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Brasier-Lutz P, Jäggi-Wickes C, Schädelin S, Burian R, Schoenenberger CA, Zanetti-Dällenbach R. Patient perception of meander-like versus radial breast ultrasound. Ultrasound Int Open 2024; 10:a22829193. [PMID: 38737925 PMCID: PMC11086955 DOI: 10.1055/a-2282-9193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 03/06/2024] [Indexed: 05/14/2024] Open
Abstract
Background Radial breast ultrasound scanning (r-US) and commonly used meander-like ultrasound scanning (m-US) have recently been shown to be equally sensitive and specific with regard to the detection of breast malignancies. As patient satisfaction has a strong influence on patient compliance and thus on the quality of health care, we compare here the two US scanning techniques with regard to patient comfort during breast ultrasound (BUS) and analyze whether the patient has a preference for either scanning technique. Materials and Methods Symptomatic and asymptomatic women underwent both m-US and r-US scanning by two different examiners. Patient comfort and preference were assessed using a visual analog scale-based (VAS) questionnaire and were compared using a Mann-Whitney U test. Results Analysis of 422 VAS-based questionnaires showed that perceived comfort with r-US (r-VAS 8 cm, IQR [5.3, 9.1]) was significantly higher compared to m-US (m-VAS 5.6 cm, IQR [5.2, 7.4]) (p < 0.001). 53.8% of patients had no preference, 44.3% of patients clearly preferred r-US, whereas only 1.9% of patients preferred m-US. Conclusion: Patients experience a higher level of comfort with r-US and favor r-US over m-US. As the diagnostic accuracy of r-US has been shown to be comparable to that of m-US and the time required for examination is shorter, a switch from m-US to r-US in routine clinical practice might be beneficial. R-US offers considerable potential to positively affect patient compliance but also to save examination time and thus costs.
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Affiliation(s)
| | | | - Sabine Schädelin
- Department of Clinical Research, Statistics and Data Management,
University of Basel, Basel, Switzerland
| | - Rosemarie Burian
- Gynecology and Obstetrics, University Hospital Basel,
Basel, Switzerland
| | - Cora-Ann Schoenenberger
- Department of Chemistry, University of Basel, 4056 Basel,
Switzerland
- Gynecology/Gynecologic Oncology, Sankt Claraspital AG,
Basel, Switzerland
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2
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Mamudu L, Li J, McEligot AJ, Wood M, Rusmevichientong P, Tetteh-Bator E, Soale AN, Fortenberry JD, Williams F. Cancer worry and its impact on self-reported depressive symptoms among adult males and females in the US: a nationwide sample study. BMC Psychiatry 2024; 24:31. [PMID: 38191340 PMCID: PMC10773041 DOI: 10.1186/s12888-023-05405-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/25/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE With cancer the second deadliest disease in the world, worry about cancer can have mental health or psychiatric implications. This study examines the prevalence, differences, and influence of cancer worry (CW), its interaction effect with age, and other confounders on self-reported depressive symptoms (SRDS) among adult males and females in the US. METHODS We utilized a nationally representative sample data of 2,950 individuals (males = 1,276; females = 1,674) from Cycle 4 of the Health Information National Trends Survey 5 (HINTS 5) 2020. Using frequencies, bivariate chi-square test, and multivariate logistic regression, we examined the prevalence, difference, and association of CW with SRDS, adjusting for confounders. RESULTS The prevalence rate of SRDS was found to be 32% among females and 23.5% among males. Among individuals with CW, females had a higher prevalence of SRDS compared to males (40.5% vs. 35.1%). However, there was a significant difference in the likelihood of experiencing SRDS between males and females with CW, with males having 84% increased risk compared to females. Across all age groups, the multivariate analysis of the relationship between CW and SRDS revealed that both males and females showed a significantly decreased likelihood of SRDS compared to those aged 18-34 years. However, males aged 35 years or older exhibited an even more pronounced decrease in likelihood compared to females in the same age group. Nonetheless, when examining the interaction of age and CW, we observed a significantly increased likelihood of SRDS across all age groups. Males, in particular, had a higher increased likelihood of SRDS compared to females across all ages, except for those aged 75 years and older. CONCLUSION The findings of this study highlight the significant influence of CW on individuals' SRDS and the modifying effect of age, particularly among males. These results are important for a better understanding of the risk of CW on mental health, which can be a preventive strategy or control mechanism.
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Affiliation(s)
- Lohuwa Mamudu
- Department of Public Health, California State University, 800 N. State College Boulevard, Fullerton, Fullerton, CA, 92831, USA.
| | - Jinyi Li
- Department of Public Health, University of California Irvine, Irvine, CA, 92967, USA
| | - Archana J McEligot
- Department of Public Health, California State University, 800 N. State College Boulevard, Fullerton, Fullerton, CA, 92831, USA
| | - Michele Wood
- Department of Public Health, California State University, 800 N. State College Boulevard, Fullerton, Fullerton, CA, 92831, USA
| | - Pimbucha Rusmevichientong
- Department of Public Health, California State University, 800 N. State College Boulevard, Fullerton, Fullerton, CA, 92831, USA
| | - Erasmus Tetteh-Bator
- Department of Mathematics and Statistics, University of South Florida, 4202 E. Fowler Ave, Tampa, FL, 33620, USA
| | - Abdul-Nasah Soale
- Department of Mathematics and Statistics, Applied Mathematics and Statistics, Case Western Reserve University, Yost Hall, 2049 Martin Luther King Jr. Drive, 44106-7058, Cleaveland, OH, USA
| | - James D Fortenberry
- Division of Adolescent Medicine, Indiana University School of Medicine, 410 W 10th St., Room 1001, Indianapolis, IN, 46202, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 11545 Rockville Pike, T-10 C12, Rockville, MD, 20852, USA.
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Goodwin B, Anderson L, Collins K, Sanjida S, Riba M, Singh GK, Campbell KM, Green H, Ishaque S, Kwok A, Opozda MJ, Pearn A, Shaw J, Sansom-Daly UM, Tsirgiotis JM, Janda M, Grech L. Anticipatory anxiety and participation in cancer screening. A systematic review. Psychooncology 2023; 32:1773-1786. [PMID: 37929985 DOI: 10.1002/pon.6238] [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: 08/01/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To synthesize current evidence on the association between anticipatory anxiety, defined as apprehension-specific negative affect that may be experienced when exposed to potential threat or uncertainty, and cancer screening to better inform strategies to maximize participation rates. METHODS Searches related to cancer screening and anxiety were conducted in seven electronic databases (APA PsycINFO, Scopus, Web of Science, Embase, Cochrane Library, PubMed, CINAHL), with potentially eligible papers screened in Covidence. Data extraction was conducted independently by multiple authors. Barriers to cancer screening for any type of cancer and relationships tested between anticipatory anxiety and cancer screening and intention were categorized and compared according to the form and target of anxiety and cancer types. RESULTS A total of 74 articles (nparticipants = 119,990) were included, reporting 103 relationships tested between anticipatory anxiety and cancer screening and 13 instances where anticipatory anxiety was reported as a barrier to screening. Anticipatory anxiety related to a possible cancer diagnosis was often associated with increased screening, while general anxiety showed no consistent relationship. Negative relationships were often found between anxiety about the screening procedure and cancer screening. CONCLUSION Anticipatory anxiety about a cancer diagnosis may promote screening participation, whereas a fear of the screening procedure could be a barrier. Public health messaging and primary prevention practitioners should acknowledge the appropriate risk of cancer, while engendering screening confidence and highlighting the safety and comfort of screening tests.
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Affiliation(s)
- Belinda Goodwin
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Laura Anderson
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Katelyn Collins
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia
- School of Psychology and Wellbeing, University of Southern Queensland, Springfield, Queensland, Australia
| | - Saira Sanjida
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Marcos Riba
- The University of Queensland, Saint Lucia, Queensland, Australia
| | - Gursharan K Singh
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- Cancer and Palliative Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Kimberley M Campbell
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Heather Green
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Sana Ishaque
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Alastair Kwok
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Oncology, Monash Health, Clayton, Victoria, Australia
| | - Melissa J Opozda
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia
| | - Amy Pearn
- The Gene Council, North Perth, Washington, Australia
| | - Joanne Shaw
- Psycho-oncology Co-operative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ursula M Sansom-Daly
- Psycho-oncology Co-operative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Joanna M Tsirgiotis
- Sydney Youth Cancer Centre, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Monika Janda
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lisa Grech
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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Omran M, Johansson H, Lundgren C, Silander G, Stenmark-Askmalm M, Loman N, Baan A, Adra J, Kuchinskaya E, Blomqvist L, Tham E, Bajalica-Lagercrantz S, Brandberg Y. Whole-body MRI surveillance in TP53 carriers is perceived as beneficial with no increase in cancer worry regardless of previous cancer: Data from the Swedish TP53 Study. Cancer 2023; 129:946-955. [PMID: 36601958 DOI: 10.1002/cncr.34631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND To evaluate the psychosocial consequences of surveillance with whole-body MRI (WB-MRI) in individuals with the heritable TP53-related cancer (hTP53rc) syndrome, also known as the Li-Fraumeni syndrome, with regard to cancer worry, perceived benefits and risks to surveillance and overall health. PATIENTS AND METHODS Since 2016, the national Swedish TP53 Study (SWEP53) has offered surveillance with WB-MRI to all individuals with hTP53rc syndrome. Seventy-five individuals have been included in the study. Sixty consecutive participants fulfilled a base-line evaluation as well as an evaluation after 1 year with structured questionnaires including the Cancer Worry Scale (CWS), perceived benefits and risks of surveillance, and the 36-item Short Form Survey (SF-36). Individuals with or without previous personal cancer diagnosis were enrolled and results at baseline and after 1 year of surveillance were compared. For SF-36, a comparison with the normal population was also made. RESULTS Participants with previous cancer tend to worry more about cancer, but both individuals with and without cancer had a positive attitude toward surveillance with no differences regarding perceived benefits and barriers to surveillance. Participants with a previous cancer scored significantly lower on some of the SF-36 subscales, but between-group differences were found only for social functioning after 1 year. CONCLUSIONS Surveillance with WB-MRI is feasible from a psychosocial point of view both among TP53 carriers with as well as without a previous history of cancer and does not increase cancer worry in any of the groups. PLAIN LANGUAGE SUMMARY Individuals with heritable TP53-related cancer syndrome (also known as the Li-Fraumeni syndrome) have a high lifetime risk of developing cancer. These TP53 carriers are offered surveillance with whole-body MRI to detect cancer early. There are few reports of the psychosocial impact of surveillance. In this study, we wanted to evaluate cancer worry, benefits and barriers to participation, and perceived overall health. Our study shows no increase in cancer worry after 1 year of surveillance, regardless of previous cancer.
