; 11:e043976. [PMID: 33478965 PMCID: PMC7825262 DOI: 10.1136/bmjopen-2020-043976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To identify knowledge of breast cancer (BC) symptoms, time taken to consult a doctor and factors contributing to delays in medical help-seeking. DESIGN A cross-sectional study of Omani women diagnosed with BC. SETTING The two main teaching hospitals in Oman: Royal Hospital and Sultan Qaboos University Hospital. PARTICIPANTS Adult Omani women recently diagnosed with BC. TOOLS The Breast Module of the Cancer Awareness Measure and the International Cancer Benchmarking Partnership questionnaire were used to collect data. RESULTS A total of 300 women with BC participated (response rate: 91.0%). The mean age at diagnosis was 43.0±12.50 years and 33.5% were diagnosed at stage III or IV. Although most women (74.4%) recognised breast/armpit lumps to be a symptom of BC, less than half identified other symptoms, including breast/armpit pain (44.0%), changes in the position of the nipple (36.2%), redness (31.7%), fatigue (26.3%), weight loss (23.4%) and loss of appetite (20.8%). While most (91.6%) were aware that BC could be cured if detected early, only 66.4% sought medical help within a month of developing symptoms. Initial responses to symptoms included informing husbands (40.2%) or family members (36.5%). Barriers to seeking medical help included feeling scared (68.9%) and worried about what the doctor might find (62.8%). Highly educated women were more likely to recognise the following as BC symptoms: changes in nipple position (OR: 0.16, 95% CI 0.03 to 0.81), breast pain (OR: 0.10, 95% CI 0.01 to 0.86) and unexplained weight loss (OR: 0.18, 95% CI 0.04 to 0.88) (all p<0.05). CONCLUSIONS Although many Omani women with BC were aware of the importance of early diagnosis, most demonstrated inadequate knowledge of symptoms, did not prioritise seeking medical help and reported emotional barriers to help-seeking. More educational measures are needed to improve symptom recognition and address help-seeking barriers to minimise delays in diagnosis.
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Affiliation(s)
- Mohammed Al-Azri
- Family Medicine and Public Health, Sultan Qaboos University, Muscat, Oman
| | - Khalid Al-Baimani
- Oncology Unit, Department of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Huda Al-Awaisi
- Nursing Directorate, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | | | - Jasem Al-Khamayasi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Yaseen Al-Lawati
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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Schliemann D, Ismail R, Donnelly M, Su TT. Anticipated delay in help-seeking for cancer symptoms: Findings from a nationwide study of Malaysian adults. Cancer Epidemiol 2021; 71:101882. [PMID: 33433363 DOI: 10.1016/j.canep.2020.101882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND To investigate the relationship between anticipated delay in help-seeking and cancer symptom recognition and the extent to which this relationship varied according to socio-demographic and health-related characteristics. METHODS A cross-sectional telephone survey was conducted of 1895 adults aged ≥40 years who were randomly selected across Malaysia and interviewed using the Awareness and Beliefs about Cancer questionnaire, which was previously validated and culturally adapted by the research team. Logistic regression analysis was used to test the associations between anticipated delay for help seeking >2 weeks and socio-demographic and health-related variables. RESULTS Anticipated delay in help-seeking was reported for persistent cough (19.3 %), rectal bleeding (6.1 %) and breast changes (2.5 %). Difficulty in accessing a doctor was associated with anticipated delayed help-seeking for breast changes and rectal bleeding (adjusted ORs 7.58; 95 % CI 1.98, 28.94 and 2.37; 95 % CI 1.21, 4.66, respectively); not recognising the symptom 'unexplained bleeding' as a colorectal cancer warning sign was associated with anticipated delayed help-seeking for rectal bleeding (adjusted OR 1.54; 95 % CI 1.03, 2.31); and ethnicity was associated with anticipated delay for rectal bleeding and persistent cough. CONCLUSIONS Generally, anticipated delay to help-seeking for cancer symptoms in Malaysia (a middle-income country) appeared to be a less significant problem compared to other countries including high-income countries. There appeared to be a significant association between social variation indicators in Malaysia and anticipated delay in help-seeking.
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Affiliation(s)
- Désirée Schliemann
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Roshidi Ismail
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Malaysia; Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Malaysia
| | - Michael Donnelly
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Tin Tin Su
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Malaysia; Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Malaysia.
