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Bancroft EK, Page EC, Brook MN, Pope J, Thomas S, Myhill K, Helfand BT, Talaty P, Ong KR, Douglas E, Cook J, Rosario DJ, Salinas M, Buys SS, Anson J, Davidson R, Longmuir M, Side L, Eccles DM, Tischkowitz M, Taylor A, Cruellas M, Ballestero EP, Cleaver R, Varughese M, Barwell J, LeButt M, Greenhalgh L, Hart R, Azzabi A, Jobson I, Cogley L, Evans DG, Rothwell J, Taylor N, Hogben M, Saya S, Eeles RA, Aaronson NK. The psychosocial impact of prostate cancer screening for BRCA1 and BRCA2 carriers. BJU Int 2024; 134:484-500. [PMID: 38839570 DOI: 10.1111/bju.16432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
OBJECTIVES To report the long-term outcomes from a longitudinal psychosocial study that forms part of the 'Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted Screening in men at higher genetic risk and controls' (IMPACT) study. The IMPACT study is a multi-national study of targeted prostate cancer (PrCa) screening in individuals with a known germline pathogenic variant (GPV) in either the BReast CAncer gene 1 (BRCA1) or the BReast CAncer gene 2 (BRCA2). SUBJECTS AND METHODS Participants enrolled in the IMPACT study were invited to complete a psychosocial questionnaire prior to each annual screening visit for a minimum of 5 years. The questionnaire included questions on sociodemographics and the following measures: Hospital Anxiety and Depression Scale, Impact of Event Scale, 36-item Short-Form Health Survey, Memorial Anxiety Scale for PrCa, Cancer Worry Scale, risk perception and knowledge. RESULTS A total of 760 participants completed questionnaires: 207 participants with GPV in BRCA1, 265 with GPV in BRCA2 and 288 controls (non-carriers from families with a known GPV). We found no evidence of clinically concerning levels of general or cancer-specific distress or poor health-related quality of life in the cohort as a whole. Individuals in the control group had significantly less worry about PrCa compared with the carriers; however, all mean scores were low and within reported general population norms, where available. BRCA2 carriers with previously high prostate-specific antigen (PSA) levels experience a small but significant increase in PrCa anxiety (P = 0.01) and PSA-specific anxiety (P < 0.001). Cancer risk perceptions reflected information provided during genetic counselling and participants had good levels of knowledge, although this declined over time. CONCLUSION This is the first study to report the longitudinal psychosocial impact of a targeted PrCa screening programme for BRCA1 and BRCA2 carriers. The results reassure that an annual PSA-based screening programme does not have an adverse impact on psychosocial health or health-related quality of life in these higher-risk individuals. These results are important as more PrCa screening is targeted to higher-risk groups.
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Affiliation(s)
- Elizabeth K Bancroft
- Oncogenetics Team, Royal Marsden NHS Foundation Trust, London, UK
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | | | - Mark N Brook
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | - Jennifer Pope
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | - Sarah Thomas
- Oncogenetics Team, Royal Marsden NHS Foundation Trust, London, UK
| | - Kathryn Myhill
- Oncogenetics Team, Royal Marsden NHS Foundation Trust, London, UK
| | - Brian T Helfand
- Division of Urology, John and Carol Walter Center for Urological Health, NorthShore University HealthSystem, Evanston, IL, USA
| | - Pooja Talaty
- Division of Urology, John and Carol Walter Center for Urological Health, NorthShore University HealthSystem, Evanston, IL, USA
| | - Kai-Ren Ong
- West Midlands Regional Clinical Genetics Service, Birmingham Women's Hospital, Birmingham, UK
| | - Emma Douglas
- West Midlands Regional Clinical Genetics Service, Birmingham Women's Hospital, Birmingham, UK
| | - Jackie Cook
- Sheffield Clinical Genetics Service, Sheffield Children's Hospital, Sheffield, UK
| | | | - Monica Salinas
- Hereditary Cancer Program, ICO (Catalan Institute of Oncology), Barcelona, Spain
| | - Saundra S Buys
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jo Anson
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Rosemarie Davidson
- West of Scotland Genetic Service, Queen Elizabeth University Hospital, Glasgow, UK
| | - Mark Longmuir
- West of Scotland Genetic Service, Queen Elizabeth University Hospital, Glasgow, UK
| | - Lucy Side
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Diana M Eccles
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
- The University of Southampton Medical School, Southampton, UK
| | - Marc Tischkowitz
- East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Amy Taylor
- East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Mara Cruellas
- Hereditary Cancer Genetics Group, Medical Oncology Department, Hospital Vall d'Hebron, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Eduard Perez Ballestero