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Affiliation(s)
- Meis Omran
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Cancer Theme, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Lundgren
- Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Gustav Silander
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Marie Stenmark-Askmalm
- Division of Clinical Genetics, Department of Laboratory Medicine, Office for Medical Services, Skåne University Hospital, Lund, Sweden
| | - Niklas Loman
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Annika Baan
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jamila Adra
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Imaging and Physiology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Emma Tham
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Svetlana Bajalica-Lagercrantz
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Cancer Theme, Karolinska University Hospital Solna, Stockholm, Sweden.,Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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5
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Yang Y, Qi H, Li W, Liu T, Xu W, Zhao S, Yang F, Humphris G, Chen Y, Sun H. Predictors and trajectories of fear of cancer recurrence in Chinese breast cancer patients. J Psychosom Res 2023; 166:111177. [PMID: 36739729 DOI: 10.1016/j.jpsychores.2023.111177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/06/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is one of the most common and aversive psychological phenomena among cancer patients. This study explored the trajectories of FCR over the 18 months following discharge, and evaluated the associations between baseline demographic and clinical variables and FCR trajectories among Chinese women treated for breast cancer. METHODS This is a longitudinal prospective study. All participants were asked to completed a battery of questionnaires (FCR-7, PHQ-9, GAD-7 and MPQ-VAS) at baseline, 6, 12, and 18 months after discharge. Generalized linear mixed model and group-based trajectory analyses were conducted. RESULTS Three hundred women with breast cancer were recruited. Latent class growth modeling analysis showed that three-group trajectory solution was the best fitting (i.e., 'intermediate level-stable group' (63.3%), 'low level-increasing group' (18.3%), and 'high level-decreasing group' (18.3%). Patients reported significant higher FCR at baseline assessment compared to other time points. Significant positive associations were found between anxiety, depression and FCR. Patients who had no baseline depression (estimate = -2.14, 95% CI: -2.78-(-1.51), P < 0.001) or anxiety (estimate = -2.77, 95% CI: -3.44-(-2.10), P < 0.001) tended to report significant lower FCRs over time. Women with none/mild life stress exhibited significant lower FCRs than those with moderate/high life stress, and participants with a family history of cancer or pessimism reported higher FCRs. CONCLUSION >60% of the breast cancer women showed intermediate level-stable FCRs over the 18 months after discharge. Baseline anxiety, depression, life stress, family cancer history and pessimism predicts higher FCR levels. Clinical teams responsible for continuing patient care following treatment should develop clearer strategies for management of FCR.
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Affiliation(s)
- Yuan Yang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China.
| | - Han Qi
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100000, China
| | - Wengao Li
- Department of Psychiatry, Guangdong 999 Brain Hospital, Guangzhou 510515, China
| | - Ting Liu
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
| | - Wenjing Xu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China; Department of Radiotherapy, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Shunzhen Zhao
- Department of Radiotherapy, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Fan Yang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China.
| | - Gerry Humphris
- Division of Population and Behavioural Sciences, Medical School, University of St Andrews, St Andrews KY16 9TF, UK.
| | - Yu Chen
- School of Nursing, Southern Medical University, Guangzhou 510515, China.
| | - Hengwen Sun
- Department of Radiotherapy, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China.
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6
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Adams-Campbell LL, Taylor T, Hicks J, Lu J, Dash C. The Effect of a 6-Month Exercise Intervention Trial on Allostatic Load in Black Women at Increased Risk for Breast Cancer: the FIERCE Study. J Racial Ethn Health Disparities 2022; 9:2063-2069. [PMID: 34580826 PMCID: PMC8957631 DOI: 10.1007/s40615-021-01145-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Allostatic load comprises cardiovascular, metabolic, and inflammatory markers, which is characterized by abdominal obesity, high blood glucose levels, impaired glucose tolerance, dyslipidemia, and hypertension and associated with an increased risk in breast cancer. METHODS The study was a 6-month, 3-arm randomized controlled trial of two moderate-intensity exercise interventions (compared with a control group) among obese, physically inactive, postmenopausal Black women aged 45 to 65 years, who were at increased risk for breast cancer based on the CARE model. Two hundred thirteen participants were randomly assigned to (1) supervised, facility-based aerobic exercise intervention (n = 73), (2) home-based exercise intervention (n = 69), or (3) a wait-listed control group (n = 71). The intervention effects of exercise on allostatic load were examined with intent-to-treat analyses using generalized linear models. RESULTS It was revealed that statistically significant decreases in allostatic load over the 6-month period for both exercise intervention groups (i.e., home-based and supervised arms) compared to the controls were observed among the total population, pc-h = 0.023 and pc-s = 0.035, as well as among women with a family history of breast cancer, pc-h = 0.006 and pc-s = 0.012. CONCLUSIONS Short-term aerobic activity improved allostatic load scores in metabolically unhealthy postmenopausal Black women at increased risk for cancer. TRIAL REGISTRATION Clinical trial registration number NCT02103140.
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Affiliation(s)
- Lucile L Adams-Campbell
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 1000 New Jersey Ave SE, Washington, DC, 20003, USA.
| | - Teletia Taylor
- Howard University Cancer Center, Howard University, Washington, DC, USA
| | - Jennifer Hicks
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 1000 New Jersey Ave SE, Washington, DC, 20003, USA
| | - Jiachen Lu
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 1000 New Jersey Ave SE, Washington, DC, 20003, USA
- University of Texas Health Science Center At Houston, Houston, TX, USA
| | - Chiranjeev Dash
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 1000 New Jersey Ave SE, Washington, DC, 20003, USA
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Trajectories and individual determinants of regular cancer screening use over a long period based on data from the French E3N cohort. Soc Sci Med 2021; 294:114663. [PMID: 34974385 DOI: 10.1016/j.socscimed.2021.114663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022]
Abstract
Despite several incentive policies for cancer screenings over the last two decades, the overall and regular use of cancer screenings remains insufficient in France. While the individual determinants of cancer screening uptake have been fairly well studied, the literature has rarely focused on the regularity of screening uptake, which is key to early cancer detection. We aimed to address this issue by studying cancer screening behaviors over 15 years, emphasizing the regularity and diversity of use. Using data from 40,021 women in the French E3N cohort, we studied the individual trajectories of screenings for breast, colorectal and cervical cancer between 2000 and 2014. We employed optimal matching methods to identify typical behaviors of use for each cancer screening. Then, we determined the associations between the identified behavior screening patterns for the different cancer screenings and, finally, assessed the associated individual determinants with logistical and multinomial models. We found that screening behaviors were fairly stable over time, with few typical screening patterns for each cancer. Overall, once a woman starts screening, she continues, and once she stops, she no longer returns. Cancer screening behaviors appear consistent; in particular, insufficient use of mammography appears to be associated with long-term nonuse of other cancer screenings. Factors associated with low or nonuse of screening are overall common between cancer screenings and are similar to those identified in the literature of screening use at a single point in time. Ultimately, these barriers prevent some women from entering a screening process in the long run, ultimately reinforcing social inequalities in health. Targeting women with insufficient mammography uptake may reach women outside of cancer screening settings more generally and, thus, both increase the overall uptake of cancer screening and reduce social inequalities in cancer screening.
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8
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Crook A, Kwa R, Ephraums S, Wilding M, Thiyagarajan L, Fleming J, Moore K, Berman Y. The psychological impact and experience of breast cancer screening in young women with an increased risk of breast cancer due to neurofibromatosis type 1. Fam Cancer 2021; 21:241-253. [PMID: 33963463 PMCID: PMC8105152 DOI: 10.1007/s10689-021-00259-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/20/2021] [Indexed: 01/22/2023]
Abstract
Women with neurofibromatosis type 1 (NF1) have an increased risk of developing early breast cancer with a poorer prognosis compared to the general population. Therefore, international management guidelines recommend regular screening in women with NF1 starting from 30 to 35 years. As the psychological impacts of breast cancer screening in other high-risk populations cannot be extended to women with NF1, due to increased incidence of cognitive and mental health issues, the psychological harms of breast screening in women with NF1 are unknown. Consequently, the aim of this study was to assess the psychological impact of breast cancer screening in women with NF1 attending an established risk management clinic. Twenty-eight women with NF1 (30–50 years) completed psychological well-being and patient experience questionnaires, administered across five time points, before and after their initial and second round annual breast screening visits. Preliminary findings demonstrated the screening regimen was well-tolerated, with most participants reporting high satisfaction with the screening process. Overall, no significant increase in psychological distress related to the breast screening process was identified, with mean cancer worry and anxiety scores decreasing over time. However, some women did experience negative aspects of screening and barriers to re-attendance at annual breast screening appointments. As some women with NF1 exhibited clinical levels of psychological distress prior to screening, efforts to identify those at risk and additional support to address concerns and expectations throughout the breast screening process may be beneficial.
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Affiliation(s)
- Ashley Crook
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia.
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Rebekah Kwa
- Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Sarah Ephraums
- Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Mathilda Wilding
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Lavvina Thiyagarajan
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Jane Fleming
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Katrina Moore
- Department of Breast Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Yemima Berman
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
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9
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Rodenbach RA, Althouse AD, Schenker Y, Smith TJ, Chu E, White DB, Bakitas M, Arnold RM. Relationships Between Advanced Cancer Patients' Worry About Dying and Illness Understanding, Treatment Preferences, and Advance Care Planning. J Pain Symptom Manage 2021; 61:723-731.e1. [PMID: 32926962 PMCID: PMC7952460 DOI: 10.1016/j.jpainsymman.2020.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/29/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT Patients with advanced cancer often worry about dying. Less is known about the role of worry in decision making regarding future care. OBJECTIVES To explore relationships between patients' worry about dying and their illness understanding, treatment preferences, and advance care planning (ACP). METHODS This cross-sectional study used baseline data from a primary palliative care intervention trial. All participants had metastatic solid tumors. Using patients' response to I worry about dying from the Functional Assessment of Chronic Illness-Palliative Care survey instrument, univariate and multivariate analyses assessed associations with illness understanding, treatment preferences, and ACP. RESULTS Of 672 patients, 47% reported worrying about dying not at all, whereas 9.7% worried quite a bit or very much. In regression analysis, compared with patients who reported not worrying about dying, those who reported high levels of worry were more likely to describe themselves as terminally ill (adjusted odds ratio [AOR] = 1.98; 95% CI = 1.10-3.54; P = 0.021) and prefer life-extending therapy over symptom-focused care (AOR = 2.61; 95% CI = 1.30-5.22; P = 0.007). They were less likely to have completed an advance directive (AOR = 0.49; 95% CI = 0.25-0.94; P = 0.032). The same relationships were seen using patients' response to I feel scared about my future from the Herth Hope Index. CONCLUSION Patients with advanced cancer who worry about dying are more likely to identify as terminally ill and desire life-extending treatment and are less likely to engage in ACP. Understanding how patients cope with worry and make medical decisions is important in providing quality care to these patients.
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Affiliation(s)
- Rachel A Rodenbach
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Hematology, Medical Oncology and Palliative Care, University of Wisconsin-Madison, Madison, Wisconsin, USA.
| | - Andrew D Althouse
- Division of General Internal Medicine, Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas J Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Edward Chu
- Division of Hematology-Oncology and Cancer Therapeutics Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Douglas B White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marie Bakitas
- School of Nursing, Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UAB Center for Palliative and Supportive Care, Birmingham, Alabama, USA
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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10
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Abstract
Longitudinal or observational study designs are important methodologies to investigate potential associations that may not be amenable to randomized controlled trials. In many cases, they may be performed using existing data and are often cost-effective ways of addressing important questions. The major disadvantage of observational studies is the potential for bias. The absence of randomization means that one can never be certain that unknown confounders are present, and specific studies designs have their own inherent forms of bias. Careful study design may minimize bias. Establishing casual association based on observational methods requires due consideration of the quality of the individual study and knowledge of their limitations.
