Is cancer a good way to die? A population-based survey among middle-aged and older adults in the United Kingdom

OBJECTIVES: Despite improved outcomes, cancer remains widely feared, often because of its association with a long and protracted death as opposed to the quick death that people associate with that other common cause of adult mortality: heart disease. Former editor-in-chief of the BMJ Richard Smith's view that 'cancer is the best way to die' therefore attracted much criticism. We examined middle-aged and older adults' agreement with this view and compared their attitudes towards dying from cancer versus heart disease in terms of which was a good death. METHODS: This study was part of an online survey (February 2015) in a United Kingdom (UK) population sample of 50- to 70-year olds (n = 391), with sampling quotas for gender and education. Five characteristics of 'a good death' were selected from the end-of-life literature. Respondents were asked to rate the importance of each characteristic for their own death to ensure their relevance to a population sample and the likelihood of each for death from cancer and heart disease. We also asked whether they agreed with Smith's view. RESULTS: At least 95% of respondents considered the selected five characteristics important for their own death. Death from cancer was rated as more likely to provide control over what happens (p  0.05). Almost half (40%) agreed that cancer is 'the best way to die', with no differences by age (p = 0.40), gender (p = 0.85), or education (p = 0.27). CONCLUSION: Despite the media commotion, a surprisingly high proportion of middle-aged and older adults viewed cancer as 'the best way to die' and rated cancer death as better than heart disease. Given that one in two of us are likely to be diagnosed with cancer, conversations about a good death from cancer may in a small way mitigate fear of cancer. Future research could explore variations by type of cancer or heart disease and by previous experience of these illnesses in others

Emotional responses to the experience of cancer 'alarm' symptoms

To qualitatively explore associations between emotional responses to experience of cancer 'alarm' symptoms and help-seeking in a community sample of adults

Melanocortins and Neuropathic Pain

Neuropathic pain (pain initiated by a lesion or dysfunction of the nervous system) is characterised by symptoms such as allodynia (pain due to a stimulus that does not normally provoke pain) and hyperalgesia (an increased response to a stimulus that is normally painful). It constitutes a major clinical problem, since in many cases treatment is unsatisfactory. The main focus of this thesis is the role of the melanocortin system in neuropathic pain and its possible contribution to the treatment of this syndrome. The melanocortins comprise a group of peptides derived from the precursor molecule POMC (e.g. alpha-MSH and ACTH), and synthetically derived analogues. Melanocortins are known to antagonize opioid effects, such as analgesia and tolerance, and to have direct effects on nociception. So far, 5 melanocortin receptor (MC-R) subtypes are identified. The MC4-R subtype is the only one present in the spinal cord, located in nociception-associated areas (laminae II and X), which prompted us to investigate its role in neuropathic pain. Therefore we used the rat chronic constriction injury (CCI) model for neuropathic pain. By using a radioactively labelled alpha-MSH analogue, 125I-NDP-MSH, we demonstrated an increased binding in the outer layer of the dorsal horn, suggesting an upregulation of spinal MC4R in neuropathic pain. Both acute and chronic intrathecal administration of MC-R agonists to CCI rats increased cold allodynia (as measured by withdrawal latency to immersion in 4.5oC water bath) and mechanical allodynia (as measured by withdrawal threshold to von Frey filaments). Conversely, the MC4R antagonist SHU9119 decreased symptoms, suggesting that blockade of the spinal MC4R alleviates neuropathic pain. In the dorsal horn the MC-R agonist alpha-MSH as well as the endogenous opioid agonist beta-endorphin, both derived from POMC, are present. Also the mu- and delta-opioid receptors (for which beta-endorphin displays high affinity) are located in the same area, suggesting the presence of both a functional melanocortin and opioid system in the dorsal horn. We hypothesize that the anti-allodynic effects of SHU9119 are caused by blockade of a tonic influence of alpha-MSH on nociception, through the MC4R. This could reveal tonic anti-nociceptive effects of beta-endorphin (through the opioid receptors), coreleased with alpha-MSH. By administering naloxone (which increased pain symptoms) we furhter supported this hypothesis. In addition we investigated a possible interaction of the spinal melanocortin and opioid systems, and tested whether opioid effectiveness could be increased through modulation of the spinal melanocortin system activity. A low dose of naloxone (which by itself had no effect on nociception) was able to block the anti-allodynic effect of SHU9119, confirming an interaction between the two systems. Combined treatment with SHU9119 and morphine resulted in additive anti-allodynic effects. Based upon these results we suggest that MC4R antagonists, possibly combined with opioids, might contribute to the treatment of human neuropathic pain. In addition to the investigation of the role of the melanocortins in neuropathic pain a novel animal model for neuropathic pain (the sciatic nerve crush) and an alternative method for quantifying mechanical allodynia (the "CatWalk") are also described in this thesis

Self-Reported And Objectively Recorded Colorectal Cancer Screening Participation In England

Objective To compare self-reported with objectively recorded participation in Faecal Occult Blood testing (FOBt) colorectal cancer (CRC) screening in a national programme. Methods Survey respondents living in England who were eligible for screening were asked in face-to-face interviews if they had ever been invited to do a CRC screening test, how many times they had been invited, and how many times they had participated. National Health Service (NHS) Bowel Cancer Screening Programme (BCSP) records were consulted for respondents who had consented to a record check. The outcome measures were ‘ever uptake’ (responded to ≥1 invitation), ‘repeat uptake’ (responded to ≥2 invitations), and ‘consistent uptake’ (responded to all invitations). Results In the verified group, self-reported ever uptake was highly consistent with recorded ever uptake (87.0% vs. 87.8%). Among those who indicated that they had been invited more than once, self-reported repeat uptake was 89.8% compared with 84.8% recorded repeat uptake. Among those with more than one recorded invitation, self-reported repeat uptake was 72.7% compared with 77.2% recorded repeat uptake, and self-reported consistent uptake was 81.6% compared with 65.6% recorded consistent uptake. Conclusion Our results suggest that people can accurately report whether they have ever taken part in CRC screening. The vast majority of those whose records were verified could also accurately report whether they had taken part in screening at least twice. They were somewhat less accurate in reporting whether they had responded to all screening invitations

An n-of-one RCT for intravenous immunoglobulin G for inflammation in hereditary neuropathy with liability to pressure palsy (HNPP).

Paroxysmal Cerebral Disorder