Men, women, gender and cancer

Men's perspectives of caring for a female partner with cancer: A longitudinal narrative study

Increasing evidence on men's involvement in informal, unpaid care has not transferred to the research literature around men's experiences. The aim was to explore the perspectives of men who are caring for a female partner with cancer over 1 year. Longitudinal narrative interviews (n = 22) were conducted with eight men in the UK from 2018 to 2019. Participants were aged from 32 to 76 years old, were all white British and in heterosexual relationships with women diagnosed with a range of cancer types. Interviews were transcribed and then analysed using a structural and performance approach to narrative analysis. We present, across four scenes, a process of change, transition and emotion management as the men were launched into a role that came with new responsibilities and expectations. Our study advances knowledge by highlighting the way that men perform and reflect on their negotiation with masculine discourses while supporting their partner, with implications for policy, research and practice.

Gender Differences in Psychosocial, Religious, and Spiritual Aspects in Coping: A Cross-Sectional Study with Cancer Patients

Background: There is a growing awareness of religiosity and/or spirituality (R/S) as a possible resource in coping with cancer. Gender differences in religious coping have not yet been thoroughly examined. This study aimed to analyze differences in religious coping between men and women with cancer and compare the impact of R/S on anxiety and depression symptoms.

Methods: This cross-sectional study was conducted at the Divisions of Hematology and Oncology of the Medical University of Vienna. In total, 352 patients with a cancer diagnosis, who regarded themselves as religious and/or spiritual, were interviewed at Vienna's university hospital with standardized questionnaires. To answer our research questions, we used the Hospital Anxiety and Depression Scale (HADS), the Benefit Through Spirituality/Religiosity (Benefit) questionnaire, and collected demographic characteristics.

Results: Of 689 cancer patients, 51% (352) regard themselves as religious and/or spiritual. Women with cancer tend toward R/S more significantly (57%) than men (45%). In patients with an R/S belief, women scored higher in almost all items of the Benefit questionnaire and showed higher prevalence of anxiety (p < 0.001) and depression than men. Regarding the socioeconomic characteristics, more women were widowed, and had significantly lower income than men.

Conclusions: The results show a significant gender gap concerning the importance of R/S for cancer patients and the effect on psychological well-being.

Women in this study were more religious/spiritual than men and scored higher on anxiety and depression. We support the notion that the gender perspective is essential and can contribute to better patient care in identifying gender-specific concerns.

Awkward Choreographies from Cancer's Margins: Incommensurabilities of Biographical and Biomedical Knowledge in Sexual and/or Gender Minority Cancer Patients' Treatment

Canadian and American population-based research concerning sexual and/or gender minority populations provides evidence of persistent breast and gynecologic cancer-related health disparities and knowledge divides. The Cancer's Margins research investigates the complex intersections of sexual and/or gender marginality and incommensurabilities and improvisation in engagements with biographical and biomedical cancer knowledge. The study examines how sexuality and gender are intersectionally constitutive of complex biopolitical mappings of cancer health knowledge that shape knowledge access and its mobilization in health and treatment decision-making. Interviews were conducted with a diverse group (n=81) of sexual and/or gender minority breast or gynecologic cancer patients. The LGBQ//T2 cancer patient narratives we have analyzed document in fine grain detail how it is that sexual and/or gender minority cancer patients punctuate the otherwise lockstep assemblage of their cancer treatment decision-making with a persistent engagement in creative attempts to resist, thwart and otherwise manage the possibility of discrimination and likewise, the probability of institutional erasure in care settings. Our findings illustrate the demands that cancer places on LGBQ//T2 patients to choreograph access to, and mobilization of knowledge and care, across significantly distinct and sometimes incommensurable systems of knowledge.

Social Support of Male Breast Cancer Patients-a Mixed-Methods Analysis

The aim of this study is to explore the social support of male breast cancer patients (MBCP) in Germany. In particular, three aspects of social support focus on (a) the used resources within the social environment, (b) the received support, and (c) the differences of used social support between MBCP. A mixed-methods design is applied including data of qualitative interviews (N = 27 MBCP) and a written questionnaire (N = 100 MBCP). MBCP use different resources of support from their social environment like partners, family, friends, colleagues, other breast cancer patients, and medical experts. Mostly, MBCP receive emotional and informational support. They often receive emotional support from their partners and informational support from medical experts. Different types of social support usage can be identified dependent on age, occupation, and severity of disease. The older the patients and the less the disease severity, the less social support MBCP use. Within cancer care, partners and the closer social environment should be included more as they are a key resource for MBCP. As health-care professions might also be an important resource of support for MBCP, further research should examine this resource.

