Health behavior change among women with recent familial diagnosis of breast cancer

Factors Affecting Breast Screening Behavior of First-Degree Relatives of Breast Cancer Patients in China: A Cross-sectional Study

BACKGROUND

Breast cancer is the most common cancer in women, and first-degree relatives (FDRs) of breast cancer patients have a significantly higher risk of developing breast cancer. However, the factors affecting breast cancer screening behavior of FDRs in China remain unclear.

OBJECTIVE

The aim of this study was to determine the social cognitive theory factors influencing screening behaviors of FDRs.

METHODS

A cross-sectional survey was conducted, and 430 FDRs were recruited. Data were collected using demographic information and self-reported questionnaire based on the social cognitive theory. The structural equation modeling method was used to analyze the influence of social cognitive factors on breast cancer screening behavior.

RESULTS

The model showed a good fit (goodness of fit = 0.462). Goal setting and self-regulation (β = 0.631, P < .001) and positive outcome expectation (β = 0.098, P = .042) were positively related to breast cancer screening behavior. Negative outcome expectation was negatively related to breast cancer screening behavior (β = -0.102, P = .024). In addition, positive outcome expectation, negative outcome expectation, and goal setting and self-regulation are mediators of self-efficacy (β = 0.475, P < .001) to breast cancer screening behavior.

CONCLUSION

Goal setting and self-regulation are important influences on breast cancer screening behavior. The social cognitive theory is both applicable to and effective in explaining and predicting breast cancer screening behavior.

IMPLICATIONS FOR PRACTICE

Health professionals can develop appropriate intervention strategies based on the social cognitive theory among FDRs. It is necessary to focus on the people who influence women, such as spouses, mothers, or daughters.

Dietary behaviours of individuals with lynch syndrome at high risk of colorectal cancer: Results from the AAS-lynch study

BACKGROUND & AIMS

Individuals with Lynch syndrome (LS) have a high lifetime risk of developing colorectal cancer (CRC) due to genetic alterations. Nutrition is one of the main modifiable risk factors for sporadic CRC, however this has not been established in LS patients. The present study aimed to give a detailed overview of dietary intakes in individuals with LS, and associated individual characteristics.

METHODS

Dietary behaviours of individuals with LS from the AAS-Lynch clinical trial (2017-2022) were obtained using a food frequency questionnaire. Dietary intakes, food group consumption and overall diet quality (dietary patterns, adherence to the Mediterranean diet) were described according to sociodemographic, anthropometric and clinical characteristics, and compared to participants without LS from the NutriNet-Santé study (matched on sex, age, BMI and region).

RESULTS

280 individuals with LS were included in this analysis and matched with 547 controls. Compared to controls, LS patients consumed less fibre, legumes, fruit and vegetables and more red and processed meat (all p < 0.01). They also had a lower Mediterranean diet score (p = 0.002). Among LS patients, men, younger patients, or those with disadvantaged situation had a diet of poorer nutritional quality with lower adherence to a "Healthy" diet (all p ≤ 0.01). LS Patients with prevalent CRC had a higher consumption of dairy products than recommended, while those with prevalent adenoma consumed more vegetables, and less sugar and sweets (all p ≤ 0.01).

CONCLUSIONS

Although patients with LS were aware of their high lifetime risk of developing cancer, their diets were not optimal and included nutritional risk factors associated to CRC.

The impact of having a relative or a friend with cancer on person's modifiable cancer-related risk factors

BACKGROUND

It is known that targeting cancer-related modifiable risk factors is the best way to fight cancer. Behavioral and lifestyle changes can significantly reduce the burden of cancer.

AIMS

We aim to assess the impact of having a relative/friend with cancer on the number of cancer-related modifiable risk factors a participant might have.

METHODS

A survey-based cross-sectional study was conducted at King Hussein Cancer Center from June 2020 until July 2020. The survey was distributed via social media platforms, where we targeted adults who have never been diagnosed with cancer. We asked about modifiable cancer-related risk factors and compared between participants with and without relatives or friends with cancer.

RESULTS

A total of 1486 participants were considered for analysis, with a mean age of 30.62 (SD 11.19) years. Participants who had a relative with cancer had a mean of 0.31 (p = 0.007; 95% CI: 0.08-0.54) fewer risk factors, with smoking and extra sun exposure were significantly lower among participants with a cancer relative. No significant difference in modifiable risk factors was found between participants with a friend who have cancer and those who do not (p = 0.193).

CONCLUSION

People who have relatives with cancer had less modifiable risk factors, which might reflect on their willingness to modify their cancer-related risk factors.

Opportunities for diabetes and peripheral artery disease-related lower limb amputation prevention in an Appalachian state: A longitudinal analysis

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Patients in the rural state of WV are at high-risk for atraumatic amputation.

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There are opportunities for improved diabetes and vascular disease management in WV.

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Patients at risk for vascular disease require preventive foot care and medication.

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Amputation may represent a sentinel event that promotes patient behavior change.

Lower extremity amputation due to peripheral artery disease (PAD) and diabetes (DM) is a life-altering event that identifies disparities in access to healthcare and management of disease. West Virginia (WV), a highly rural state, is an ideal location to study these disparities. The WVU longitudinal health system database was used to identify 1) risk factors for amputation, 2) how disease management affects the risk of amputation, and 3) whether the event of amputation is associated with a change in HbA1c and LDL levels.

Adults (≥18 years) with diagnoses of DM and/or PAD between 2011 and 2016 were analyzed. Multivariable logistic regression analyses were performed on patients with lab information for both HbA1c and LDL while adjusting for patient factors to examine associations with amputations. In patients who underwent amputation, we compared laboratory values before and after using Wilcoxon signed rank tests.

50,276 patients were evaluated, 369 (7.3/1000) underwent amputation. On multivariable analyses, Male sex and Self-pay insurance had higher odds for amputation. Compared to patients with DM alone, PAD patients had 12.3 times higher odds of amputation, while patients with DM and PAD had 51.8 times higher odds of amputation compared to DM alone. We found significant associations between odds of amputation and HbA1c (OR 1.31,CI = 1.15–1.48), but not LDL. Following amputation, we identified significant decreases in lab values for HbA1c and LDL.

These findings highlight the importance of medical optimization and patient education and suggest that an amputation event may provide an important opportunity for changes in disease management and patient behavior.

[What causes prostate cancer: patient-perceived causes]

BACKGROUND

 Psychosocial distress caused by prostate cancer (PCa) can persist in patients for years after treatment. A possible factor in this context is the subjectively perceived cause of the disease, which can have a significant influence on the experience of distress, therapy adherence and preventive behaviour. The aim of this study was to record subjective reasons for PCa in long-term survivors and to investigate associated factors.

MATERIAL AND METHODS

 PCa survivors from the national research project "Familial Prostate Cancer" were included in the study. As part of the annual postal follow-up questionnaire, PCa survivors were asked about subjectively perceived causes of their PCa. Responses were assigned to 18 possible categories. In addition, the association between the subjectively perceived causes of PCa and secondary tumours, a positive family history of tumour diseases and sociodemographic factors was investigated.

RESULTS

 Of the 9 047 PCa survivors surveyed, 4 054 (44.8 %) provided information on the subjectively perceived causes of their PCa and were included in this analysis. The mean time since diagnosis was 10.1 years with a mean age of 63.1 years at diagnosis. The most frequent responses were "don't know" (31.8 %), genetics (30.1 %) and stress (18.5 %). Age, the most important risk factor for PCa, was rarely mentioned (2.5 %). In addition to these responses, unusual non-evidence-based reasons were also reported. Men with a positive family history of PCa cited genetics as the cause of their disease about 4 times more frequently than sporadic cases. This proportion increased with the number of affected family members. PCa survivors aged ≤ 65 years at diagnosis indicated stress as the cause of their PCa approximately 2 times more often than men who were older than 65 years at PCa diagnosis.

