Understanding variation in men’s help-seeking for cancer symptoms: a semi-structured interview study

Men appear more likely to delay seeking medical advice for cancer symptoms, resulting in later stage at diagnosis and poorer health outcomes. Limited research has investigated variation in men’s experiences of and responses to cancer symptoms. This study examined the psychosocial aspects of men’s help-seeking for cancer symptoms, as well as potential variation across men residing in urban and rural Australia. Semi-structured interviews were conducted with men recently diagnosed with cancer (n=13). Participants’ partners (n=8) were recruited to enable data triangulation. Interview schedules addressed participants’ pathway to cancer treatment, cancer knowledge, masculinity, and rural living. A theoretical thematic analysis approach was used. Medical help-seeking behaviour was similar for participants residing in urban and rural areas. Five key themes and one sub-theme were identified, including: symptom factors, traditional masculine norms (sub-theme: women’s health-related responsibilities), level of concern, conflicting responsibilities and access, and trust in medical professionals. Participants from rural Australia experienced greater access difficulties and noted optimism regarding symptoms. Results highlight important within-gender differences in the psychosocial barriers to help-seeking for cancer symptoms. Future research should further explore variation between men and test the predictive strength of factors

Chemotherapy for advanced breast cancer: what influences oncologists' decision-making?

Chemotherapy is widely used in the management of patients with advanced breast cancer. However, a considerable proportion of patients experience toxic side effects without gaining benefit. This study aimed to elicit oncologists' views of the goals of chemotherapy for patients with advanced breast cancer and to elicit which factors are important in decisions to recommend chemotherapy to such patients. 30 oncologists underwent a semi-structured interview to examine their views of 5 goals of chemotherapy and of various disease, treatment and patient-related factors that might influence decisions to offer treatment. The clinicians also made decisions regarding treatment in relation to a hypothetical patient scenario under varying clinical conditions. Relief of symptoms and improvement of activity were rated as the most valuable and achievable goals of treatment. The patient's performance status, frailty and their wishes regarding treatment were the most important patient-related factors in determining decision-making. The most important disease/treatment-related factors were pace of the disease, previous poor response to chemotherapy, co-existing symptoms and concurrent medical conditions. The hypothetical scenario revealed that co-existing medical conditions, adverse previous response, increased age and depression would decrease the likelihood of recommending chemotherapy, whereas key symptoms (e.g. breathlessness) and the patient's goals would increase the likelihood. The findings suggest that British oncologists primarily aim to improve patients' physical function, although subjective factors, such as a patient's desire for anti-cancer treatment and their future goals, also influence decisions to offer treatment. © 2001 Cancer Research Campaign http://www.bjcancer.co

Predicting men’s intentions to seek help for cancer symptoms: a comparison of the Theory of Planned Behaviour and the Health Belief Model

Objective: Targeted behavioural interventions are needed to address psychosocial factors leading to slower help-seeking for cancer symptoms among men. This study compared the variance in men’s help-seeking intentions explained by the Theory of Planned Behaviour and Health Belief Model. Method: A cross-sectional survey of 127 men was conducted, testing symptom knowledge and theory-derived constructs from the Theory of Planned Behaviour (attitudes, perceived norms, perceived behavioural control) and Health Belief Model (susceptibility, severity, benefits, barriers). The outcome variable was intention to seek help for cancer symptoms. Separate and combined hierarchical regressions tested the relative predictive power of the two models, potential overlap in variance explained, and the most salient constructs within the models. Results: Separate regressions (controlling for age and symptom knowledge) showed each model explained 10–12% variance in men’s help-seeking intentions over and above the adjusted variables. The combined regression indicated symptom knowledge, perceived benefits, and perceived behavioural control were significant predictors of men’s intentions (35% total variance explained). Conclusions: The Theory of Planned Behaviour and Health Belief Model may not be optimal models for explaining men’s help-seeking intentions for cancer symptoms, however, select constructs are important correlates. Future interventions may usefully target symptom knowledge, health beliefs, and control beliefs

Options for early breast cancer follow-up in primary and secondary care : a systematic review