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35
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Koo MM, Unger-Saldaña K, Mwaka AD, Corbex M, Ginsburg O, Walter FM, Calanzani N, Moodley J, Rubin GP, Lyratzopoulos G. Conceptual Framework to Guide Early Diagnosis Programs for Symptomatic Cancer as Part of Global Cancer Control. JCO Glob Oncol 2021; 7:35-45. [PMID: 33405957 PMCID: PMC8081530 DOI: 10.1200/go.20.00310] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/06/2020] [Accepted: 11/06/2020] [Indexed: 12/15/2022] Open
Abstract
Diagnosing cancer earlier can enable timely treatment and optimize outcomes. Worldwide, national cancer control plans increasingly encompass early diagnosis programs for symptomatic patients, commonly comprising awareness campaigns to encourage prompt help-seeking for possible cancer symptoms and health system policies to support prompt diagnostic assessment and access to treatment. By their nature, early diagnosis programs involve complex public health interventions aiming to address unmet health needs by acting on patient, clinical, and system factors. However, there is uncertainty regarding how to optimize the design and evaluation of such interventions. We propose that decisions about early diagnosis programs should consider four interrelated components: first, the conduct of a needs assessment (based on cancer-site-specific statistics) to identify the cancers that may benefit most from early diagnosis in the target population; second, the consideration of symptom epidemiology to inform prioritization within an intervention; third, the identification of factors influencing prompt help-seeking at individual and system level to support the design and evaluation of interventions; and finally, the evaluation of factors influencing the health systems' capacity to promptly assess patients. This conceptual framework can be used by public health researchers and policy makers to identify the greatest evidence gaps and guide the design and evaluation of local early diagnosis programs as part of broader cancer control strategies.
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Affiliation(s)
- Minjoung Monica Koo
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Karla Unger-Saldaña
- CONACYT (National Council of Science and Technology)–National Cancer Institute, Mexico City, Mexico
| | - Amos D. Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Ophira Ginsburg
- Perlmutter Cancer Center and the Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Fiona M. Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Natalia Calanzani
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jennifer Moodley
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- SAMRC Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Greg P. Rubin
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, United Kingdom
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Araghi M, Arnold M, Rutherford MJ, Guren MG, Cabasag CJ, Bardot A, Ferlay J, Tervonen H, Shack L, Woods RR, Saint-Jacques N, De P, McClure C, Engholm G, Gavin AT, Morgan E, Walsh PM, Jackson C, Porter G, Møller B, Bucher O, Eden M, O'Connell DL, Bray F, Soerjomataram I. Colon and rectal cancer survival in seven high-income countries 2010-2014: variation by age and stage at diagnosis (the ICBP SURVMARK-2 project). Gut 2021; 70:114-126. [PMID: 32482683 DOI: 10.1136/gutjnl-2020-320625] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/01/2020] [Accepted: 04/23/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES As part of the International Cancer Benchmarking Partnership (ICBP) SURVMARK-2 project, we provide the most recent estimates of colon and rectal cancer survival in seven high-income countries by age and stage at diagnosis. METHODS Data from 386 870 patients diagnosed during 2010-2014 from 19 cancer registries in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK) were analysed. 1-year and 5-year net survival from colon and rectal cancer were estimated by stage at diagnosis, age and country, RESULTS: (One1-year) and 5-year net survival varied between (77.1% and 87.5%) 59.1% and 70.9% and (84.8% and 90.0%) 61.6% and 70.9% for colon and rectal cancer, respectively. Survival was consistently higher in Australia, Canada and Norway, with smaller proportions of patients with metastatic disease in Canada and Australia. International differences in (1-year) and 5-year survival were most pronounced for regional and distant colon cancer ranging between (86.0% and 94.1%) 62.5% and 77.5% and (40.7% and 56.4%) 8.0% and 17.3%, respectively. Similar patterns were observed for rectal cancer. Stage distribution of colon and rectal cancers by age varied across countries with marked survival differences for patients with metastatic disease and diagnosed at older ages (irrespective of stage). CONCLUSIONS Survival disparities for colon and rectal cancer across high-income countries are likely explained by earlier diagnosis in some countries and differences in treatment for regional and distant disease, as well as older age at diagnosis. Differences in cancer registration practice and different staging systems across countries may have impacted the comparisons.