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11
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Notebaert L, Clarke PJ, Macleod C. Does attentional bias to threat ameliorate or exacerbate the detrimental effect of trait anxiety on behavioural preparedness for real‐world danger? AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Lies Notebaert
- Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, Crawley, Western Australia, Australia,
| | - Patrick J.f. Clarke
- Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, Crawley, Western Australia, Australia,
- School of Psychology and Speech Pathology, Curtin University, Bentley, Western Australia, Australia,
| | - Colin Macleod
- Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, Crawley, Western Australia, Australia,
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12
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Fisher CL, Wright KB, Rising CJ, Cai X, Mullis MD, Burke-Garcia A, Afanaseva D. Helping Mothers and Daughters Talk about Environmental Breast Cancer Risk and Risk-Reducing Lifestyle Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134757. [PMID: 32630657 PMCID: PMC7370108 DOI: 10.3390/ijerph17134757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 01/30/2023]
Abstract
Background: Mothers and daughters struggle to talk about breast cancer risk. Even less attention is paid to environmental determinants of cancer. Third-party online approaches can be helpful navigating these conversations. The aim of this study was to obtain feedback from mothers exposed to a social media intervention (“mommy bloggers”) and identify their preferences for message-design approaches that could help them talk to their daughter(s) about environmental breast cancer risk. Methods: We conducted semi-structured interviews with 50 mothers. A thematic analysis was conducted using the constant comparative method. Results: Mothers identified four approaches to message design that could help facilitate mother–daughter communication about environmental breast cancer risk. These included two action-oriented approaches that centered on getting the conversation started and keeping the conversation going and two approaches based on lifespan factors to promote daughters’ engagement by using age-appropriate language and visuals and focusing on developmentally specific lifestyle behaviors. Mothers also provided recommended strategies within each approach. Conclusions: Mothers identified various approaches interventionists can utilize to overcome barriers to talking to daughters about environmental breast cancer risk. To promote mother–daughter communication, the messages should be action-oriented to facilitate interaction, but also developed with lifespan and developmental considerations in mind to engage daughters.
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Affiliation(s)
- Carla L. Fisher
- UF Health Cancer Center, College of Journalism and Communications, University of Florida, P.O. Box 118400, Gainesville, FL 32611-8400, USA;
- Correspondence: ; Tel.: +1-352-294-1019
| | - Kevin B. Wright
- Department of Communication, George Mason University, 4400 University, Dr, MSN3D6, Fairfax, VA 22030, USA; (K.B.W.); (C.J.R.); (X.C.)
| | - Camella J. Rising
- Department of Communication, George Mason University, 4400 University, Dr, MSN3D6, Fairfax, VA 22030, USA; (K.B.W.); (C.J.R.); (X.C.)
| | - Xiaomei Cai
- Department of Communication, George Mason University, 4400 University, Dr, MSN3D6, Fairfax, VA 22030, USA; (K.B.W.); (C.J.R.); (X.C.)
| | - Michaela D. Mullis
- UF Health Cancer Center, College of Journalism and Communications, University of Florida, P.O. Box 118400, Gainesville, FL 32611-8400, USA;
| | - Amelia Burke-Garcia
- NORC at the University of Chicago, 4350 East West Highway, Bethesda, MD 20814, USA;
| | - Dasha Afanaseva
- Fors Marsh Group, 901 N. Glebe Road, Arlington, VA 22201, USA;
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13
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Xie Z, Wenger N, Stanton AL, Sepucha K, Kaplan C, Madlensky L, Elashoff D, Trent J, Petruse A, Johansen L, Layton T, Naeim A. Risk estimation, anxiety, and breast cancer worry in women at risk for breast cancer: A single-arm trial of personalized risk communication. Psychooncology 2019; 28:2226-2232. [PMID: 31461546 DOI: 10.1002/pon.5211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/17/2019] [Accepted: 08/21/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Elevated anxiety and breast cancer worry can impede mammographic screening and early breast cancer detection. Genetic advances and risk models make personalized breast cancer risk assessment and communication feasible, but it is unknown whether such communication of risk affects anxiety and disease-specific worry. We studied the effect of a personalized breast cancer screening intervention on risk perception, anxiety, and breast cancer worry. METHODS Women with a normal mammogram but elevated risk for breast cancer (N = 122) enrolled in the Athena Breast Health risk communication program were surveyed before and after receiving a letter conveying their breast cancer risk and a breast health genetic counselor consultation. We compared breast cancer risk estimation, anxiety, and breast cancer worry before and after risk communication and evaluated the relationship of anxiety and breast cancer worry to risk estimation accuracy. RESULTS Women substantially overestimated their lifetime breast cancer risk, and risk communication somewhat mitigated this overestimation (49% pre-intervention, 42% post-intervention, 13% Gail model risk estimate, P < .001). Both general anxiety and breast cancer worry declined significantly after risk communication in women with high baseline anxiety. Baseline anxiety and breast cancer worry were essentially unrelated to risk estimation accuracy, but risk communication increased alignment of worry with accuracy of risk assessment. CONCLUSIONS Personalized communication about breast cancer risk was associated with modestly improved risk estimation accuracy in women with relatively low anxiety and less anxiety and breast cancer worry in women with higher anxiety. We detected no negative consequences of informing women about elevated breast cancer risk.
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Affiliation(s)
- Zhuoer Xie
- Department of Hematology and Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Neil Wenger
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Karen Sepucha
- Health Decision Sciences Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Celia Kaplan
- General Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Lisa Madlensky
- Division of Medical Genetics, University of California, San Diego, San Diego, California
| | - David Elashoff
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Jacqueline Trent
- Department of Hematology and Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Antonia Petruse
- Department of Hematology and Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Liliana Johansen
- Department of Hematology and Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Tracy Layton
- Department of Biomedical Informatics, University of California, San Diego, San Diego, California
| | - Arash Naeim
- UCLA Center for SMART Health, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
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14
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Grauman Å, Hansson MG, Puranen A, James S, Veldwijk J. Short-term mental distress in research participants after receiving cardiovascular risk information. PLoS One 2019; 14:e0217247. [PMID: 31125371 PMCID: PMC6534302 DOI: 10.1371/journal.pone.0217247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/01/2019] [Indexed: 11/30/2022] Open
Abstract
Background Understanding of how cardiovascular risk information influence individuals is critical for the practice of risk assessment and the management of patients with cardiovascular disease. Objectives The objective of this study was to investigate change in mental distress among research participants after undergoing a cardiovascular risk assessment and receiving individual test results. Methods In 2017, a questionnaire measuring mental distress after taking part in a risk assessment was distributed among 615 participants in the Swedish Cardiopulmonary Bio Image Study in Uppsala, Sweden, aged 50–64 years. Outcome measures were re-assessed after three months (30% were lost to follow-up). Results There were no differences in outcomes after three months for participants with normal test results or for participants who were referred to primary health care. Mental distress increased in participants who were referred to the hospital, and were further explained by the fact that these participants were diagnosed with coronary artery stenosis. Conclusions CV risk information can be provided to individuals with lower levels of risk without concerns of inducing mental distress. However, in order to prevent unnecessary worry in contexts similar to this study, one should be prepared for different risk outcomes and plan for support for individuals with higher risk. The increased utility of powerful, yet not fully mature, imaging techniques requires careful considerations extending beyond medical risks and benefits; the clinician must also take into account the risk of mental distress and secure support when necessary.
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Affiliation(s)
- Åsa Grauman
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Mats G. Hansson
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | | | - Stefan James
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Jorien Veldwijk
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, Netherlands
- Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, Netherlands
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15
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Whitney CA, Dorfman CS, Shelby RA, Keefe FJ, Gandhi V, Somers TJ. Reminders of cancer risk and pain catastrophizing: relationships with cancer worry and perceived risk in women with a first-degree relative with breast cancer. Fam Cancer 2019; 18:9-18. [PMID: 29679190 DOI: 10.1007/s10689-018-0082-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
First-degree relatives of women with breast cancer may experience increased worry or perceived risk when faced with reminders of their own cancer risk. Worry and risk reminders may include physical symptoms (e.g., persistent breast pain) and caregiving experiences. Women who engage in pain catastrophizing may be particularly likely to experience increased distress when risk reminders are present. We examined the degree to which persistent breast pain and experience as a cancer caregiver were related to cancer worry and perceived risk in first-degree relatives of women with breast cancer (N = 85) and how catastrophic thoughts about breast pain could impact these relationships. There was a significant interaction between persistent breast pain and pain catastrophizing in predicting cancer worry (p = .03); among women who engaged in pain catastrophizing, cancer worry remained high even in the absence of breast pain. Pain catastrophizing also moderated the relationships between caregiving involvement and cancer worry (p = .003) and perceived risk (p = .03). As the degree of caregiving responsibility increased, cancer worry and perceived risk increased for women who engaged in pain catastrophizing; levels of cancer worry and perceived risk remained low and stable for women who did not engage in pain catastrophizing regardless of caregiving experience. The results suggest that first-degree relatives of breast cancer survivors who engage in pain catastrophizing may experience greater cancer worry and perceived risk and may benefit from interventions aimed at reducing catastrophic thoughts about pain.
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Affiliation(s)
- Colette A Whitney
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA
| | - Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA
| | - Vicky Gandhi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA.
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16
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Mazzocco K, Masiero M, Carriero MC, Pravettoni G. The role of emotions in cancer patients' decision-making. Ecancermedicalscience 2019; 13:914. [PMID: 31123497 PMCID: PMC6467455 DOI: 10.3332/ecancer.2019.914] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Indexed: 12/30/2022] Open
Abstract
Introduction Despite the attempt to make decisions based on evidence, doctors still have to consider patients' choices which often involve other factors. In particular, emotions seem to influence the way that options and the surrounding information are interpreted and used. Objective The objective of the present review is to provide a brief overview of research on decision making and cancer with a specific focus on the role of emotions. Method Thirty-nine studies were identified and analysed. Most of the studies investigated anxiety and fear. Worry was the other psychological factor that, together with anxiety, played a crucial role in cancer-related decision-making. Results The roles of fear, anxiety and worry were described for detection behaviour, diagnosis, choice about prevention and curative treatments and help-seeking behaviour. Results were inconsistent among the studies. Results stressed that cognitive appraisal and emotional arousal (emotion's intensity level) interact in shaping the decision. Moderate levels of anxiety and worry improved decision-making, while low and high levels tended to have no effect or a hindering effect on decision making. Moderating factors played an under-investigated role. Conclusions Decision making is a complex non-linear process that is affected by several factors, such as, for example, personal knowledge, past experiences, individual differences and certainly emotions. Research studies should investigate further potential moderators of the effect of emotions on cancer-related choice. Big data and machine learning could be a good opportunity to test the interaction between a large amount of factors that is not feasible in traditional research. New technologies such as eHealth and virtual reality can offer support for the regulation of emotions and decision making.