CONCLUSION

 Most men surveyed reported non-evidence-based causes of their PCa. Preventive programs should address the evidence-based causes more distinctly and with a high visibility. Due to the significance of lay illness beliefs for the experience of distress and the adherence to treatment, the patient's subjective cause of disease should be surveyed and considered by the urologist in charge.

Risk perception of radiation emergency medical staff on low-dose radiation exposure: Knowledge is a critical factor

Radiation emergency medical (REM) staff respond to many types of disasters such as radiological and nuclear accidents as well as environmental radioactivity exposure. The objective of this study was to evaluate the risk perception of REM staff on radiation exposure in various situations and to analyze the factors that affect their risk perception. A questionnaire was given to 284 REM staff affiliated with various organizations, including nuclear power generation, nuclear fuel manufacturing, large-scale irradiation, and radiation-waste disposal facilities, as well as research and development institutions. To determine the substantially influential factors for risk perception, we analyzed the questionnaire responses using ordinal logistic regression, Kruskal-Wallis, and Spearman correlation analyses. It was generally perceived by REM staff that low-dose radiation exposure in daily life and work environments does not pose any health risks. A higher level of radiation knowledge was tightly associated with a lower risk perception of REM staff on extremely low-dose (several mSv) radiation exposure, thus exhibiting an inverse correlation. In contrast to radiation researchers, the work experience of REM staff was not a contributing factor to their risk perception. In our study, REM staff with a high level of radiation knowledge did not have any health concerns in their work environments. Efforts to enhance the radiation knowledge of REM staff through proper education and training would result in analytical risk evaluation, which may also improve their willingness to help meet surge capacity needs in large-scale radiological events.

A 15-year follow-up study on long-term adherence to health behaviour recommendations in women diagnosed with breast cancer

BACKGROUND

Whilst a cancer diagnosis may prompt health behaviour change, there is limited evidence regarding whether such changes are maintained in the long-term. We aimed to investigate the impact of cancer diagnosis on health behaviour changes over the long-term survivorship period among breast cancer survivors (BCSs).

METHODS

The sample comprised 153 BCSs and 4778 cancer-free women, aged 49-55 years in 2001 (our baseline), from the 1946-1951 birth cohort of the Australian Longitudinal Study on Women's Health. Health behaviours (physical activity, smoking, alcohol, diet and Body Mass Index), recommended by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR), were assessed in five survivorship periods: ≤ 3 years, 3 to ≤ 6 years, 6 to ≤ 9 years, 9 to ≤ 12 years, and 12 to 15 years since diagnosis. A validated semi-quantitative Food Frequency Questionnaire was used for dietary assessment. Pre-diagnosis (baseline) health behaviours of BCSs and cancer-free women were compared (using Generalized Linear Models (GLM)). Multilevel (mixed effect) models were used for longitudinal data in BCSs.

RESULTS

There was no significant difference in health behaviours between BCSs (prior to diagnosis) and cancer-free women. Following diagnosis, BCSs were significantly more physically active (≥ 600 MET min/week; 50.8% to 63.3%; p = 0.02) and consumed more fruit (≥ 2 serves/day; 57.4% to 66.4%; p = 0.01) in the recent survivorship period, but were less likely to be classified in the healthy weight range (p < 0.01). The proportion of non-drinkers and non-smokers slightly increased over the survivorship period. Whole-vegetable intake did not significantly change; however, the intake of non-starchy vegetables significantly increased from pre-diagnosis (LS mean = 89.1 g/day) to post-diagnosis, 6 to ≤ 9 years (LS mean = 137.1 g/day), and 9 to ≤ 12 years (LS mean = 120.8 g/day). There were no significant changes in the total intake of fibre, carotenoids, calcium, fat, saturated fat, vitamin C, or vitamin E observed, except for increased total energy intake (p = 0.012).

CONCLUSION

Before diagnosis, BCSs had similar adherence to health behaviours compared to cancer-free women. Initial positive changes to health behaviours were observed post BC diagnosis, except healthy body weight, but maintenance of such changes over the long-term was poor. BCSs may benefit from additional advice and support to make healthy lifestyle choices throughout survivorship.

Is diagnosis of type 2 diabetes a "teachable moment"? A qualitative study

AIMS

To explore the potential of type 2 diabetes diagnosis to be a "teachable moment".

METHODS

Semi-structured interviews were conducted with 23 participants (10 people with type 2 diabetes, 13 relatives of people with type 2 diabetes) in Scotland, UK. They explored cognitive, emotional and behavioural changes following diagnosis of type 2 diabetes in oneself or in a relative. Data were analysed using Framework approach.

RESULTS

Strong emotional responses are not always related to the occurrence of a teachable moment. Risk perception and outcome expectancy were found to be teachable moment factors for patients with type 2 diabetes and their offspring, but not their partners. Change in self-concept increases the likelihood of type 2 diabetes diagnosis to be a teachable moment for patients but not for relatives. In some cases, type 2 diabetes is perceived as incompatible with current roles thus hindering diabetes self-management. Relatives often engage in caring for patients and "policing" their behaviour but did not report perceived changes in social roles.

CONCLUSIONS

The study suggests that diagnosis of type 2 diabetes is a teachable moment for some patients and their relatives. These findings have implications for interventions to address diabetes self-management in patients and primary prevention in their relatives.

Fear of cancer recurrence in lymphoma survivors: A descriptive study

Objectives: Fear of cancer recurrence (FCR) is a common experience among cancer survivors and often persists after the termination of cancer treatments. The purpose of this paper was to evaluate FCR in survivors of Hodgkin's and diffuse large B-cell lymphomas, given a high rate of survivorship in this patient population.Research Approach: The parent study was a multi-site, cluster-randomized trial to assess a communication skills intervention: survivorship planning consultation (versus a time-attention control - wellness rehabilitation intervention) to promote transition to survivorship.Participants & Methodological Approach: 199 patients enrolled in the study and completed a survivorship (or control) consultation one-month after receiving the news of their survivorship status; 141 of those patients (n = 92 experimental arm, n = 49 control arm) completed an interview at their 6-month follow-up consultation. In the interview, participants described frequency of FCR, causes of FCR, coping mechanisms, and specific things oncologists said to reduce FCR. Both qualitative and quantitative methods were utilized for analyzing participant responses.Findings: The majority (88%) of participants reported experiencing FCR, with a higher number of participants in the experimental arm significantly more likely to endorse FCR compared to the control group participants. The main causes of FCR were having medical appointments and concerns about potential relapse and secondary cancers. Participants endorsed utilizing self-sufficient coping mechanisms. As well, participants reported that oncologists most frequently cited specific cure rates of lymphoma to reduce patients' FCR.Interpretation & Implications for Psychosocial Providers: Communication skills training programs should emphasize FCR in survivorship consultations.

Integration of breast cancer prevention and early detection into cancer palliative care model

BACKGROUND

Breast cancer is common among Ghanaian women. Late stage presentation has been credited to knowledge deficit and lack of breast cancer prevention and early detection services for women.

OBJECTIVE

This study aimed to develop a model to facilitate the integration of breast cancer prevention and early detection into cancer palliative care.

METHOD

This study used synthesized concepts emerging from a single case study research. The case was a tertiary health care facility, embedded with sub-units of analysis. Mixed-method approach was used to collect data from 102 participants. The study examined the experiences and views of the participants on breast cancer and screening pathways in Ghana. Thematic analysis and descriptive statistics ware used to analyze the qualitative and quantitative data respectively. This was followed with a cross-case analysis across the sub-units of analysis. A theory development approach was further used towards the development of a model, following three steps: concept analysis, statement synthesis and theory synthesis.