- Hereditary Cancer Genetics Group, Medical Oncology Department, Hospital Vall d'Hebron, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Ruth Cleaver
- Peninsula Clinical Genetics Service, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Mohini Varughese
- Peninsula Clinical Genetics Service, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Julian Barwell
- University of Leicester, Leicester, UK
- University Hospitals Leicester, Leicester, UK
| | | | - Lynn Greenhalgh
- Liverpool Centre for Genomic Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Rachel Hart
- Liverpool Centre for Genomic Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Ashraf Azzabi
- Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Irene Jobson
- Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Lynn Cogley
- Peninsular Genetics, Derriford Hospital, Plymouth, UK
| | - D Gareth Evans
- Genomic Medicine, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jeanette Rothwell
- Genomic Medicine, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Natalie Taylor
- Oncogenetics Team, Royal Marsden NHS Foundation Trust, London, UK
| | - Matthew Hogben
- Oncogenetics Team, Royal Marsden NHS Foundation Trust, London, UK
| | - Sibel Saya
- Oncogenetics Team, Institute of Cancer Research, London, UK
- The University of Melbourne, Melbourne, Australia
| | - Rosalind A Eeles
- Oncogenetics Team, Royal Marsden NHS Foundation Trust, London, UK
- Oncogenetics Team, Institute of Cancer Research, London, UK
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Moreno PI, Worch SM, Thomas JL, Nguyen RL, Medina HN, Penedo FJ, Moskowitz JT, Yanez B, Kircher SM, Kundu SD, Flury SC, Cheung EO. Quality of Life in Patients and Their Spouses and Cohabitating Partners in the Year Following a Cancer Biopsy (the Couples Cope Study): Protocol for a Prospective Observational Study. JMIR Res Protoc 2024; 13:e52361. [PMID: 38889402 PMCID: PMC11220434 DOI: 10.2196/52361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Receiving a diagnosis of cancer is a profound and often very stressful experience. Few studies have prospectively recruited patients prior to receiving a new diagnosis of cancer and included spouses or partners. OBJECTIVE The aim of the Couples Cope Study is to understand the impact of undergoing a diagnostic biopsy and receiving a new cancer diagnosis on quality of life (QoL) in both patients and their spouses or partners, as well as on the quality of their relationship. This protocol paper describes the study design and assesses the feasibility of recruitment and retention. METHODS Study staff reviewed the schedules of collaborating physicians using specific encounter codes to identify patients scheduled for breast or prostate biopsies. Potential participants were prescreened via the electronic health record and sent a recruitment letter at least 2 to 3 weeks prior to their biopsy procedure. Patients subsequently underwent a phone screening to determine eligibility. Patients who enrolled provided study staff with contact information for their spouses or partners. All consent forms were completed online. Surveys were completed online prior to receiving the biopsy results (baseline), and at 1, 3, 6, and 9 months after the biopsy. Study staff engaged in ongoing, personalized contact with participants and sent assessment completion reminders via phone and email. RESULTS A total of 2294 patients undergoing a breast or prostate biopsy were identified and 69% (n=1582) were eligible for phone screening following electronic health record prescreening. Of the 431 patients who underwent phone screening, 75% (n=321) were eligible to participate. Of the eligible patients, 72% (n=231) enrolled and 82% (n=190) of enrolled patients had an accompanying partner or spouse who also enrolled. A total of 77% (34/44) of patients who received a cancer diagnosis and 72% (26/36) of their spouses or partners were retained through 9 months, while 80% (53/66) of patients who received a benign diagnosis and 68% (42/62) of their partners were retained. CONCLUSIONS Prospective recruitment of patients undergoing diagnostic biopsy and their partners is feasible and requires both strategic collaboration with providers and concerted prescreening and recruitment efforts by study staff. Importantly, this study was able to conduct all study activities online without disrupting clinical workflow and without requiring patients and their spouses or partners to come into the laboratory. Consideration should be given to the ratio of biopsies to cancer diagnoses, which can vary significantly by cancer type. Prospective studies are needed and can inform our ability to provide effective support earlier to couples facing a possible cancer diagnosis. Future studies should examine other tumor types that have received less attention in QoL studies, include behavioral and neurobiological assessments beyond self-report measures, and follow couples beyond 9 months in order to examine long-term effects on QoL. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52361.