What does an oncology social worker deal with in patient consultations? - An empirical study

The oncology social worker is a core profession in the psychosocial care of cancer patients, and has been scrutinised according to its role, function, and delivery of care, primarily from an Anglo-Saxon perspective. There is, however, a lack of studies outside this context, and empirical studies based on individual data. This study is a contribution by exploring the variability in clinical practice from a Swedish perspective. It is based on documentation from one oncology social worker's (OSW's) patient contacts over the course of one year. The essence of the majority of contacts was counseling and the patients displayed a wide variety of motives for seeing an OSW. The function of the OSW is thus multifaceted, and the findings suggest that the OSW, in addition to guiding patients in social legislation issues, also should be prepared to act as an anchor in an acute crisis, contain despair in different phases of the trajectory, and facilitate the 'carrying on as before' or finding a 'new normal'. The paper discusses the importance of the OSW being acquainted with different counseling/psychotherapy perspectives in the illness context, but primarily the importance of having the ability to establish a 'working alliance' with their patients.

The Relevance of Gender in Tumor-Influencing Epigenetic Traits

Tumorigenesis as well as the molecular orchestration of cancer progression are very complex mechanisms that comprise numerous elements of influence and regulation. Today, many of the major concepts are well described and a basic understanding of a tumor's fine-tuning is given. Throughout the last decade epigenetics has been featured in cancer research and it is now clear that the underlying mechanisms, especially DNA and histone modifications, are important regulators of carcinogenesis and tumor progression. Another key regulator, which is well known but has been neglected in scientific approaches as well as molecular diagnostics and, consequently, treatment conceptualization for a long time, is the subtle influence patient gender has on molecular processes. Naturally, this is greatly based on hormonal differences, but from an epigenetic point of view, the diverse susceptibility to stress and environmental influences is of prime interest. In this review we present the current view on which and how epigenetic modifications, emphasizing DNA methylation, regulate various tumor diseases. It is our aim to elucidate gender and epigenetics and their interconnectedness, which will contribute to understanding of the prospect molecular orchestration of cancer in individual tumors.

Next of kin's motives for psychosocial consultation-Oncology social workers' perceptions of 54 next of kin cases

OBJECTIVE

Although oncology social workers (OSWs) have emerged as a core profession in the provision of psychosocial services, there is a lack of empirical studies that describe their daily clinical work with next of kin (NOK). The overall aim of this study was to explore NOK's motives for consulting an OSW. This can provide us with insights into what types of skills OSWs need to have in order to fulfil their duties.

METHODS

From a nationwide survey, we used data from 54 NOK cases that Swedish OSWs met face to face.

RESULTS

About half of the motives concerned help in dealing with personal grief connected to the patients' cancer and distressing symptoms, while the other half concerned needs for help in dealing with the position of being the NOK, relationship conflicts, and assistance with socio-economic issues.

CONCLUSIONS

The motives show that NOK does not just ask for help to come to terms with distress related to the patient's situation. Based on the diversity of motives, we suggest that OSWs (at least in Sweden) need a broad education in counselling psychology. Furthermore, health care personnel need to be attentive to the NOK's own voice and not reduce it to the voice of the patient and the patient's needs in referrals.

Men's Mental Health: Social Determinants and Implications for Services

Numerous scholars have stated that there is a silent crisis in men's mental health. In this article, we aim to provide an overview of core issues in the field of men's mental health, including a discussion of key social determinants as well as implications for mental health services. Firstly, we review the basic epidemiology of mental disorders with a high incidence and prevalence in men, including suicide and substance use disorder. Secondly, we examine controversies around the low reported rates of depression in men, discussing possible measurement and reporting biases. Thirdly, we explore common risk factors and social determinants that may explain higher rates of certain mental health outcomes in men. This includes a discussion of 1) occupational and employment issues; 2) family issues and divorce; 3) adverse childhood experience; and 4) other life transitions, notably parenthood. Fourthly, we document and analyze low rates of mental health service utilization in men. This includes a consideration of the role of dominant notions of masculinity (such as stubbornness and self-reliance) in deterring service utilization. Fifthly, we note that some discourse on the role of masculinity contains much "victim blaming," often adopting a reproachful deficit-based model. We argue that this can deflect attention away from social determinants as well as issues within the mental health system, such as claims that it is "feminized" and unresponsive to men's needs. We conclude by calling for a multipronged public health-inspired approach to improve men's mental health, involving concerted action at the individual, health services, and societal levels.

Representations of Young Cancer Survivorship: A Discourse Analysis of Online Presentations of Self

BACKGROUND

More young people are surviving treatment for cancer than ever before. Survival can have an adverse impact on their transition to adulthood. Discourses of cancer are applied to cancer survivors of all ages, but they manifest differently for young people.

OBJECTIVE

The aim of this study was to describe practices of self-representation in an online Web site that supports young Australian cancer survivors.

METHOD

We conducted a discourse analysis of images and text produced by young cancer survivors (aged 18-35 years) on a public cancer charity Web site.