RESULTS

Six key concepts synthesized from the data were used to develop the model: initiate and sustain breast cancer prevention and early detection program, collaboration of health professionals, patients, families and micro-communities, conducive environment of the health care facility and needed resources, actions, services, and lastly diffusing innovation into the community through agents.

CONCLUSION

A model has been developed based on the experiences shared by women diagnosed with advanced breast cancer, their first degree relatives, micro-communities as well as clinicians working in a palliative care setting. This model will aid clinicians to provide breast cancer education, teach breast self-examination and offer clinical breast examination to families and micro-communities of advanced breast cancer patients receiving supportive care in a resource-limited setting.

Association Between Health Behaviors and Family History of Cancer According to Sex in the General Population

INTRODUCTION

Family history of cancer and modifiable risk factors are each associated with cancer development, but no studies have assessed their association with each other by sex. This study aimed to examine modifiable risk factors in individuals with a family history of cancer compared with those without a family history of cancer, according to sex.

METHODS

This study recruited 166,810 participants aged 40-79 years from Korea's Health Examinee Study cohort between 2004 and 2014. Results were calculated as AORs and 95% CIs to determine the relationship between family history of cancer in first-degree relatives and modifiable risk factors. Data analyses were performed in 2018.

RESULTS

The prevalence of modifiable cancer risk factors, including current smoking, drinking alcohol, physical inactivity, obesity, and abdominal obesity, were different according to the presence of a family history of cancer, cancer type of such a family history, and sex. Male participants with a family history of cancer were less likely to be current smokers or obese (AOR=0.95, 95% CI=0.91, 0.99 and AOR=0.95, 95% CI=0.92, 0.99, respectively) than those without a family history of cancer, whereas female participants with a family history of cancer were more likely to be current smokers but less likely to be physically inactive (AOR=1.13, 95% CI=1.03, 1.23 and AOR=0.96, 95% CI=0.93, 0.98, respectively) than those without a family history of cancer.

CONCLUSIONS

This study's findings suggest that, in general, males with a family history of cancer show better health behaviors, whereas females with a family history of cancer demonstrate worse health behaviors.

Adult Physical Activity and Breast Cancer Risk in Women with a Family History of Breast Cancer

BACKGROUND

Recreational physical activity has been consistently associated with reduced breast cancer risk. Less is known about how family history of breast cancer affects the association and whether it varies by menopausal status.

METHODS

The Sister Study is a cohort of 50,884 women who had a sister with breast cancer but no prior breast cancer themselves at enrollment. Women reported all recreational sport/exercise activities they participated in over the past 12 months. Hours/week and MET-hours/week of physical activity were considered in association with breast cancer risk. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated with Cox regression. Extent of family history, examined as a modifier, was characterized by a Bayesian score incorporating characteristics of the family structure.

RESULTS

During follow-up (average 8.4 years), 3,023 cases were diagnosed. Higher hours/week (HR_≥7vs<1 = 0.77; 95% CI, 0.66-0.90) and MET-hours/week (HR_quartile4vs1 = 0.75; 95% CI, 0.67-0.85) of physical activity were associated with reduced postmenopausal breast cancer risk. Hours/week and MET-hours/week were associated with suggestively increased premenopausal breast cancer risk (MET-hours/week HR_quartile4vs1 = 1.25; 95% CI, 0.98-1.60). Associations did not vary with extent of family history. However, the increased risk in premenopausal women may be limited to those with stronger family history.

CONCLUSIONS

In women with a family history of breast cancer, physical activity was associated with reduced postmenopausal, but not premenopausal, breast cancer risk and was not modified by extent of family history.

IMPACT

This was the first study to examine the association between physical activity and breast cancer risk in a large population with a family history of breast cancer.

Health education models application by peer group for improving breast cancer screening among Iranian women with a family history of breast cancer: A randomized control trial

Background: Studies have shown that participation of Iranian women with family history of breast cancer in screening service is low. This investigation has evaluated the effectiveness of health models according to peer group in improving clinical breast exam (CBE) among Iranian women with a family history of breast cancer.

Methods: This was a randomized control trial conducted during June and August 2015 in Isfahan. A total of 54 women were assigned into intervention and 53 to control group. Women 20 years or older with an affected relative were included. CBE screening, stage of change screening, knowledge, and belief were considered as outcomes after educational program. Data were analyzed by ANOVA and descriptive statistics by SPSS. Significance level was set at 0.025.

Results: Investigation was completed by 98 women; and we considered 22% as effect size. Three months after the intervention, screening practice was 52% in interventional versus 18% in control group (p<0.001). Knowledge and all health belief subscales scores were significantly affected by time factor and time-group interaction (p<0.001). The effect of group factor was significantly related to knowledge score and perceived sensitivity, benefits, and health motivation subscales. Three months after the intervention, most women in the intermediation group were in the action stage of CBE compared to the controls who continued to be in contemplation stage (p<0.001).

Conclusion: Peer group interventions, which can be organized by health models, have positive effects on CBE in women with positive history of breast cancer.

First-degree relatives of cancer patients: a target group for primary prevention? A cross-sectional study

Background

Persons with a first-degree relative (FDR) with cancer are at increased cancer risk. We investigated preventive behaviour, cancer risk perception and readiness to change an unhealthy lifestyle in persons with and without an FDR with cancer.

Methods

Using an online questionnaire, we conducted a cross-sectional study in Germany including persons (≥35 years) with an FDR with colorectal, lung, prostate, breast, stomach or cervical/uterine cancer (n = 621) and persons without cancer in FDRs (n = 303). Quota sampling ensured similar age and sex distributions in both groups.

Results

Unfavourable lifestyle factors were equally common in both groups. The proportion perceiving an increased cancer risk significantly differed (p < 0.0001) with 4% among respondents without cancer in FDRs and 18% (colorectal cancer) to 30% (stomach cancer) among cancer patients’ relatives. The proportion of smokers ready to quit smoking was significantly higher among those perceiving an increased vs. a lower cancer risk (64 vs. 46%, p = 0.04). There was a similar association for readiness to increase physical activity and consumption of fruits/vegetables and to reduce alcohol consumption.

Conclusions

Given the increased risk perception and motivation to change an unhealthy lifestyle, our study provides a strong rationale for research on the effectiveness of lifestyle interventions in cancer patients’ relatives.

Investigating relationships between ancestry, lifestyle behaviors and perceptions of heart disease and breast cancer among Canadian women with British and with South Asian ancestry

BACKGROUND

Ethnic minority groups including Asians in Canada have different knowledge and perceptions of heart disease and breast cancer compared with the ethnic majority group.

AIM

Examine relationships between perceptions of heart disease and breast cancer, and lifestyle behaviors for Canadian women with British and with South Asian ancestry.

METHODS

Women with South Asian ( n = 170) and with British ( n = 373) ancestry ( M_age = 33.01, SD = 12.86) reported leisure time physical activity, intended fruit and vegetable consumption, disease perceptions (ability to reduce risk, control over getting the diseases, and influence of family history), and demographic information. Mann-Whitney tests and multiple hierarchical linear regressions were used to examine the relationships between lifestyle behaviors and disease perceptions, with ancestry explored as a possible moderator.

RESULTS

Participants with South Asian ancestry believed they had greater ability to reduce their risk and have control over getting breast cancer than participants with British ancestry. Family history influences on getting either disease was perceived as higher for women with British ancestry. Age was positively related to all three perceptions in both diseases. Intended fruit and vegetable consumption was positively related to perceptions of ability to reduce risk and control of both diseases, but was stronger for women with South Asian ancestry regarding perceptions of breast cancer. Leisure time physical activity was positively related to perceptions of control over getting heart disease for women with British ancestry.