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Affiliation(s)
- Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sarah M Worch
- Department of Psychology, Lynn University, Boca Raton, FL, United States
| | - Jessica L Thomas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Rebecca L Nguyen
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, United States
| | - Heidy N Medina
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Frank J Penedo
- Departments of Medicine & Psychology, University of Miami, Miami, FL, United States
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sheetal M Kircher
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Shilajit D Kundu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sarah C Flury
- Department of Urology, Vanderbilt University School of Medicine, Nashville, TN, United States
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Nakai Y, Tanaka N, Matsubara T, Anai S, Miyake M, Hori S, Fujii T, Ohbayashi C, Fujimoto K. Effect of Prolonged Duration of Transrectal Ultrasound-Guided Biopsy of the Prostate and Pre-Procedure Anxiety on Pain in Patients without Anesthesia. Res Rep Urol 2021; 13:111-120. [PMID: 33692969 PMCID: PMC7939514 DOI: 10.2147/rru.s297703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/12/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate factors correlated with pain during prostate biopsy and willingness to undergo transrectal ultrasound-guided prostate biopsy (TR-PBx) again without anesthesia in patients undergoing TR-PBx without anesthesia. Methods This retrospective, single-center study evaluated 624 patients who underwent TR-PBx without anesthesia. Based on a nomogram using patient age and prostate volume, 6-12 core biopsy samples were allocated. Anxiety was evaluated using the Faces Anxiety Scale before the TR-PBx. Pain was evaluated using the Faces Pain Scale at each puncture and immediately after confirmation of cessation of bleeding from the rectum after the transrectal probe was pulled out. The question "If this operation must be repeated, would you agree to undergo it again under same conditions?" was asked after the procedure was completed. The change in pain at each puncture and factors correlated with post-procedural pain were calculated using multiple regression analysis, and factors predicting an answer of "yes" to the question using binary logistic analysis were evaluated. Results Scores on the Faces Pain Scale significantly increased from the first core sample to last as the number of samples increased. However, the number of samples did not show significant correlation with pain evaluated after the procedure was complete. Time during the biopsy and the anxiety score had a significant correlation with the pain scale score for the completed procedure. Short duration of TR-biopsy and a low anxiety score predicted a reply of "Yes" to the question. Conclusion A long operative time during the TR-PBx procedure and strong pre-procedure anxiety can increase pain for patients undergoing the procedure without anesthesia and cause patients to be unwilling to undergo TR-PBx again without anesthesia.
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Affiliation(s)
- Yasushi Nakai
- Department of Urology, Nara Medical University, Nara, Japan
| | | | | | - Satoshi Anai
- Department of Urology, Nara Medical University, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Nara, Japan
| | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
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Bancroft EK, Saya S, Page EC, Myhill K, Thomas S, Pope J, Chamberlain A, Hart R, Glover W, Cook J, Rosario DJ, Helfand BT, Hutten Selkirk C, Davidson R, Longmuir M, Eccles DM, Gadea N, Brewer C, Barwell J, Salinas M, Greenhalgh L, Tischkowitz M, Henderson A, Evans DG, Buys SS, Eeles RA, Aaronson NK. Psychosocial impact of undergoing prostate cancer screening for men with BRCA1 or BRCA2 mutations. BJU Int 2019; 123:284-292. [PMID: 29802810 PMCID: PMC6378691 DOI: 10.1111/bju.14412] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To report the baseline results of a longitudinal psychosocial study that forms part of the IMPACT study, a multi-national investigation of targeted prostate cancer (PCa) screening among men with a known pathogenic germline mutation in the BRCA1 or BRCA2 genes. PARTICPANTS AND METHODS Men enrolled in the IMPACT study were invited to complete a questionnaire at collaborating sites prior to each annual screening visit. The questionnaire included sociodemographic characteristics and the following measures: the Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES), 36-item short-form health survey (SF-36), Memorial Anxiety Scale for Prostate Cancer, Cancer Worry Scale-Revised, risk perception and knowledge. The results of the baseline questionnaire are presented. RESULTS A total of 432 men completed questionnaires: 98 and 160 had mutations in BRCA1 and BRCA2 genes, respectively, and 174 were controls (familial mutation negative). Participants' perception of PCa risk was influenced by genetic status. Knowledge levels were high and unrelated to genetic status. Mean scores for the HADS and SF-36 were within reported general population norms and mean IES scores were within normal range. IES mean intrusion and avoidance scores were significantly higher in BRCA1/BRCA2 carriers than in controls and were higher in men with increased PCa risk perception. At the multivariate level, risk perception contributed more significantly to variance in IES scores than genetic status. CONCLUSION This is the first study to report the psychosocial profile of men with BRCA1/BRCA2 mutations undergoing PCa screening. No clinically concerning levels of general or cancer-specific distress or poor quality of life were detected in the cohort as a whole. A small subset of participants reported higher levels of distress, suggesting the need for healthcare professionals offering PCa screening to identify these risk factors and offer additional information and support to men seeking PCa screening.