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Affiliation(s)
- Marzieh Araghi
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Melina Arnold
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Mark J Rutherford
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Marianne Grønlie Guren
- Department of Oncology and K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Oslo, Norway
| | - Citadel J Cabasag
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Aude Bardot
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Hanna Tervonen
- Cancer Institute NSW, Alexandria, New South Wales, Australia
| | - Lorraine Shack
- Cancer Control Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Ryan R Woods
- BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Nathalie Saint-Jacques
- Registry & Analytics, Nova Scotia Health Authority Cancer Care Program, Halifax, Nova Scotia, Canada
| | - Prithwish De
- Surveillance and Cancer Registry, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Carol McClure
- PEI Cancer Registry, Charlottetown, Prince Edward Island, Canada
| | - Gerda Engholm
- Cancer Prevention & Documentation, Danish Cancer Society, Copenhagen, Denmark
| | - Anna T Gavin
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | - Eileen Morgan
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | | | | | - Geoff Porter
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Bjorn Møller
- Institute of Population-Based Cancer Research, Cancer Registry of Norway, Oslo, Norway
| | - Oliver Bucher
- Population Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Eden
- National Cancer Registry and Analysis Service, London, UK
| | - Dianne L O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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Harris M, Brekke M, Dinant GJ, Esteva M, Hoffman R, Marzo-Castillejo M, Murchie P, Neves AL, Smyrnakis E, Vedsted P, Aubin-Auger I, Azuri J, Buczkowski K, Buono N, Foreva G, Babić SG, Jacob E, Koskela T, Petek D, Šter MP, Puia A, Sawicka-Powierza J, Streit S, Thulesius H, Weltermann B, Taylor G. Primary care practitioners' diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries. BMJ Open 2020; 10:e035678. [PMID: 33130560 PMCID: PMC7783622 DOI: 10.1136/bmjopen-2019-035678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Cancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different healthcare systems influence primary care practitioners' (PCPs) referral decisions in patients who could have cancer.This study aimed to explore PCPs' diagnostic actions (whether or not they perform a key diagnostic test and/or refer to a specialist) in patients with symptoms that could be due to cancer and how they vary across European countries. DESIGN A primary care survey. PCPs were given vignettes describing patients with symptoms that could indicate cancer and asked how they would manage these patients. The likelihood of taking immediate diagnostic action (a diagnostic test and/or referral) in the different participating countries was analysed. Comparisons between the likelihood of taking immediate diagnostic action and physician characteristics were calculated. SETTING Centres in 20 European countries with widely varying cancer survival rates. PARTICIPANTS A total of 2086 PCPs answered the survey question, with a median of 72 PCPs per country. RESULTS PCPs' likelihood of immediate diagnostic action at the first consultation varied from 50% to 82% between countries. PCPs who were more experienced were more likely to take immediate diagnostic action than their peers. CONCLUSION When given vignettes of patients with a low but significant possibility of cancer, more than half of PCPs across Europe would take diagnostic action, most often by ordering diagnostic tests. However, there are substantial between-country variations.
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Affiliation(s)
- Michael Harris
- Department for Health, University of Bath, Bath, Somerset, UK
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Mette Brekke
- Department of General Practice and General Practice Research Unit, University of Oslo, Oslo, Norway
| | - Geert-Jan Dinant
- Department of General Practice, Maastricht University, Maastricht, The Netherlands
| | - Magdalena Esteva
- Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Illes Balears, Spain
| | - Robert Hoffman
- Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Peter Murchie
- Division of Applied Health Science, University of Aberdeen, Aberdeen, UK
| | - Ana Luísa Neves
- Centre for Health Policy, Imperial College London, London, UK
- Centre for Health Technology and Services Research, Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Peter Vedsted
- Research Unit for General Practice, University of Aarhus, Aarhus, Denmark
| | - Isabelle Aubin-Auger
- Department of General Practice, Université Paris Diderot, Paris, Île-de-France, France
| | - Joseph Azuri
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Krzysztof Buczkowski
- Department of Family Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Nicola Buono
- Department of Family Medicine, National Society of Medical Education in General Practice (SNaMID), Prata Sannita, Italy
| | | | | | - Eva Jacob
- Primary Health Centre, Centro de Saúde Sarria, Sarria, Lugo, Spain
| | - Tuomas Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Davorina Petek
- Department of Family Medicine, Univerza v Ljubljani, Ljubljana, Slovenia
| | - Marija Petek Šter
- Department of Family Medicine, Univerza v Ljubljani, Ljubljana, Slovenia
| | - Aida Puia
- Family Medicine Department, Iuliu Hagieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | | | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Hans Thulesius
- Department of Research and Development, Lund University, Malmö, Sweden
| | - Birgitta Weltermann
- Institut für Hausarztmedizin, University of Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Gordon Taylor
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
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Sarma EA, Quaife SL, Rendle KA, Kobrin SC. Negative cancer beliefs: Socioeconomic differences from the awareness and beliefs about cancer survey. Psychooncology 2020; 30:471-477. [PMID: 33064857 DOI: 10.1002/pon.5573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Socioeconomic gaps in cancer mortality may be driven partially by poorer uptake of early detection behaviors among lower socioeconomic status (SES) groups. Lower SES groups may hold both fewer positive and more negative cancer beliefs that discourage these behaviors. We examined SES differences in positive and negative cancer beliefs in US adults. METHODS We conducted telephone interviews with a population-representative sample, aged 50+, using the Awareness and Beliefs about Cancer instrument (N = 1425). Cancer beliefs were measured using three positively and three negatively framed items. We used multivariable logistic regression models to examine associations between beliefs and education, which served as a marker of individual-level SES. RESULTS Agreement with positive statements was high (>80%) and did not vary with education, while agreement with negative statements varied. Relative to adults with a bachelor's degree, adults with a high school degree or less were more likely to agree that "treatment is worse than cancer" (45.2% vs. 68.2%; adjusted odds ratio (aOR) = 2.43, 99% CI = 1.50-3.94), cancer is "a death sentence" (17.4% vs. 33.2%; aOR = 2.51, 99% CI = 1.45-4.37), and they "would not want to know if I have cancer" (15.7% vs. 31.6%; aOR = 2.88, 99% CI = 1.54-5.36). CONCLUSIONS Positive cancer statements were generally endorsed, but negative statements were more frequently endorsed by lower SES groups. Additional work is needed to understand how negative beliefs develop and coexist alongside positive beliefs. Interventions to improve detection behaviors targeting lower SES groups may benefit from focusing on reducing negative beliefs, rather than increasing positive beliefs.
