Best practice in reducing the suicide risk in head and neck cancer patients: a structured review

The treatment of head and neck cancer (HNC) is often radical and the patient’s journey challenging, especially for individuals who are struggling with pre-existing mental health problems and who lack social support. Patients frequently suffer from high levels of emotional distress at some point before, during, or after treatment, and their risk of suicide is markedly elevated. This structured review aimed to identify the extent of the problem, appropriate interventions, and areas for future research. We found that the incidence of suicide among HNC patients was significantly elevated above that of the demographically matched general population. Furthermore, the risk was frequently higher in patients with HNC than in those with cancers in other sites. Despite the clear burden of suicide in patients with HNC, there is an absence of evidence on interventions used to reduce suicidal ideation and the risk of suicide. Recommendations for practice are made, drawing from the wider literature on the prevention of suicide

Improving quality of life through the routine use of the Patient Concerns Inventory for head and neck cancer patients: a cluster preference randomized controlled trial

This trial is funded by the RfPB on behalf of the NIHR (PB-PG-0215-36047).Background: The consequences of treatment for Head and Neck cancer (HNC) patients has profound detrimental impacts such as impaired QOL, emotional distress, delayed recovery and frequent use of healthcare. The aim of this trial is to determine if the routine use of the Patients Concerns Inventory (PCI) package in review clinics during the first year following treatment can improve overall quality of life, reduce the social-emotional impact of cancer and reduce levels of distress. Furthermore, we aim to describe the economic costs and benefits of using the PCI. Methods: This will be a cluster preference randomised control trial with consultants either ‘using’ or ‘not using’ the PCI package at clinic. It will involve two centres Leeds and Liverpool. 416 eligible patients from at least 10 consultant clusters are required to show a clinically meaningful difference in the primary outcome. The primary outcome is the percentage of participants with less than good overall quality of life at the final one-year clinic as measured by the University of Washington QOL questionnaire version 4 (UWQOLv4). Secondary outcomes at one-year are the mean social-emotional subscale (UWQOLv4) score, Distress Thermometer (DT) score ≥ 4, and key health economic measures (QALY-EQ-5D-5 L; CSRI). Discussion: This trial will provide knowledge on the effectiveness of a consultation intervention package based around the PCI used at routine follow-up clinics following treatment of head and neck cancer with curative intent. If this intervention is (cost) effective for patients, the next step will be to promote wider use of this approach as standard care in clinical practice. Trial registration: 32,382. Clinical Trials Identifier, NCT03086629. Protocol: Version 3.0, 1st July 2017.Publisher PDFPeer reviewe

Unidimensional scales for fears of cancer recurrence and their psychometric properties : the FCR4 and FCR7

Funding: Support was received from SUPAC (NCRI) Early Career Fund to complete this study. NCRI Supportive & Palliative Care (SuPaC) Research Collaboratives Capacity Building Grant Scheme: G Ozakinci (PI), G Humphris, M Sharpe.Background:  The assessment of fear of recurrence (FCR) is crucial for understanding an important psychological state in patients diagnosed and treated for cancer. The study aim was to determine psychometric details of a seven question self-report scale (FCR7) and a short form (FCR4) based upon items already used in various extensive measures of FCR. Methods:  Two consecutive samples of patients (breast and colorectal) were recruited from a single specialist cancer centre. The survey instrument contained the FCR7 items, Hospital Anxiety and Depression Scale (HADS), and demographic details. Clinical information was obtained from patient hospital records. Statistical analyses were performed using classical test and item response theory approaches, to demonstrate unidimensional factor structure and testing key parameters. Construct validity was inspected through nomological and theoretical prediction. Results:  Internal consistency was demonstrated by alpha coefficients (FCR4: 0.93 and FCR7: 0.92). Both scales (FCR7 & FCR4) were associated with the HADs subscales as predicted. Patients who experienced chemotherapy, minor aches/pains, thought avoidance of cancer and high cancer risk belief were more fearful. Detailed inspection of item responses profile provided some support for measurement properties of scales. Conclusion: The internal consistency, and pattern of key associations and discriminability indices provided positive psychometric evidence for these scales. The brief measures of FCR may be considered for audit, screening or routine use in clinical service and research investigations.Publisher PDFPeer reviewe