CONCLUSIONS

Women's disease perceptions can vary by ancestry and lifestyle behaviors. Accurate representation of diseases is essential in promoting effective preventative behaviors.

Smartphone-Enabled Health Coaching Intervention (iMOVE) to Promote Long-Term Maintenance of Physical Activity in Breast Cancer Survivors: Protocol for a Feasibility Pilot Randomized Controlled Trial

Background

Although physical activity has been shown to contribute to long-term disease control and health in breast cancer survivors, a majority of breast cancer survivors do not meet physical activity guidelines. Past research has focused on promoting physical activity components for short-term breast cancer survivor benefits, but insufficient attention has been devoted to long-term outcomes and sustained exercise adherence. We are assessing a health coach intervention (iMOVE) that uses mobile technology to increase and sustain physical activity maintenance in initially inactive breast cancer survivors.

Objective

This pilot randomized controlled trial (RCT) is an initial step in evaluating the iMOVE intervention and will inform development of a full-scale pragmatic RCT.

Methods

We will enroll 107 physically inactive breast cancer survivors and randomly assign them to intervention or control groups at the University Health Network, a tertiary cancer care center in Toronto, Canada. Participants will be women (age 18 to 74 years) stratified by age (55 years and older/younger than 55 years) and adjuvant hormone therapy (AHT) exposure (AHT vs no AHT) following breast cancer treatment with no metastases or recurrence who report less than 60 minutes of preplanned physical activity per week. Both intervention and control groups receive the 12-week physical activity program with weekly group sessions and an individualized, progressive, home-based exercise program. The intervention group will additionally receive (1) 10 telephone-based health coaching sessions, (2) smartphone with data plan, if needed, (3) supportive health tracking software (Connected Wellness, NexJ Health Inc), and (4) a wearable step-counting device linked to a smartphone program.

Results

We will be assessing recruitment rates; acceptability reflected in selective, semistructured interviews; and enrollment, retention, and adherence quantitative intervention markers as pilot outcome measures. The primary clinical outcome will be directly measured peak oxygen consumption. Secondary clinical outcomes include health-related quality of life and anthropometric measures. All outcome measures are administered at baseline, after exercise program (month 3), and 6 months after program (month 9).

Conclusions

This pilot RCT will inform full-scale RCT planning. We will assess pilot procedures and interventions and collect preliminary effect estimates.

Trial Registration

ClinicalTrials.gov NCT02620735; https://clinicaltrials.gov/ct2/show/NCT02620735 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02620735)

Cancer beliefs in cancer survivors, cancer relatives and persons with no cancer experience

Aims: Negative cancer beliefs have been associated with late stage at cancer diagnosis. High levels of negative cancer beliefs have been found among individuals with low socioeconomic position and ethnic minority women, but the impact of cancer experience on cancer beliefs is unexamined. The aim of this study was to examine whether cancer beliefs are associated with cancer experience. Methods: This was a cross-sectional population-based study. Telephone interviews of 2992 Danish residents (30+) were carried out using the Awareness and Beliefs about Cancer Measure (ABC). Respondents reported whether they or someone close had been diagnosed with cancer and whether they agreed/disagreed with three positively and three negatively framed cancer beliefs. Results: Respondents with someone close diagnosed was reference group. Compared with these, respondents with no cancer experience (RR_adj=0.91, 95% CI=0.84-0.98) or who had had cancer themselves (RR_adj=0.87, 0.77-0.98) were less likely to believe that cancer treatment is worse than the cancer itself, and respondents with no cancer experience were less likely to believe that a diagnosis of cancer is a death sentence (RR_adj=0.83, 0.70-0.98), but more likely to report that they did not want to know if they had cancer (RR_adj=1.31, 1.01-1.71). Conclusions: The results suggest that cancer beliefs are sensitive to cancer experience. This is an important addition to previous results focusing on the association between cancer beliefs and static factors such as socioeconomic position and ethnicity. Since cancer beliefs may determine health-related behaviour, it is important that negative cancer beliefs are addressed and possibly reframed in population-based interventions.

An exploratory study of patients' views about being at high-risk for breast cancer and risk management beliefs and intentions, before and after risk counselling: Preliminary evidence of the influence of beliefs on post-counselling prevention intentions

OBJECTIVES

1) To describe how women at high-risk for breast cancer (BC) perceive their at-risk status and the options available to manage this risk, before and after risk counselling; 2) to explore the contributions of pre-counselling demographic, clinical, cognitive and emotional factors to post-counselling risk management intentions.

METHODS

58 of 173 eligible patients (34%) enrolled and were asked to fill surveys including measures of 1) subjective risk, 2) illness (being at high-risk for BC) and 3) treatment (surveillance, lifestyle modifications, and chemoprevention) cognitions, 4) BC fear and 5) future risk management intentions, prior to and 3 months after risk consultation.

RESULTS

48 of 58 participants (83%) completed both surveys. Beliefs and emotions about their condition and its management were stable over time. Surveillance and lifestyle were associated with stronger intentions, higher perceived need, and lower concerns than chemoprevention (all ps <0.001). The strongest predictors of intentions strengths were the women's beliefs about the risk reduction methods, especially for lifestyle and chemoprevention (all ps <0.01).

CONCLUSIONS

The findings emphasize the importance of patients' beliefs in risk management decisions.

PRACTICAL IMPLICATIONS

Patients' treatment beliefs appear to influence their choice of BC risk reduction strategies and should be discussed during risk reduction consultations.

Health Behaviors and their Relationship with Disease Control in People Attending Genetic Clinics with a Family History of Breast or Colorectal Cancer

The current work aimed to assess health behaviors, perceived risk and control over breast/colorectal cancer risk and views on lifestyle advice amongst attendees at cancer family history clinics. Participants attending the East of Scotland Genetics Service were invited to complete a questionnaire (demographic data, weight and height, health behaviors and psycho-social measures of risk and perceived control) and to participate in an in-depth interview. The questionnaire was completed by 237 (49 %) of attendees, ranging from 18 to 77 years (mean age 46 (±10) years). Reported smoking rates (11 %) were modest, most (54 %) had a BMI > 25 kg/m2, 55 % had low levels of physical activity, 58 % reported inappropriate alcohol intakes and 90 % had fiber intakes indicative of a low plant diet. Regression analysis indicated that belief in health professional control was associated with higher, and belief in fatalism with poorer health behavior. Qualitative findings highlighted doubts about the link between lifestyle and cancer, and few were familiar with the current evidence. Whilst lifestyle advice was considered interesting in general there was little appetite for non-tailored guidance. In conclusion, current health behaviors are incongruent with cancer risk reduction guidance amongst patients who have actively sought advice on disease risk. There are some indications that lifestyle advice would be welcomed but endorsement requires a sensitive and flexible approach, and the acceptability of lifestyle interventions remains to be explored.

An Exploratory Study on the Information Needs of Prostate Cancer Patients and Their Partners

The aim of this study is to explore the information needs of men with prostate cancer and their partners retrospectively at various points in the treatment process. An online questionnaire was used to collect information from men with prostate cancer and their partners about information needs, and when these developed. Readers of a Prostate Care Cookbook and members of a Prostate Cancer Charity were invited to participate: 73 men with prostate cancer and 25 partners completed the questionnaire. Responses showed that participants develop their information needs close to diagnosis. Less educated men with prostate cancer and partners developed their needs closer to the time after diagnosis than those with higher education. Partners develop an interest on information related to treatment and interaction earlier than patients. Patients prioritised treatment and disease-specific information. Patients and partners differ in how their information needs develop. Medical information is prioritized by patients as opposed to practical information by partners. Health care provision can be tailored to meet the different needs of prostate cancer patients and their partners at different times in the treatment process.