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Affiliation(s)
- Ketti Mazzocco
- Department of Oncology and Hemato-oncology, University of Milan, 20122 Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Marianna Masiero
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, 20141 Milan, Italy.,Department of Biomedical and Clinical Sciences, University of Milan, 20122 Milan, Italy
| | - Maria Chiara Carriero
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-oncology, University of Milan, 20122 Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, 20141 Milan, Italy
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17
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Wong EC, Kaplan CP, Dreher N, Hwang J, Van't Veer L, Melisko ME. Integration of Health Questionnaire Systems to Facilitate Supportive Care Services for Patients at an Academic Breast Care Center. JCO Clin Cancer Inform 2019; 2:1-13. [PMID: 30652601 DOI: 10.1200/cci.18.00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study evaluated the use of an electronic Health Questionnaire System (HQS) within the University of California San Francisco Breast Care Center as a screening and triage tool to proactively recognize patients' supportive care needs during new patient consultations and identify demographic characteristics associated with referrals to three supportive care services. PATIENTS AND METHODS A total of 428 patients with and without breast cancer between the ages of 18 and 84 years completed HQS intake forms before appointments at the University of California San Francisco Breast Care Center between November 2014 and May 2015 and agreed to participate in this study. Patient HQS responses triggered referrals to supportive care services, and a review of electronic health records was conducted to determine the outcomes of these referrals. RESULTS A total of 242 patients (56.5%) met criteria for at least one supportive care referral. Women with invasive breast cancer or ductal carcinoma in situ met criteria for supportive services more frequently than women without breast cancer diagnoses (76.9% v 23.8%; P < .001) and were most likely to receive referrals for genetic counseling (67.0%), psychological services (32.2%), and social services (12.1%). Multivariable logistic regression analysis showed that being married was associated with fewer referrals to social work (OR, 0.42; 95% CI, 0.21 to 0.81) and that those between 45 and 54 years of age were less likely to receive referrals to genetic counseling than those ≥ 55 years of age (OR, 0.41; 95% CI, 0.23 to 0.73). Among all referrals (n = 369), 26.8% resulted in completed appointments. CONCLUSION Using an automated intake form is an efficient way to identify and triage individuals in need of supportive care services and can provide insight into the populations with supportive care needs for targeted outreach.
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Affiliation(s)
- Emily C Wong
- All authors: University of California San Francisco, San Francisco, California
| | - Celia P Kaplan
- All authors: University of California San Francisco, San Francisco, California
| | - Nickolas Dreher
- All authors: University of California San Francisco, San Francisco, California
| | - Jimmy Hwang
- All authors: University of California San Francisco, San Francisco, California
| | - Laura Van't Veer
- All authors: University of California San Francisco, San Francisco, California
| | - Michelle E Melisko
- All authors: University of California San Francisco, San Francisco, California
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18
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El Hachem Z, Zoghbi M, Hallit S. Psychosocial consequences of false-positive results in screening mammography. J Family Med Prim Care 2019; 8:419-425. [PMID: 30984648 PMCID: PMC6436251 DOI: 10.4103/jfmpc.jfmpc_4_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: To evaluate the psychosocial impact of benign breast biopsies on Lebanese women after a screening mammography and the effect of these biopsies on patients’ attitudes toward subsequent screening. Methods: In this retrospective study (January 2005 till April 2011), 109 consecutive patients with a history of breast biopsy without cancer were asked to answer a phone questionnaire. The response rate was 91.7% (100 women accepted to participate). A questionnaire about sociodemographic characteristics, biopsy characteristics, and patients’ attitudes as measured by the negative Psychosocial Consequences Questionnaire (PCQ) and other independent questions was filled by phone call by one interviewer. Results: The negative PCQ score was low for most women (only 9% have a negative PCQ score ≥18/36) and is statistically dependent on the result of the last mammography (P = 0.01) and the number of previous benign breast biopsies (P = 0.01). A total of 10% of women increased their medical visits after this biopsy, 8% were treated for psychiatric problems after this biopsy, and 19% self-examine their breasts more than once per week. The benign breast biopsy experience increases the willingness to adhere to the screening mammography in 71% of the patients, this reported adherence depends positively on the score of the negative PCQ (P = 0.043). Conclusions: The negative psychosocial effect of the biopsy is minimal in general and is positively correlated to the adherence to future mammographies. Interventions are necessary to decrease the anxiety in most susceptible women and to raise the awareness of women at risk of nonadherence to the screening mammography.
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Affiliation(s)
- Zeina El Hachem
- Department of Internal Medicine, Hayek Hospital, Horsh Tabet, Sin el Fil, Beirut, Lebanon
| | - Marouan Zoghbi
- Department of Family Medicine, Universite Saint Joseph, Beirut.,Psychiatric Hospital of the Cross, Jounieh, Lebanon
| | - Souheil Hallit
- Department of Family Medicine, Universite Saint Joseph, Beirut.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut.,Faculty of Medicine, Universite Saint-Esprit Kaslik, Kaslik, Lebanon
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19
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Sun H, Yang Y, Zhang J, Liu T, Wang H, Garg S, Zhang B. Fear of cancer recurrence, anxiety and depressive symptoms in adolescent and young adult cancer patients. Neuropsychiatr Dis Treat 2019; 15:857-865. [PMID: 31118635 PMCID: PMC6498985 DOI: 10.2147/ndt.s202432] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/01/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Previous studies have indicated that younger age is consistently associated with high levels of fear of cancer recurrence (FCR), anxiety and depression. However, the associations among these variables in adolescent and young adult (AYA) cancer patients are not clear. This study explores the prevalence and correlates of FCR, anxiety and depressive symptoms in Chinese AYA cancer population. Methods: This is a cross-sectional study that includes 249 patients aged between 15 and 39 yrs at the time of cancer diagnosis. Patient's sociodemographic, clinical as well as psychological characteristics were collected by an information sheet, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), General Anxiety Disorder Questionnaire (GAD-7) and Patient Health Questionnaire (PHQ-9). Descriptive statistics and multivariate analyses were conducted. Results: Eighty-nine (35.74%) patients experienced dysfunctional level of FCR, eighty-two (32.93%) patients experienced anxiety symptoms and ninety-six (38.55%) reported depressive symptoms. In multivariate analyses, being single, pessimistic, having more concurrent stressful life events and physical comorbidity were independently associated with higher FCR, anxiety and depressive symptoms. Patients who were not engaging in radiotherapy were more likely to report higher anxiety level. Conclusion: FCR, anxiety and depressive symptoms are frequently reported problems among AYA cancer patients. Age-appropriate and flexible psychological interventions are needed for this high-risk population.
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Affiliation(s)
- Hengwen Sun
- Department of Radiotherapy, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, People's Republic of China
| | - Yuan Yang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macau SAR, Macau.,Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangzhou, 510515, People's Republic of China
| | - Jingying Zhang
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangzhou, 510515, People's Republic of China
| | - Ting Liu
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangzhou, 510515, People's Republic of China
| | - Hongmei Wang
- Department of Radiotherapy, Southern Medical University Nanfang Hospital, Guangzhou 510515, People's Republic of China
| | - Samradhvi Garg
- School of Health in Social Science, University of Edinburgh, Edinburgh EH8 9BL, UK
| | - Bin Zhang
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangzhou, 510515, People's Republic of China
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20
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Yang Y, Sun H, Liu T, Zhang J, Wang H, Liang W, Chen Y, Zhang B. Factors associated with fear of progression in chinese cancer patients: sociodemographic, clinical and psychological variables. J Psychosom Res 2018; 114:18-24. [PMID: 30314574 DOI: 10.1016/j.jpsychores.2018.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Fear of progression (FoP) is a widespread problem among cancer patients and is considered to be one of the most distressing psychological consequences of cancer. The aim of this study was to investigate the association of sociodemographic, clinical, and psychological variables to FoP in Chinese cancer patients. METHODS In this cross-sectional study, six hundred and thirty-six cancer patients were recruited. All participants were asked to complete a personal information sheet, the Chinese version of Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder Questionnaire (GAD-7). Descriptive statistics and hierarchical multiple regression was conducted to analyze the data. RESULTS Hierarchical multiple regression revealed that childhood severe illness experience (P = .011), stress (P < .001), anxiety (P < .001), depressive symptom (P < .001) and personality (P = .042) were independently predictive of higher FoP. The final regression model explained up to 40.0% (adjusted R square: 38.8%) of the observed variance. CONCLUSION There are a number of factors that increase the likelihood of the development of FoP. The findings underline the necessity to provide effective psychological intervention for patients with high FoP in the future.
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Affiliation(s)
- Yuan Yang
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China
| | - Hengwen Sun
- Department of Radiotherapy, Cancer Centre, Guangdong General Hospital, Guangzhou, Guangdong 510080, China
| | - Ting Liu
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China
| | - Jingying Zhang
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China
| | - Hongmei Wang
- Department of Radiotherapy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China
| | - Weijiang Liang
- Department of Oncology, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China
| | - Yu Chen
- Nursing School, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Bin Zhang
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China.
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21
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Abstract
Our knowledge of genetic mechanisms involved in cancer initiation, promotion, and progression recently bas expanded. In order to benefit from this expansion and to apply genetic discoveries to current protocols for prevention, screening, diagnosis, treatment, prognosis, and monitoring for minimal residual disease, a working knowledge must be developed of the genetic principles, oncogenes, tumor suppressor genes, and genetic models of carcinogenesis. Genetic susceptibility testing for cancer soon will be introduced into oncology practice through established familial risk counseling programs, and the oncologist must be prepared to address the medical, ethical, legal, economic, psychological, and social issues that accompany this testing.
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Affiliation(s)
- June Peters
- Familial Cancer Program at Oncogenetics, Phoenix, Ariz
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22
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Arnold M, Quante AS. Personalized Mammography Screening and Screening Adherence-A Simulation and Economic Evaluation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:799-808. [PMID: 30005752 DOI: 10.1016/j.jval.2017.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 11/23/2017] [Accepted: 12/13/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Personalized breast cancer screening has so far been economically evaluated under the assumption of full screening adherence. This is the first study to evaluate the effects of nonadherence on the evaluation and selection of personalized screening strategies. METHODS Different adherence scenarios were established on the basis of findings from the literature. A Markov microsimulation model was adapted to evaluate the effects of these adherence scenarios on three different personalized strategies. RESULTS First, three adherence scenarios describing the relationship between risk and adherence were identified: 1) a positive association between risk and screening adherence, 2) a negative association, or 3) a curvilinear relationship. Second, these three adherence scenarios were evaluated in three personalized strategies. Our results show that it is more the absolute adherence rate than the nature of the risk-adherence relationship that is important to determine which strategy is the most cost-effective. Furthermore, probabilistic sensitivity analyses showed that there are risk-stratified screening strategies that are more cost-effective than routine screening if the willingness-to-pay threshold for screening is below US $60,000. CONCLUSIONS Our results show that "nonadherence" affects the relative performance of screening strategies. Thus, it is necessary to include the true adherence level to evaluate personalized screening strategies and to select the best strategy.
