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Prostate cancer ( PCa) can negatively impact on men's sexual, urinary and emotional functioning, affecting quality of life. Most men with PCa are older (≥65 years), married and heterosexual and little is known about the impact on men who are younger, unpartnered or gay. We aimed to synthesise existing qualitative research on these three groups of men. A systematic metasynthesis was undertaken that included data on the unique impacts of PCa on younger (<65 years) ( n = 7 papers), unpartnered ( n = 17 papers) or gay or bisexual men ( n = 11 papers) using a modified meta-ethnographic approach. The three overarching constructs illustrated the magnified disruption to men's biographies, that included: marginalisation, isolation and stigma-relating to men's sense of being 'out of sync'; the burden of emotional and embodied vulnerabilities and the assault on identity-illustrating the multiple threats to men's work, sexual and social identities; shifting into different communities of practice-such as the shift from being part of a sexually active community to celibacy. These findings suggest that PCa can have a particular impact on the quality of life of younger, unpartnered and gay men. This has implications for the provision of tailored support and information to these potentially marginalised groups. [ABSTRACT FROM AUTHOR]

Objective. To characterise cancer diagnosis in Scottish primary care in 2018/19 and draw comparisons with diagnostic activity in 2014. Methods. A national audit of cancer diagnosis undertaken in Scottish general practices. Participating GPs collected diagnostic pathway data on patients diagnosed with cancer in 2018/19 from medical records. These data were supplemented by linkage to the Scottish Cancer Registry and previous audit data from 2014. Analyses explored and compared patient demographics, presentation, diagnostic routes, and intervals. Results. Seventy-three practices submitted data on 2,014 cases in 2014 and 90 practices submitted data on 2,318 cases in 2018/2019. Individual demographics and types of cancer were similar. There was a higher proportion of USC (urgent suspected cancer) referrals in 2019 than 2014 (42.9% vs 38.1%, p = 0.008) but a similar proportion of emergency presentations (19.2% vs 20.4%). Primary care (median 4 (IQR 0–22) vs 5 (0–23)) and diagnostic intervals (27 (10–59) vs 30 (13–68)) were similar in both periods. Significantly fewer (24.5% vs 28.3, p = 0.015) had a diagnostic interval >60 days in 2019 than 2014. Harder to diagnose cancers were more likely to present as emergencies and be subject to prolonged delays in both cohorts. Conclusions. The 2014 and 2018/19 cohorts were broadly similar. There is limited evidence that USC use had increased between 2014 and 2018/19. Harder to diagnose cancers are still most likely to present as emergencies and be subject to delays. Overall, it seems there were small improvements in cancer diagnosis prepandemic and a further audit could examine evidence for a postpandemic recovery. [ABSTRACT FROM AUTHOR]

We conducted in-depth interviews with 20 women living with breast cancer and invited them to take part in a drawing method. In this paper, we discuss the lived experiences and meaning-making of breast cancer among women in southern Thailand. Our data revealed that the diagnosis of breast cancer generated numerous emotional responses. However, after the initial shock, most women started to accept their reality. The acceptance of their breast cancer played an essential role in the meaning-making discourse because it assisted the women to be able to sustain the equilibrium of their emotional well-being. Meaning-making and the Buddhist belief about bad karma was a prominent theme. The belief that adversities in life were the result of bad deeds that one had committed to others in the past not only helped the women to accept their fate but also to deal with their life situations better. Our findings suggest that these women act in their own agencies to counteract any negativity they might encounter from their breast cancer trajectory. It provides a theoretical understanding about the ways Thai women deal with their breast cancer which can be adopted as a means to provide culturally sensitive care for women with breast cancer in Thailand and elsewhere. [ABSTRACT FROM AUTHOR]

Background. Adherence to complete decongestion therapy (CDT) is of utmost importance for patients with breast cancer-related lymphedema (BCRL). However, past studies have demonstrated that adherence to CDT in BCRL patients is less than satisfactory. Our study aimed to describe the level of adherence to CDT among BCRL patients and utilize the Health Belief Model to analyse the key factors that influence adherence. Methods. We employed a convenient sampling method to select 158 patients with BCRL who were in the maintenance stage of CDT in a grade A tertiary tumour hospital in Guangzhou. A questionnaire survey was used to investigate patients' adherence to CDT, as well as their sociodemographic characteristics, medical history characteristics, disease knowledge, and health beliefs. Results. The CDT adherence score of BCRL patients was 96.46 ± 18.46 points, with an average score of 2.61 ± 0.50 points per item. The adherence rate was 65.18 ± 12.47%, indicating a moderate level of adherence. Factors that significantly influenced CDT adherence in BCRL patients included age under 45 years, having 0 or 1 child, experiencing 9 lymphedema symptoms, and having low levels of disease knowledge and health beliefs (p < 0.05). Conclusions. The level of adherence to CDT in BCRL patients is moderate and requires improvement. To enhance adherence to CDT, medical professionals should focus on patients who are younger, have fewer children, exhibit fewer symptoms of lymphedema, possess limited disease knowledge, and have weak health beliefs. [ABSTRACT FROM AUTHOR]