RESULTS

The dominant subject position of participants published on this web site is one of empowered, beautiful cancer survivor. This applies to young people who have learned to embrace their cancer as providing a positive influence on their lives. However, this discourse can marginalize those whose cancer experience remains a source of distress or shame.

CONCLUSION

Web based media can provide a valuable forum for some young people to celebrate their cancer survival and to affirm the constructive influence that their cancer experience has had on their lives. However, we ponder the apparent unsuitability of some forums for young cancer survivors who have not yet found cause for celebration.

IMPLICATIONS FOR PRACTICE

Nurses have the opportunity to contribute to the development of supportive structures that meet the specific needs of different groups of young cancer survivors. This might mean assisting young cancer survivors who are struggling to find meaning in their cancer experience to negotiate the establishment of a new normal that they can embrace.

Ambiguity in a masculine world: Being a BRCA1/2 mutation carrier and a man with prostate cancer

OBJECTIVE

Increased risk of prostate cancer (PCa) is observed in men with BRCA1/BRCA2 mutations. Sex and gender are key determinants of health and disease although unequal care exists between the sexes. Stereotypical male attitudes are shown to lead to poor health outcomes.

METHODS

Men with BRCA1/2 mutations and diagnosed with PCa were identified and invited to participate in a qualitative interview study. Data were analysed using a framework approach. "Masculinity theory" was used to report the impact of having both a BRCA1/2 mutation and PCa.

RESULTS

Eleven of 15 eligible men were interviewed. The umbrella concept of "Ambiguity in a Masculine World" was evident. Men's responses often matched those of women in a genetic context. Men's BRCA experience was described, as "on the back burner" but "a bonus" enabling familial detection and early diagnosis of PCa. Embodiment of PCa took precedence as men revealed stereotypical "ideal" masculine responses such as stoicism and control while creating new "masculinities" when faced with the vicissitudes of having 2 gendered conditions.

CONCLUSION

Health workers are urged to take a reflexive approach, void of masculine ideals, a belief in which obfuscates men's experience. Research is required regarding men's support needs in the name of equality of care.

Exploring Nursing Values in the Development of a Nurse-Led Service

This article considers the development of nurse-led services as a part of a pilot study and explores the therapeutic nature of the role of the nurse. In particular it suggests a need for reconsideration of the fundamental values of nurse-led care in the context of changing organizational culture. Within the UK there has been pressure from policy makers to extend the role of the specialist nurse and create new nursing roles, shifting the boundaries between professional health groups. The philosophy of nurse-led initiatives has therefore been driven mainly from a service redesign and clinical need standpoint rather than necessarily focusing on enhancing patients’ experience and the changes in organizational culture required to achieve this. While several studies have focused on the safety, comparative cost and comparative patient outcomes in nurse-led care in relation to traditional or doctor-led care, little attention has been given to the changing organizational values underlying the nursing role. Exploring this context is essential if new nursing roles are to provide more than relief for bottlenecks in the system and also meet their potential for providing patient centred and innovative models of care.

Interpersonal complaints regarding cancer care through a gender lens

Purpose

– The purpose of this paper is to investigate healthcare customer complaints concerning interpersonal matters in cancer care.

Design/methodology/approach

– Complaints from cancer patients and their relatives (n=116) that dealt with interpersonal matters registered between 2009 and 2011 at four local Patients’ Advisory Committees in Western Sweden were sampled and analyzed using qualitative content analysis.

Findings

– Complaints concerned lack of information and consideration from healthcare providers. Lack of empathy and civility also caused dissatisfaction, the latter particularly for women. Relatives complained that they did not feel included in the care process or were not offered proper support. Most complaints by relatives were filed by a female relative and concerned a male patient.

Research limitations/implications

– Information about patient demographics other than gender could not be investigated due to database limitations. Hence, factors such as age, country of birth, and geographical residence were not included for analysis. In addition, neither the type nor stage of cancer among the sampled patients was able to be addressed.

Practical implications

– Patient complaints should not only be viewed as a post-consumption judgment, but also as a service interaction activity. This may require healthcare providers to enhance their interpersonal skills, allowing patients and relatives to provide feedback during service interaction to satisfactorily address dissatisfaction. Visualizing gender disparities may help healthcare providers prevent stereotypical encounters. In addition, the provider should be invited to participate in the customer’s value creating network, which may also include knowledge and skills from other sources, such as relatives.

Originality/value

– Value co-creation offers a different view on patient complaints. Incorporating social construction into value co-creation may reveal socially constructed disparities. The paper provides aggregated information on cancer patients’ and relatives’ complaints concerning interpersonal issues, which can increase knowledge about patient healthcare service perceptions.