Randomized trial of a phone- and web-based weight loss program for women at elevated breast cancer risk: the HELP study

Excess weight and physical inactivity are modifiable risk factors for breast cancer. Behavioral intervention is particularly important among women with an elevated risk profile. This trial tested an intervention that trained women to use a self-monitoring website to increase activity and lose weight. Women with BMI ≥27.5 kg/m(2) at elevated breast cancer risk were randomized to the intervention (N = 71) or usual care (N = 34). The intervention group received telephone-based coaching and used web-based self-monitoring tools. At 6 months, significant weight loss was observed in the intervention group (4.7 % loss from starting weight; SD = 4.7 %) relative to usual care (0.4 % gain; SD = 3.0 %) (p < 0.0001). By 12 months, the intervention group had lost 3.7 % of weight (SD = 5.4 %), compared to 1.3 % (SD = 4.2) for usual care (p = 0.003). At 12 months, accelerometer-measured moderate-to-vigorous physical activity increased by 12 min/day (SD = 24) compared to no change in usual care (p = 0.04. In summary, this web- and phone-based approach produced modest but significant improvements in weight and physical activity for women at elevated breast cancer risk.

Family Ties: The Role of Family Context in Family Health History Communication About Cancer

Family health history about cancer is an important prevention and health promotion tool. Yet few studies have identified family context factors that promote such discussions. We explored relations among family context (cohesion, flexibility, and openness), self-efficacy, and cancer communication (gathering family history, sharing cancer risk information, and frequency) in a diverse group of women enrolled in a randomized control trial. Baseline survey data for 472 women were analyzed. The women's average age was 34 years, 59% identified as Black, 31% had graduated high school, and 75% reported a family history of any cancer. Results showed that greater family cohesion and flexibility were related to higher communication frequency and sharing cancer information. Women who reported greater self-efficacy were more likely to have gathered family history, shared cancer risk information, and communicated more frequently with relatives. Openness was not associated with communication but was related to greater family cohesion and flexibility. Adjusting for demographic variables, self-efficacy, and family cohesion significantly predicted communication frequency. Women with higher self-efficacy were also more likely to have gathered family health history about cancer and shared cancer risk information. Future research may benefit from considering family organization and self-efficacy when developing psychosocial theories that in turn inform cancer prevention interventions.

What women think: cancer causal attributions in a diverse sample of women

Women hold diverse beliefs about cancer etiology, potentially affecting their use of cancer preventive behaviors. Research has primarily focused on cancer causal attributions survivors and participants from non-diverse backgrounds hold. Less is known about attributions held by women with and without a family history of cancer from a diverse community sample. Participants reported factors they believed cause cancer. Open-ended responses were coded and relations between the top causal attributions and key factors were explored. Findings suggest certain socio-cultural factors play a role in the causal attributions women make about cancer, which can, in turn, inform cancer awareness and prevention messages.

Beliefs about weight and breast cancer: an interview study with high risk women following a 12 month weight loss intervention

Background

Breast cancer is the most common cancer in the UK. Lifestyle factors including excess weight contribute to risk of developing the disease. Whilst the exact links between weight and breast cancer are still emerging, it is imperative to explore how women understand these links and if these beliefs impact on successful behaviour change.

Method

Overweight/obese premenopausal women (aged 35–45) with a family history of breast cancer (lifetime risk 17–40%) were invited to a semi-structured interview following their participation in a 12 month weight loss intervention aimed at reducing their risk of breast cancer. Interviews were carried out with 9 women who successfully achieved ≥5% weight loss and 11 who were unsuccessful. Data were transcribed verbatim and analysed using thematic analysis.

Results

Three themes were developed from the analysis. The first theme how women construct and understand links between weight and breast cancer risk is composed of two subthemes, the construction of weight and breast cancer risk and making sense of weight and breast cancer risk. This theme explores women’s understanding of what contributes to breast cancer risk and whether they believe that weight loss could reduce their breast cancer risk. The second theme motivation and adherence to weight loss interventions explains that breast cancer risk can be a motivating factor for adherence to a weight loss intervention. The final theme, acceptance of personal responsibility for health is composed of two subthemes responsibility for one’s own health and responsibility for family health through making sensible lifestyle choices.

Conclusion

Beliefs about weight and breast cancer risk were informed by social networks, media reports and personal experiences of significant others diagnosed with breast cancer. Our study has highlighted common doubts, anxieties and questions and the importance of providing a credible rationale for weight control and weight loss which addresses individual concerns. Counselling and health education material should be tailored to facilitate understanding of both genetic and modifiable risk factors and should do more help individuals to visualise the weight and breast cancer link.

Health behaviors in family members of patients completing cancer treatment

PURPOSE/OBJECTIVES

To describe the impact of the cancer experience on the health behaviors of survivors' family members and to determine factors associated with family members' intentions for health behavior change.

DESIGN

Descriptive, cross-sectional, correlational.

SETTING

A National Cancer Institute-designated comprehensive cancer center in the midwestern United States.

SAMPLE

39 family members and 50 patients with diagnoses of breast, colorectal, head and neck, lung, or prostate cancer who were completing definitive cancer treatment.

METHODS

Patients and family members were approached in the clinic at three weeks or fewer before the completion of their course of treatment. Family members completed surveys and a structured interview in person or via telephone.

MAIN RESEARCH VARIABLES

Intention, perceived benefit, and confidence about eating a healthful diet, physical activity, and smoking cessation; emotional distress; and family cohesion, conflict, and expressiveness.

FINDINGS

Family members had high ratings for intention, perceived benefit, and confidence related to the behaviors of eating a healthful diet and performing 30 minutes of daily moderate-intensity physical activity. They also had high ratings for the extent to which the cancer experience had raised awareness of their cancer risk and made them consider undergoing screening tests for cancer; ratings were lower for making changes in their health behaviors.

CONCLUSIONS

Family members expressed strong intentions to engage in health-promoting behaviors related to physical activity and nutrition at the post-treatment transition.

IMPLICATIONS FOR NURSING

Oncology nurses are in a key position to engage family members and patients in behavior change. Nurses should assess family members at the completion of treatment for distress and provide interventions to influence the trajectory of distress in survivorship.

Health behaviors in family members of patients completing cancer treatment

PURPOSE/OBJECTIVES

To describe the impact of the cancer experience on the health behaviors of survivors' family members and to determine factors associated with family members' intentions for health behavior change.

DESIGN

Descriptive, cross-sectional, correlational.

SETTING

A National Cancer Institute-designated comprehensive cancer center in the midwestern United States.

SAMPLE

39 family members and 50 patients with diagnoses of breast, colorectal, head and neck, lung, or prostate cancer who were completing definitive cancer treatment.

METHODS

Patients and family members were approached in the clinic at three weeks or fewer before the completion of their course of treatment. Family members completed surveys and a structured interview in person or via telephone.

MAIN RESEARCH VARIABLES

Intention, perceived benefit, and confidence about eating a healthful diet, physical activity, and smoking cessation; emotional distress; and family cohesion, conflict, and expressiveness.

FINDINGS

Family members had high ratings for intention, perceived benefit, and confidence related to the behaviors of eating a healthful diet and performing 30 minutes of daily moderate-intensity physical activity. They also had high ratings for the extent to which the cancer experience had raised awareness of their cancer risk and made them consider undergoing screening tests for cancer; ratings were lower for making changes in their health behaviors.

CONCLUSIONS

Family members expressed strong intentions to engage in health-promoting behaviors related to physical activity and nutrition at the post-treatment transition.

IMPLICATIONS FOR NURSING

Oncology nurses are in a key position to engage family members and patients in behavior change. Nurses should assess family members at the completion of treatment for distress and provide interventions to influence the trajectory of distress in survivorship.