Objective. To investigate age differences in treatment and survival from acute lymphoblastic (ALL) and acute myeloid leukemia (AML). Methods. 1053 ALL/566 AML patients diagnosed in 2003–2015 on the New South Wales Cancer Registry were included. Treatment within 12 months from diagnosis was assessed using linked registry, hospital, and health-insurance data. Differences by age at diagnosis in treatment and survival were investigated using socio-demographically adjusted regression analyses, with adolescents and young adults (AYA, 15–24 years) as the reference category. Results. Children were less likely than AYA to start ALL treatment >3 days from diagnosis (adjusted odds ratio (aOR 0.39, 95% CI 0.27–0.57)) and to have multiple treatment types (aOR 0.22, 95% CI 0.14–0.34). For AML, aOR of treatment start >3 days was 0.16 (95% CI 0.09–0.29) for children compared with AYA, with no age differences in treatment types. Five-year disease-specific survival for ALL was 84%. Children were less likely than AYA to die from ALL (adjusted subhazard ratio (aSHR 0.32, 95% CI 0.22–0.50)). For AML, the corresponding survival was 73% without an age difference. Children having multiple treatment types for ALL had an increased risk of mortality at aSHR 2.67 (95% CI 1.53–4.67), but not adults at 1.26 (95% CI 0.67–2.47) (interaction p = 0.017). Time from diagnosis to initial treatment start and initial treatment type were not associated with mortality outcomes after adjusting for socio-demographic variables. Conclusion. Children with ALL had better survival. ALL Mortality were negatively associated with multiple treatment types. [ABSTRACT FROM AUTHOR]

Objective: The EORTC QOL Group has recently completed the cross‐cultural development and validation of a standalone measure of spiritual well‐being (SWB) for cancer patients receiving palliative care: the EORTC QLQ‐SWB32. The measure includes four scales: Relationships with Others, Relationship with Self, Relationship with Someone or Something Greater, and Existential, plus a Global‐SWB item. This paper reports on further research investigating relationships between sex, age and SWB for patients receiving palliative care for cancer—adjusting for other socio‐demographic, clinical and function variables, including WHO performance status and EORTC QLQ‐C15‐PAL emotional and physical function scores. Methods: Cross‐sectional data from the validation study were used, and chi‐square, independent t tests, Mann–Whitney U tests and multiple regression analyses applied. Results: The study included 451 participants with advanced and incurable cancer, from 14 countries. Adjusted analyses found better scores for female participants than males on three of the four EORTC QLQ‐SWB32 subscales; Relationship with others, Relationship with Someone or Something Greater and Existential plus Global‐SWB. Older age was positively associated with better Relationship with Self. Conclusion: The findings from our participants suggest that it might be beneficial if healthcare providers seeking to address patients' spiritual needs pay particular attention to male patients, younger patients and those with poor emotional functioning. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate changes in health‐related quality of life (HR‐QoL) 1 year after surgical treatment in patients with primary resectable colon cancer and to assess whether changes at group level differ from changes at individual level. In addition, we assess which characteristics are associated with a decline of HR‐QoL. Methods: Patients with primary resectable colon cancer who received surgical treatment and adjuvant chemotherapy if indicated were selected from the Prospective Dutch ColoRectal Cancer cohort (PLCRC). HR‐QoL was assessed using EORTC‐QLQ‐C30 questionnaire before surgery and 12 months post‐surgery. Outcomes were assessed at group and individual levels. Logistic regression analysis was conducted to assess which socio‐demographic and clinical characteristics were associated with a clinically relevant decline of HR‐QoL at 12 months. Results: Of all 324 patients, the baseline level of HR‐QoL summary score was relatively high with a mean of 88.1 (SD 11.4). On group level, the change of HR‐QoL at 12 months varied between −2% for cognitive functioning and +9% for emotional functioning. On individual level, 15% of all patients experienced a clinically relevant decline in HR‐QoL summary score at 12 months. Older age, comorbidity burden or the reception of adjuvant chemotherapy was independently associated with a decline of HR‐QoL in one of the functional subscales of EORTC‐QLQ‐C30 at 12 months. Conclusion: Only trivial changes of HR‐QoL were observed after colon cancer treatment on group level, whereas on individual level, at least 1 out of 10 patients experienced a decline of HR‐QoL 12 months post‐surgery. It is important to consider individual differences while making a treatment decision. [ABSTRACT FROM AUTHOR]