Understanding male cancer patients' barriers to participating in cancer rehabilitation

The aim was to describe male cancer survivors' barriers towards participation in cancer rehabilitation as a means to guiding future targeted men's cancer rehabilitation. Symbolic Interactionism along with the interpretive descriptive methodology guided the study of 35 male cancer survivors representing seven cancer types. Data were generated through a 5-month fieldwork study comprising participant observations, semi-structured individual interviews and informal conversations. The analyses revealed two overarching findings shedding light on male cancer survivors' barriers to rehabilitation: 'Fear of losing control' and 'Striving for normality'. While 'Fear of losing control' signified what the men believed rehabilitation would invoke: 'Reduced manliness', 'Sympathy and dependency' and 'Confrontation with death', 'Striving for normality' was based on what the men believed rehabilitation would hinder: 'Autonomy and purpose', 'Solidarity and fellowship' and 'Forget and move on'. This study of male cancer survivors' and cancer rehabilitation documents how masculine ideals may constitute barriers for participation in rehabilitation and provides insights about why men are underrepresented in rehabilitation. The findings can guide practice to develop research-based rehabilitation approaches focused on preserving control and normality. Further empirical evidence is needed to: (1) explore the conduct of health professionals' towards male cancer patients and (2) address gender inequalities in cancer rehabilitation.

Impact of Radiotherapy When Added to Androgen-Deprivation Therapy for Locally Advanced Prostate Cancer: Long-Term Quality-of-Life Outcomes From the NCIC CTG PR3/MRC PR07 Randomized Trial

PURPOSE

The NCIC CTG PR3/MRC PR07 randomized phase III trial compared androgen-deprivation therapy (ADT) alone versus ADT with radiotherapy (RT) for patients with locally advanced prostate cancer. This article reports the health-related quality-of-life (HRQOL) outcomes of this trial.

PATIENTS AND METHODS

A total of 1,205 patients were randomly allocated to either ADT alone or ADT with RT. HRQOL was assessed at baseline and every 6 months thereafter using the European Organisation for Research and Treatment of Cancer Core Questionnaire and a prostate cancer-specific checklist or the Functional Assessment of Cancer Therapy-Prostate questionnaire. Mean changes from baseline scores for five function domains and nine symptom domains were analyzed as those most relevant to ADT and RT. The proportions of patients with improved, stable, or worsened HRQOL scores according to instrument-specific minimal important differences were calculated.

RESULTS

Baseline questionnaires were completed by 1,028 patients (88%). At 6 months, RT had a statistically significant impact on mean score for bowel symptoms (P = .02), diarrhea (P < .001), urinary function (P = .003), and erectile dysfunction (P = .008); by 3 years, however, there were no significant between-group differences in any domain. Generalized linear mixed modeling revealed no significant between-arm differences in any of the function scales but showed significant deterioration in both arms over time for Functional Assessment of Cancer Therapy-Prostate total score, treatment outcome index, and physical and functional well-being.

CONCLUSION

The addition of RT to ADT for patients with locally advanced prostate cancer significantly improved overall survival and had only modest and transient negative impact on relevant domains of HRQOL.

Psychosocial Oncology Supports for Men: A Scoping Review and Recommendations

Although men's cancer experiences have received limited attention within the field of psychosocial oncology, increasing attention is being devoted to the development and evaluation of men-centered programs. This scoping review describes this emergent body of literature, detailing the focus, participation, and impact of interventions designed to help men with cancer build illness-specific knowledge, adapt to illness, manage side effects, distress, and uncertainty, sustain relationships, and more. Striving to build on existing knowledge, research gaps and opportunities are discussed, including a need for stronger methodologies, more tailored and targeted supports, attention to the experiences of men with nonprostate cancers, and the explicit integration of gender analyses in the research process.

Australian men with cancer practice complementary therapies (CTs) as a coping strategy

OBJECTIVE

The aim of this study was to explore how and why Australian men with cancer practice complementary therapies (CTs) and how their significant others (SOs) contribute to the regular uptake of CTs.

METHODS

This qualitative study employed semi-structured interviews with 26 male cancer patients and 24 SOs. Participants were purposefully sampled from a preceding Australian survey investigating the use of CTs in men with cancer (94% response rate and 86% consent rate for follow-up interview). Interviews were conducted in a metropolitan location, and the 43 interview transcripts were analyzed thematically.

RESULTS

Three core themes were identified: men used CTs as (a) problem-focused coping (e.g., diet modification), (b) emotion-focused coping (e.g., meditation), and (c) meaning-based coping (e.g., prayer). Practicing CTs helped men to cope with physical, emotional, and spiritual concerns, although some men spoke of difficulties with practicing meditation to regulate their emotions. SOs were supportive of men's coping strategies but were only rarely involved in men's emotion-focused coping.