Differences in response to a dietary intervention between the general population and first-degree relatives of colorectal cancer patients

OBJECTIVE

To determine whether response to a dietary intervention is greater among people with family history of colorectal cancer (CRC) compared with a general population.

DESIGN

Cohort study examining participants from 2 related studies.

SETTING

Rural Virginia.

PARTICIPANTS

Seventy people with first-degree relatives with CRC and 113 participants from the intervention arm of a trial in the general population.

INTERVENTION

Both studies implemented a low-intensity intervention delivered via telephone and mail, including low-literacy self-help booklets and personalized dietary feedback.

MAIN OUTCOME MEASURES

Fat, fiber, and fruit and vegetable behavior.

ANALYSIS

Propensity score matching controlled for confounders. Mixed-model ANOVAs compared samples; mediation by perceived cancer risk was assessed.

RESULTS

Participants in both groups significantly improved fat, fiber, and fruit and vegetable behavior at 1-month follow-up; there was significantly greater improvement in the general population sample. Cancer risk perception did not mediate the relationship between study sample and dietary change.

CONCLUSIONS AND IMPLICATIONS

Contrary to expectations, first-degree relatives of CRC patients did not respond better to a dietary intervention than the general population, nor was risk perception related to dietary change. Given the role of diet in CRC risk, additional research should investigate targeted strategies to improve dietary intakes of people at higher cancer risk.

100 years Lynch syndrome: what have we learned about psychosocial issues?

In the care of patients with Lynch Syndrome (LS), a range of psychosocial issues are encountered, which significantly affect patient outcomes. A brief historical background of 'psycho-onco-genetics' (the domain where psychology, oncology and genetics meet) in relation to LS is presented, followed by an overview of important psychosocial issues identified in the past 20 years. The identification of mismatch repair genes in 1993-1994 made possible genetic counseling and testing for patients who had cancer and for potentially high-risk relatives without cancer. At that time, concerns were raised about the potentially negative psychosocial impact of predictive genetic testing. Since 1993, a large number of studies have been conducted to investigate the possible psychosocial benefits and limitations of such testing. This article presents an overview of: the uptake of and motivations for genetic testing, its psychosocial impact (e.g. psychological adaptation, impact on risk perception and self-concept, and concerns about, and experiences of, genetic discrimination), psychological screening instruments, adherence to and decision-making about preventive strategies, family communication, lifestyle changes, reproductive technology utilization, and professional psychosocial support needs of members of families with LS. Finally, challenges for the future are discussed, including population screening and genomic testing.

Do health behaviours change after colonoscopy? A prospective cohort study on diet, alcohol, physical activity and smoking among patients and their partners

OBJECTIVES

To describe diet, alcohol, physical activity and tobacco use prospectively, that is, before and 10 months after colonoscopy for patients and their partners.

DESIGN

Prospective cohort study of health behaviour change in patients and partners. Comparison groups are patients receiving a normal result notification (NRN) versus patients receiving an abnormal result notification (ARN). Patients and partners (controls) are also compared.

SETTING

5 Scottish hospitals.

PARTICIPANTS

Of 5798 colonoscopy registrations, 2577 (44%) patients met the eligibility criteria of whom 565 (22%) were recruited; 460 partners were also recruited.

MEASURES

International Physical Activity Questionnaire, Scottish Collaborative Group Food Frequency Questionnaire (includes alcohol), smoking status, sociodemographic characteristics, body mass index, medical conditions, colonoscopy result, Multidimensional Health Locus of Control Scale, behaviour-specific self-efficacy scales.

RESULTS

57% of patients were men, with a mean age of 60.8 years (SE 0.5) and 43% were from more affluent areas. 72% (n=387) of patients received an ARN and 28% (n=149) received an NRN. Response rate of the second questionnaire was 68.9%. Overall, 27% of patients consumed <5 measures of fruit and vegetables/day, 20% exceeded alcohol limits, 50% had low levels of physical activity and 21% were obese. At 10-month follow-up, a 5% reduction in excessive alcohol consumption and an 8% increase in low levels of physical activity were observed among patients; no significant changes occurred in partners. Baseline high alcohol consumption and low physical activity were the strongest predictors of these behaviours at follow-up. Low alcohol self-efficacy and increasing age were associated with poorer health-related behaviours at follow-up for alcohol consumption and physical activity, respectively.

CONCLUSIONS

Colonoscopy is associated with marginal beneficial changes in some behaviours but not others. Further work is needed to explore how services can optimise increases in beneficial behaviours and mitigate increases in harmful ones.

REGISTRATIONS

REC REF 10/S0709/24, UKCRN 9911.

Change in physical activity after a diabetes diagnosis: opportunity for intervention

INTRODUCTION

Moderate-intensity physical activity is recommended for individuals with diabetes to control glucose and prevent diabetes-related complications. The extent to which a diabetes diagnosis motivates patients to increase physical activity is unclear. This study used data from the Women's Health Initiative Observational Study (baseline data collected from 1993 to 1998) to examine change in physical activity and sedentary behavior in women who reported a diabetes diagnosis compared with women who did not report diabetes during 7 yr of follow-up (up to 2005).

METHODS

Participants (n = 84,300) were postmenopausal women who did not report diabetes at baseline (mean ± SD; age = 63.49 ± 7.34 yr; body mass index = 26.98 ± 5.67 kg·m). Linear mixed-model analyses were conducted adjusting for study year, age, race/ethnicity, body mass index, education, family history of diabetes, physical functioning, pain, energy/fatigue, social functioning, depression, number of chronic diseases, and vigorous exercise at age 18 yr. Analyses were completed in August 2012.

RESULTS

Participants who reported a diabetes diagnosis during follow-up were more likely to report increasing their total physical activity (P = 0.002), walking (P < 0.001), and number of physical activity episodes (P < 0.001) compared with participants who did not report a diabetes diagnosis. On average, participants reporting a diabetes diagnosis reported increasing their total physical activity by 0.49 MET·h·wk, their walking by 0.033 MET·h·wk, and their number of physical activity episodes by 0.19 MET·h·wk. No differences in reported sedentary behavior change were observed (P = 0.48).

CONCLUSIONS

A diabetes diagnosis may prompt patients to increase physical activity. Healthcare professionals should consider how best to capitalize on this opportunity to encourage increased physical activity and maintenance.

Does and should breast cancer genetic counselling include lifestyle advice?

To optimally inform counselees about their and their relatives' risks, information about lifestyle risk factors, e.g. physical activity and alcohol consumption, might be discussed in breast cancer genetic counselling. This study explored whether lifestyle was discussed, on whose initiative, whether information and/or advice was given, and whether discussion of lifestyle was related to counselees' characteristics and their causal attributions. First and follow-up consultations with 192 consecutive counselees for breast cancer genetic counselling were videotaped and coded for discussion of lifestyle topics. Counselees completed web-based questionnaires before the initial and after the final consultation. With 52 (27%) counselees lifestyle was discussed, either in the first, or the final consultation, or both. Counselees mostly raised the topic (60%). Counsellors provided information about lifestyle risk factors to 19% and lifestyle advice to 6% of the counselees. Discussion of lifestyle was not associated with counselees' characteristics or causal attributions. Post-counselling, more affected counselees considered lifestyle as a cause of their breast cancer (29%) compared to pre-counselling (15%; p = 0.003). Information and advice about lifestyle risk factors was infrequently provided, both with breast cancer unaffected and affected counselees and with those who did and did not consider their lifestyle as a cause of their breast cancer. Modifiable lifestyle factors could be discussed more frequently to optimally inform counselees about possible ways to reduce their risk. Counsellors should be educated about effects of lifestyle and research should be conducted on how to best integrate lifestyle information in breast cancer genetic counselling.

