Women's advocacy groups and research in breast cancer

Involving people affected by cancer in research: a review of literature

The purpose of the literature review was to find out why people affected by cancer have been involved in research; how they have been involved and the impact of their involvement. We used systematic methods to search for literature, applied inclusion and exclusion criteria, conducted a quality appraisal, selected relevant data from the included articles for analysis, and provided a narrative summary of these data. The literature shows that people affected by cancer, particularly women with breast cancer, have been involved in a range of research programmes, projects and initiatives especially in the USA, UK, Canada and Australia. Their involvement has impacted upon research design, accrual and response rates. There is increasing recognition of the need for an infrastructure, including formal recruitment procedures, training and mentoring, to support an agenda of involvement and a need to challenge the ethos of traditional research, which does not easily lend itself to this agenda. Further critique of the role of 'experiential knowledge' in research is required so that researchers and people affected by cancer can work in partnership.

A review of literature about involving people affected by cancer in research, policy and planning and practice

OBJECTIVE

To systematically review the literature on involving people affected by cancer in healthcare research, policy and planning and practice.

METHODS

Database searches, cited author, and grey literature searches were conducted.

RESULTS

131 documents were included. Rationales for the agenda of involvement represent two polar characteristics of modernity: individualism and collectivism. In research, people acted as advocates, strategists, advisors, reviewers and as participatory researchers. In policy and planning, people were involved in one-off involvement exercises and in longer-term partnerships. Men, those with rare cancers, children, and people who are socially deprived have been rarely involved. There is little research evidence about the impact of involvement. Training and information, resources and a change in attitudes and roles are required to implement an agenda of involvement.

CONCLUSION

The USA, the UK, followed by Canada and Australia have promoted an agenda of involvement.

PRACTICE IMPLICATIONS

A dissemination strategy to share good practice; involvement of all types of people; an individualised and flexible approach; training, resources and a shift in thinking from paternalism towards partnership working are required. More research is needed about the impact of involvement and relationships between rationales for involvement and implementation.

The Role of Ovarian Ablation in the Management of Breast Cancer

In recent years the role of ovarian ablation as a therapeutic modality not only in the prevention but also in the treatment of breast cancer has reemerged after its initial use more than a century ago. BRCA-1 and BRCA-2 mutation carriers have an 85% lifetime risk of developing breast cancer. Bilateral salpingo-oophorectomy is effective in reducing the risk of developing breast cancer in both BRCA-1 and BRCA-2 mutation carriers by 50%. Tamoxifen reduces the risk of breast cancer in BRCA-2 mutation carriers, but not in BRCA-1 mutation carriers. Breast cancer arising in BRCA-1 mutation carriers is often estrogen receptor (ER) negative, unlike breast cancer developing in BRCA-2 mutation carriers. Sixty percent of premenopausal patients with breast cancer have ER-positive disease and 25% of breast cancer patients are premenopausal at diagnosis. The Early Breast Cancer Trialists' Collaborative Group review has shown ovarian ablation to be an effective adjuvant therapy for premenopausal breast cancer patients less than 50 years of age. But the Early Breast Cancer Trialists' overview also shows the benefit of ovarian ablation is uncertain if these patients also receive chemotherapy. Does the overview underestimate the efficacy of ovarian ablation? Some patients in these trials were ER negative. Most women less than 50 years of age who receive adjuvant chemotherapy become menopausal. So there is a need to test ovarian function suppression in the group who can benefit, or in other words, those that remain premenopausal after chemotherapy and have endocrine responsive breast cancer.

Patient perspectives on involvement in cancer research in the UK

The patient's perspective is offered to identify the benefits of patient involvement in the research process so that it will lead to research that is reliable and relevant to cancer patients' needs. A brief outline of recent consumer involvement in research and initiatives being undertaken in the UK will provide a guide for those seeking to consider what has already been achieved. Practical suggestions are offered to those seeking to facilitate this mode of working. A wider conceptual approach suggests the interrelationships that should be built, through networks of communication, so that efficient, effective, economic and equitable health care may be provided to all those suffering from cancer. This should lead to an appreciation of work that still needs to be undertaken to achieve progress.