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Affiliation(s)
- Matthias Arnold
- Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany; Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
| | - Anne S Quante
- Chair of Genetic Epidemiology, IBE, Faculty of Medicine, LMU Munich, Germany; Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Department of Gynecology and Obstetrics, University Hospital rechts der Isar, Technical University Munich, Munich, Germany
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Smits S, Boivin J, Menon U, Brain K. Influences on anticipated time to ovarian cancer symptom presentation in women at increased risk compared to population risk of ovarian cancer. BMC Cancer 2017; 17:814. [PMID: 29202783 PMCID: PMC5716383 DOI: 10.1186/s12885-017-3835-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 11/23/2017] [Indexed: 02/06/2023] Open
Abstract
Background In the absence of routine ovarian cancer screening, promoting help-seeking in response to ovarian symptoms is a potential route to early diagnosis. The factors influencing women’s anticipated time to presentation with potential ovarian cancer symptoms were examined. Methods Cross-sectional questionnaires were completed by a sample of women at increased familial risk (n = 283) and population risk (n = 1043) for ovarian cancer. Measures included demographic characteristics, symptom knowledge, anticipated time to symptom presentation, and health beliefs (perceived susceptibility, worry, perceived threat, confidence in symptom detection, benefits and barriers to presentation). Structural equation modelling was used to identify determinants of anticipated time to symptomatic presentation in both groups. Results Associations between health beliefs and anticipated symptom presentation differed according to risk group. In increased risk women, high perceived susceptibility (r = .35***), ovarian cancer worry (r = .98**), perceived threat (r = −.18**), confidence (r = .16**) and perceiving more benefits than barriers to presentation (r = −.34**), were statistically significant in determining earlier anticipated presentation. The pattern was the same for population risk women, except ovarian cancer worry (r = .36) and perceived threat (r = −.03) were not statistically significant determinants. Conclusions Associations between underlying health beliefs and anticipated presentation differed according to risk group. Women at population risk had higher symptom knowledge and anticipated presenting in shorter time frames than the increased risk sample. The cancer worry component of perceived threat was a unique predictor in the increased risk group. In increased risk women, the worry component of perceived threat may be more influential than susceptibility aspects in influencing early presentation behaviour, highlighting the need for ovarian symptom awareness interventions with tailored content to minimise cancer-related worry in this population. Electronic supplementary material The online version of this article (10.1186/s12885-017-3835-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephanie Smits
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Jacky Boivin
- School of Psychology, Cardiff University, Cardiff, UK
| | - Usha Menon
- Institute for Women's Health, University College London, London, UK
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
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Hwang M, Park B. Association Between Health Behaviors and Family History of Cancer in Cancer Survivors: Data From the Korean Genome and Epidemiology Study. J Cancer Prev 2017; 22:166-173. [PMID: 29018781 PMCID: PMC5624457 DOI: 10.15430/jcp.2017.22.3.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/03/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND We compared health behaviors, including current smoking, alcohol drinking, regular exercise, obesity, and abdominal obesity, among Korean cancer survivors with and without family history of cancer. METHODS This study included 5,247 cancer survivors with family history of cancer (1,894 with and 3,353 without), who were recruited from the Health Examinee cohort. Health behaviors were identified using questionnaire. Adjusted ORs (aORs) between health behaviors and family history of cancer were estimated by multivariate logistic regression analysis adjusted for sociodemographic factors. All analyses were conducted separately according to sex. RESULTS Prevalence of current smoking, alcohol drinking, no regular exercise, obesity, and abdominal obesity was 16.3%, 48.3%, 36.0%, 31.3%, and 42.3% in male cancer survivors and 1.7%, 20.6%, 43.8%, 28.5%, and 72.5% in female, respectively. Health behaviors in male cancer survivors with and without family history of cancer were not significantly different after being adjusted for other covariates (aOR = 1.04, 95% CI = 0.75-1.44 for current smoking; aOR = 0.96, 95% CI = 0.76-1.22 for current drinking; aOR = 0.85, 95% CI = 0.66-1.10 for regular exercise; aOR = 0.96, 95% CI = 0.73-1.25 for obesity; aOR = 0.97, 95% CI = 0.75-1.25 for abdominal obesity). In female cancer survivors, there were no significant differences in health behaviors according to family history of cancer (aOR = 0.76, 95% CI = 0.44-1.32; aOR = 1.11, 95% CI = 0.94-1.31; aOR = 0.99, 95% CI = 0.87-1.14; aOR = 0.99, 95% CI = 0.85-1.16; aOR = 0.93, 95% CI = 0.80-1.10, respectively). CONCLUSIONS We identified no significant differences in health behaviors according to family history of cancer in cancer survivors. More studies should be conducted to identify correlations between family history of cancer and prognosis in cancer survivors.
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Affiliation(s)
- Minji Hwang
- Center for Breast Cancer, Hospital, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.,National Cancer Control Institute, National Cancer Center, Goyang, Korea
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25
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De Pelsmacker P, Lewi M, Cauberghe V. The Effect of Personal Characteristics, Perceived Threat, Efficacy and Breast Cancer Anxiety on Breast Cancer Screening Activation. Healthcare (Basel) 2017; 5:E65. [PMID: 28953261 PMCID: PMC5746699 DOI: 10.3390/healthcare5040065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/23/2017] [Accepted: 09/23/2017] [Indexed: 11/30/2022] Open
Abstract
In order to activate women to participate in breast cancer screening programs, a good understanding is needed of the personal characteristics that influence how women can be activated to search for more information, consult friends and doctors, and participate in breast cancer screening programs. In the current study, we investigate the effect of six personal characteristics that have in previous research been identified as important triggers of health behavior on breast cancer screening activation: Health awareness, Need for Cognition, Affect Intensity, Breast cancer knowledge, Topic involvement, and the Perceived breast cancer risk. We test the effect of these factors on four activation variables: intention of future information seeking, forwarding the message to a friend, talking to a doctor, and actual breast cancer screening attendance. Additionally, we try to unravel the process by means of which the antecedents (the six personal characteristics) lead to activation. To that end, we test the mediating role of perceived breast cancer threat, perceived efficacy of screening, and the evoked breast cancer anxiety as mediators in this process. The data were collected by means of a cross-sectional survey in a sample of 700 Flemish (Belgium) women who were invited to the free-of-charge breast cancer population screening. Screening attendance of this sample was provided by the government agency in charge of the organisation of the screening. Health awareness, affects intensity, topic involvement, and perceived risk have the strongest influence on activation. Breast cancer anxiety and perceived breast cancer threat have a substantial mediation effect on these effects. Efficacy perceptions are less important in the activation process. Increased health awareness and a higher level of perceived risk lead to less participation in the free of charge population based breast screening program. Implications for theory and practice are offered. The limitation of the study is that only a standard invitation message was used. In future research, other types of awareness and activation messages should be tested. Additionally, the analysis could be refined by investigating the potentially different activation process in different subgroups of women.
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Affiliation(s)
- Patrick De Pelsmacker
- Department of Marketing, Faculty of Applied Economics, University of Antwerp, Prinsstraat 13, 2000 Antwerpen, Belgium.
| | - Martine Lewi
- Department of Marketing, Faculty of Applied Economics, University of Antwerp, Prinsstraat 13, 2000 Antwerpen, Belgium.
| | - Veroline Cauberghe
- Department of Communication Sciences, Ghent University, Korte Meer 7-11, 9000 Gent, Belgium.
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Chad-Friedman E, Coleman S, Traeger LN, Pirl WF, Goldman R, Atlas SJ, Park ER. Psychological distress associated with cancer screening: A systematic review. Cancer 2017; 123:3882-3894. [PMID: 28833054 DOI: 10.1002/cncr.30904] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Current national cancer screening recommendations include the potential risk of psychological harm related to screening. However, data on the relation of psychological distress to cancer screening is limited. The authors conducted a systematic review to assess psychological distress associated with cancer screening procedures. METHODS Studies that administered measures of psychological distress between 2 weeks before and 1 month after the screening procedure were included. RESULTS In total, 22 eligible studies met criteria for review, including 13 observational trials and 9 randomized controlled trials. Eligible studies used a broad range of validated and unvalidated measures. Anxiety was the most commonly assessed construct and was measured using the State Trait Anxiety Inventory. Studies included breast, colorectal, prostate, lung, and cervical screening procedures. Distress was low across procedures, with the exception of colorectal screening. Distress did not vary according to the time at which distress was measured. None of the studies were conducted exclusively with the intention of assessing distress at the time of screening. CONCLUSIONS Evidence of low distress during the time of cancer screening suggests that distress might not be a widespread barrier to screening among adults who undergo screening. However, more studies are needed using validated measures of distress to further understand the extent to which screening may elicit psychological distress and impede adherence to national screening recommendations. Cancer 2017;123:3882-94. © 2017 American Cancer Society.
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Affiliation(s)
- Emma Chad-Friedman
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Lara N Traeger
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - William F Pirl
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Roberta Goldman
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Steven J Atlas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Elyse R Park
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Massachusetts General Hospital Cancer Center, Boston, Massachusetts.,Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
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27
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Dunn CE, Edwards A, Carter B, Field JK, Brain K, Lifford KJ. The role of screening expectations in modifying short-term psychological responses to low-dose computed tomography lung cancer screening among high-risk individuals. PATIENT EDUCATION AND COUNSELING 2017; 100:1572-1579. [PMID: 28274672 DOI: 10.1016/j.pec.2017.02.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/23/2017] [Accepted: 02/26/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This study aimed to examine the relationship between pre-screening expectations and psychological responses to low-dose computerised tomography (LDCT) screening among high-risk individuals in the United Kingdom Lung Cancer Screening (UKLS) pilot trial. METHODS Prior to screening, high-risk individuals randomised into the intervention arm of the UKLS were asked about their expected screening test result. Their actual LDCT scan result was compared with their baseline screening expectation to determine the level of congruence. Levels of concern about and perceived accuracy of the result were assessed in a questionnaire two weeks following receipt of their test result. RESULTS The sample included 1589 participants. Regardless of their expected results, patients who required follow-up investigations after their initial LDCT scan were the most concerned about their result (p<0.001). Participants who expected to require follow-up, but did not need it, perceived the test to be least accurate (p=0.006). CONCLUSIONS Lung cancer screening participants who require follow-up or who have unexpected negative results can be identified for supportive interventions. PRACTICAL IMPLICATIONS These findings can be used to ensure that any future LDCT lung cancer screening programme is tailored to identify and support those high-risk individuals who may benefit from additional help.
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Affiliation(s)
- Charlotte E Dunn
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Ben Carter
- Division of Population Medicine, Cardiff University, Cardiff, UK; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London,UK
| | - John K Field
- Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool, UK
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Kate J Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK.
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28
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Goldzahl L. Contributions of risk preference, time orientation and perceptions to breast cancer screening regularity. Soc Sci Med 2017; 185:147-157. [DOI: 10.1016/j.socscimed.2017.04.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 04/12/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
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29
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Schott S, Vetter L, Keller M, Bruckner T, Golatta M, Eismann S, Dikow N, Evers C, Sohn C, Heil J. Women at familial risk of breast cancer electing for prophylactic mastectomy: frequencies, procedures, and decision-making characteristics. Arch Gynecol Obstet 2017; 295:1451-1458. [DOI: 10.1007/s00404-017-4376-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
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30
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Simon K, Soni A, Cawley J. The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions. JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2017; 36:390-417. [PMID: 28378959 DOI: 10.1002/pam.21972] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The U.S. population receives suboptimal levels of preventive care and has a high prevalence of risky health behaviors. One goal of the Affordable Care Act (ACA) was to increase preventive care and improve health behaviors by expanding access to health insurance. This paper estimates how the ACA-facilitated state-level expansions of Medicaid in 2014 affected these outcomes. Using data from the Behavioral Risk Factor Surveillance System, and a difference-in-differences model that compares states that did and did not expand Medicaid, we examine the impact of the expansions on preventive care (e.g., dental visits, immunizations, mammograms, cancer screenings), risky health behaviors (e.g., smoking, heavy drinking, lack of exercise, obesity), and self-assessed health. We find that the expansions increased insurance coverage and access to care among the targeted population of low-income childless adults. The expansions also increased use of certain forms of preventive care, but there is no evidence that they increased ex ante moral hazard (i.e., there is no evidence that risky health behaviors increased in response to health insurance coverage). The Medicaid expansions also modestly improved self-assessed health.