CONCLUSIONS

Complementary therapies have the potential to facilitate coping with cancer, independent of any measurable physiological benefit. Our findings suggest that when clinicians engage in conversations about CTs use, they should consider the type of coping strategy employed by their patient. Such information may enhance the efficacy of some interventions (e.g., meditation) and also provide for an opportunity to discuss patients' expectations concerning CTs.

Men managing cancer: a gender analysis

As researchers consider gendered patterns in men's prostate cancer experiences, little attention has been devoted to how men manage 'cancer', more generally. Drawing on the experiences of 30 Canadian men with a variety of cancer types, this article details how men engaged illness self-management and help-seeking activities with lay and professional support persons. Results indicate three broad responsive strategies: fortifying resources, maintaining the familiar, and getting through. In these pursuits, the participants drew on a variety of performances to respond to social contexts demanding that men embody masculine ideals including strength, control, and stoicism. Considering gendered dynamics in how men manage the challenges of cancer, this article broadens understandings about men's cancer experiences by highlighting the drivers orienting participants' responsive efforts and challenging assumptions of help-seeking as essentially problematic for men in Western society.

The role of complementary and alternative medicine (CAM) routines and rituals in men with cancer and their significant others (SOs): a qualitative investigation

PURPOSE

Complementary and alternative medicine (CAM) is frequently used in cancer patients, often with contribution of the significant others (SOs), but without consultation of healthcare professionals. This research explored how cancer patients integrate and maintain CAM use in their everyday life, and how SOs are involved in it.

METHODS

In this qualitative study, male participants were selected from a preceding Australian survey on CAM use in men with cancer (94 % response rate and 86 % consent rate for follow-up interview). Semistructured interviews were conducted with 26 men and 24 SOs until data saturation was reached. Interview transcripts were coded and analyzed thematically, thereby paying close attention to participants' language in use.

RESULTS

A major theme associated with high CAM use was "CAM routines and rituals," as it was identified that men with cancer practiced CAM as (1) functional routines, (2) meaningful rituals, and (3) mental/spiritual routines or/and rituals. Regular CAM use was associated with intrapersonal and interpersonal benefits: CAM routines provided men with certainty and control, and CAM rituals functioned for cancer patients and their SOs as a means to create meaning, thereby working to counter fear and uncertainty consequent upon a diagnosis of cancer. SOs contributed most to men's uptake and maintenance of dietary-based CAM in ritualistic form resulting in interpersonal bonding and enhanced closeness.

CONCLUSIONS

CAM routines and rituals constitute key elements in cancer patients' regular and satisfied CAM use, and they promote familial strengthening. Clinicians and physicians can convey these benefits to patient consultations, further promoting the safe and effective use of CAM.

Men's reflections on participating in cancer rehabilitation: a systematic review of qualitative studies 2000-2013

This paper aims to report on a systematic review of qualitative studies on men's reflections on participating in cancer rehabilitation. Nine databases were systematically searched to identify qualitative papers published between 2000 and 2013. Papers were selected by pre-defined inclusion criteria and subsequently critically appraised. Key themes were extracted and synthesised. Fifteen papers were selected and represented. Four central themes were identified in the analytical process: 'changed life perspective', 'the masculinity factor', 'a desire to get back to normal' and 'the meaning of work'. Six peripheral themes were identified: 'the meaning of context', 'music', 'physical training', 'religion', 'humour' and 'the unmentionable'. The themes were synthesised into an integrative model representing men's reflections on participating in cancer rehabilitation. We conclude that existing qualitative literature offers insight into men's reflections on cancer rehabilitation and highlights the interrelationship between men's reflections on their changed life perspective, masculinity, orientation towards a normal life and getting back to work. Further research-based knowledge is needed to explore (1) the underlying causes and patterns of the men's needs, preferences and choices in rehabilitation; and (2) the health professional perspective on male cancer rehabilitation.

'Living under assault': men making sense of cancer

In accepting illness as a subjective experience, there is value in examining how individuals perceive, interpret and understand its challenges, knowledge critical to understanding patterns of response. Although researchers have considered how prostate cancer can challenge 'embodied masculinities' few studies have considered gendered dynamics in men's cancer experiences more broadly. This article helps attends to this gap by examining how men with a variety of cancers made sense of the challenges of their illness. The results, part of a grounded theory study including 30 Canadian adult men, highlight how the men perceived a troubled future and a discordant present, a profound sense of uncertainty, and feelings of isolation. These patterns, infused with societal expectations for male bodies and lives, move beyond the particular needs varying by medical, demographic and situational diversities. More specifically, they are recognised as consistent with a 'biographical disruption' or an ongoing problematic situation destabilising how the men made sense of their individual selves and the world around them. Focused on commonalities and considerate of diversities, findings are reviewed in relation to existing work on illness and gender identity and work specific to men with cancer. Implications are discussed.