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Affiliation(s)
- Elizabeth K. Bancroft
- Oncogenetics TeamRoyal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamInstitute of Cancer ResearchLondonUK
| | - Sibel Saya
- Oncogenetics TeamRoyal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamInstitute of Cancer ResearchLondonUK
| | - Elizabeth C. Page
- Oncogenetics TeamRoyal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamInstitute of Cancer ResearchLondonUK
| | - Kathryn Myhill
- Oncogenetics TeamRoyal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamInstitute of Cancer ResearchLondonUK
| | - Sarah Thomas
- Oncogenetics TeamRoyal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamInstitute of Cancer ResearchLondonUK
| | - Jennifer Pope
- Oncogenetics TeamRoyal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamInstitute of Cancer ResearchLondonUK
| | - Anthony Chamberlain
- Oncogenetics TeamRoyal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamInstitute of Cancer ResearchLondonUK
| | - Rachel Hart
- Clinical Genetics UnitBirmingham Women's HospitalBirminghamUK
| | - Wayne Glover
- Clinical Genetics UnitBirmingham Women's HospitalBirminghamUK
| | - Jackie Cook
- Sheffield Clinical Genetics ServiceSheffield Children's HospitalSheffieldUK
| | | | - Brian T. Helfand
- John and Carol Walter Center for Urological HealthNorthShore University HealthSystemEvanstonILUSA
| | - Christina Hutten Selkirk
- John and Carol Walter Center for Urological HealthNorthShore University HealthSystemEvanstonILUSA
| | - Rosemarie Davidson
- Clinical Genetics DepartmentQueen Elizabeth University HospitalGlasgowUK
| | - Mark Longmuir
- Clinical Genetics DepartmentQueen Elizabeth University HospitalGlasgowUK
| | - Diana M. Eccles
- Wessex Clinical Genetics ServicePrincess Anne HospitalSouthamptonUK
- Faculty of MedicineUniversity of SouthamptonUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Neus Gadea
- High Risk and Cancer Prevention ClinicVall d'Hebron University HospitalBarcelonaSpain
| | - Carole Brewer
- Clinical Genetics DepartmentRoyal Devon and Exeter HospitalExeterUK
| | - Julian Barwell
- Department of GeneticsUniversity of LeicesterLeicesterUK
- Clinical GeneticsUniversity Hospitals LeicesterLeicesterUK
| | - Monica Salinas
- Hereditary Cancer ProgrammeCatalan Institute of Oncology (ICO‐IDIBELL, CIBERONC)L'Hospitalet de LlobregatBarcelonaSpain
| | - Lynn Greenhalgh
- Cheshire and Mersey Clinical Genetics ServiceLiverpool Women's HospitalLiverpoolUK
| | - Marc Tischkowitz
- Academic Department of Medical GeneticsUniversity of CambridgeCambridgeUK
| | - Alex Henderson
- Northern Genetics ServiceNewcastle upon Tyne HospitalsNewcastleUK
| | - David Gareth Evans
- Manchester Centre for Genomic MedicineCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - Saundra S. Buys
- Huntsman Cancer InstituteUniversity of Utah HealthSalt Lake CityUTUSA
| | | | | | - Rosalind A. Eeles
- Oncogenetics TeamRoyal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamInstitute of Cancer ResearchLondonUK
| | - Neil K. Aaronson
- Division of Psychosocial Research and EpidemiologyNetherlands Cancer InstituteAmsterdamThe Netherlands
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Eineluoto JT, Järvinen P, Kilpeläinen T, Lahdensuo K, Kalalahti I, Sandeman K, Mirtti T, Rannikko A. Patient Experience of Systematic Versus Fusion Prostate Biopsies. Eur Urol Oncol 2018; 1:202-207. [PMID: 31102622 DOI: 10.1016/j.euo.2018.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/12/2018] [Accepted: 02/20/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND The magnetic resonance imaging/ultrasound fusion-guided biopsy (FBx) technique has gained popularity in prostate cancer (PCa) diagnostics, but little is known about its effect on patient experience. OBJECTIVE To evaluate pain, discomfort and other non-infectious complications in PCa patients undergoing either systematic 12-core transrectal ultrasound-guided biopsy (SBx) or FBx and patient willingness to undergo rebiopsy. DESIGN, SETTING, AND PARTICIPANTS A prospective trial of 262 male patients, 203 of whom underwent transrectal SBx and 59 FBx at Helsinki University Hospital in 2015-2016. Patients completed two questionnaires immediately after and at 30 d after biopsy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES Patients reported pain and discomfort on a numeric