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Affiliation(s)
- Kosali Simon
- School of Public Health and Environmental Affairs, Indiana University, Bloomington, IN, USA.
| | | | - John Cawley
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA.
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31
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Nilsson M. Postgastrectomy follow-up in the West: evidence base, guidelines, and daily practice. Gastric Cancer 2017; 20:135-140. [PMID: 27718134 PMCID: PMC5316395 DOI: 10.1007/s10120-016-0654-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/28/2016] [Indexed: 02/07/2023]
Abstract
Follow-up after gastrectomy for gastric cancer has several purposes, including management of side effects of surgery, oncological recurrence surveillance, psychological support, and data collection for research. How follow-up after gastrectomy, and especially recurrence surveillance, is performed differs immensely between different Western countries, despite guidelines from Western oncological organizations quite unanimously advocating symptom-driven surveillance, without scheduled cross-sectional imaging, endoscopies, or analysis of tumor markers. Given a complete lack of randomized data, the available body of observational data does not support intensive routine surveillance for recurrent disease. Moreover, studies of other cancers have shown a negative emotional impact of routine surveillance. There is an apparent need for randomized controlled trials to address the issue of optimized strategies for postgastrectomy recurrence surveillance.
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Affiliation(s)
- Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Kirurggatan 53, 141 86 Stockholm, Sweden ,Center for Digestive Diseases, Karolinska University Hospital, Kirurggatan 53, 141 86 Stockholm, Sweden
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32
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April-Sanders A, Oskar S, Shelton RC, Schmitt KM, Desperito E, Protacio A, Tehranifar P. Predictors of Breast Cancer Worry in a Hispanic and Predominantly Immigrant Mammography Screening Population. Womens Health Issues 2016; 27:237-244. [PMID: 27863982 DOI: 10.1016/j.whi.2016.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 09/01/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Worry about developing breast cancer (BC) has been associated with participation in screening and genetic testing and with follow-up of abnormal screening results. Little is known about the scope and predictors of BC worry in Hispanic and immigrant populations. METHODS We collected in-person interview data from 250 self-identified Hispanic women recruited from an urban mammography facility (average age 50.4 years; 82% foreign-born). Women reported whether they worried about developing breast cancer rarely/never (low worry), sometimes (moderate worry), or often/all the time (high worry). We examined whether sociocultural and psychological factors (e.g., acculturation, education, perceived risk), and risk factors and objective risk for BC (e.g., family history, Gail model 5-year risk estimates, parity) predicted BC worry using multinomial and logistic regression. RESULTS In multivariable models, women who perceived higher absolute BC risk (odds ratio, 1.66 [95% confidence interval, 1.28-2.14] for a one-unit increase in perceived lifetime risk) and comparative BC risk (e.g., odds ratio, 2.73, 95% confidence interval, 1.23-6.06) were more likely to report high BC worry than moderate or low BC worry. There were no associations between BC worry and indicators of objective risk or acculturation. CONCLUSIONS In Hispanic women undergoing screening mammography, higher perceptions of BC risk, in both absolute and comparative terms, were associated independently with high BC worry, and were stronger predictors of BC worry than indicators of objective BC risk, including family history, mammographic density, and personal BC risk estimates.
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Affiliation(s)
- Ayana April-Sanders
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Sabine Oskar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Karen M Schmitt
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York; Division of Academics, School of Nursing, Columbia University, New York, New York; Avon Foundation Breast Imaging Center-New York Presbyterian, New York, New York
| | - Elise Desperito
- Department of Radiology, Columbia University Medical Center-New York Presbyterian, New York, New York
| | - Angeline Protacio
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Parisa Tehranifar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.
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Gurmankin AD, Helweg-Larsen M, Armstrong K, Kimmel SE, Volpp KGM. Comparing the Standard Rating Scale and the Magnifier Scale for Assessing Risk Perceptions. Med Decis Making 2016; 25:560-70. [PMID: 16160211 DOI: 10.1177/0272989x05280560] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective. A new risk perception rating scale (“magnifier scale”) was recently developed to reduce elevated perceptions of low-probability health events, but little is known about its performance. The authors tested whether the magnifier scale lowers risk perceptions for low-probability (in 0%–1% magnifying glass section of scale) but not high-probability (>1%) events compared to a standard rating scale (SRS). Method. In studies 1 (n = 463) and 2 (n = 105), undergraduates completed a survey assessing risk perceptions of high- and low-probability events in a randomized 2X 2 design: in study 1 using the magnifier scale or SRS, numeric risk information provided or not, and in study 2 using the magnifier scale or SRS, high- or low-probability event. In study 3, hypertension patients at the Philadelphia Veterans Affairs hospital completed a similar survey (n = 222) assessing risk perceptions of 2 self-relevant high-probability events—heart attack and stroke—with the magnifier scale or the SRS. Results. In study 1, when no risk information was provided, risk perceptions for both high- and low-probability events were significantly lower (P < 0.0001) when using the magnifier scale compared to the SRS, but risk perceptions were no different by scale when risk information was provided (interaction term: P = 0.003). In studies 2 and 3, risk perceptions for the high-probability events were significantly lower using the magnifier scale than the SRS (P = 0.015 and P = 0.014, respectively). Conclusions. The magnifier scale lowered risk perceptions but did so for low- and high-probability events, suggesting that the magnifier scale should not be used for assessments of risk perceptions for high-probability events.
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Affiliation(s)
- Andrea D Gurmankin
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA.
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Foster C, Watson M, Moynihan C, Ardern-jones A, Eeles R. Genetic Testing for Breast and Ovarian Cancer Predisposition: Cancer Burden and Responsibility. J Health Psychol 2016; 7:469-84. [DOI: 10.1177/1359105302007004627] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to explore experiences of cancer in the family and motivation for predictive genetic testing among women at increased risk of developing breast and/or ovarian cancer due to their family history. Fifteen women were interviewed prior to receiving their genetic test results. A grounded theory approach was adopted to analyse the interview transcripts. The findings indicated that experiences of cancer in the family play an important role in formulating beliefs about one’s own risk and motivation for predictive genetic testing. A sense of responsibility for one’s own health and the need to take action either to prevent cancer or detect cancer at as early a stage as possible, as well as a feeling of responsibility towards children and other family members was apparent. The findings raise the question of whether there is any real choice available to these women and whether there is a negative impact on family dynamics.
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Affiliation(s)
- Claire Foster
- Psychology Research Group & Section of Cancer Genetics, The Institute of Cancer Research & Royal Marsden NHS Trust, UK,
| | - Maggie Watson
- Psychology Research Group & Section of Cancer Genetics, The Institute of Cancer Research & Royal Marsden NHS Trust, UK
| | - Clare Moynihan
- Psychology Research Group & Section of Cancer Genetics, The Institute of Cancer Research & Royal Marsden NHS Trust, UK
| | - Audrey Ardern-jones
- Psychology Research Group & Section of Cancer Genetics, The Institute of Cancer Research & Royal Marsden NHS Trust, UK
| | - Rosalind Eeles
- Psychology Research Group & Section of Cancer Genetics, The Institute of Cancer Research & Royal Marsden NHS Trust, UK
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Smits S, Boivin J, Menon U, Brain K. The double-edged sword of ovarian cancer information for women at increased risk who have previously taken part in screening. Ecancermedicalscience 2016; 10:650. [PMID: 27433283 PMCID: PMC4929978 DOI: 10.3332/ecancer.2016.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Women at increased risk who decide not to have, or to delay, risk-reducing salpingo-oophorectomy have to rely on early diagnosis through symptom awareness and presenting to primary care as soon as possible in the absence of screening. However, little is known about the acceptability to women of this strategy. We aimed to gain an in-depth understanding of women's perceptions and previous experiences of ovarian cancer symptom management, and the influences on ovarian cancer awareness and anticipated symptom presentation. METHOD Qualitative interviews were conducted with eight women at increased risk of ovarian cancer who had previously taken part in ovarian cancer screening and analysed using interpretative phenomenological analysis (IPA). RESULTS Familial experience of ovarian cancer and perceived personal risk shaped women's perceptions and behavioural responses to disease threat. Ovarian cancer information was perceived to be a double-edged sword, regarded as either useful for increasing knowledge and confidence in discussing symptom concerns with health professionals or to be avoided due to fears about cancer. CONCLUSION Women may be cautious about searching for information independently and in the absence of routine ovarian screening. PRACTICE IMPLICATIONS Thought needs to be given to how best to create and disseminate credible ovarian cancer symptom information materials.
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Affiliation(s)
- Stephanie Smits
- Divison of Population Medicine, School of Medicine, Cardiff University, Neuadd, Meirionnydd, Heath Park, Cardiff CF14 4YS, United Kingdom
| | - Jacky Boivin
- School of Psychology, Cardiff University, Cardiff CF10 3AT, United Kingdom
| | - Usha Menon
- Institute for Women’s Health, University College London, London W1T 7DN, United Kingdom
| | - Kate Brain
- Divison of Population Medicine, School of Medicine, Cardiff University, Neuadd, Meirionnydd, Heath Park, Cardiff CF14 4YS, United Kingdom
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Vetter L, Keller M, Bruckner T, Golatta M, Eismann S, Evers C, Dikow N, Sohn C, Heil J, Schott S. Adherence to the breast cancer surveillance program for women at risk for familial breast and ovarian cancer versus overscreening: a monocenter study in Germany. Breast Cancer Res Treat 2016; 156:289-99. [PMID: 26960712 DOI: 10.1007/s10549-016-3748-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/04/2016] [Indexed: 12/26/2022]
Abstract
Breast cancer (BC) is the leading cancer among women worldwide and in 5-10 % of cases is of hereditary origin, mainly due to BRCA1/2 mutations. Therefore, the German Consortium for Familial Breast and Ovarian Cancer (HBOC) with its 15 specialized academic centers offers families at high risk for familial/hereditary cancer a multimodal breast cancer surveillance program (MBCS) with regular breast MRI, mammography, ultrasound, and palpation. So far, we know a lot about the psychological effects of genetic testing, but we know little about risk-correlated adherence to MBCS or prophylactic surgery over time. The aim of this study was to investigate counselees' adherence to recommendations for MBCS in order to adjust the care supply and define predictors for incompliance. All counselees, who attended HBOC consultation at the University Hospital Heidelberg between July 01, 2009 and July 01, 2011 were eligible to participate. A tripartite questionnaire containing sociodemographic information, psychological parameters, behavioral questions, and medical data collection from the German consortium were used. A high participation rate was achieved among the study population, with 72 % returning the questionnaire. This study showed a rate of 59 % of full-adherers to the MBCS. Significant predictors for partial or full adherence were having children (p = 0.0221), younger daughters (p = 0.01795), a higher awareness of the topic HBOC (p = 0.01795, p < 0.0001), a higher perceived breast cancer risk (p < 0.0001), and worries (p = 0.0008)/impairment (p = 0.0257) by it. Although the current data suggest a good adherence of MBCS, prospective studies are needed to understand counselees' needs to further improve surveillance programs and adherence to them. Adherence to the breast cancer surveillance program for women at risk for familial breast and ovarian cancer versus overscreening-a monocenter study in Germany.