Receptivity and preferences of pancreatic cancer family members for participating in lifestyle programs to reduce cancer risk

Background

Cancer is a shared family experience that might provide an opportunity for lifestyle change among at-risk family members. The purpose of this study was to assess receptivity and preferences for cancer risk reduction programs among at-risk family members with two or more relatives affected with pancreas cancer.

Methods

We surveyed 401 at-risk family members in an existing pancreatic cancer family registry. Participants completed a mailed survey which examined demographic, medical, and psychosocial correlates of willingness to participate in lifestyle cancer risk reduction programs. Multivariable generalized estimating equation approaches were used to model preferences.

Results

Overall, 85% (n = 342) of at-risk family members were receptive to lifestyle cancer risk reduction programs. Participant preferred programs focused on nutrition (36%, n = 116) and weight management (33%, n = 108), with Web/Internet (46%, n = 157) being the most preferred delivery channel. Most respondents preferred to participate in programs with their family or friends (74%, n = 182), rather than alone (25%, n = 85). In multivariable analysis, younger age (p = 0.008) and higher perceived likelihood of developing cancer (p = 0.03) were associated with willingness to participate in lifestyle programs.

Conclusions

Family members of those with pancreatic cancer are receptive to cancer risk reduction programs focusing on nutrition and weight management delivered via the internet. Further research is indicated to determine how to best incorporate a family-based approach when designing lifestyle intervention programs.

Association between cancer screening behavior and family history among Japanese women

OBJECTIVE

To examine lifestyle habits and cancer screening behavior in relation to a family history of cancer among Japanese women.

METHODS

A cross-sectional study was conducted based on baseline data from the Japan Nurses' Health Study collected from June 2001 to March 2007. Participants were 47,347 female nurses aged 30-59 years residing in 47 prefectures in Japan. We compared lifestyle habits and the utilization of cancer screenings (cervical and breast) between women with and without a family history of the relevant cancer.

RESULTS

Although there were no differences in lifestyle habits with the exception of smoking status, women with a family history of uterine cancer were more likely to have undergone cervical cancer screenings (p<0.01). Women with a family history of breast cancer were also more likely to have undergone breast cancer screenings regardless of their age (p<0.01), but lifestyle behaviors did not differ. Among women with a family history of uterine cancer, those with a sister history were more likely to have undergone not only cervical (OR, 1.89; 95% CIs, 1.39-2.58), but also breast cancer screenings (OR, 1.54; 95% CIs 1.13-2.09).

CONCLUSION

Having a family history of cancer was associated with cancer screening behavior, but not health promotive behaviors.

Evaluating epidemiological evidence: a simple test

Epidemiological studies that investigate the relationships between health behaviors and diseases may be affected by both known and unknown confounding factors. Alcohol use is one of these behaviors that have been intensively investigated in epidemiological studies. This manuscript introduced a simple test that can identify confounded epidemiological studies. This approach is sensitive to both known and unknown confounders. It provides a new perspective to develop measures for evidence selection in the future.

Receptivity and Preferences in Cancer Risk Reduction Lifestyle Programs: A Survey of Colorectal Cancer Family Members

BACKGROUND

Cancer is a shared family experience, and thus the purpose of this study was to assess receptivity and preferences for cancer risk reduction programs among at-risk family members with two or more relatives affected with colorectal cancer (CRC).

METHODS

The sample comprised 401 at-risk family members with two or more relatives affected with CRC from the Colon Cancer Family Registry. In March 2009, respondents completed a mailed survey assessing receptivity and preferences for participating in cancer risk reduction programs and evaluated their relationship to demographic, medical, and psychosocial variables. Multivariable generalized estimating equation approaches were used to model preferences.

RESULTS

Overall, 81% of respondents were receptive to a lifestyle cancer risk reduction program; of these, about half (54%) preferred to participate with their family. Program preferences included: weight management (36%) and nutrition (31%); delivered through the internet (41%) or mail (39%). In a multivariate model, a greater level of concern about cancer (p<0.001), female gender (p=0.002), and higher education (p=0.016) were significantly correlated with willingness to participate in lifestyle programs.

CONCLUSIONS

Family members of those with CRC are receptive to cancer risk reduction programs that focus on weight management and nutrition delivered via the internet or mail. Future research is needed to determine how best to incorporate a family-based approach that addresses the cancer experience when designing lifestyle intervention programs.

Health behaviors and cancer screening among Californians with a family history of cancer

PURPOSE

The purpose of this study was to compare health behaviors and cancer screening among Californians with and without a family history of cancer.

METHODS

We analyzed data from the 2005 California Health Interview Survey to ascertain cancer screening test use and to estimate the prevalence of health behaviors that may reduce the risk of cancer. We used logistic regression to control for demographic factors and health-care access.

RESULTS

Women with a family history of breast or ovarian cancer were more likely to be up to date with mammography as compared with women with no family history of cancer (odds ratio = 1.69, 95% confidence interval (1.39, 2.04)); their health behaviors were similar to other women. Men and women with a family history of colorectal cancer were more likely to be up to date with colorectal cancer screening as compared with individuals with no family history of cancer (odds ratio = 2.77, 95% confidence interval (2.20, 3.49)) but were less likely to have a body mass index <25 kg/m(2) (odds ratio = 0.80, 95% confidence interval (0.67, 0.94)).

CONCLUSION

Innovative methods are needed to encourage those with a moderate-to-strong familial risk for breast cancer and colorectal cancer to increase their physical activity levels, strive to maintain a healthy weight, quit smoking, and reduce alcohol use.Genet Med 2013:15(3):212-221.

Stomach cancer screening and preventive behaviors in relatives of gastric cancer patients

AIM: To investigate gastric cancer screening and preventive behaviors among the relatives of patients with gastric cancer [i.e., gastric cancer relatives (GCRs)].

METHODS: We examined the Korean National Health and Nutrition Examination Survey 2005 (KNHANES III) database and compared the gastric cancer screening and preventive behaviors of GCRs (n = 261) with those of non-GCRs (n = 454) and controls without a family history of cancer (n = 2842).

RESULTS: The GCRs were more likely to undergo gastric cancer screening compared with the control group (39.2% vs 32.3%, adjusted odds ratio: 1.43, CI: 1.05-1.95), although the absolute screening rate was low. Dietary patterns and smoking rates did not differ significantly between the groups, and a high proportion of GCRs reported inappropriate dietary habits (i.e., approximately 95% consumed excessive sodium, 30% were deficient in vitamin C, and 85% were deficient in dietary fiber).

CONCLUSION: The gastric cancer screening and preventive behaviors of GCRs have yet to be improved. To increase awareness among GCRs, systematic family education programs should be implemented.

Comparing screening and preventive health behaviors in two study populations: daughters of mothers with breast cancer and women responding to the behavioral risk factor surveillance system survey

BACKGROUND

Studies show that daughters of mothers with breast cancer may be at increased risk for developing the disease. However, daughters' adherence to health behavior and screening recommendations, compared to the general population, is unknown.

METHODS

Telephone interviews explored characteristics of adult daughters (n=147), including primary and secondary preventive behaviors, body mass index (BMI, kg/m(2)), physical activity, fruit/vegetable intake, alcohol intake, smoking, and mammography. Daughters of mothers with breast cancer were recruited from the community and were compared with Virginia women (n=2528) from the 2005 Behavioral Risk Factor Surveillance System (BRFSS) survey. Differences were examined using logistic regression, adjusting for demographic covariates.

RESULTS

Daughters were younger (p<0.001), more highly educated (p<0.001), and more likely to never have been married (p<0.001) than BRFSS participants, but groups were similar by race. In adjusted analyses, daughters were significantly more likely to have ever had a mammogram (p<0.001) and to have had one recently (p=0.001). Daughters also were significantly less likely to consume>3 fruit/vegetable servings daily (p=0.032) compared to BRFSS results. There were no differences in BMI, smoking rates, alcohol consumption, or level of physical activity at work.