rating scale (NRS; 0-10) immediately after biopsy. At 30 d, discomfort was measured on a scale ranging from 1 (no inconvenience) to 4 (maximal inconvenience). Other symptoms were reported dichotomously (yes/no) in both questionnaires. Mann-Whitney U, Pearson's χ2, and logistic regression tests were used. RESULTS AND LIMITATIONS For the SBx and FBx groups the median number of cores per patient was 12 and three, respectively. At 30 d, a higher proportion of patients in the SBx group had experienced pain than in the FBx group (70/203 [34%] vs 12/59 [20%]; p=0.043), whereas there was no difference in the median discomfort scores. Hematuria was less common in the FBx group (26/59 [44%] vs 140/203 [69%]; p<0.001). Patients willing to undergo rebiopsy immediately post-biopsy reported lower median NRS (3.0 [interquartile range 2.0-5.0] vs 5.0 [4.3-6.0]; p<0.001) and discomfort scores (4.0 [2.0-6.0] vs 7.0 [5.0-8.0]; p<0.001) than those unwilling. At 30 d, less discomfort (2.0 [interquartile range 1.0-2.0] vs 2.0 [2.0-3.0]; p=0.008) and fever (6/195 [3.1%] vs 6/28 [22%]; p=0.001) were experienced by patients willing to undergo rebiopsy. The nonrandomized design was a limitation. CONCLUSIONS FBx is associated with less pain and hematuria than SBx during the 30-d interval after biopsy. PATIENT SUMMARY Magnetic resonance imaging (MRI)-targeted prostate biopsy is associated with less pain, discomfort, and blood in the urine compared to the standard ultrasound-guided procedure. Performing MRI-targeted procedures may reduce biopsy-related complications and promote adherence to recommended repeat biopsy for patients on active surveillance for prostate cancer.
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Affiliation(s)
- Juho T Eineluoto
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Petrus Järvinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Kilpeläinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kanerva Lahdensuo
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Inari Kalalahti
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kevin Sandeman
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Mirtti
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Medicum, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Rannikko
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Clinicum, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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[Psychological impact of prostate cancer on patients receiving a 6-month androgen deprivation therapy]. Prog Urol 2017; 28:32-38. [PMID: 29223415 DOI: 10.1016/j.purol.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 09/04/2017] [Accepted: 10/19/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Prostate cancer (PCa) is often associated with psychopathological symptoms such as anxiety. This study evaluated the effects of the luteinizing hormone-releasing hormone agonist therapy leuprorelin acetate (LA) on anxiety and quality of life (QoL) over time in men with PCa. METHODS This observational, non interventional, multicenter study was conducted in France. Patients with PCa eligible for therapy with a 6-month LA depot were enrolled. Patients completed questionnaires assessing anxiety (memorial anxiety scale for prostate cancer [MAX-PC] ; state trait anxiety inventory [STAI]) and QoL (medical outcomes study 12-item short-form health survey [SF-12] physical summary component [PCS] and mental component summary [MSCS] subscales) at baseline and 6 months after 6-month LA depot administration. RESULTS Questionnaires were completed by 575 men at baseline and 315 men at 6 months. Mean age was 75.5 years; median time since first diagnosis was 0.4 years. At baseline, the mean (±standard deviation [SD]) MAX-PC score was 17.7±12.0, with anxiety primarily related to the PCa diagnosis. STAI-state and MAX-PC scores were consistent. Following 6 months of LA administration, the mean MAX-PC score decreased (-2.0±10.4 ; P<0.001). The PCa diagnosis negatively affected patients' QoL, as assessed by the SF-12 PCS and MCS subscores. At 6 months, the SF-12 vitality score significantly increased (1.2±9.8; P=0.0142) vs baseline and the SF-12 PCS score decreased by -2.0±8.0 from baseline. CONCLUSION After 6 months of leuprorelin 45mg therapy, prostate cancer patients appeared to be less anxious with a mental health improvement. LEVEL OF EVIDENCE 3.
