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

Photometric Studies of New Southern SU UMa-type dwarf novae, FL Triangulum Australe and CTCV J0549-4921

We report time-resolved optical CCD photometry on newly discovered SU UMa-type dwarf novae, FL TrA and CTCV J0549-4921. During the 2006 August outburst, we detected superhumps with a period of 0.59897(11) days for FL TrA, clarifying the SU UMa nature of the system. On the first night of our observations on FL TrA, the object showed no superhumps. This implies that it takes a few days for full development of superhumps. The superhump period variation diagram of FL TrA was similar to that observed in some WZ Sge stars and short period SU UMa-type stars. This indicates that the system is closely related to WZ Sge stars and SU UMa stars having short orbital periods. For CTCV J0549-4921, the candidates of the mean superhump period are 0.083249(10) days and 0.084257(8) days, respectively. Due to a lack of the observations, we cannot determine the true superhump period, but the latter period is favorable. Using the ASAS-3 archive, it turned out that the system shows only four outbursts over the past 6 years. The outburst amplitude of CTCV J0549-4921 was relatively small, with about 4.5 mag. One possibility is that mass evaporation may play a role during quiescence.Comment: 7 pages, 8 figures, published for PASJ vol.6

Staff perceptions of the use of the patient dignity inventory (PDI) in a Welsh palliative care service

Background Dignity-related psychological distress can often be unidentified and untreated within palliative care services. The Patient Dignity Inventory (PDI) measures the factors associated with an individual’s sense of dignity-related psychological distress. This study aimed to obtain staff members’ perspectives on the feasibility of utilising the PDI in a palliative care service in Wales. Method Seven experienced staff members were recruited from a Welsh Cancer and Palliative Care service. A thematic analysis of data collected via semi-structured interviews revealed three key themes and nine associated subthemes. Main findings The first theme was ‘Positive Outcomes and Uses’, which included three subthemes: Supporting Staff in their Clinical Practice, Patient Empowerment and Flexibility of Use. The second theme was 'Staff Concerns' that had two subthemes: Causing Distress and Confidence in Existential Conversations. The third theme was 'Barriers and Considerations to Implementation', which included Cultural Considerations, Staff Support and Length of the Measure. Conclusions The findings suggest that the PDI could be valuable to clinical staff in supporting the identification of dignity difficulties and/or distress among patients. However, steps should be taken to address barriers to successful implementation and increased staff training on the measure

Recognition of cancer warning signs and anticipated time to help-seeking in a population sample of adults in the UK

Background: Not recognising a symptom as suspicious is a common reason given by cancer patients for delayed help-seeking; but inevitably this is retrospective. We therefore investigated associations between recognition of warning signs for breast, colorectal and lung cancer and anticipated time to help-seeking for symptoms of each cancer. Methods: Computer-assisted telephone interviews were conducted with a population-representative sample (N=6965) of UK adults age greater than or equal to50 years, using the Awareness and Beliefs about Cancer scale. Anticipated time to help-seeking for persistent cough, rectal bleeding and breast changes was categorised as >2 vs less than or equal to2 weeks. Recognition of persistent cough, unexplained bleeding and unexplained lump as cancer warning signs was assessed (yes/no). Associations between recognition and help-seeking were examined for each symptom controlling for demographics and perceived ease of health-care access. Results: For each symptom, the odds of waiting for >2 weeks were significantly increased in those who did not recognise the related warning sign: breast changes: OR=2.45, 95% CI 1.47–4.08; rectal bleeding: OR=1.77, 1.36–2.30; persistent cough: OR=1.30, 1.17–1.46, independent of demographics and health-care access. Conclusion: Recognition of warning signs was associated with anticipating faster help-seeking for potential symptoms of cancer. Strategies to improve recognition are likely to facilitate earlier diagnosis

Cancer symptom awareness and barriers to symptomatic presentation in England – Are we clear on cancer?

Background: Low cancer awareness may contribute to delayed diagnosis and poor cancer survival. We aimed to quantify socio-demographic differences in cancer symptom awareness and barriers to symptomatic presentation in the English population. Methods: Using a uniquely large data set (n=49?270), we examined the association of cancer symptom awareness and barriers to presentation with age, gender, marital status and socio-economic position (SEP), using logistic regression models to control for confounders. Results: The youngest and oldest, the single and participants with the lowest SEP recognised the fewest cancer symptoms, and reported most barriers to presentation. Recognition of nine common cancer symptoms was significantly lower, and embarrassment, fear and difficulties in arranging transport to the doctor’s surgery were significantly more common in participants living in the most deprived areas than in the most affluent areas. Women were significantly more likely than men to both recognise common cancer symptoms and to report barriers. Women were much more likely compared with men to report that fear would put them off from going to the doctor. Conclusions: Large and robust socio-demographic differences in recognition of some cancer symptoms, and perception of some barriers to presentation, highlight the need for targeted campaigns to encourage early presentation and improve cancer outcomes