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Affiliation(s)
- Elizabeth A Sarma
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA.,Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
| | - Samantha L Quaife
- Department of Behavioral Science and Health, University College London, London, England
| | - Katharine A Rendle
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah C Kobrin
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
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Al-Azri M, Al-Hinai AS, Al-Ghafri MH, Panchatcharam SM. Knowledge and Awareness of Prostate Cancer Among Omani Men Attending a Teaching Hospital. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:1002-1010. [PMID: 31154637 DOI: 10.1007/s13187-019-01556-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Prostate cancer is ranked as the fourth most prevalent cancer in the world and the second most common cancer affecting men. In Oman, prostate cancer is one of the most common cancers among men, with the majority of prostate cancer patients presenting in the more advanced stages of the disease. Public awareness of the risk factors, symptoms and emphasising the importance of seeking early medical attention could help to improve the outcomes and survival rates of prostate cancer patients. The aim of this study is to determine the awareness levels of the risk factors, symptoms and barriers to seeking early medical intervention among adult Omani men. A validated questionnaire measuring the knowledge of risk factors, symptoms and barriers to seeking early medical help was used to collect data from adult Omani men attending a teaching hospital in Muscat, Oman. Out of 720 men who were invited, 600 participated in the study (response rate = 83%). The most recognised risk factor was obesity (366; 61.0%), and the least was sexually transmitted diseases (204; 34.0%); the most recognised symptom was unexplained weight loss (26.5%), the least was changes in seminal fluid (13.3%); the most common barrier to seeking early intervention was "not trusting the medical knowledge of the doctors" (57.5%), the least was "difficulty in arranging transport" (19.5%). Age, education level, marital status and family history of cancer were significantly associated with the participants' knowledge of prostate cancer. Participants received a significant part of their prostate cancer awareness via the social media. National awareness campaigns using social media and information leaflets are needed to educate Omani men on prostate cancer awareness and prevention and to increase trust in the expertise of medical professionals. Further research exploring the barriers to seeking early medical intervention is needed.
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Affiliation(s)
- Mohammed Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
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Kaushal A, Waller J, von Wagner C, Kummer S, Whitaker K, Puri A, Lyratzopoulos G, Renzi C. The role of chronic conditions in influencing symptom attribution and anticipated help-seeking for potential lung cancer symptoms: a vignette-based study. BJGP Open 2020; 4:bjgpopen20X101086. [PMID: 32816742 PMCID: PMC7606154 DOI: 10.3399/bjgpopen20x101086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/07/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Very little is known about the influence of chronic conditions on symptom attribution and help-seeking for potential cancer symptoms. AIM To determine if symptom attribution and anticipated help-seeking for potential lung cancer symptoms is influenced by pre-existing respiratory conditions (often referred to as comorbidity), such as asthma or chronic obstructive pulmonary disease (COPD). DESIGN & SETTING A total of 2143 adults (1081 with and 1062 without a respiratory condition) took part in an online vignette survey. METHOD The vignette described potential lung cancer symptoms (persistent cough and breathlessness) after which questions were asked on symptom attribution and anticipated help-seeking. RESULTS Attribution of symptoms to cancer was similar in participants with and without respiratory conditions (21.5% and 22.1%, respectively). Participants with respiratory conditions, compared with those without, were more likely to attribute the new or changing cough and breathlessness to asthma or COPD (adjusted odds ratio [OR] = 3.64, 95% confidence interval [CI] = 3.02 to 4.39). Overall, 56.5% of participants reported intention to seek help from a GP within 3 weeks if experiencing the potential lung cancer symptoms. Having a respiratory condition increased the odds of prompt help-seeking (OR = 1.25, 95% CI = 1.04 to 1.49). Regular healthcare appointments were associated with higher odds of anticipated help-seeking. CONCLUSION Only one in five participants identified persistent cough and breathlessness as potential cancer symptoms, and half said they would promptly seek help from a GP, indicating scope for promoting help-seeking for new or changing symptoms. Chronic respiratory conditions did not appear to interfere with anticipated help-seeking, which might be explained by regular appointments to manage chronic conditions.
