Conducting interviews about penile cancer: A patient-conducted-interview study

Objectives: Penile cancer is a rare but destructive condition. It has been found to be detrimental to body image, general health and sexual functioning, while increasing anxiety and social problems. The UK now manages penile cancer through specialist multi-disciplinary teams that see at least 25 new patients a year. There is a need to understand patients’ experiences so that treatment can be improved. The aim of this research is to allow patients to participate in the development of a nationwide interview study. Methods: A one-day participative workshop where a range of men diagnosed with penile cancer design and conduct audio and video interviews exploring experiences of treatment within the group. Results: Key themes included the rehabilitation of urinary functioning and strategies for coping with the physical and social impact of treatment. Conclusions: The findings emphasise the importance of day-to-day practicalities for men treated for penile cancer, which can form the basis for larger studies about how to better understand and manage their treatment

Psychology, men and cancer

A disease of the anatomical or social body, cancer raises fears about the uncontrollable division and multiplication of some abnormality that will lead ultimately to the destruction of those very conditions that make possible our lives. Cancer incidence and mortality rates are higher in men than women, raising questions about the roles for psychologists in relation to gender and cancer. Psychologists are wont to question the division of population level statistics by sex rather than other, such as behavioural, categories. Conceptual distinctions between biological sex and psychosocial gender are taught early in the psychology curriculum, but cancer of the breast questions the easy separation of the biological bod

Patients’ Experiences of penile Cancer

Penile cancer is a rare but destructive disease in Western populations. In the United Kingdom, penile cancer accounts for <1% of all new cases of cancer and <1% of deaths due to cancer every year (see Table 1). [Table 1] Surgical removal of the cancer is the primary form of treatment. This involves surgical excision of the primary tumour and of involved inguinal lymph nodes. Chemotherapy and radiotherapy are rarely helpful, with their use restricted either to adjuvant use or for palliative treatment of extensive disease. In treating the primary tumour, the standard of care is to provide a surgical cure (ie, excising the tumour and a margin of normal penile tissue) while maintaining the function of the penis. The traditional view was that at least a 2-cm margin of normal tissue should be removed, but recent publications suggest that more conservative surgery may be safe [1], and [2]. The advantage of such organ-preserving surgery is intuitively advantageous to the patient in that penile function can be better preserved, but the evidence to support this view is limited at present

Engaging men with penile cancer in qualitative research: reflections from an interview-based study.

To explore the challenges of engaging men with penile cancer in qualitative interview research

THE IMPACT OF PENILE CANCER TREATMENT ON SEXUAL RELATIONSHIPS: A QUALITATIVE ENQUIRY

Background: Penile cancer is a rare but highly treatable condition. Current guidance recommends the use of a surgical procedure to excise the primary tumour (and a margin of normal penile tissue). Whilst treatment can be effective, treatment often has a significant impact on a patient's sexual and urinary function, and physical and mental wellbeing. The objective of this study was to explore the impact of treatment for penile cancer on sexual function and relationships. Methods: Qualitative data was collected via narrative video interviews. Maximum variation sampling was used to acquire the widest possible range of experiences. All interviews were recorded using either a digital video recorder or digital audio recorder, transcribed. A method of constant comparison analysis was used to illicit themes and outliers. Results: Twenty seven men were interviewed; mean age at diagnosis = 63 (range = 41-82); Mean number of years post-surgery = 3 (range = 0-15 years) 15 men were married, a further two were in a committed relationship, the remaining 10 were single/widowed. All men had received surgical treatment ranging from circumcision to total penectomy. Just two men had attended any form of psychological therapy. The impact of treatment varied considerably. The majority of men talked about still being able to experience arousal and sexual pleasure in some way. However, for many, penetrative sex was awkward and less gratifying than before treatment. One man who had received a total penectomy was surprised to experience a form of orgasm after surgery. For a number of men, the impact of treatment on their ability to satisfy their sexual partners was a key concern. Men who were able to openly talk with their partners about sex and the impact of the treatment on sexual practice found this a great comfort. Conclusion: The significance of sex for a man can differ considerably between individuals; relationship status, age and life stage are all likely to have a bearing on the role that sex plays in a man life. A diagnosis of cancer can also affect how a man (and his partner) views sex and the level of importance which he attaches to it. For men who are sexually active prior to treatment, surgery will undoubtedly result in changes to sexual practice, however, treatment does not have to result in sexual abstinence

The self-care for people initiative: the outcome evaluation.

To determine the effects of a community-based training programme in self-care on the lay population

Self-care in primary care: findings from a longitudinal comparison study.

To examine the effects of self-care training workshops for primary healthcare workers on frequently attending patients

Clinical Perspectives on Incorporating Cardiorespiratory Fitness in Clinical Practice

Cardiorespiratory fitness (CRF) has been documented as a strong, independent predictor of non-communicable disease and mortality in both clinical and apparently healthy populations. This well-established relationship has impelled organizations, including the American Heart Association, to release scientific statements highlighting the importance of accurate quantification of CRF. Current knowledge of the relationship between CRF and mortality is predominantly based on estimated CRF obtained from varying indirect methods. Cardiopulmonary exercise testing (CPX), the gold standard method of CRF measurement, provides a more accurate and reliable quantification of CRF compared to estimated methods. This review provides support for the diagnostic and prognostic use of CRF based on the current literature and makes a case for the use of CPX when available, as well as the need for standardization of normative values defining CRF levels to increase the efficacy of the risk assessment. Further, clinical applications of CPX-derived CRF are discussed, providing clinicians with recommendations on how to use and interpret this measure in practice to guide clinical decisions and improve patient outcomes

The trypanocidal benzoxaborole AN7973 inhibits trypanosome mRNA processing

Kinetoplastid parasites—trypanosomes and leishmanias—infect millions of humans and cause economically devastating diseases of livestock, and the few existing drugs have serious deficiencies. Benzoxaborole-based compounds are very promising potential novel anti-trypanosomal therapies, with candidates already in human and animal clinical trials. We investigated the mechanism of action of several benzoxaboroles, including AN7973, an early candidate for veterinary trypanosomosis. In all kinetoplastids, transcription is polycistronic. Individual mRNA 5'-ends are created by trans splicing of a short leader sequence, with coupled polyadenylation of the preceding mRNA. Treatment of Trypanosoma brucei with AN7973 inhibited trans splicing within 1h, as judged by loss of the Y-structure splicing intermediate, reduced levels of mRNA, and accumulation of peri-nuclear granules. Methylation of the spliced leader precursor RNA was not affected, but more prolonged AN7973 treatment caused an increase in S-adenosyl methionine and methylated lysine. Together, the results indicate that mRNA processing is a primary target of AN7973. Polyadenylation is required for kinetoplastid trans splicing, and the EC50 for AN7973 in T. brucei was increased three-fold by over-expression of the T. brucei cleavage and polyadenylation factor CPSF3, identifying CPSF3 as a potential molecular target. Molecular modeling results suggested that inhibition of CPSF3 by AN7973 is feasible. Our results thus chemically validate mRNA processing as a viable drug target in trypanosomes. Several other benzoxaboroles showed metabolomic and splicing effects that were similar to those of AN7973, identifying splicing inhibition as a common mode of action and suggesting that it might be linked to subsequent changes in methylated metabolites. Granule formation, splicing inhibition and resistance after CPSF3 expression did not, however, always correlate and prolonged selection of trypanosomes in AN7973 resulted in only 1.5-fold resistance. It is therefore possible that the modes of action of oxaboroles that target trypanosome mRNA processing might extend beyond CPSF3 inhibition