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7
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Dillard AJ, Scherer LD, Ubel PA, Alexander S, Fagerlin A. Anxiety symptoms prior to a prostate cancer diagnosis: Associations with knowledge and openness to treatment. Br J Health Psychol 2016; 22:151-168. [PMID: 27882638 DOI: 10.1111/bjhp.12222] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/27/2016] [Indexed: 01/06/2023]
Abstract
AIM Research suggests that anxiety may be a common response to a cancer diagnosis, but research is needed to examine anxiety before diagnosis. Anxiety before diagnosis may relate to the comprehension of relevant health information or openness to potential treatments. This study examined anxiety and these outcomes in men who were waiting to learn of a prostate cancer diagnosis. OBJECTIVES One goal of this study was to determine whether anxiety would increase as men came closer to learning the results of their prostate cancer biopsy. Another goal was to test whether anxiety was associated with knowledge about prostate cancer or openness to different treatments. METHODS Men (N = 265) who were facing a prostate cancer diagnosis were surveyed at two time points. Time 1 occurred at the time of biopsy, and Time 2 occurred immediately before men received their biopsy result. At each time point, men reported their anxiety about prostate cancer and their biopsy result. At Time 2, they completed a knowledge test of information about prostate cancer and reported their openness to different potential treatments. RESULTS Anxiety symptoms increased as men came closer to learning their diagnosis. Also, higher anxiety was associated with lower knowledge and greater openness to particular treatments like surgery. Interactions showed that when anxiety increased from Time 1 to Time 2, having high or low knowledge mattered less to treatment openness. CONCLUSION Waiting for a cancer diagnosis is an important time period in which anxiety may increase and relate to information processing and openness to treatments. Statement of contribution What is already known on this subject? Men undergoing prostate cancer screening have been found to experience high and low levels of anxiety. Research has shown that negative emotions like anxiety are common following a cancer diagnosis, but little research has examined emotions right before diagnosis. Anxiety has been associated with information processing and motivation to engage in preventive behaviours. What does this study add? Applies and tests a theoretical idea related to how anxiety may change as one approaches personally relevant threatening health feedback. Shows relationships between changes in anxiety and knowledge in the context of waiting for actual health feedback. Associates increased anxiety in the prostate cancer context with knowledge and openness to different treatments.
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Affiliation(s)
- Amanda J Dillard
- Department of Psychology, Grand Valley State University, Allendale, Michigan, USA
| | - Laura D Scherer
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Peter A Ubel
- Fuqua School of Business and Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
| | - Stewart Alexander
- Department of Consumer Science, Purdue University, West Lafayette, Indiana, USA
| | - Angela Fagerlin
- Departments of Internal Medicine and Psychology, Ann Arbor VA Center for Clinical Management Research, Michigan, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Brath JM, Grill S, Ankerst DP, Thompson IM, Gschwend JE, Herkommer K. No Detrimental Effect of a Positive Family History on Long-Term Outcomes Following Radical Prostatectomy. J Urol 2016; 195:343-8. [DOI: 10.1016/j.juro.2015.07.097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Johannes M.S. Brath
- Department of Urology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Sonja Grill
- Departments of Life Sciences and Mathematics, Technische Universitaet Muenchen, Munich, Germany
| | - Donna P. Ankerst
- Departments of Life Sciences and Mathematics, Technische Universitaet Muenchen, Munich, Germany
| | - Ian M. Thompson
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Juergen E. Gschwend
- Department of Urology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Kathleen Herkommer
- Department of Urology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
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9
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Vasarainen H, Malmi H, Määttänen L, Ruutu M, Tammela T, Taari K, Rannikko A, Auvinen A. Effects of prostate cancer screening on health-related quality of life: results of the Finnish arm of the European randomized screening trial (ERSPC). Acta Oncol 2013; 52:1615-21. [PMID: 23786174 DOI: 10.3109/0284186x.2013.802837] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND As prostate cancer (PC) mortality reduction results are not unequivocal, a special emphasis has to be put on other aspects of the prostate-specific antigen (PSA) screening, including effects on quality of life. In the present study we describe the short-term effects of various phases of PC screening on health-related quality of life (HRQL). MATERIAL AND METHODS The study participants were randomized into the screening arm within the Finnish component of the European Randomized Study on Screening for Prostate Cancer (ERSPC). The RAND 36-Item Health Survey on HRQL and questionnaires on sociodemographic and behavioral factors were delivered to participants at various phases of the first screening round: 1) 500 participants at invitation; 2) 500 after screening; 3) 500 after obtaining the PSA result; 4) to 300 participants after undergoing digital rectal examination (DRE) (but prior to being informed of its result); and 5) approximately 300 after prostate biopsy. At each stage, a new sample of participants was recruited. RESULTS Response rates were 59% at invitation, 77% after PSA blood test, 54% after PSA result and 69% after DRE. The men recruited at each stage were comparable in respect to socioeconomic variables. The HRQL scores in RAND-36 subscales showed little variation in the different phases of the screening process. Compared with the previous phase, the social function score was slightly lower after obtaining the PSA result than after blood test, the emotional role score lower after DRE than after PSA result and the pain-related score lower after DRE than after TRUS and biopsy. The screening participants were comparable to the general population as their HRQL scores were similar to an age-stratified general Finnish male population. CONCLUSION Short-term HRQL effects of prostate cancer screening appear minor and transient.