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Affiliation(s)
- Aradhna Kaushal
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Research Department of Behavioural Science and Health, University College London, London, UK
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Sonja Kummer
- Research Department of Behavioural Science and Health, University College London, London, UK
| | | | - Aishwarya Puri
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Georgios Lyratzopoulos
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Cristina Renzi
- Research Department of Behavioural Science and Health, University College London, London, UK
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Espina C, Bauld L, Bonanni B, Brenner H, Brown K, Dillner J, Kampman E, Nilbert M, Vineis P, Weijenberg MP, Cox A, de Kok TM, Fecht D, Mitrou G, Muller DC, Serrano D, Steindorf K, Storm H, Thorat MA, van Duijnhoven F, Weiderpass E, Schüz J. WITHDRAWAL-Administrative Duplicate Publication: The essential role of prevention in reducing the cancer burden in Europe: a commentary from Cancer Prevention Europe. TUMORI JOURNAL 2020; 106:NP2-NP4. [PMID: 31099306 PMCID: PMC7583442 DOI: 10.1177/0300891619851865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/19/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France
| | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH8 9AG, United Kingdom, UK
- Cancer Research UK, 407 St John Street, London EC1V 4AD, UK
| | - Bernardo Bonanni
- European Institute of Oncology, Via Ripamonti, 435 - 20141 Milano, Italy
| | - Hermann Brenner
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Karen Brown
- UK Therapeutic Cancer Prevention Network, Leicester Cancer Research Centre, University of Leicester, Leicester, LE2 7LX, UK
| | - Joakim Dillner
- Karolinska University Laboratory, Karolinska University Hospital, 14186 Stockholm, Sweden
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University, PO Box 17, 6700 AA Wageningen, the Netherlands
| | - Mef Nilbert
- Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Paolo Vineis
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College, Norfolk Place, London W2 1PG, UK
| | - Matty P. Weijenberg
- GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Alison Cox
- Cancer Research UK, 407 St John Street, London EC1V 4AD, UK
| | - Theo M. de Kok
- GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Daniela Fecht
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College, Norfolk Place, London W2 1PG, UK
| | - Giota Mitrou
- World Cancer Research Fund International, London, UK
| | - David C Muller
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College, Norfolk Place, London W2 1PG, UK
| | - Davide Serrano
- European Institute of Oncology, Via Ripamonti, 435 - 20141 Milano, Italy
| | - Karen Steindorf
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Hans Storm
- Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Mangesh A. Thorat
- UK Therapeutic Cancer Prevention Network, Leicester Cancer Research Centre, University of Leicester, Leicester, LE2 7LX, UK
- UK Therapeutic Cancer Prevention Network, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Fränzel van Duijnhoven
- Division of Human Nutrition and Health, Wageningen University, PO Box 17, 6700 AA Wageningen, the Netherlands
| | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC/WHO), 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France
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Understanding the link between health systems and cancer survival: A novel methodological approach using a system-level conceptual model. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2020.100233] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Investigating cancer symptoms in older people: what are the issues and where is the evidence? Br J Gen Pract 2020; 70:321-322. [PMID: 32586799 DOI: 10.3399/bjgp20x710789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Alshammari SA, Alenazi HA, Alshammari HS. Knowledge, attitude and practice towards early screening of colorectal cancer in Riyadh. J Family Med Prim Care 2020; 9:2273-2280. [PMID: 32754487 PMCID: PMC7380819 DOI: 10.4103/jfmpc.jfmpc_290_20] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/14/2020] [Accepted: 04/07/2020] [Indexed: 12/30/2022] Open
Abstract
Background and Aims: Colorectal cancer (CRC) is a common cause of mortality worldwide. It is preventable, treatable when detected early. The aim of this study is to assess knowledge, attitude and practice (KAP) of the participants toward CRC and its early screening, and identify the sources of information on the subjects. Methods: We conducted a cross-sectional study on the people 40y old and above at the primary care clinics at King Saud university medical city (KSUMC) in Riyadh. The estimated sample size was 245 subjects whom we requested to complete a self-administered Arabic questionnaire, which consisted of three parts. These were: 1. Demographic data, 2. KAP toward CRC, its early detection. 3 sources of information of the public about colorectal cancer. Results: A total of 231 subjects participated; (54.5%) were male (mean age = 50.7 ± 9.8). About 47% of the participants heard about cancer screening, and 45% knew that colonoscopy is used for such purposes. Another 24.2% were aware that occult blood in the stool test is a method of early detection of colon cancer. About 40% to 50% of the subjects were knowledgeable about hazardous factors and cautioning symptoms for CRC. Only 6.5% of the subjects did an early screening for CRC, but 82.9% would do it if their doctor advised them to do so. Conclusion: The participant's knowledge and early checkups of CRC are inadequate. They would undergo early screening if their doctors advised them to do so. It is time to develop a national policy for CRC screening involving primary care doctors and utilizing social media to improve people's information.
