Examining the psychosocial impact of human papillomavirus oropharyngeal cancer

The causal role of human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma (OSCC) has been well established. The work presented in this thesis sets out to explore the information available about HPV-OSCC and examine the psychosocial issues associated with a diagnosis of HPV-OSCC. Six studies were carried out between 2013 and 2016. Study 1 systematically reviewed the existing literature examining the psychosocial impact of HPV-OSCC in patients (n=10 studies) and current knowledge of the relationship between HPV and OSCC (n=41 studies). Study 2 was a content analysis examining the media coverage in the UK of the link between HPV and OSCC (n=112 articles). Study 3 was a qualitative study with health professionals caring for HNC patients (n=15). Study 4 was an extension of study 3, developing a survey for dissemination among health professionals working with HPV-OSCC patients (n=260). Both studies explored their experiences of and attitudes to discussing HPV with their patients, with study 4 additionally measuring knowledge of HPV-OSCC. Study 5 was a qualitative study with patients diagnosed with HPV-OSCC (n=20) and with some of these patients’ partners (n=12), examining their experiences around the diagnosis of HPV-OSCC. Study 6 involved the development of an information booklet about HPV-OSCC, based on the findings of studies 1-5. The existing literature examining the psychosocial impact of HPV-OSCC provided limited evidence about the impact of HPV in OSCC patients. Knowledge of HPV in OSCC was not well known across most populations, and the HPV-OSCC content presented in the media lacked basic facts about HPV. The increasing incidence of HPV-OSCC was a significant issue for health professionals and key messages to communicate to HPV-OSCC were found. Reactions about HPV were mixed among participants whose cancer or partners’ cancer was caused by HPV. An information booklet developed about HPV-OSCC was well received by patients and health professionals and could act as a discussion tool to provide patients with evidence-based information. De-escalation of treatment in the future may help minimise some of the negative psychosocial outcomes associated with HPV-OSCC and improve long-term functioning

Perceived life expectancy and colorectal cancer screening intentions and behaviour: A population-based UK study

The relationships between perceived life expectancy (PLE), cancer screening intentions and behaviour are not well understood, despite the importance of remaining life expectancy for the early diagnosis benefits of screening. This study investigates the relationships between PLE and each of: the intention to complete faecal occult blood test (FOBt) screening, 'ever' uptake of FOBt screening, and repeat uptake of FOBt screening for colorectal cancer. Data were from the population-representative Attitudes, Behaviour and Cancer UK Survey II (ABACUS II) in England in 2015. Eligible respondents for the present analysis were aged 60-70 years (FOBt eligible age range), who completed the survey question on perceived life expectancy (N = 824). We used logistic regression models to estimate the associations between PLE and the intention to complete screening, 'ever' uptake of screening, and repeat uptake of screening, with adjustment for age, gender, occupation-based social grade, marital status, ethnicity, and smoking status. PLE was positively associated with repeated uptake of FOBt (adjusted OR = 2.55; 95% CI: 1.04-6.30 for expecting to live to ≥90 years versus <80 years). Older adults may base decisions to continually participate in cancer screening on their expectations of remaining life expectancy. Future research should investigate the feasibility and acceptability of individualised cancer screening recommendations that take life expectancy into account

Print and online newspaper coverage of the link between HPV and oral cancer in the UK: a mixed-methods study

OBJECTIVES: The role of human papillomavirus (HPV) in some oral cancers has been reported in the news press, though little is known about the content of these articles. This study aimed to examine how frequently the link between HPV and oral cancer has been reported in the news press and to examine the content of these articles. DESIGN: UK media articles were searched for articles relating to oral cancer and HPV in the database NexisUK. Of 854 articles identified by the initial search, 112 were eligible for inclusion (2002-2014) and content analysis was used to determine the main themes discussed. RESULTS: Themes included actor Michael Douglas' claim that his throat cancer was caused by HPV, the riskiness of oral sex, health information (including HPV as a cause of oral cancer) and the need to vaccinate boys against HPV. Many articles also referred to the link between HPV and cervical cancer and the increasing incidence of HPV-related oral cancer. The largest peak in articles occurred when Michael Douglas discussed his cancer (June 2013). Facts about HPV and references to research were provided in some articles. CONCLUSIONS: The link between HPV and oral cancer and the transmission of HPV via oral sex was regularly discussed, yet coverage often lacked detailed health information. This could increase awareness of the link between oral sex and HPV risk, but may also lead to public concern about oral sex as a sexual behaviour

