Katie O' Brien

We examined whether demographic and tumour characteristics (including subtype) were different for women with breast cancer diagnosed via mammography screening compared with women with interval breast cancers, lapsed attenders of the screening programme and non-participants of the screening programme. In addition, we explored whether there were survival differences between the groups, taking into account lead time bias.

Analysing linked, routinely collected data may be useful to identify characteristics of patients with suspected lung cancer who could benefit from early assessment for palliative care. The aim of this study was to compare characteristics of newly diagnosed lung cancer patients dying within 30 days of diagnosis (short term survivors) with those surviving more than 30 days. To identify indicators for early palliative care assessment we distinguished between characteristics available at diagnosis (age, gender, smoking status, marital status, comorbid disease, admission type, tumour stage and histology) from those available post diagnosis. A second aim was to examine the association between receiving any tumour-directed treatment, place of death and survival time. A retrospective observational population based study comparing lung cancer patients who died within 30 days of diagnosis (short term survivors) with those who survived longer using Chi-squared tests and logistic regression. Incident lung cancer (ICD-03:C34) patients diagnosed 2005–2012 inclusive who died before 01–01-2014 (n = 14,228) were identified from the National Cancer Registry of Ireland linked to death certificate data and acute hospital episode data. One in five newly diagnosed lung cancer patients died within 30 days of diagnosis. After adjusting for stage and histology, death within 30 days was higher in patients who were aged 80 years or older (adjusted OR 2.46; 95%CI 2.05–3.96; p < 0.001), patients with emergency admissions at diagnosis (adjusted OR 2.96; 95%CI 2.61–3.37; p < 0.001) and patients with any comorbidities at diagnosis (adjusted OR 1.32 95%CI 1.15–1.52; p < 0.001). Overall, 75% of those who died within 30 days died in hospital compared to 43% of longer term survivors. We have shown a high proportion of lung cancer patients who die within 30 days of diagnosis are older, have comorbidities and are admitted through the emergency department. These characteristics, available at diagnosis, may be useful prognostic factors to guide decisions on early assessment for palliative care for lung cancer patients. Patients who die shortly after diagnosis are more likely to die in hospital so reporting place of death by survival time may be useful to evaluate interventions to reduce deaths in acute hospitals.

Objective: To estimate prevalence of post‐colposcopy physical after‐effects and investigate associations between these and subsequent psychological distress.Design: Longitudinal survey.Setting: Two hospital‐based colposcopy clinics.Population: Women with abnormal cytology who underwent colposcopy (±related procedures).Methods: Questionnaires were mailed to women 4, 8 and 12 months post‐colposcopy. Details of physical after‐effects (pain, bleeding and discharge) experienced post‐colposcopy were collected at 4 months. Colposcopy‐specific distress was measured using the Process Outcome‐Specific Measure at all time‐points. Linear mixed‐effects regression was used to identify associations between physical after‐effects and distress over 12 months, adjusting for socio‐demographic and clinical variables.Main outcome measures: Prevalence of post‐colposcopy physical after‐effects. Associations between the presence of any physical after‐effects, awareness of after‐effects, and number of after‐effects and distress.Results: Five‐hundred and eighty‐four women were recruited (response rate = 73, 59 and 52% at 4, 8 and 12 months, respectively). Eighty‐two percent of women reported one or more physical after‐effect(s). Multiple physical after‐effects were common (two after‐effects = 25%; three after‐effects = 25%). Psychological distress scores declined significantly over time. In adjusted analyses, women who experienced all three physical after‐effects had on average a 4.58 (95% CI: 1.10–8.05) higher distress scored than those who experienced no after‐effects. Women who were unaware of the possibility of experiencing after‐effects scored significantly higher for distress during follow‐up.Conclusions: The prevalence of physical after‐effects of colposcopy and related procedures is high. The novel findings of inter‐relationships between awareness of the possibility of after‐effects and experiencing multiple after‐effects, and post‐colposcopy distress may be relevant to the development of interventions to alleviate post‐colposcopy distress.Tweetable Experiencing multiple physical after‐effects of colposcopy is associated with psychological distress.

Head and neck cancer is a serious form of cancer that can generate substantial physical and psychosocial morbidity. Informal caregivers can help patients to manage head and neck cancer and its emotional impacts, both during and after treatment. Caregivers, however, can experience considerable stress as a result of their caring activities. Supportive relationships can protect caregivers from psychosocial strain. Thirty-one head and neck cancer caregivers were interviewed about their experiences of accessing social support from their social networks; difficulties that they experienced accessing this support; and strategies that they used to address these difficulties. Results suggest that head and neck cancer caregivers strongly value social support, but can find it difficult to obtain, and a number of them experience socially negative responses from their networks. Some carers attempt to answer or supplement support deficiencies by turning to non-human coping supports, such as pets, spiritual figures or medication. Implications for theory and practice are discussed.

The purpose of this study was to quantify the general cancer support activities that long‐term carers of head and neck cancer (HNC) survivors engage in; and the relationships between these care activities and psychological well‐being. Respondents answered a survey detailing their caring activities, the amount of time that they spent on those activities and how comfortable they felt engaging in them. Psychological well‐being was assessed by the Depression Anxiety Stress Scales‐21. A total of 197 carers took part in the study. The majority (76%) were women, mean age 57.4. Mean time since diagnosis was 6.2 years. In the past month, 45% of carers did not spend any extra time per week helping their relative/friend with general caring activities such as cleaning the house; 31% spent 1–19 hr/week and 23% spent 20 or more hours/week doing so. Most carers were comfortable assisting their relative/friend, though more carers felt uncomfortable assisting with HNC‐specific support tasks (31% uncomfortable helping with medication) compared with general support tasks (7% uncomfortable helping with appointments). Feeling uncomfortable with head and neck‐specific care tasks was a significant predictor of experiencing depression and anxiety.

Aims and objectives: To examine the unmet supportive care needs of long‐term head and neck cancer caregivers, and the factors associated with those needs.Background: Research on the unmet needs of head and neck cancer caregivers is lacking, particularly in the long‐term survivorship period.Design: Survey of 197 caregivers.Methods: The study collected information on caregivers’ demographic characteristics and their unmet supportive care needs (as measured by the Partners and Caregivers Supportive Care Needs Survey). An overall score of unmet need was generated, as were scores for four separate domains of unmet needs (emotional, health, information and work/social).Results: Seventy six percentage of respondents were female, and 88% reported being married or living with a partner. Mean age was 57 years. Most caregivers had low levels of unmet needs. Managing fears about the cancer recurring was the most commonly reported individual need, described by slightly more than one in five respondents. The highest levels of need were located in the emotional and the health services domains. Loneliness and financial stress were consistently and significantly associated with high levels of unmet need in the multivariable analysis.Conclusions: Most head and neck cancer caregivers appear to have low levels of unmet need in the extended survivorship period. The greatest levels of unmet need that are experienced occur in relation to emotional and health service domains. Needs diminish over time.Relevance to clinical practice: Health professionals should be aware that a minority of long‐term head and neck caregivers continue to experience strong fears of cancer recurrence. To reduce unmet needs across multiple domains, health professionals should seek to reduce caregivers’ feelings of loneliness, and to assist caregivers to reduce the financial burdens that they experience as a result of long‐term caring.