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Affiliation(s)
- Sulaiman A Alshammari
- Health Promotion and Health Education Research chair, Department of Family and Community Medicine, College of Medicine, King Saud University, Ad Diriyah, Saudi Arabia
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MacArtney JI, Andersen RS, Malmström M, Rasmussen B, Ziebland S. The convivial and the pastoral in patient-doctor relationships: a multi-country study of patient stories of care, choice and medical authority in cancer diagnostic processes. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:844-861. [PMID: 32103515 PMCID: PMC7318254 DOI: 10.1111/1467-9566.13067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Experiences of cancer diagnosis are changing in light of both the increasingly technological-clinical diagnostic processes and the socio-political context in which interpersonal relations take place. This has raised questions about how we might understand patient-doctor relationship marked by asymmetries of knowledge and social capital, but that emphasise patients' empowered choices and individualised care. As part of an interview study of 155 participants with bowel or lung cancer across Denmark, England and Sweden, we explored participants' stories of the decisions made during their cancer diagnostic process. By focusing on the intersections of care, choice and medical authority - a convivial pastoral dynamic - we provide a conceptual analysis of the normative ambivalences in people's stories of their cancer diagnosis. We found that participants drew from care, choice and medical authority to emphasise their relationality and interdependence with their doctors in their stories of their diagnosis. Importantly negotiations of an asymmetrical patient-doctor relationship were part of an on-going realisation of the healthcare processes as a human endeavour. We were therefore able to draw attention to the limitations of dichotomising emancipatory-empowerment discourses and argue for a theorisation of the patient-doctor relationship as a contextually bounded and relationally ambivalent humanity.
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Affiliation(s)
- John I. MacArtney
- Unit of Academic Primary CareWarwick Medical SchoolUniversity of WarwickWarwickUK
| | - Rikke S. Andersen
- Research Centre for Cancer Diagnosis in Primary CareResearch Unit of General Practice & Department of AnthropologyAarhus UniversityAarhusDenmark
| | - Marlene Malmström
- The Institute for Palliative CareLund University and Region SkåneLundSweden
- Lund UniversityDepartment of Health SciencesLundSweden
| | - Birgit Rasmussen
- The Institute for Palliative CareLund University and Region SkåneLundSweden
- Lund UniversityDepartment of Health SciencesLundSweden
| | - Sue Ziebland
- Health Experiences Research GroupNuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
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Jones D, Neal RD, Duffy SRG, Scott SE, Whitaker KL, Brain K. Impact of the COVID-19 pandemic on the symptomatic diagnosis of cancer: the view from primary care. Lancet Oncol 2020; 21:748-750. [PMID: 32359404 PMCID: PMC7251992 DOI: 10.1016/s1470-2045(20)30242-4] [Citation(s) in RCA: 177] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Daniel Jones
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9NL, UK.
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9NL, UK
| | - Sean R G Duffy
- West Yorkshire and Harrogate Cancer Alliance, White Rose House, Wakefield, UK
| | - Suzanne E Scott
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, Guy's Hospital, London, UK
| | | | - Kate Brain
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Schliemann D, Ismail R, Donnelly M, Cardwell CR, Su TT. Cancer symptom and risk factor awareness in Malaysia: findings from a nationwide cross-sectional study. BMC Public Health 2020; 20:464. [PMID: 32252721 PMCID: PMC7137199 DOI: 10.1186/s12889-020-08581-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/25/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Cancer incidence in Malaysia is expected to double by 2040. Understanding cancer awareness is important in order to tailor preventative efforts and reduce the cancer burden. The objective of this research was to assess nationwide awareness about the signs and symptoms as well as risk factors for various cancers in Malaysia and identify socio-demographic factors associated with awareness. METHODS This cross-sectional study was conducted from March-November 2014 in the form of a telephone survey. Participants aged 40 years and above were randomly selected across Malaysia and interviewed using the validated Awareness Beliefs about Cancer (ABC) measurement tool. Linear regression was conducted to test the association between symptom and risk factor recognition and socio-demographic variables. RESULTS A sample of 1895 participants completed the survey. On average, participants recognised 5.8 (SD 3.2) out of 11 symptoms and 7.5 (SD 2.7) out of 12 risk factors. The most commonly recognised symptom was 'lump or swelling' (74.5%) and the most commonly recognised risk factor was 'smoking' (88.7%). Factors associated with prompted awareness were age, ethnicity, education and smoking status. CONCLUSION Recognition of symptom and risk factors for most cancers was relatively low across Malaysia compared to previous studies in high-income countries and to studies conducted in Malaysia. There is a need to conduct regular public health campaigns and interventions designed to improve cancer awareness and knowledge as a first step towards increasing the early detection of cancer.