Human Papillomavirus and Head and Neck Cancer: Psychosocial Impact in Patients and Knowledge of the Link - A Systematic Review

Head and neck cancer (HNC) currently affects approximately 11 200 people in the UK, with an increasing proportion known to be caused by the human papillomavirus (HPV). We undertook a systematic review of studies measuring the psychosocial impact of HPV-related HNC and also studies measuring knowledge about the link between HPV and HNC among different populations. Searches were conducted on MEDLINE, Embase, PsycINFO, CINAHL Plus and Web of Science, with reference and forward citation searches also carried out on included studies. Studies were selected if they (i) were original peer-reviewed research (qualitative or quantitative), (ii) mentioned HPV and HNC, (iii) measured an aspect of the psychosocial impact of the diagnosis of HPV-related HNC as the dependent variable and/or (iv) measured knowledge of the association between HPV and HNC. In total, 51 papers met the inclusion criteria; 10 measuring psychosocial aspects and 41 measuring knowledge of the link between HPV and HNC. Quality of life in those with HPV-positive HNC was found to be higher, lower or equivalent to those with HPV-negative HNC. Longitudinal studies found quality of life in patients was at its lowest 2-3 months after diagnosis and some studies found quality of life almost returned to baseline levels after 12 months. Knowledge of the link between HPV and HNC was measured among different populations, with the lowest knowledge in the general population and highest in medical and dental professionals. Due to the limited studies carried out with patients measuring the psychosocial impact of a diagnosis of HPV-positive HNC, future work is needed with the partners of HPV-positive HNC patients and health professionals caring for these patients. The limited knowledge of the association between HPV and HNC among the general population also indicates the need for research to explore the information that these populations are receiving

Understanding middle-aged and older adults' first associations with the word 'cancer': a mixed methods study in England

OBJECTIVE: Cancer is still widely feared and often associated with death. Fatalistic beliefs adversely affect help-seeking for cancer symptoms and engagement in cancer prevention. This study aims to understand middle-aged and older adults' first association with the word 'cancer', and their relationship with sociodemographic factors, cancer fear, and cancer information avoidance. METHODS: We conducted a cross-sectional survey of 1464 community-based adults aged 50 to 70 living in England in April 2015. First associations with cancer were measured qualitatively and analysed using content analysis. We used binary logistic regression to analyse associations between the most common first association of cancer and sociodemographic characteristics, cancer fear and cancer information avoidance. RESULTS: Cancer was most commonly associated with 'death' (26%). Respondents with lower levels of education, living in the Midlands or North of England where cancer mortality is higher, or with close friends or family members with a cancer history, were more likely to associate cancer with death. Cancer fear was significantly associated with death associations, but cancer information avoidance was not. CONCLUSIONS: Despite improved cancer outcomes, middle-aged and older adults often associate cancer with death. Further efforts to decrease fatalistic associations in this age group may be needed

Psychosocial impact of human papillomavirus‐related head and neck cancer on patients and their partners: A qualitative interview study

OBJECTIVES: Increasing numbers of patients face the psychosocial challenge of a diagnosis of oropharyngeal squamous cell carcinoma (OSCC) caused by human papillomavirus (HPV). We explored the psychosocial impact of an HPV‐OSCC diagnosis for patients and their partners. METHODS: In‐depth interviews were conducted with patients (n = 20) and a subset of their partners (n = 12), identified through medical records at two UK hospitals. Interviews were recorded, transcribed verbatim and analysed using thematic Framework Analysis. RESULTS: Only 12/20 patients interviewed (and five partners) were aware of their HPV status and the main analysis focused on this sub‐sample. In discussing the cause of their cancer, patients and their partners talked about not wanting to know; whether they disclosed the cause of their cancer to others; their reactions to being diagnosed with HPV; the prognosis information they were given and the questions they had about HPV. Most concerns were cancer‐related rather than HPV‐related, but some patients (n = 3) described feelings of embarrassment and perceived stigma about HPV. CONCLUSION: Some patients and partners who are told HPV is the cause of their OSCC have questions about HPV and seek further information. Concerns and uncertainties about the sexually transmitted nature of HPV need to be addressed by health professionals

Lung cancer screening program factors that influence psychosocial outcomes: A systematic review.