Background Both incidence of breast cancer and survival have increased in recent years and there is a need to review follow up strategies. This study aims to assess the evidence for benefits of follow-up in different settings for women who have had treatment for early breast cancer. Method A systematic review to identify key criteria for follow up and then address research questions. Key criteria were: 1) Risk of second breast cancer over time - incidence compared to general population. 2) Incidence and method of detection of local recurrence and second ipsi and contra-lateral breast cancer. 3) Level 1–4 evidence of the benefits of hospital or alternative setting follow-up for survival and well-being. Data sources to identify criteria were MEDLINE, EMBASE, AMED, CINAHL, PSYCHINFO, ZETOC, Health Management Information Consortium, Science Direct. For the systematic review to address research questions searches were performed using MEDLINE (2011). Studies included were population studies using cancer registry data for incidence of new cancers, cohort studies with long term follow up for recurrence and detection of new primaries and RCTs not restricted to special populations for trials of alternative follow up and lifestyle interventions. Results Women who have had breast cancer have an increased risk of a second primary breast cancer for at least 20 years compared to the general population. Mammographically detected local recurrences or those detected by women themselves gave better survival than those detected by clinical examination. Follow up in alternative settings to the specialist clinic is acceptable to women but trials are underpowered for survival. Conclusions Long term support, surveillance mammography and fast access to medical treatment at point of need may be better than hospital based surveillance limited to five years but further large, randomised controlled trials are needed

Reduction of circulating cholesterol and apolipoprotein levels during sepsis

Sepsis with multiple organ failure is frequently associated with a substantial decrease of cholesterol levels. This decrease of cholesterol is strongly associated with mortality suggesting a direct relation between inflammatory conditions and altered cholesterol homeostasis. The host response during sepsis is mediated by cytokines and growth factors, which are capable of influencing lipid metabolism. Conversely lipoproteins are also capable of modulating cytokine production during the inflammatory response. Therefore the decrease in circulating cholesterol levels seems to play a crucial role in the pathophysiology of sepsis. In this review the interaction between cytokines and lipid metabolism and its clinical consequences will be discussed

Public awareness of cancer in Britain: a population-based survey of adults

*_Objective:_* To assess public awareness of cancer warning signs, anticipated delay, and perceived barriers to seeking medical advice in the British population. 
Methods: We carried out a population-based survey using face-to-face, computer-assisted interviews to administer the Cancer Awareness Measure (CAM), a newly-developed, validated measure of cancer awareness. The sample included 2216 adults (970 male and 1246 female) recruited as part of the Office for National Statistics Opinions Survey using stratified probability sampling.

*_Results:_* Awareness of cancer warning signs was low when open-ended (recall) questions were used and higher with closed (recognition) questions; but on either measure, awareness was lower in those who were male, younger, and from lower socioeconomic status (SES) groups or ethnic minorities. The most commonly endorsed barriers to help-seeking were difficulty making an appointment, worry about wasting the doctor’s time and worry about what would be found. Emotional barriers were more prominent in lower SES groups and practical barriers (e.g. too busy) more prominent in higher SES groups. Anticipated delay was lower in ethnic minority and lower SES groups. In multivariate analysis, higher symptom awareness was associated with lower anticipated delay, and more barriers with greater anticipated delay.

*_Conclusions:_* A combination of public education about symptoms and empowerment to seek medical advice, as well as support at primary care level, could enhance early presentation and improve cancer outcomes

QCD equation of state in a virial expansion

We describe recent three-flavor QCD lattice data for the pressure, speed of soun d and interaction measure at nonzero temperature and vanishing chemical potentia l within a virial expansion. For the deconfined phase we use a phenomenological model which includes non-pert urbative effects from dimension two gluon condensates that reproduce the free en ergy of quenched QCD very well. The hadronic phase is parameterized by a generalized resonance-gas model. Furthermore, we extend this approach to finite quark densities introducing an ex plicit $\mu$-dependence of the interaction. We calculate pressure, quark-number density, entropy and energy density and compare to results of lattice calculatio ns. We, additionally, investigate the structure of the phase diagram by calculating the isobaric and isentropic lines as well as the critical endpoint in the ($T, \mu_q$)-plane.Comment: 9 pages, 11 figures. Submitted to Phys. Rev.