CONCLUSIONS

Daughters with familial breast cancer risk were more likely to receive mammography screening than BRFSS participants, but they were no different in BMI, physical activity at work, exercise, or smoking than BRFSS participants and were less likely to consume more fruits and vegetables. More research is needed to explore group differences in screening practices compared to modifiable health behaviors in daughters of mothers with breast cancer.

Proactive recruitment of cancer patients' social networks into a smoking cessation trial

BACKGROUND

This report describes the characteristics associated with successful enrollment of smokers in the social networks (i.e., family and close friends) of patients with lung cancer into a smoking cessation intervention.

METHODS

Lung cancer patients from four clinical sites were asked to complete a survey enumerating their family members and close friends who smoke, and provide permission to contact these potential participants. Family members and close friends identified as smokers were interviewed and offered participation in a smoking cessation intervention. Repeated measures logistic regression model examined characteristics associated with enrollment.

RESULTS

A total of 1062 eligible lung cancer patients were identified and 516 patients consented and completed the survey. These patients identified 1325 potentially eligible family and close friends. Of these, 496 consented and enrolled in the smoking cessation program. Network enrollment was highest among patients who were white and had late-stage disease. Social network members enrolled were most likely to be female, a birth family, immediate family, or close friend, and live in close geographic proximity to the patient.

CONCLUSIONS

Proactive recruitment of smokers in the social networks of lung cancer patients is challenging. In this study, the majority of family members and friends declined to participate. Enlisting immediate female family members and friends, who live close to the patient as agents to proactively recruit other network members into smoking cessation trials could be used to extend reach of cessation interventions to patients' social networks. Moreover, further consideration should be given to the appropriate timing of approaching network smokers to consider cessation.

Anticipated behaviors of emergency prehospital medical care providers during an influenza pandemic

INTRODUCTION

Emergency prehospital medical care providers are frontline health workers during emergencies. However, little is known about their attitudes, perceptions, and likely behaviors during emergency conditions. Understanding these attitudes and behaviors is crucial to mitigating the psychological and operational effects of biohazard events such as pandemic influenza, and will support the business continuity of essential prehospital services.

PROBLEM

This study was designed to investigate the association between knowledge and attitudes regarding avian influenza on likely behavioral responses of Australian emergency prehospital medical care providers in pandemic conditions.

METHODS

Using a reply-paid postal questionnaire, the knowledge and attitudes of a national, stratified, random sample of the Australian emergency prehospital medical care workforce in relation to pandemic influenza were investigated. In addition to knowledge and attitudes, there were five measures of anticipated behavior during pandemic conditions: (1) preparedness to wear personal protective equipment (PPE); (2) preparedness to change role; (3) willingness to work; and likely refusal to work with colleagues who were exposed to (4) known and (5) suspected influenza. Multiple logistic regression models were constructed to determine the independent predictors of each of the anticipated behaviors, while controlling for other relevant variables.

RESULTS

Almost half (43%) of the 725 emergency prehospital medical care personnel who responded to the survey indicated that they would be unwilling to work during pandemic conditions; one-quarter indicated that they would not be prepared to work in PPE; and one-third would refuse to work with a colleague exposed to a known case of pandemic human influenza. Willingness to work during a pandemic (OR = 1.41; 95% CI = 1.0-1.9), and willingness to change roles (OR = 1.44; 95% CI = 1.04-2.0) significantly increased with adequate knowledge about infectious agents generally. Generally, refusal to work with exposed (OR = 0.48; 95% CI = 0.3-0.7) or potentially exposed (OR = 0.43; 95% CI = 0.3-0.6) colleagues significantly decreased with adequate knowledge about infectious agents. Confidence in the employer's capacity to respond appropriately to a pandemic significantly increased employee willingness to work (OR = 2.83; 95% CI = 1.9-4.1); willingness to change roles during a pandemic (OR = 1.52; 95% CI = 1.1-2.1); preparedness to wear PPE (OR = 1.68; 95% CI = 1.1-2.5); and significantly decreased the likelihood of refusing to work with colleagues exposed to (suspected) influenza (OR = 0.59; 95% CI = 0.4-0.9).

CONCLUSIONS

These findings indicate that education and training alone will not adequately prepare the emergency prehospital medical workforce for a pandemic. It is crucial to address the concerns of ambulance personnel and the perceived concerns of their relationship with partners in order to maintain an effective prehospital emergency medical care service during pandemic conditions.

Causal attribution among cancer survivors of the 10 most common cancers

In an attempt to understand and cope with their diagnosis, individuals with cancer may develop beliefs about the cause of their illness and these causal attributions may impact psychosocial adjustment. Connecticut participants (N = 775) from the American Cancer Society's Study of Cancer Survivors-I completed a self-administered questionnaire assessing beliefs of the cause of their cancer and if they had contemplated the question "why me?" regarding their diagnosis. Written causal belief responses were coded into thematic categories and defined as either in (modifiable) or out (fixed) of an individual's control. Using logistic regression, the authors examined associations between sociodemographic, clinical, and psychosocial measures and identifying modifiable causal attributions, as well as contemplating "why me." Most cancer survivors (78.2%) identified one or more causes. Lifestyle and biological factors were most common, whereas psychological factors were least common, with some variation by cancer type. After multivariate adjustment, only cancer type was associated with identifying modifiable causes. Participants who contemplated "why me" (47.5%) were more likely to be younger and reported a greater number of cancer-related problems. In conclusion, the majority of cancer survivors reported specific causal attributions, and many had contemplated "why me." Understanding and assessing causal attributions and more general existential questions regarding diagnosis could aid in our understanding of survivors' adjustment and psychosocial well-being. Additional research in large populations is also needed to determine if other characteristics are associated with identifying modifiable causal attributions and asking "why me."

Intention to quit smoking: role of personal and family member cancer diagnosis

Individuals who have ever experienced a cancer diagnosis and their family members may be priority audiences for health improving interventions. Guided by the heuristic model of the 'teachable moment' and using data from the 2003 National Cancer Institute's Health Information National Trends Survey, we explored whether having a lifetime history of cancer or having a family member with a lifetime history of cancer was associated with intention to quit smoking. Results showed that having a personal lifetime history of cancer was not associated with intention to quit, while having a family member with a lifetime history of cancer was (χ(2) = 7.08, P < 0.01). Path analysis showed that individual perceived risk of cancer mediated the relationship between having a family member with a history of cancer and quitting intention: smokers who had a family member with a history of cancer in addition to an elevated level of perceived cancer risk were 36% more likely to report intending to quit. These preliminary data suggest that family members of cancer patients may be a viable target population for smoking cessation interventions, especially when they have heightened levels of perceived cancer risk. An adequately powered, controlled trial is needed to fully evaluate this hypothesis.

Relationship between family history of breast cancer and health-related behavior

This article explores the relationship between family history of breast cancer (FHBC) and health-related behavior and medical management, using a cross-sectional analysis of 685 women, based on self-report. The influence of FHBC on lifestyle (alcohol use, physical activity, weight and diet) and medical management decisions (screening for chronic diseases) was assessed using odds ratios (OR) and 95% confidence interval (CI). Adjustment for confounders was performed using unconditional logistic regression. Sixty five women (9.5%) reported relatives with breast cancer. Women with FHBC are more likely to have had a mammography and colonoscopy or sigmoidoscopy. These women have about twice the probability of performing more intense physical exercise, contrasting with high-risk women whose consumption of fibre is lower and sweets is higher. No significant association was found between alcohol consumption or Body Mass Index and family history. Spontaneous behavioral change to a more preventive lifestyle in relatives of cancer patients is very low.