Risk factors for delay in symptomatic presentation: a survey of cancer patients

Background: Delay in symptomatic presentation leading to advanced stage at diagnosis may contribute to poor cancer survival. To inform public health approaches to promoting early symptomatic presentation, we aimed to identify risk factors for delay in presentation across several cancers. Methods: We surveyed 2371 patients with 15 cancers about nature and duration of symptoms using a postal questionnaire. We calculated relative risks for delay in presentation (time from symptom onset to first presentation >3 months) by cancer, symptoms leading to diagnosis and reasons for putting off going to the doctor, controlling for age, sex and deprivation group. Results: Among 1999 cancer patients reporting symptoms, 21% delayed presentation for >3 months. Delay was associated with greater socioeconomic deprivation but not age or sex. Patients with prostate (44%) and rectal cancer (37%) were most likely to delay and patients with breast cancer least likely to delay (8%). Urinary difficulties, change of bowel habit, systemic symptoms (fatigue, weight loss and loss of appetite) and skin symptoms were all common and associated with delay. Overall, patients with bleeding symptoms were no more likely to delay presentation than patients who did not have bleeding symptoms. However, within the group of patients with bleeding symptoms, there were significant differences in risk of delay by source of bleeding: 35% of patients with rectal bleeding delayed presentation, but only 9% of patients with urinary bleeding. A lump was a common symptom but not associated with delay in presentation. Twenty-eight percent had not recognised their symptoms as serious and this was associated with a doubling in risk of delay. Embarrassment, worry about what the doctor might find, being too busy to go to the doctor and worry about wasting the doctor’s time were also strong risk factors for delay, but were much less commonly reported (<6%). Interpretation: Approaches to promote early presentation should aim to increase awareness of the significance of cancer symptoms and should be designed to work for people of the lowest socioeconomic status. In particular, awareness that rectal bleeding is a possible symptom of cancer should be raised

Interventions to Promote Cancer Awareness and Early Presentation: Systematic Review

Low cancer awareness contributes to delay in presentation for cancer symptoms and may lead to delay in cancer diagnosis. The aim of this study was to review the evidence for the effectiveness of interventions to raise cancer awareness and promote early presentation in cancer to inform policy and future research. We searched bibliographic databases and reference lists for randomised controlled trials of interventions delivered to individuals, and controlled or uncontrolled studies of interventions delivered to communities. We found some evidence that interventions delivered to individuals modestly increase cancer awareness in the short term and insufficient evidence that they promote early presentation. We found limited evidence that public education campaigns reduce stage at presentation of breast cancer, malignant melanoma and retinoblastoma

The 2006 November outburst of EG Aquarii: the SU UMa nature revealed

We report time-resolved CCD photometry of the cataclysmic variable EG Aquarii during the 2006 November outburst During the outburst, superhumps were unambiguously detected with a mean period of 0.078828(6) days, firstly classifying the object as an SU UMa-type dwarf nova. It also turned out that the outburst contained a precursor. At the end of the precursor, immature profiles of humps were observed. By a phase analysis of these humps, we interpreted the features as superhumps. This is the second example that the superhumps were shown during a precursor. Near the maximum stage of the outburst, we discovered an abrupt shift of the superhump period by ${\sim}$ 0.002 days. After the supermaximum, the superhump period decreased at the rate of $\dot{P}/P$=$-8.2{\times}10^{-5}$, which is typical for SU UMa-type dwarf novae. Although the outburst light curve was characteristic of SU UMa-type dwarf novae, long-term monitoring of the variable shows no outbursts over the past decade. We note on the basic properties of long period and inactive SU UMa-type dwarf novae.Comment: 9 pages, 7 figures, accepted for PAS

Breast cancer awareness and barriers to symptomatic presentation among women from different ethnic groups in East London

BACKGROUND: During 2001 to 2005, 1-year breast cancer survival was low in ethnically diverse East London. We hypothesised that this was due to low breast cancer awareness and barriers to symptomatic presentation, leading to late stage at diagnosis in women from ethnic minorities. We examined ethnic differences in breast cancer awareness and barriers to symptomatic presentation in East London. METHODS: We carried out a population-based survey of 1515 women aged 30+ using the Cancer Research UK Breast Cancer Awareness Measure. We analysed the data using logistic regression adjusting for age group and level of deprivation. RESULTS: South Asian and black women had lower breast cancer awareness than white women. South Asian women, but not black women, reported more emotional barriers to seeking medical help than white women. White women were more likely than non-white women to report worry about wasting the doctor's time as a barrier to symptomatic presentation. CONCLUSION: Interventions to promote early presentation of breast cancer for South Asian and black women should promote knowledge of symptoms and skills to detect changes, and tackle emotional barriers to symptomatic presentation and for white women tackle the idea that going to the doctor to discuss a breast symptom will waste the doctor's time

EndNote training for academic staff and students: the experience of the Manchester Metropolitan University Library

This article describes how the Manchester Metropolitan University Library delivers EndNote training to its academic staff and students through hands-on workshops and online tutorials. As the demand is user-led and the response extremely positive, the Library considers the provision of EndNote training as analogous to a 'Trojan horse' that allows the Library welcomed and unchallenged into the camp of the user. The Library has used the opportunity strategically and, consequently, has benefited in a number of ways, including improved communication with academic staff and increased awareness of library resources on the part of users. A short literature review is provided