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Affiliation(s)
- Désirée Schliemann
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen’s University Belfast, Belfast, UK
| | - Roshidi Ismail
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Michael Donnelly
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen’s University Belfast, Belfast, UK
| | - Christopher R. Cardwell
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen’s University Belfast, Belfast, UK
| | - Tin Tin Su
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Cabasag CJ, Butler J, Arnold M, Rutherford M, Bardot A, Ferlay J, Morgan E, Møller B, Gavin A, Norell CH, Harrison S, Saint-Jacques N, Eden M, Rous B, Nordin A, Hanna L, Kwon J, Cohen PA, Altman AD, Shack L, Kozie S, Engholm G, De P, Sykes P, Porter G, Ferguson S, Walsh P, Trevithick R, Tervonen H, O'Connell D, Bray F, Soerjomataram I. Exploring variations in ovarian cancer survival by age and stage (ICBP SurvMark-2): A population-based study. Gynecol Oncol 2020; 157:234-244. [PMID: 32005583 DOI: 10.1016/j.ygyno.2019.12.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/24/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The study aims to evaluate the differences in ovarian cancer survival by age and stage at diagnosis within and across seven high-income countries. METHODS We analyzed data from 58,161 women diagnosed with ovarian cancer during 2010-2014, followed until 31 December 2015, from 21 population-based cancer registries in Australia, Canada, Denmark, Ireland, New Zealand, Norway, and United Kingdom. Comparisons of 1-year and 3-year age- and stage-specific net survival (NS) between countries were performed using the period analysis approach. RESULTS Minor variation in the stage distribution was observed between countries, with most women being diagnosed with 'distant' stage (ranging between 64% in Canada and 71% in Norway). The 3-year all-ages NS ranged from 45 to 57% with Australia (56%) and Norway (57%) demonstrating the highest survival. The proportion of women with 'distant' stage was highest for those aged 65-74 and 75-99 years and varied markedly between countries (range:72-80% and 77-87%, respectively). The oldest age group had the lowest 3-year age-specific survival (20-34%), and women aged 65-74 exhibited the widest variation across countries (3-year NS range: 40-60%). Differences in survival between countries were particularly stark for the oldest age group with 'distant' stage (3-year NS range: 12% in Ireland to 24% in Norway). CONCLUSIONS International variations in ovarian cancer survival by stage exist with the largest differences observed in the oldest age group with advanced disease. This finding endorses further research investigating international differences in access to and quality of treatment, and prevalence of comorbid conditions particularly in older women with advanced disease.
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Affiliation(s)
- Citadel J Cabasag
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France.
| | - John Butler
- Royal Marsden Hospital, Fulham Road, London SW3 6JJ, England, UK
| | - Melina Arnold
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Mark Rutherford
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France; Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Aude Bardot
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Eileen Morgan
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France; Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Bjørn Møller
- Cancer Registry of Norway, Institute of Population-based Cancer Research, P.O. Box 5313, Majorstuen, 0304 Oslo, Norway
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Charles H Norell
- Policy & Information Directorate, Cancer Research UK, London, England, UK
| | - Samantha Harrison
- Policy & Information Directorate, Cancer Research UK, London, England, UK
| | - Nathalie Saint-Jacques
- Nova Scotia Health Authority Cancer Care Program, Registry & Analytics, 1276 South Street, Halifax B3H 2Y9, NS, Canada
| | - Michael Eden
- National Cancer Registrations and Analysis Service, Public Health England, Wellington House, London, UK
| | - Brian Rous
- National Cancer Registrations and Analysis Service, Public Health England, Wellington House, London, UK
| | - Andy Nordin
- East Kent Hospitals University National Health Service Foundation Trust, Kent, England, UK
| | - Louise Hanna
- Velindre University National Health Service Trust, Cardiff, Wales, UK
| | - Janice Kwon
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer, Department of Surgical Oncology, Vancouver, British Columbia, Canada
| | - Paul A Cohen
- University of Western Australia, Division of Obstetrics and Gynaecology, Crawley, Western Australia, Australia; St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Alon D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Lorraine Shack
- Cancer Control Alberta, Alberta Health Services, 2210 2nd Street, SW, Calgary, AB T2S 3C3, Canada
| | - Serena Kozie
- Registry Department, Saskatchewan Cancer Agency, Regina, SK S4W 0G3, Canada
| | - Gerda Engholm
- Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Prithwish De
- Surveillance & Cancer Registry, Cancer Care Ontario, 620 University Ave., Toronto, ON M5G 2L7, Canada
| | - Peter Sykes
- University of Otago, Christchurch, New Zealand
| | - Geoff Porter
- Canadian Partnership Against Cancer, 145 King Street West, Suite 900, Toronto, Ontario M5H 1J8, Canada
| | - Sarah Ferguson
- Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Paul Walsh
- National Cancer Registry Ireland, Cork Airport Business Park, Kinsale Road, Cork T12 CDF7, Ireland
| | - Richard Trevithick
- Western Australia Cancer and Palliative Care Network Policy Unit, Health Networks Branch, Department of Health, Perth, Western Australia, Australia
| | - Hanna Tervonen
- Cancer Institute NSW, PO Box 41, Alexandria NSW 1435, Australia
| | - Dianne O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