Species diversity of Trichoderma in Poland

In the present study, we reinvestigate the diversity of Trichoderma in Poland utilizing a combination of morphological and molecular/phylogenetic methods. A total of 170 isolates were collected from six different substrata at 49 sites in Poland. These were divided among 14 taxa as follows: 110 of 170 Trichoderma isolates were identified to the species level by the analysis of their ITS1, ITS2 rDNA sequences as: T. harzianum (43 isolates), T. aggressivum (35), T. citrinoviride (11), T. hamatum (9), T. virens (6), T. longibrachiatum (4), T. polysporum (1), and T. tomentosum (1); 60 isolates belonging to the Viride clade were identified based on a fragment of the translation-elongation factor 1-alpha (tef1) gene as: T. atroviride (20 isolates), T. gamsii (2), T. koningii (17), T. viridescens (13), T. viride (7), and T. koningiopsis (1). Identifications were made using the BLAST interface in TrichOKEY and TrichoBLAST (http://www.isth.info). The most diverse substrata were soil (nine species per 22 isolates) and decaying wood (nine species per 75 isolates). The most abundant species (25%) isolated from all substrata was T. harzianum

Development and testing of innovative patient resources for the management of coronary heart disease (CHD): a descriptive study

BACKGROUND: Although heart disease is a major cause of morbidity and mortality the majority of patients do not access existing rehabilitation programs and patient resources are not designed to facilitate patient choice and decision-making. The objective of this study was to develop and test a series of risk factor modules and corresponding patient information leaflets for secondary prevention of CHD. METHODS: In phase one, a series of risk factor modules and management options were developed following analysis of literature and interviews with health professionals. In phase two, module information leaflets were developed using published guidelines and interviews of people with CHD. In phase three, the leaflets were tested for quality (DISCERN), readability (Flesch) and suitability (SAM) and were compared to the existing cardiac rehabilitation (CR) information leaflet. Finally, the patients assessed the leaflets for content and relevance. RESULTS: Four key risk factors identified were cholesterol, blood pressure, smoking and physical inactivity. Choice management options were selected for each risk factor and included medical consultation, intensive health professional led program, home program and self direction. Patient information needs were then identified and leaflets were developed. DISCERN quality scores were high for cholesterol (62/80), blood pressure (59/80), smoking (62/80) and physical activity (62/80), all scoring 4/5 for overall rating. The mean Flesch readability score was 75, representing "fairly easy to read", all leaflets scored in the superior category for suitability and were reported to be easy to understand, useful and motivating by persons with CHD risk factors. The developed leaflets scored higher on each assessment than the existing CR leaflets. CONCLUSION: Using a progressive three phase approach, a series of risk factor modules and information leaflets were successfully developed and tested. The leaflets will contribute to shared-decision making and empowerment for persons with CHD

The association of cigarette smoking and anxiety, depression and fears of recurrence in patients following treatment of oral and oropharyngeal cancer

Psychological factors, including distress and fears of recurrence, may be implicated in explaining why head and neck oncology patients continue or refrain from smoking. The aim was to determine the role of psychological factors in understanding smoking behaviour in a consecutive group of cancer patients attending a Regional Maxillofacial Unit over an assessment period of 12 months. A consecutive sample (n = 87) was assessed at 3, 7, 11 and 15 months following initial treatment. Measures of psychological distress included the Worry of Cancer Scale and the Hospital Anxiety and Depression Scale. Patient self-report assessed tobacco consumption. At follow-up, 73 patients successfully completed the four timed assessments (84% response rate). Twenty patients were consistent smokers (27%), 37 (51%) abstained, 7 (10%) returned to smoking, whereas 9 (12%) ceased to smoke by the final 15-month follow-up. Between the consistent smokers and abstainers there was a significant raised level of distress in the smoking group at each assessment after the initial baseline. Fear of recurrence was weakly related to smoking behaviour. The level of cigarette consumption at baseline was a significant predictor (adjust r (2) = 0.37) of psychological distress at 15 months in committed smokers. Previous duration of tobacco consumption prior to illness predicted psychological distress in abstainers (standardized coefficient = 0.29, n = 30, P &lt; 0.036). In conclusion, past and current smoking behaviour is associated with psychological distress in patients with oral and oropharyngeal malignancy in their first 15 months of recovery following initial treatment. This behaviour successfully identified a psychologically at-risk group.</p