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Affiliation(s)
- Hanna Vasarainen
- Department of Urology, Helsinki University Central Hospital and University of Helsinki , Helsinki , Finland
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10
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Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, Rosario DJ, Scattoni V, Lotan Y. Systematic review of complications of prostate biopsy. Eur Urol 2013; 64:876-92. [PMID: 23787356 DOI: 10.1016/j.eururo.2013.05.049] [Citation(s) in RCA: 676] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/24/2013] [Indexed: 12/11/2022]
Abstract
CONTEXT Prostate biopsy is commonly performed for cancer detection and management. The benefits and risks of prostate biopsy are germane to ongoing debates about prostate cancer screening and treatment. OBJECTIVE To perform a systematic review of complications from prostate biopsy. EVIDENCE ACQUISITION A literature search was performed using PubMed and Embase, supplemented with additional references. Articles were reviewed for data on the following complications: hematuria, rectal bleeding, hematospermia, infection, pain, lower urinary tract symptoms (LUTS), urinary retention, erectile dysfunction, and mortality. EVIDENCE SYNTHESIS After biopsy, hematuria and hematospermia are common but typically mild and self-limiting. Severe rectal bleeding is uncommon. Despite antimicrobial prophylaxis, infectious complications are increasing over time and are the most common reason for hospitalization after biopsy. Pain may occur at several stages of prostate biopsy and can be mitigated by anesthetic agents and anxiety-reduction techniques. Up to 25% of men have transient LUTS after biopsy, and <2% have frank urinary retention, with slightly higher rates reported after transperineal template biopsy. Biopsy-related mortality is rare. CONCLUSIONS Preparation for biopsy should include antimicrobial prophylaxis and pain management. Prostate biopsy is frequently associated with minor bleeding and urinary symptoms that usually do not require intervention. Infectious complications can be serious, requiring prompt management and continued work into preventative strategies.
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Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University, New York, NY, USA.
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11
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McDowell ME, Occhipinti S, Gardiner RA, Chambers SK. Prevalence and predictors of cancer specific distress in men with a family history of prostate cancer. Psychooncology 2013; 22:2496-504. [PMID: 23712946 DOI: 10.1002/pon.3312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 04/17/2013] [Accepted: 04/25/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine prevalence and predictors of cancer-specific distress in undiagnosed men with and without a family history of prostate cancer, and to examine the contribution of perceptions of an affected relative's cancer experience on the distress of unaffected male relatives. METHODS Men with a first degree relative with prostate cancer (n = 207) and men without a family history (n = 239) from Australia completed a Computer Assisted Telephone Interview. Participants completed the Prostate Cancer Anxiety Subscale of the Memorial Anxiety Scale for Prostate Cancer, measures of perceived risk, and socio-demographic information. Men with a family history provided details about their family history (number of relatives diagnosed with and dead from prostate cancer, relationship to affected relative, months since diagnosis) and reported their perceptions of their affected relative's prostate cancer experience including perceptions of threat related to the relative's diagnosis and perceived treatment phase and prognosis. RESULTS Cancer-specific distress was low for all men and there was no significant difference in the distress experienced by men with and without a family history. Regression analyses showed that for all men, cancer-specific distress increased with urinary symptoms and decreased in those with higher education and in older participants. For men with a family history, having a relative who died from prostate cancer and perceiving greater threat from a relative's diagnosis was associated with greater cancer-specific distress. CONCLUSIONS Interventions would benefit from examining appraisals of familial risk and examining prospective assessments of distress in the unaffected male relatives of men with prostate cancer over the course of the cancer trajectory.
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Affiliation(s)
- M E McDowell
- Griffith Health Institute, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
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12
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Carlsson S, Vickers AJ, Roobol M, Eastham J, Scardino P, Lilja H, Hugosson J. Prostate cancer screening: facts, statistics, and interpretation in response to the US Preventive Services Task Force Review. J Clin Oncol 2012; 30:2581-4. [PMID: 22711853 DOI: 10.1200/jco.2011.40.4327] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sigrid Carlsson
- Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, 307 E 63rd Street, New York, NY 10065, USA.