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Elshami M, Elshami A, Alshorbassi N, Alkhatib M, Ismail I, Abu-Nemer K, Hana M, Qandeel A, Abdelwahed A, Yazji H, Abuamro H, Matar G, Alsahhar A, Abolamzi A, Baraka O, Elblbessy M, Samra T, Bottcher B. Knowledge level of cancer symptoms and risk factors in the Gaza Strip: a cross-sectional study. BMC Public Health 2020; 20:414. [PMID: 32228661 PMCID: PMC7106782 DOI: 10.1186/s12889-020-08553-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/18/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In low-income settings, cancer is often diagnosed in advanced stages due to late presentation. Good public awareness of cancer signs and symptoms has a positive impact on the time patients take before they present to healthcare professionals. Therefore, this study examined public knowledge of cancer signs and symptoms as well as risk factors in Gaza. METHODS This was a cross-sectional study. Participants were recruited from adult visitors (≥18 years) to governmental hospitals covering all five governorates of Gaza, and adolescent students (15 to 17 years) from 10 high schools in corresponding locations. An Arabic version of the Cancer Awareness Measure (CAM) was completed in a face-to-face interview. It described demographic data and knowledge of: cancer prevalence, age-related risk, signs and symptoms as well as risk factors both in recall and recognition questions. RESULTS Of 3033 participants invited, 2886 completed the CAM (response rate = 95.2%). Adult mean age ± standard deviation was 33.7 ± 11.7 years and that of adolescents was 16.3 ± 0.8 years. Half of the participants (n = 1457, 50.5%) were adolescent (781 females; 53.6%) and 1429 (49.5%) were adult (702 females; 49.1%). About two thirds (n = 1885) thought about cancer as unrelated to age. Only 196 participants (6.8%) identified colorectal cancer as the most common cancer among men. Awareness of cancer signs/symptoms was poor to fair, where 'lump' was most commonly recognized (n = 2227, 77.2%) and 'change of bowel habit' the least (n = 670, 23.2%). Only 217 participants (7.5%) had a good level of recognizing risk factors with 'smoking' being the most identified and 'eating less than five portions of fruits and vegetables a day' the least. There was a higher likelihood for adults to identify most cancer signs/symptoms and risk factors than adolescents, except for recalling 'unexplained pain', 'persistent cough/hoarseness', 'non-healing ulcer', 'smoking', and 'eating less than five portions of fruits and vegetables a day'. CONCLUSION Public awareness of cancer signs/symptoms and risk factors needs to improve to facilitate early presentation and diagnosis in Gaza. Combining the delivery of public campaigns with tailored education to population groups, including the youth, may increase their knowledge and maintain its impact.
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Affiliation(s)
- Mohamedraed Elshami
- Ministry of Health, Gaza, Palestine. .,Harvard Medical School, Boston, MA, USA.
| | - Alaa Elshami
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | | | - Mohammed Alkhatib
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Iyad Ismail
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Khitam Abu-Nemer
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Mustafa Hana
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Ahmed Qandeel
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Ahmed Abdelwahed
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Hamza Yazji
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Hisham Abuamro
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Ghadeer Matar
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Ahmed Alsahhar
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Ahmed Abolamzi
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Obay Baraka
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Mahmood Elblbessy
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Tahani Samra
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Bettina Bottcher
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
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Nwagbara UI, Ginindza TG, Hlongwana KW. Health systems influence on the pathways of care for lung cancer in low- and middle-income countries: a scoping review. Global Health 2020; 16:23. [PMID: 32188467 PMCID: PMC7081618 DOI: 10.1186/s12992-020-00553-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/03/2020] [Indexed: 01/01/2023] Open
Abstract
Background Globally, lung cancer is the most common cancer and cause of cancer-related deaths, responsible for nearly one in five deaths. Many health systems in low- and middle-income countries, including sub-Saharan Africa have weak organizational structure, which results in delayed lead time for lung cancer patient care continuum from diagnosis to palliative care. Aim To map evidence on the health systems issues impacting on the delays in timely lung cancer care continuum from diagnosis to palliative care in LMICs, including sub-Saharan Africa. Methods A scoping review was performed following the method of Arksey and O’Malley. Systematic searches were performed using EBSCOhost platform, a keyword search from the following electronic databases were conducted: PubMed/MEDLINE, Google Scholar, Science Direct, World Health Organization (WHO) library, and grey literature. The screening was guided by the inclusion and exclusion criteria. The quality of the included studies was determined by Mixed Method Appraisal Tool (MMAT). Results A total of 2886 articles were screened, and 236 met the eligibility criteria for this scoping review study. Furthermore, 155 articles were also excluded following abstract screening. Eighty-one articles were selected for full-article screening by two researchers with 10 being selected for independent detailed data extraction for synthesis. These studies were also subjected to methodological quality assessment. All included studies were conducted in LMICs mostly Asia, the Middle East, and Latin America and published between January 2008 and June 2018. The ten included studies described at least one interval in lung cancer care. Conclusions Reducing wait time across this care continuum is needed to improve easy access to healthcare, quality care, survival and patient outcomes, as many patients still face longer wait times for diagnosis and treatment of lung cancer than recommended in several healthcare settings. A multidisciplinary team approach will help to reduce wait time and ensure that all patients receive appropriate care. Interventions are needed to address delays in lung cancer care in LMICs. Health-care providers at all levels of care should be educated and equipped with skills to identify lung cancer symptoms and perform or refer for appropriate diagnostic tests.
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Affiliation(s)
- Ugochinyere I Nwagbara
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4041, South Africa.
| | - Themba G Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Khumbulani W Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4041, South Africa
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