Moving Beyond the Prostate

As researchers recognize the value in considering gender dynamics within the cancer experience, a majority of the masculinities work has centered on men with prostate cancer. This focus has positioned prostate cancer as the flagship of men’s cancer (and perhaps men’s health). There is value in this research. However, as 78% of men experience cancers of a different type, a narrow focus on prostate cancer does not necessarily account for broader intersections of cancer and masculinity. Argued here are the benefits to expanding the focus of research on men’s cancer experiences. As researchers consider patterns and diversities among men managing an array of cancers, there is opportunity to broaden understanding of the challenges “cancer” can present for men, disrupt assumptions that the study of men’s gendered experience of cancer must be tethered to male sex–specific biology, and enhance the relevance and impact of psychosocial interventions for men living with cancer.

Close ties: an exploratory Colored Eco-Genetic Relationship Map (CEGRM) study of social connections of men in Familial Testicular Cancer (FTC) families

BACKGROUND

Testicular cancer, while rare compared with other adult solid tumors, is the most common cancer in young men in northern Europe and North America. Risk factors include white race, positive family history, contralateral testicular cancer, cryptorchidism, infertility and testicular microlithiasis. As the genetic causes of familial clusters (Familial Testicular Cancer or FTC) are being sought, it is also important to understand the psycho-social experiences of members of FTC families.

METHODS

This is a cross-sectional examination via the Colored Eco-Genetic Relationship Map (CEGRM) of social connections reported by 49 men in FTC families participating in NCI research study 02-C-178.

RESULTS

The CEGRM was acceptable and feasible for use with men in FTC families, and valuable in understanding their social connections. These men have largely adjusted to the TC history in themselves and/or their relatives. They have considerable social and emotional support from family and friends, although there is wide variability in sources and types.

CONCLUSIONS

The CEGRM focuses on men's social connections and close emotional bonds in FTC families. This action-oriented process of placing colored symbols on significant relationships uncovered previously under-appreciated emotions accompanying men's social exchanges. Most men in FTC families succeed in re-establishing a sense of normalcy in their lives and social connections, in the aftermath of a testicular cancer diagnosis.

Unpacking the blockers: understanding perceptions and social constraints of health communication in hereditary breast ovarian cancer (HBOC) susceptibility families

Family communication is essential for accurate cancer risk assessment and counseling; family blockers play a role in this communication process. This qualitative analysis of social exchanges is an extension of earlier work characterizing those who are perceived by study participants as health information gatherers, disseminators, and blockers within families with Hereditary Breast and Ovarian Cancer (HBOC) susceptibility. Eighty-nine women, ages 23-56 years, enrolled in a Breast Imaging Study (BIS) and participated in a sub-study utilizing a social assessment tool known as the Colored Ecological Genetic Relational Map (CEGRM). Purposive sampling ensured that participants varied according to numbers of participating family members e.g., ranging from 1 to 6. Eighty-nine women from 42 families (1-8 relatives/family) participated. They collectively designated 65 blockers, both male and female. Situational factors, beliefs, attitudes and cultural traditions, privacy and protectiveness comprised perceived reasons for blocking intra-family health communications. Longitudinal data collected over 4 years showed families where blocking behavior was universally recognized and stable over time, as well as other families where blocking was less consistent. Self-blocking was observed among a significant minority of participating women. Blocking of health communications among family members with HBOC was variable, complex, and multifaceted. The reasons for blocking were heterogeneous; duration of the blocking appeared to depend on the reasons for blocking. Blocking often seemed to involve bi-directional feedback loops, in keeping with Lepore's Social Constraints and Modulation Theory. Privacy and protectiveness predominated as explanations for long-term blocking.

Development and pilot testing of an online screening decision aid for men with a family history of prostate cancer

OBJECTIVE

This study aimed to develop and pilot test an online screening decision aid (DA) for men with a family history of prostate cancer.

METHODS

Eligible men (with no previous prostate cancer diagnosis) were recruited through relatives attending a urology outpatient clinic. Men evaluated the DA in two stages. First, they appraised a paper-based version using a questionnaire (n=22). Second, the same men were asked to reflect on an interactive web-based version via a semi-structured telephone interview (n=20).

RESULTS

Men evaluated both forms of the DA positively. Of the paper-based version, the majority of participants found the DA useful (91%), and that it contained enough information to make a screening decision (73%). All participants reported that the online DA was easy to use and navigate. Most participants reported that a website was their preferred mode of receiving prostate cancer screening information (70%).

CONCLUSION

The developed DA may represent the first online decision-making tool designed specifically for men with a family history prostate cancer that presents age and risk specific information to the user.

PRACTICE IMPLICATIONS

Comprehensive evaluations of the efficacy and impact of educational interventions such as this are crucial to improve services for individuals making informed screening decisions.