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Lane JA, Hamdy FC, Martin RM, Turner EL, Neal DE, Donovan JL. Latest results from the UK trials evaluating prostate cancer screening and treatment: the CAP and ProtecT studies. Eur J Cancer 2011; 46:3095-101. [PMID: 21047592 DOI: 10.1016/j.ejca.2010.09.016] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 08/11/2010] [Accepted: 09/07/2010] [Indexed: 11/19/2022]
Abstract
The European Randomised Study of Screening for Prostate Cancer (ERSPC) demonstrated a significant reduction in prostate cancer-specific mortality. The ongoing Comparison Arm for ProtecT (CAP) cluster randomised controlled trial (RCT) evaluates prostate cancer screening effectiveness by comparing primary care centres allocated to a round of prostate specific antigen (PSA) testing (intervention) or standard clinical care. Over 550 centres (around 450,000 men) were randomised in eight United Kingdom areas (2002-2008). Intervention group participants were also eligible for the ProtecT (Prostate testing for cancer and Treatment) RCT evaluating active monitoring, radiotherapy and radical prostatectomy treatments for localised prostate cancer. In ProtecT, over 1500 of around 3000 men with prostate cancer were randomised from over 10,000 with an elevated PSA in around 111,000 attendees at clinics. Investigation of the psychological impact of screening in a sub-sample showed that 10% of men still experienced high distress up to 3 months following prostate biopsies (22/227), although most were relatively unaffected. The risk of prostate cancer with a raised PSA was lower if urinary symptoms were present (frequent nocturia odds ratio (OR) 0.44, 95% confidence interval (CI) 0.22-0.83) or if a repeat PSA decreased by > or = 20% prior to biopsy (OR 0.43, 95% CI 0.35-0.52). Men aged 45-49 years attended PSA clinics less frequently (442/1299, 34%) in a nested cohort with a cancer detection rate of 2.3% (10/442). The CAP and ProtecT trials (ISRCTN92187251 and ISRCTN20141217) will help resolve the prostate cancer screening debate, define the optimum treatment for localised disease and generate evidence to improve men's health.
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Affiliation(s)
- J A Lane
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
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14
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Abstract
The process of PSA screening and subsequent monitoring of PSA levels may represent a great source of emotional distress to patients, the majority of whom are not adequately informed about the screening process and the implications of an abnormal result. The need remains for education of patients on the subject, but no consensus has been reached as to the content of information men should be offered. Helping patients to attribute a different meaning to a potentially stressful event can avoid the development of emotional distress, and physicians can have an important role in this process. Informing patients is essential to allow the development of positive coping styles, and establishing good doctor-patient communication leads to improved compliance and the improvement of patients' psychological wellbeing.
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Affiliation(s)
- Riccardo G V Torta
- Clinical and Oncologic Psychology, San Giovanni Battista University Hospital, Turin, Italy.
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15
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Macefield RC, Metcalfe C, Lane JA, Donovan JL, Avery KNL, Blazeby JM, Down L, Neal DE, Hamdy FC, Vedhara K. Impact of prostate cancer testing: an evaluation of the emotional consequences of a negative biopsy result. Br J Cancer 2010; 102:1335-40. [PMID: 20372151 PMCID: PMC2865757 DOI: 10.1038/sj.bjc.6605648] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 03/04/2010] [Accepted: 03/17/2010] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND When testing for prostate cancer, as many as 75% of men with a raised prostate-specific antigen (PSA) have a benign biopsy result. Little is known about the psychological effect of this result for these men. METHODS In all, 330 men participating in the prostate testing for cancer and treatment (ProtecT) study were studied; aged 50-69 years with a PSA level of > or = 3 ng ml(-1) and a negative biopsy result. Distress and negative mood were measured at four time-points: two during diagnostic testing and two after a negative biopsy result. RESULTS The majority of men were not greatly affected by testing or a negative biopsy result. The impact on psychological health was highest at the time of the biopsy, with around 20% reporting high distress (33 out of 171) and tense/anxious moods (35 out of 180). Longitudinal analysis on 195 men showed a significant increase in distress at the time of the biopsy compared with levels at the PSA test (difference in Impact of Events Scale (IES) score: 9.47; 95% confidence interval (CI) (6.97, 12.12); P<0.001). These levels remained elevated immediately after the negative biopsy result (difference in score: 7.32; 95% CI (5.51, 9.52); P<0.001) and 12 weeks later (difference in score: 2.42; 95% CI (0.50, 1.15); P=0.009). Psychological mood at the time of PSA testing predicted high levels of distress and anxiety at subsequent time-points. CONCLUSIONS Most men coped well with the testing process, although a minority experienced elevated distress at the time of biopsy and after a negative result. Men should be informed of the risk of distress relating to diagnostic uncertainty before they consent to PSA testing.
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Affiliation(s)
- R C Macefield
- Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - C Metcalfe
- Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - J A Lane
- Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - J L Donovan
- Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - K N L Avery
- Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - J M Blazeby
- Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - L Down
- Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - D E Neal
- University Department of Oncology, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - F C Hamdy
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - K Vedhara
- I-WHO, University of Nottingham, International House, Jubilee Campus, Wollaton Road, Nottingham NG8 1BB, UK
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