OBJECTIVES: Lung cancer screening (LCS) programs are being designed and implemented globally. Early data suggests that the psychosocial impacts of LCS are influenced by program factors, but evidence synthesis is needed. This systematic review aimed to elucidate the impact of service-level factors on psychosocial outcomes to inform optimal LCS program design and future implementation. METHODS: Four databases were searched from inception to July 2023. Inclusion criteria were full-text articles published in English that reported an association between any program factors and psychosocial outcomes experienced during LCS. Study quality was appraised, and findings were synthesised narratively. RESULTS: Thirty-two articles were included; 29 studies were assessed at high or moderate risk of bias. Study designs were RCT (n = 3), pre-post (n = 6), cross-sectional (n = 12), mixed-methods (n = 1), and qualitative (n = 10) studies, and conducted primarily in the USA (n = 25). Findings suggested that targeted interventions can improve smoking-related or decisional psychosocial outcomes (e.g., smoking cessation interventions increase readiness/motivation to quit) but impacts of interventions on other psychological outcomes were varied. There was limited evidence reporting association between service delivery components and psychological outcomes, and results suggested moderation by individual aspects (e.g., expectation of results, baseline anxiety). Opportunities for discussion were key in reducing psychological harm. CONCLUSIONS: Certain program factors are reportedly associated with psychosocial impacts of LCS, but study heterogeneity and quality necessitate more real-world studies. Future work should examine (a) implementation of targeted interventions and high-value discussion during LCS, and (b) optimal methods and timing of risk and result communication, to improve psychosocial outcomes while reducing time burden for clinicians

Knowledge of human papillomavirus (HPV) testing in the USA, the UK and Australia: an international survey.

To measure knowledge and awareness of human papillomavirus (HPV) testing in the USA, the UK and Australia

Specific targeting of the GABA-A receptor α5 subtype by a selective inverse agonist restores cognitive deficits in Down syndrome mice

An imbalance between inhibitory and excitatory neurotransmission has been proposed to contribute to altered brain function in individuals with Down syndrome (DS). Gamma-aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the central nervous system and accordingly treatment with GABA-A antagonists can efficiently restore cognitive functions of Ts65Dn mice, a genetic model for DS. However, GABA-A antagonists are also convulsant which preclude their use for therapeutic intervention in DS individuals. Here, we have evaluated safer strategies to release GABAergic inhibition using a GABA-A-benzodiazepine receptor inverse agonist selective for the α5-subtype (α5IA). We demonstrate that α5IA restores learning and memory functions of Ts65Dn mice in the novel-object recognition and in the Morris water maze tasks. Furthermore, we show that following behavioural stimulation, α5IA enhances learning-evoked immediate early gene products in specific brain regions involved in cognition. Importantly, acute and chronic treatments with α5IA do not induce any convulsant or anxiogenic effects that are associated with GABA-A antagonists or non-selective inverse agonists of the GABA-A-benzodiazepine receptors. Finally, chronic treatment with α5IA did not induce histological alterations in the brain, liver and kidney of mice. Our results suggest that non-convulsant α5-selective GABA-A inverse agonists could improve learning and memory deficits in DS individuals

COVID-19 Misinformation Trends in Australia: Prospective Longitudinal National Survey.

Background: Misinformation about COVID-19 is common and has been spreading rapidly across the globe through social media platforms and other information systems. Understanding what the public knows about COVID-19 and identifying beliefs based on misinformation can help shape effective public health communications to ensure efforts to reduce viral transmission are not undermined. Objective: This study aimed to investigate the prevalence and factors associated with COVID-19 misinformation in Australia and their changes over time. Methods: This prospective, longitudinal national survey was completed by adults (18 years and above) across April (n=4362), May (n=1882), and June (n=1369) 2020. Results: Stronger agreement with misinformation was associated with younger age, male gender, lower education level, and language other than English spoken at home (P<.01 for all). After controlling for these variables, misinformation beliefs were significantly associated (P<.001) with lower levels of digital health literacy, perceived threat of COVID-19, confidence in government, and trust in scientific institutions. Analyses of specific government-identified misinformation revealed 3 clusters: prevention (associated with male gender and younger age), causation (associated with lower education level and greater social disadvantage), and cure (associated with younger age). Lower institutional trust and greater rejection of official government accounts were associated with stronger agreement with COVID-19 misinformation. Conclusions: The findings of this study highlight important gaps in communication effectiveness, which must be addressed to ensure effective COVID-19 prevention