Art therapy in psycho-oncology--recruitment of participants and gender differences in usage

PURPOSE

Over the last years, there has been increasing focus on the effect of art therapy for oncological patients. The small sample sizes of these studies show that recruiting participants is difficult and has been poorly investigated. It is also apparent that women participate in art therapy more often than men. The question remains why this difference exists and if participating men benefit from these courses more, less or in a different way than women do.

METHODS

We developed and tested an outpatient art intervention for cancer patients, whereby different recruitment strategies were documented. Participants were questioned about their mental health (HADS), coping strategies (FKV), and quality of life (EORTC QLQ-C30) at the beginning and end of the intervention.

RESULTS

The recruitment strategies included personal letters, referrals from the "Information Center For Cancer Patients", press releases and leaflets/posters distributed to hospitals and medical practices. About half of the participants (N=35), especially the male ones, took part in response to receiving a personal letter. All in all, 14 men and 60 women took part in the intervention whereby all 18 drop-outs were female. There were no significant gender differences regarding distress and quality of life before and after the intervention (men=14; women=41).

CONCLUSIONS

A variety of approaches and intense public relations are necessary to recruit patients for art therapy. Describing recruitment strategies more in detail is suggested for upcoming art therapy studies. First gender specific differences were found in recruitment and usage. Exploring further questions in this area referring to quality of life and distress larger and uniformly distributed samples are desirable.

Understanding how men experience, express and cope with mental distress: where next?

In line with the shift towards prioritising lay accounts and narratives of chronic illness in sociology, there is an emerging literature on men, their subjectivities and experiences of mental distress. We argue in this paper that subjectivities and distress among men are an important area for critical sociological research. Very little is known about men's subjectivities or the meanings they give to - and how they cope with or seek help for - distress. At the same time, current theories of gender relations, performativity and wellbeing as they pertain to men are likely to shed further light on subjectivity and distress. However, current theories (and qualitative research involving men and women) are pointing to considerable complexity. In this paper, we outline what is known about distress and men, and consider the utility of gender relations, performativity, subjectivities and wellbeing for a better understanding of distress. We also ask: What other factors influence distress, and how should these be considered in relation to men and masculinities? What are the implications for research and policy?

Men, food, and prostate cancer: gender influences on men's diets

Although healthy eating might enhance long-term survival, few men with prostate cancer make diet changes to advance their well-being. Men's typically poor diets and uninterest in self-health may impede nutrition interventions and diet change. Food choice behavior is complex involving many determinants, including gender, which can shape men's health practices, diets, and prostate cancer experiences. Developing men-centered prostate cancer nutrition interventions to engage men (and where appropriate their partners) in promoting healthy diets can afford health benefits. This article presents an overview and synthesis of current knowledge about men's food practices and provides an analysis of diet and diet change behaviors for men with prostate cancer. Masculinity and gender relations theory are discussed in the context of men's food practices, and suggestions for future applications to nutrition and prostate cancer research and diet interventions are made.

Disclosing a cancer diagnosis to friends and family: a gendered analysis of young men's and women's experiences

Little is known about how young adults disclose their cancer diagnosis to family and friends, and whether there are similarities or differences between men and women. This article compares young adults' experiences of disclosing a cancer diagnosis, drawing on narrative interviews with 37 respondents aged 18 to 34 years. Most respondents were open about their diagnosis, and there were striking similarities in the difficulties that men and women described and in their desire to protect relatives. However, men made up most of the minority of respondents who were more secretive about their diagnosis. Men also made more explicit connections between their gendered identity and disclosure; worries about being perceived differently by peers resulted in some men hiding their diagnosis and others using humor to pre-empt sympathy. These findings are discussed in the context of gender stereotypes of "expressive" women and "stoical" men.

Development and pilot testing of a decision aid for men considering genetic testing for breast and/or ovarian cancer-related mutations (BRCA1/2)

Despite the fact that both men and women can carry a breast/ovarian cancer-related mutation, the main emphasis in genetic counseling for breast/ovarian cancer-related risk remains on females. This study aimed to develop and pilot a decision aid specifically designed for men with a strong family history of breast and/or ovarian cancer who are considering genetic testing. The decision aid was developed by a multidisciplinary team of experts and a consumer representative. It was then reviewed by 27 men who had previously undergone genetic testing to identify a mutation in a BRCA1 or BRCA2 gene. All men who reviewed the decision aid indicated that they would recommend the booklet to other men in the same situation, and 96% of the sample (n = 26) reported being "very satisfied" or "satisfied" with the information contained in the decision aid. The decision aid was perceived by all participants as "very relevant" or "quite relevant" for men considering genetic testing. Ninety-three percent of men felt that it was easy to weigh the pros and cons of genetic testing with the help of the decision aid. The perceived impact on participants' emotions and understanding of the genetic testing process was also assessed. Several factors may hinder men from effectively weighing up the potential benefits and risks of genetic testing. A greater understanding of these issues may help health professionals to encourage men with a strong family history of breast and/or ovarian cancer to learn about cancer risk and the appropriate management strategies for themselves and their female relatives.

