Risk and the importance of absent symptoms in constructions of the ‘cancer candidate’

Cancer is a disease that is imbued with notions of risk, with individuals expected to avoid ‘risky’ behaviours and act swiftly when symptoms indicating a risk of cancer emerge. Cancer symptoms, however, are often ambiguous and indicative of a number of other conditions, making it difficult for people to assess when symptoms may, or may not, be the result of cancer. Here, we discuss interview data from a study examining the symptom appraisal and help-seeking experiences of patients referred for assessment of symptoms suspicious of a lung or colorectal cancer in the North-East of England. We explore how individuals draw upon ideas about cancer risks to assess whether cancer may be a possible explanation for their symptoms and to inform their decisions about help-seeking. In our analysis, we applied the concept of candidacy to the data, to highlight how lay epidemiology shapes people’s perceptions of cancer risk, and their subsequent responses to it. We found that participants appraised their symptoms, and the likelihood that they may have cancer, in light of relevant information on risk. These sources of information related to lifestyle factors, family history of cancer, environmental factors, and importantly, the symptomatic experience itself, including the absence of symptoms that participants associated with cancer. The importance of experienced, and absent, symptoms was a core element of participants’ everyday constructions of the ‘cancer candidate’, which informed symptom appraisal and subsequent help-seeking decision-making

Reconceptualising Rural Cancer Inequalities : Time for a New Research Agenda

Peer reviewedPublisher PD

Going Forward with the Nancy Grace Roman Space Telescope Transient Survey: Validation of Precision Forward-Modeling Photometry for Undersampled Imaging

The Nancy Grace Roman Space Telescope (Roman) is an observatory for both wide-field observations and coronagraphy that is scheduled for launch in the mid 2020's. Part of the planned survey is a deep, cadenced field or fields that enable cosmological measurements with type Ia supernovae (SNe Ia). With a pixel scale of 0".11, the Wide Field Instrument will be undersampled, presenting a difficulty for precisely subtracting the galaxy light underneath the SNe. We use simulated data to validate the ability of a forward-model code (such codes are frequently also called "scene-modeling" codes) to perform precision supernova photometry for the Nancy Grace Roman Space Telescope SN survey. Our simulation includes over 760,000 image cutouts around SNe Ia or host galaxies (~ 10% of a full-scale survey). To have a realistic 2D distribution of underlying galaxy light, we use the VELA simulated high-resolution images of galaxies. We run each set of cutouts through our forward-modeling code which automatically measures time-dependent SN fluxes. Given our assumed inputs of a perfect model of the instrument PSFs and calibration, we find biases at the millimagnitude level from this method in four red filters (Y106, J129, H158, and F184), easily meeting the 0.5% Roman inter-filter calibration requirement for a cutting-edge measurement of cosmological parameters using SNe Ia. Simulated data in the bluer Z087 filter shows larger ~ 2--3 millimagnitude biases, also meeting this requirement, but with more room for improvement. Our forward-model code has been released on Zenodo.Comment: Accepted for Publication in PAS

Symptom Signatures and Diagnostic Timeliness in Cancer Patients: A Review of Current Evidence.

Early diagnosis is an important aspect of contemporary cancer prevention and control strategies, as the majority of patients are diagnosed following symptomatic presentation. The nature of presenting symptoms can critically influence the length of the diagnostic intervals from symptom onset to presentation (the patient interval), and from first presentation to specialist referral (the primary care interval). Understanding which symptoms are associated with longer diagnostic intervals to help the targeting of early diagnosis initiatives is an area of emerging research. In this Review, we consider the methodological challenges in studying the presenting symptoms and intervals to diagnosis of cancer patients, and summarize current evidence on presenting symptoms associated with a range of common and rarer cancer sites. We propose a taxonomy of cancer sites considering their symptom signature and the predictive value of common presenting symptoms. Finally, we consider evidence on associations between symptomatic presentations and intervals to diagnosis before discussing implications for the design, implementation, and evaluation of public health or health system interventions to achieve the earlier detection of cancer

Barriers to Early Presentation amongst Rural Residents Experiencing Symptoms of Colorectal Cancer : A Qualitative Interview Study

Peer reviewedPublisher PD

The researchers’ role in knowledge translation: a realist evaluation of the development and implementation of diagnostic pathways for cancer in two UK localities

Abstract Background In examining an initiative to develop and implement new cancer diagnostic pathways in two English localities, this paper evaluates ‘what works’ and examines the role of researchers in facilitating knowledge translation amongst teams of local clinicians and policymakers. Methods Using realist evaluation with a mixed methods case study approach, we conducted documentary analysis of meeting minutes and pathway iterations to map pathway development. We interviewed 14 participants to identify the contexts, mechanisms and outcomes (CMOs) that led to successful pathway development and implementation. Interviews were analysed thematically and four CMO configurations were developed. Results One site produced three fully implemented pathways while the other produced two that were partly implemented. In explaining the differences, we found that a respected, independent, well-connected leader modelling partnership-working who facilitates a local, stable group that agree about the legitimacy of the data and project (context) can empower local teams to become sufficiently autonomous (mechanism) to develop and implement research-based pathways (outcome). Although both teams designed relevant, research-based cancer pathways, the research team assisted where the pathways were successfully implemented while in the other the research team drove the initiative. Discussion Based on our study findings, local stakeholders can apply local and research knowledge to develop and implement research-based pathways. However, success will depend on how academics empower local teams to create autonomy. After re-packaging and translating research for local circumstances, identifying fertile environments with the right elements for implementation and developing collaborative relationships with local leaders, crucially academics then have to step back. Keywords Knowledge translation; realist evaluation; qualitative research; diagnostic pathways for cance