Illness Identity and the Self-regulatory Model in Recovery from Early Stage Gynaecological Cancer

Women in recovery from early stage gynaecological cancer have extremely good survival and low recurrence rates. Despite this, women continue to feel vulnerable to cancer recurrence for years after treatment. Semi-structured interviews were utilized to explore the factors involved in recovery from gynaecological cancer. This article argues that the illness identity of gynaecological cancer perpetuates a vulnerability to cancer recurrence. The absence of self-diagnosis prior to medical diagnosis is important in the formation of gynaecological cancer illness identity. A lack of self-diagnosis may be due to the 'normalization' of initial symptomatology. It is suggested that illness identity is responsible for maintaining fears of symptom-free cancer recurrence. The self-regulatory model is employed to explore this process, looking in particular at the reinforcement of reassurance needs.

What are the factors associated with the follow-up preferences of women in long-term remission from gynaecological cancer?

We set out to examine factors associated with follow up preferences of women attending routine hospital follow up after treatment for early stage gynaecological cancer. This was a retrospective cohort study, using hospital records and questionnaire data, and was based in North Staffordshire, UK. Fifty-four women, who had undergone successful treatment for early stage gynaecological cancer and currently attending routine hospital follow up appointments, were studied. Follow-up preferences were established using a specially designed questionnaire. A questionnaire package containing psychological and demographic measures was used. Clinical details including site and stage of disease, treatment and follow-up type were obtained from medical records. There were no significant demographic or clinical differences between the women with preference for hospital follow-up and those women with a preference for discharge. Women with a preference for follow-up were found to have significantly higher anxiety (as measured by the MAC anxiety scale). These results were not found for the other anxiety scales (STAI and HADS). Three predictor variables (MAC anxiety, Education and Car ownership) were found to predict significantly group membership. It is not possible to predict follow-up needs using demographic, clinical or psychological factors. Follow-up needs are achieved through effective medical communication. The role of the specialist nurse is implicated. A larger scale study is necessary to elaborate this preliminary research.

Audit of the views of gynaecological cancer patients regarding follow-up

The purpose of this study was to audit patients opinions on routine follow-up and discharge from the gynaecology clinic. The setting was the gynaecology clinic of a large district general hospital and the design was a cross-sectional audit analysis using a written questionnaire. The subjects were 103 women attending the gynaecological out patients for review following previous treatment for various gynaecological cancers. Ninety patients took part in the study, of these 36 (40%) wished for 'free access', 29 (32%) wished for routine hospital follow-up, and 25 (28%) wished for discharge but with follow-up by their general practitioner. There were no statistically significant differences in choices between cancer groups. The choice of 'free access'seemed to be an important choice for women. We conclude that routine hospital follow-up of women treated for gynaecological cancer is not the desire of the majority and it appears the women may have different inherent psychological characteristics.

Geriatric trauma: resource use and patient outcomes

INTRODUCTION

Elderly patients who suffer trauma have a higher mortality and use disproportionately more trauma resources than younger patients. To compare these 2 groups and determine the outcomes and characteristics of elderly patients, we reviewed patients in these 2 groups admitted and treated in our tertiary care provincial trauma centre.

METHODS

From the provincial trauma registry we selected a cohort of 40 geriatric patients (group 1) (> or = 65 yr of age) with an ISS of 16 or more who were admitted to and spent time in our trauma service for more than 48 hours and compared them with a similar randomly selected cohort of 44 patients (group 2) aged 20-30 years. Family physicians were contacted for follow-up of these patients 2 years after discharge. We considered length of hospital stay, complications, disposition of the patients and use of consultation services.

RESULTS

Patients in group 1 had a mean age of 72.1 years (range from 65-98 yr) and a mean ISS of 27.3 (range from 17-50). Patients in group 2 had a mean age of 26.3 years (range from 22-29 yr) and a mean ISS of 26.3 (range from 17-54). Hospital stay was significantly longer in the group 1: 34.5 days (95% confidence interval [CI]: 24-44 d) versus 21.6 days (95% CI: 15-28 d). More elderly patients experienced complications (35 v. 13, p < 0.001) and required medical consultations (35 v. 26, p < 0.001). In-hospital death rates were 8% (3 of 40) and 4% (2 of 44) respectively (p = 0.3). Fewer geriatric patients could be discharged home (35% [14 of 40] v. 27% [22 of 44], p = 0.056) or to rehabilitation facilities (28% [11 of 40] v. 34% [15 of 44], p = 0.3). Five geriatric patients were discharged to nursing homes (p = 0.007). Of the geriatric patients discharged to rehabilitation facilities or home, 75% were independent 2 years after discharge.