Risk of colorectal cancer in general practice patients presenting with rectal bleeding, change in bowel habit or anaemia

The aim was to use data routinely collected in general practice to assess the absolute risk of colorectal cancer in patients newly presenting to their general practitioner (GP) with relevant symptoms. Three cohorts were identified from patients attending a sample of UK general practices. Patients with new symptoms of rectal bleeding, changes in bowel habit or anaemia were identified, and their incident rate for colorectal cancer and the positive predictive value (PPV) of each symptom in the following 12 months were calculated by age and gender. The total population over the age of 40 years was 2.8 million, and 9143 incident cases of colorectal cancer were identified. A total of 67,164 patients (28% men) were identified with anaemia, 27,524 (40% men) with changes in bowel habit and 44,741 (48% men) with rectal bleeding. For each cohort, the absolute risk rose with increasing age, and men were twice as likely to develop colorectal cancer. The PPV for developing colorectal cancer in the subsequent 12 months in those aged 60-69 years with anaemia was 3.02% for men, 1.38% for women; with changes in bowel habit 6.89% for men, 2.42% for women; and with rectal bleeding was 5.99% for men, 3.50% for women. A combination of any two signs and symptoms doubled the risk of an underlying cancer. In UK general practice, men are less likely to present with symptoms and signs of colorectal cancer compared with women, but after investigation are much more likely to have a colorectal cancer diagnosed. This should be taken into account in guidelines for referral.

Anemia and long-term outcome in adjuvant and neoadjuvant radiochemotherapy of stage II and III rectal adenocarcinoma: The Freiburg experience (1989-2002)

AIM: To evaluate the long-term outcome of standard 5-FU based adjuvant or neoadjuvant radiochemotherapy and to identify the predictive factors, especially anemia before and after radiotherapy as well as hemoglobin increase or decrease during radiotherapy.

METHODS: Two hundred and eighty-six patients with Union International Contre Cancer (UICC) stage II and III rectal adenocarcinomas, who underwent resection by conventional surgical techniques (low anterior or abdominoperineal resection), received either postoperative (n = 233) or preoperative (n = 53) radiochemotherapy from January 1989 until July 2002. Overall survival (OAS), cancer-specific survival (CSS), disease-free survival (DFS), local-relapse-free (LRS) and distant-relapse-free survival (DRS) were evaluated using Kaplan-Meier, Log-rank test and Cox’s proportional hazards as statistical methods. Multivariate analysis was used to identify prognostic factors. Median follow-up time was 8 years.

RESULTS: Anemia before radiochemotherapy was an independent prognostic factor for improved DFS (risk ratio 0.76, P = 0.04) as well as stage, grading, R status (free radial margins), type of surgery, carcinoembryonic antigen (CEA) levels, and gender. The univariate analysis revealed that anemia was associated with impaired LRS (better local control) but with improved DFS. In contrast, hemoglobin decrease during radiotherapy was an independent risk factor for DFS (risk ratio 1.97, P = 0.04). During radiotherapy, only 30.8% of R0-resected patients suffered from hemoglobin decrease compared to 55.6% if R1/2 resection was performed (P = 0.04). The 5-year OAS, CSS, DFS, LRS and DRS were 47.0%, 60.0%, 41.4%, 67.2%, and 84.3%, respectively. Significant differences between preoperative and postoperative radiochemotherapy were not found.

CONCLUSION: Anemia before radiochemotherapy and hemoglobin decrease during radiotherapy have no predictive value for the outcome of rectal cancer. Stage, grading, R status (free radial margins), type of surgery, CEA levels, and gender have predictive value for the outcome of rectal cancer.

Does health status explain gender dissimilarity in healthcare use among older adults?

This study investigates the extent to which gender dissimilarity in healthcare use in later life is explained by variation in health and social-economic statuses. It is based on a nationwide sample in Brazil of 12,757 men and 16,186 women aged 60+ years. Individuals with great difficulties or unable to perform at least one daily living activity and/or to walk 100m were classified as "established disability". Those who had interrupted their activities in the previous 15 days because of a health problem were regarded as "temporarily disabled". The remaining we classified as "healthy". These categories were analyzed by multinomial logistic regression, taking "healthy" as the reference category. Prevalences of established disability were 6% among men and 11% among women. Temporary disabilities were 7.9% and 10.1%, respectively. Poor health status was associated with increased use of healthcare among men and women, but men and women differed significantly in relation to use pattern after adjustment for age, health status, and income. Older women were greater consumers of outpatient services and older men of inpatient care.