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Affiliation(s)
- Lisa Vetter
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Monika Keller
- Department of Psychosomatic, Internal Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Golatta
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Sabine Eismann
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Christina Evers
- Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - Nicola Dikow
- Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - Christof Sohn
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Jörg Heil
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Sarah Schott
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
- DKTK, German Cancer Research Center, DKFZ Heidelberg, Heidelberg, Germany.
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Heidari M, Shahbazi S, Ghodusi M. Evaluation of body esteem and mental health in patients with breast cancer after mastectomy. J Midlife Health 2016; 6:173-7. [PMID: 26903758 PMCID: PMC4743280 DOI: 10.4103/0976-7800.172345] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: Mastectomy in patients with breast cancer can severely affect their body esteem. It also changes the emotions and attitudes of patients toward their body and causes psychological reactions such as depression, anxiety, and stress. Aims: This study was conducted with the aim of assessing correlation between body esteem and mental health in patients with breast cancer after mastectomy. Materials and Methods: This study is a descriptive study. One hundred patients with breast cancer after mastectomy were selected by convenience sampling from Seyed Al Shohada Hospital in Isfahan. Data gathering tools were questionnaires of body esteem and SCL-25 mental health and were analyzed by SPSS-PC (v.17). Results: According to the score of body esteem (2.80) and the overall average score for body esteem (36.46), patients had low body esteem. About dimensions of the mental health, the highest average was associated with depressive disorders. According to the results of the Spearman correlation coefficient, there was a direct linear relationship between body esteem and mental health. Conclusion: Considering the impact of mastectomy on body esteem and mental health and the relationship between the variables, nurses take steps for identifying and referring patients to the counseling centers to prevent psychological disorder aspects.
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Affiliation(s)
- Mohammad Heidari
- Department of Nursing, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Sara Shahbazi
- Department of Nursing, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mansureh Ghodusi
- Department of Nursing, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Physician trust moderates the relationship between intolerance of uncertainty and cancer worry interference among women with Lynch syndrome. J Behav Med 2016; 39:420-8. [DOI: 10.1007/s10865-016-9711-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022]
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Livaudais-Toman J, Karliner LS, Tice JA, Kerlikowske K, Gregorich S, Pérez-Stable EJ, Pasick RJ, Chen A, Quinn J, Kaplan CP. Impact of a primary care based intervention on breast cancer knowledge, risk perception and concern: A randomized, controlled trial. Breast 2015; 24:758-66. [PMID: 26476466 PMCID: PMC4698352 DOI: 10.1016/j.breast.2015.09.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/06/2015] [Accepted: 09/22/2015] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To estimate the effects of a tablet-based, breast cancer risk education intervention for use in primary care settings (BreastCARE) on patients' breast cancer knowledge, risk perception and concern. METHODS From June 2011-August 2012, we enrolled women from two clinics, aged 40-74 years with no personal breast cancer history, and randomized them to the BreastCARE intervention group or to the control group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room prior to visit for intervention). All women were categorized as high or average risk based on the Referral Screening Tool, the Gail model or the Breast Cancer Surveillance Consortium model. Intervention patients and their physicians received an individualized risk report to discuss during the visit. All women completed a follow-up telephone survey 1-2 weeks after risk assessment. Post-test comparisons estimated differences at follow-up in breast cancer knowledge, risk perception and concern. RESULTS 580 intervention and 655 control women completed follow-up interviews. Mean age was 56 years (SD = 9). At follow-up, 73% of controls and 71% of intervention women correctly perceived their breast cancer risk and 22% of controls and 24% of intervention women were very concerned about breast cancer. Intervention patients had greater knowledge (≥75% correct answers) of breast cancer risk factors at follow-up (24% vs. 16%; p = 0.002). In multivariable analysis, there were no differences in correct risk perception or concern, but intervention patients had greater knowledge ([OR] = 1.62; 95% [CI] = 1.19-2.23). CONCLUSIONS A simple, practical intervention involving physicians at the point of care can improve knowledge of breast cancer without increasing concern. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT01830933.
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Affiliation(s)
- Jennifer Livaudais-Toman
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA; Medical Effectiveness Research Center for Diverse Populations, Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Leah S Karliner
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; Medical Effectiveness Research Center for Diverse Populations, Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey A Tice
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Karla Kerlikowske
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; General Internal Medicine Section, Department of Veterans Affairs, San Francisco, CA, USA
| | - Steven Gregorich
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA; Medical Effectiveness Research Center for Diverse Populations, Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Eliseo J Pérez-Stable
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; Medical Effectiveness Research Center for Diverse Populations, Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rena J Pasick
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Alice Chen
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Jessica Quinn
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Celia P Kaplan
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; Medical Effectiveness Research Center for Diverse Populations, Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
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McBride CM, Abrams LR, Koehly LM. Using a Historical Lens to Envision the Next Generation of Genomic Translation Research. Public Health Genomics 2015; 18:272-82. [PMID: 26226840 DOI: 10.1159/000435832] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 06/09/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The past 20 years have witnessed successive and exponential advances in genomic discovery and technology, with a broad scientific imperative pushing for continual advancements. The most consistent critique of these advances is that they have vastly outpaced translation of new knowledge into improvements in public health and medicine. METHODS We employ a historical and epistemological analysis to characterize how prevailing scientific meta-narratives have shaped the pace and priorities of research applying genomics to health promotion. We use four 'pivotal events' - the genetic characterization of Down syndrome, the launch of the Human Genome Research Project, the discovery of BRCA1, and the emergence of direct-to- consumer genetic testing - to illustrate how these scientific meta-narratives have inhibited genomic translation research. RESULTS The notion that discovery should precede translation research has over-focused translation research on the latest genetic testing platform. The idea that genetic-related research has an exceptional potential for public harm has encouraged research on worst case scenarios. The perceived competition between genetics and social determinants of health has discouraged a unified research agenda to move genomic translation forward. CONCLUSION We make a case for creating new scientific meta-narratives in which discovery and translation research agendas are envisioned as an interdependent enterprise.
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Penles Stadler M, Mulvihill JJ. Cancer Risk Assessment and Genetic Counseling in an Academic Medical Center: Consultands' Satisfaction, Knowledge, and Behavior in the First Year. J Genet Couns 2015; 7:279-97. [PMID: 26141403 DOI: 10.1023/a:1022847323935] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In 1995, we formally established a multifaceted cancer genetics program of clinical services, research, and education at a general academic medical center. In the first year, 58 families, mostly physician referred, received cancer risk assessment and genetic counseling for a family and/or medical history of cancer. The primary reasons for seeking consultation were to determine their risk or their offspring's risk for developing certain cancers and to inquire about the availability of DNA testing for predisposition to breast, ovarian, or colon cancers. To assess the level of satisfaction with program services, 51 consultands (22% with a personal history of cancer) were interviewed independently by telephone 3-12 months after the session. One goal of the survey was to improve program service. Ninety percent of respondents reported that the consultation was worth their time and money. Forty-two percent stated that their anxiety related to their cancer risk had decreased following counseling and 56% indicated no change. Recall of exact numerical risk was poor and one-third could not remember hearing any risk estimate. More respondents would recommend the service to friends (90%) than to family members (75%). Overall, the service was positively received by the majority of patients.
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Affiliation(s)
- M Penles Stadler
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania
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Matthews AK, Brandenburg DL, Cummings S, Olopade OI. Incorporating a Psychological Counselor in a Cancer Risk Assessment Program: Necessity, Acceptability, and Potential Roles. J Genet Couns 2015; 11:51-64. [PMID: 26141561 DOI: 10.1023/a:1013820515603] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Evidence suggests that cancer risk assessment may be associated with increased psychological distress. This exploratory study assessed the necessity and acceptability of incorporating psychological counseling into routine clinic procedures at a cancer risk program. Following a visit to a university-based cancer risk clinic, patients (N = 102) completed an anonymous self-report instrument. Participants reported experiencing current stress and anxiety (41%), depression (29%), and suicidal ideation (2%). Patients with a history of cancer were more likely to be experiencing current emotional difficulties. Sixty-nine percent of the participants found the visit with the psychological counselor to be helpful, while 41% of the participants reported interest in follow-up psychological services. Interest in receiving future psychological services was positively correlated with levels of anxiety, depression, and cancer worry. This pilot study demonstrates the acceptability and potential role for psychological counselors in increasing adjustment in high-risk patients undergoing genetic counseling for inherited cancers.
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Heidari M, Ghodusi M. The Relationship between Body Esteem and Hope and Mental Health in Breast Cancer Patients after Mastectomy. Indian J Palliat Care 2015; 21:198-202. [PMID: 26009674 PMCID: PMC4441182 DOI: 10.4103/0973-1075.156500] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Breast cancer and its treatment, including mastectomy, can cause feelings of mutilation, depreciation in the value of the body, reduction in attractiveness, and lead to mental disorders and hopelessness. Objective: The present study aimed to determine the relationship between appreciating the body, hope and mental health in women with breast cancer after mastectomy. Materials and Methods: This study was a descriptive study of 100 breast cancer patients who had undergone mastectomy and referred to the Sayed Al-Shohada Medical Center in Isfahan, Iran. The subjects were selected by convenient sampling. Data gathering tools were the Body Esteem Scale (BES), Herth Hope Index (HHI), and Symptom Checklist 25 (SCL-25) mental health questionnaire. Data analysis was performed using SPSS software. Results: Most of the patients had low body esteem. There was a significant direct linear relationship between body esteem and hope and mental health. This relationship was stronger between valuing the body and hope. Conclusion: Body esteem has a significant linear relationship with hope and mental health.
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Affiliation(s)
- Mohammad Heidari
- Department of Medical-Surgical, Faculty of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mansureh Ghodusi
- Department of Psycho Nursing, Borujen School of Nursing, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Abstract
OBJECTIVE The research about follow-up patterns of women attending high-risk breast-cancer clinics is sparse. This study sought to profile daughters of breast-cancer patients who are likely to return versus those unlikely to return for follow-up care in a high-risk clinic. METHOD Our investigation included 131 patients attending the UCLA Revlon Breast Center High Risk Clinic. Predictor variables included age, computed breast-cancer risk, participants' perceived personal risk, clinically significant depressive symptomatology (CES-D score ≥ 16), current level of anxiety (State-Trait Anxiety Inventory), and survival status of participants' mothers (survived or passed away from breast cancer). RESULTS A greater likelihood of reattendance was associated with older age (adjusted odds ratio [AOR] = 1.07, p = 0.004), computed breast-cancer risk (AOR = 1.10, p = 0.017), absence of depressive symptomatology (AOR = 0.25, p = 0.009), past psychiatric diagnosis (AOR = 3.14, p = 0.029), and maternal loss to breast cancer (AOR = 2.59, p = 0.034). Also, an interaction was found between mother's survival and perceived risk (p = 0.019), such that reattendance was associated with higher perceived risk among participants whose mothers survived (AOR = 1.04, p = 0.002), but not those whose mothers died (AOR = 0.99, p = 0.685). Furthermore, a nonlinear inverted "U" relationship was observed between state anxiety and reattendance (p = 0.037); participants with moderate anxiety were more likely to reattend than those with low or high anxiety levels. SIGNIFICANCE OF RESULTS Demographic, medical, and psychosocial factors were found to be independently associated with reattendance to a high-risk breast-cancer clinic. Explication of the profiles of women who may or may not reattend may serve to inform the development and implementation of interventions to increase the likelihood of follow-up care.