CONCLUSIONS

Aggressive care for geriatric trauma patients is warranted, and resources should be directed toward rehabilitation. Based on our findings, we expect that creating a directed care pathway for these patients, targetting complications and earlier discharge, will further improve their outcomes.

Water-soluble luminal contents of the gut of the earthworm Lumbricus terrestris L. and their physiological significance

In the post-gizzard gut of the earthworm Lumbricus terrestris, distinguishing the functions of the luminal epithelium from those of the chloragogenous tissue has been hindered by the close apposition of these two tissues. Moreover, both tissues may have different functions from the anterior to the posterior of the animal. We analyzed the gut luminal contents of L. terrestris so as to gain a better understanding of the function of the luminal epithelium. The intestine was divided into four regions from anterior to posterior, and the water-soluble portion of the luminal contents of these four regions was analyzed for protease and amylase activity, calcium and ammonium ions, and protein. The same four regions of the gut wall were analyzed for glutamate dehydrogenase (GDH) and serine dehydratase (SDH) to determine their location with reference to the site of ammonia production. We observed high levels of proteases, amylase, protein and calcium ions in the gut luminal contents of the first two regions, and a significant decline of all four variables in region III. Conversely, ammonia was low in the gut contents of regions I and II but rose sharply in region III, which was also the region to which the tissue enzymes GDH and SDH were localized. The ammonia content of earthworm casts was observed to be much higher than that of the surrounding soil. These data are presented as partial evidence for the proposal that the excretory ammonia produced by feeding earthworms is a product of the luminal epithelium of region III of the gut. It is also proposed that ammonia and calcium may function as ion-exchangers in the absorptive function of the earthworm gut.

The experience of long-term hospital follow-up for women who have suffered early stage gynecological cancer: a qualitative interview study

Bradley EJ, Pitts MK, Redman CWE, Calvert E. The experience of long term hospital follow-up for women who have suffered early stage gynecological cancer: a qualitative interview study. The objective of this paper is to investigate the factors involved in the wish for continuing long-term follow-up for early stage gynecological cancer in the absence of obvious clinical benefit. This qualitative study is comprised of semistructured, individual interviews. Twelve women who had been treated for early stage (I-II) gynecological cancer (cervical, vulval, ovarian, endometrial) and had been attending regular follow-up appointments at the hospital clinic for a minimum of six months were interviewed for this study. The primary outcome measures were women's views on their follow-up needs. Women who continue to express a need for follow-up appointments years after the treatment of active disease are seeking to alleviate anxiety regarding possible recurrent illness. The main element of follow-up that alleviates this recurrence anxiety is medical reassurance, this is only judged to be worthwhile when given by a gynecological consultant. There is a difficulty with regarding the period of remission as a healthy state, both cultural "lay" beliefs and family support exacerbate this difficulty. Although family support is deemed important initially, it may actually serve to maintain "sickness" identity, perpetuating views of cancer remission as another stage of illness. We conclude that the processes involved in follow-up for cancers with a very low recurrence risk are complex. Follow-up information is perhaps medical, but women who have a continued need for follow-up in the absence of any clinical disease are attending for psychological purposes. Further research is needed to study possible interventions that could be introduced to help alleviate anxiety during the period of cancer recovery.

Is the provision of information leaflets before colposcopy beneficial? A prospective randomised study

OBJECTIVE

To assess the usefulness of a leaflet distributed to women before colposcopy designed to reduce their anxiety and psychosexual morbidity by providing information.

DESIGN

Prospective randomised study.

SETTING

Colposcopy clinic of a large district general hospital.

SAMPLE

Two hundred consecutive women undergoing colposcopy for the first time for a cervical cytological abnormality of severity no greater than moderate dyskaryosis.

METHODS

Women were randomised into one of two groups (leaflet or control). Those in the leaflet group were sent an information leaflet prior to attending the clinic. In the colposcopy clinic all the women completed a State/Trait Anxiety Inventory (StAI/TrAI) and a modified psychosexual questionnaire before undergoing colposcopy. This was repeated at the six-month follow up visit. Women in the leaflet group also completed a further questionnaire on the leaflet.

MAIN OUTCOME MEASURES

Differences of anxiety and psychosexual scores between leaflet and control groups.

RESULTS

The leaflet was well received. There were no statistical differences in StAI and TrAI scores between the study group and the control group at either visit, although in the whole study population StAI and TrAI scores were reduced at the second visit. The leaflet group had significantly more psychosexual problems but by the second visit, the scores had improved and the two groups were similar. When the mean differences in anxiety and psychosexual scores at the initial and second visits were compared between the groups, the reduction in negative sexual feelings and deterioration of TrAI scores experienced by the leaflet group was significant.

CONCLUSIONS

This study suggests that the provision of sending an information leaflet prior to colposcopy is not beneficial in isolation. Other approaches need to be considered.