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Meiser B, Price MA, Butow PN, Rahman B, Tucker K, Cheah B, Bickerstaffe A, Hopper J, Phillips KA. Misperceptions of ovarian cancer risk in women at increased risk for hereditary ovarian cancer. Fam Cancer 2015; 13:153-62. [PMID: 24081834 DOI: 10.1007/s10689-013-9687-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This study assessed the sociodemographic, medical and psychological predictors of accuracy of perceived risk in women at increased genetic risk for ovarian cancer. Women participating in a large cohort study who were at increased risk of ovarian and fallopian tube cancer, had no personal history of cancer and had ≥1 ovary in situ at cohort enrollment, were eligible. Women completed self-administered questionnaires and attended an interview at enrollment. Of 2,868 women unaffected with cancer at cohort enrollment, 561 were eligible. 335 women (59.8 %) overestimated their ovarian cancer risk, while 215 women (38.4 %) accurately estimated their risk, and 10 (1.8 %) underestimated it. Women who did not know their mutation status were more likely to overestimate their risk (OR 1.74, 95 % CI 1.10, 2.77, p = 0.018), as were those with higher cancer-specific anxiety (OR 1.05, 95 % CI 1.02, 1.08, p < 0.001) and/or a mother who had been diagnosed with ovarian cancer (OR 1.98, 95 % CI 1.23, 3.18, p = 0.005). Amongst the group of women who did not know their mutation status, 63.3 % overestimated their risk and the mean perceived lifetime risk of developing ovarian cancer was 42.1 %, compared to a mean objective risk of 6.4 %. A large number of women at increased risk for ovarian cancer overestimate their risk. This is of concern especially in women who are at moderately increased risk only; for this sub-group of women, interventions are needed to reduce potentially unnecessary psychological distress and minimise engagement in unnecessary surgery or screening.
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Affiliation(s)
- Bettina Meiser
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia,
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Abstract
Longitudinal or observational study designs are important methodologies to investigate potential associations that may not be amenable to randomized controlled trials. In many cases they may be performed using existing data and are often cost-effective ways of addressing important questions. The major disadvantage of observational studies is the potential for bias. The absence of randomization means that one can never be certain that unknown confounders are present, and specific studies designs have their own inherent forms of bias. Careful study design may minimize bias. Establishing casual association based on observational methods requires due consideration of the quality of the individual study and knowledge of their limitations.
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Affiliation(s)
- Sean W Murphy
- Department of Medicine, Memorial University of Newfoundland, St. John's, NF, Canada, A1B 3V6,
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Risk perception and self-management in urban, diverse adults with type 2 diabetes: the improving diabetes outcomes study. Int J Behav Med 2014; 21:88-98. [PMID: 23385488 DOI: 10.1007/s12529-013-9291-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE AND BACKGROUND The relationship between risk perceptions and diabetes self-care remains ambiguous. This study aimed to assess baseline, 1-year follow-up, and change score relationships among perceived risk, diabetes self-care, and glycemic control for adult individuals participating in a behavioral intervention that improved glycemic control relative to the active control. METHOD One-year randomized trial compared a behavioral telephonic intervention with a print only intervention. Participants (N = 526) are members of a union/employer sponsored health benefit plan, with HbA(1c) ≥ 7.5 %, prescribed at least one oral diabetes medication. Participants rated perceived risk of diabetes and its complications and diabetes self-care at baseline and 1 year. Data were collected in a large urban area in the USA. RESULTS There were no relationships between risk perceptions and glycemic control during the study. Baseline perceived risk predicted follow-up self-care. Additionally, participants assigned to the intervention group showed significant changes in dietary and exercise adherence at high levels of risk knowledge and low levels of optimistic bias. CONCLUSION Perceived risk relates to dietary, exercise, and medication adherence in diabetes. The perceived risk construct might foster a more coherent conceptualization of the relationship between one's diabetes, possible complications, and diabetes self-care behaviors.
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Does perceived risk predict breast cancer screening use? Findings from a prospective cohort study of female relatives from the Ontario site of the breast cancer family registry. Breast 2014; 23:482-8. [PMID: 24821458 DOI: 10.1016/j.breast.2014.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/03/2014] [Accepted: 04/04/2014] [Indexed: 11/21/2022] Open
Abstract
While the relationship between perceived risk and breast cancer screening use has been studied extensively, most studies are cross-sectional. We prospectively examined this relationship among 913 women, aged 25-72 with varying levels of familial breast cancer risk from the Ontario site of the Breast Cancer Family Registry. Associations between perceived lifetime breast cancer risk and subsequent use of mammography, clinical breast examination (CBE) and genetic testing were assessed using logistic regression. Overall, perceived risk did not predict subsequent use of mammography, CBE or genetic testing. Among women at moderate/high familial risk, those reporting a perceived risk greater than 50% were significantly less likely to have a CBE (odds ratio (OR) = 0.52, 95% confidence interval (CI): 0.30-0.91, p = 0.04), and non-significantly less likely to have a mammogram (OR = 0.70, 95% CI: 0.40-1.20, p = 0.70) or genetic test (OR = 0.61, 95% CI: 0.34-1.10, p = 0.09) compared to women reporting a perceived risk of 50%. In contrast, among women at low familial risk, those reporting a perceived risk greater than 50% were non-significantly more likely to have a mammogram (OR = 1.13, 95% CI: 0.59-2.16, p = 0.78), CBE (OR = 1.11, 95% CI: 0.63-1.95, p = 0.74) or genetic test (OR = 1.29, 95% CI: 0.50-3.33, p = 0.35) compared to women reporting a perceived risk of 50%. Perceived risk did not significantly predict screening use overall, however this relationship may be moderated by level of familial risk. Results may inform risk education and management strategies for women with varying levels of familial breast cancer risk.
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Mamdouh HM, El-Mansy H, Kharboush IF, Ismail HM, Tawfik MM, El-Baky MA, El Sharkawy OG. Barriers to breast cancer screening among a sample of Egyptian females. J Family Community Med 2014; 21:119-24. [PMID: 24987281 PMCID: PMC4073560 DOI: 10.4103/2230-8229.134771] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Breast cancer (BC) is usually diagnosed in late stages in countries with limited resources. Early detection of BC is likely to improve the outcome of the disease for women in these areas. OBJECTIVE The aim of this study was to understand the possible personal, economic, and systems barriers to BC screening in a sample of Egyptian women. MATERIALS AND METHODS A cross-sectional study was conducted in family health centers representing the seven districts of Alexandria governorate, Egypt. A total of 612 women were randomly selected from the chosen centers. RESULTS IN THIS SAMPLE OF EGYPTIAN WOMEN, THE MOST FREQUENTLY IDENTIFIED POTENTIAL BARRIERS TO BC SCREENING WERE THE FOLLOWING: 81.8% would not seek care until they were ill, 77% were unwilling to have a mammogram until it was recommended by the doctor, 71.4% blamed the, lack of privacy, 69.2% thought that medical checkups were not worthwhile, and 64.6% blamed the cost of services. The study further revealed that women of lower education, women in the lower income category, women who did not do paid work, those who had poor knowledge of the risks of BC, and women with no family history of BC were more likely to perceive different screening barriers compared with their counterparts. CONCLUSION Many potential personal, economic, and health system barriers were identified. Addressing these barriers by increasing the awareness of BC and dealing with the misconceptions that the women have can help the policy makers to design more culturally relevant strategies to motivate women to utilize screening services.
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Affiliation(s)
- Heba M. Mamdouh
- Department of Family Health, High Institute of Public Health, University of Alexandria, Alexandria, Egypt
- Department of Research, Alexandria Regional Center for Women's Health and Development, Alexandria, Egypt
| | - Hazzem El-Mansy
- Medical Research Institute, High Institute of Public Health, University of Alexandria, Alexandria, Egypt
| | - Ibrahim F. Kharboush
- Department of Family Health, High Institute of Public Health, University of Alexandria, Alexandria, Egypt
- Department of Research, Alexandria Regional Center for Women's Health and Development, Alexandria, Egypt
| | - Hanaa M. Ismail
- Department of Family Health, High Institute of Public Health, University of Alexandria, Alexandria, Egypt
- Department of Nutrition, High Institute of Public Health, University of Alexandria, Alexandria, Egypt
| | - May M. Tawfik
- Department of Research, Alexandria Regional Center for Women's Health and Development, Alexandria, Egypt
| | - Mohamed Abdel El-Baky
- Department of Research, Alexandria Regional Center for Women's Health and Development, Alexandria, Egypt
| | - Omnia G. El Sharkawy
- Department of Research, Alexandria Regional Center for Women's Health and Development, Alexandria, Egypt
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Tarr GP, Crowley A, John R, Kok JB, Lee HNL, Mustafa H, Sii KM, Smith R, Son SEQ, Weaver LJ, Cameron C, Dockerty JD, Schultz M, Murray IA. Do high risk patients alter their lifestyle to reduce risk of colorectal cancer? BMC Gastroenterol 2014; 14:22. [PMID: 24507382 PMCID: PMC3922190 DOI: 10.1186/1471-230x-14-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) may be reduced by healthy lifestyle behaviours. We determined the extent of self-reported lifestyle changes in people at increased risk of CRC, and the association of these reports with anxiety, risk and knowledge-based variables. METHODS We randomly selected 250 participants who had undergone surveillance colonoscopy for family history of CRC. A telephone interview was conducted, recording demographics and family history. Self-reported lifestyle change due to thoughts about CRC across a range of dietary and lifestyle variables was assessed on a four-point scale. Participants' perceptions of the following were recorded: risk factor knowledge, personal risk, and worry due to family history. General anxiety was assessed using the GAD-7 scale. Ordinal logistic regression was used to calculate adjusted results. RESULTS There were 148 participants (69% response). 79.7% reported at least one healthy change. Change in diet and physical activity were most frequently reported (fiber, 63%; fruit and vegetables, 54%; red meat, 47%; physical activity, 45%), with consumption of tobacco, alcohol, and body weight less likely (tobacco, 25%; alcohol, 26%; weight 31%). People were more likely to report healthy change with lower levels of generalized anxiety, higher worry due to family history, or greater perceived knowledge of CRC risk factors. Risk perception and risk due to family history were not associated with healthy changes. CONCLUSIONS Self-reported lifestyle changes due to thoughts about CRC were common. Lower general anxiety levels, worries due to family history, and perceived knowledge of risk factors may stimulate healthy changes.
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Affiliation(s)
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- Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand.
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