Objective: This prospective study aimed to evaluate the performance of the 'Surprise Question' (SQ) 'Would I be surprised if this patient died in the next 12 months?' in predicting survival of 12, 6, 3 and 1 month(s), respectively, in hospitalised patients with cancer. Methods: In three hospitals, physicians were asked to answer SQs for 12/6/3/1 month(s) for inpatients with cancer. Sensitivity, specificity, positive and negative predictive values were calculated. Results: A total of 783 patients were included, of whom 51% died in the 12‐month period after inclusion. Sensitivity of the SQ predicting death within 12 months was 0.79, specificity was 0.66, the positive predictive value was 0.71 and the negative predictive value was 0.75. When the SQ concerned a shorter survival period, sensitivities and positive predictive values decreased, whereas specificities and negative predictive values increased. In multivariable logistic regression analysis, the SQ was significantly associated with mortality (OR 3.93, 95% CI 2.70–5.71, p < 0.01). Conclusions: The 12‐month SQ predicts death in patients with cancer admitted to the hospital reasonably well. Shortening the timeframe decreases sensitivities and increases specificities. The four surprise questions may help to identify patients for whom palliative care is indicated. [ABSTRACT FROM AUTHOR]

Background: Survivors of haematological malignancies endure long‐term effects of both treatment and disease. This paper examines factors that influence their quality of life through reporting on the results of a survey. Methods: Survey using previously validated quality of life questionnaires for use in cancer management. Participants were adults aged 18 and over who had completed treatment for a haematological malignancy and were between 1 and 5 years post‐treatment. Findings: A total of 131 participants, median age of 66, completed questionnaires (66% response rate). Significant associations were found between age, global quality of life, physical and role functioning. Men reported better physical functioning and lower symptom scores than women. Employed participants reported better quality of life. Increasing age was associated with lowest quality of life. Best role functioning was also noted in participants who lived beyond 2.5 years following treatment completion. The survey suggested a gender difference with men reporting better physical functioning, fewer symptoms of pain and less loss of sleep compared with women. Conclusion: This study contributes to the underdeveloped area of care for and research into adult haematological cancer survivors. Knowledge and understanding of the factors that affect the quality of life of such adults may provide an insight into implementation measures. [ABSTRACT FROM AUTHOR]

Cancer survivors may experience unmet needs beyond the end of their treatment. This paper aimed to explore the prevalence and most frequently found unmet needs and to identify factors associated with higher levels of total unmet needs and with each domain separately. Five databases were searched using the keywords neoplasms, survivors, needs assessment, health services' needs and demands. The results were presented based on the strength of the evidence (strong, moderate and weak association) and the categorisation of the pooled prevalence of at least one unmet need (high, moderate, low). Twenty‐six studies were included in the review. A higher prevalence of at least one reported unmet need was observed in survivors with less time since treatment and in women with breast cancer. The most frequently reported unmet needs were fear of cancer recurrence and requesting up to date information. Strong evidence was found for an association between a higher number of unmet needs and younger age, higher anxiety and poorer quality of life. Future studies on unmet needs should report how unmet needs are associated with each domain separately. This might solve the inconclusive evidence found for the stage of the disease at diagnosis and depression. [ABSTRACT FROM AUTHOR]

Objective: To determine the factors associated with the degree of distress experienced by patients with cancer before disclosing their cancer diagnosis to a friend and their perceptions of social support upon disclosure. Methods: Adult patients with cancer participated in a cross‐sectional Internet‐based survey on their behaviour when disclosing their diagnosis to a selected friend, degree of distress before this disclosure and perceived social support upon disclosure. Results: Of 473 eligible respondents, around half were middle‐aged (40–59 years) and around half were men. Having a younger age (20–39 years), being a woman and delaying disclosure were factors associated with greater pre‐disclosure distress. Most participants perceived receiving emotional support upon disclosure. Telling a close friend or a female friend and early disclosure timing were associated with perceived social support, although this varied by social support type. Conclusion: Younger patients and women may need more support in deciding to disclose their cancer diagnosis to friends. Selection of to whom to disclose this information and disclosure timing should be considered to achieve more desirable outcomes. In addition to selective disclosure—including planning and scheduling—communication skills may be required for effectively disclosing a cancer diagnosis and achieving favourable results following this disclosure. [ABSTRACT FROM AUTHOR]

Objective: Determine if cancer survivors have lower participation in paid work, more limitations in daily activities or more limitations in leisure compared with those without cancer, stratified by age (working age ≤65 years; retirement age >65 years). Secondary objectives are identifying sociodemographic or clinical factors associated with work, daily activities or leisure and analysis of the relationship between work, daily activities and leisure. Methods: Secondary analyses, using logistic regression, were performed on three cohorts (lymphoma, prostate and thyroid cancer) from the Dutch Patient Reported Outcomes Following Initial treatment and Long‐term Evaluation of Survivorship (PROFILES) registry and a nationally representative non‐cancer sample. Results: Working‐age cancer survivors (n = 926) were significantly (p < 0.001) less likely to participate in paid work and more likely to report limitations in daily activities and leisure compared to the non‐cancer cohort (n = 1279). Among retirement aged cancer survivors (n = 1046), paid work was significantly more likely (p < 0.001), as were limitations in leisure (p < 0.05), compared with the non‐cancer controls (n = 334). Conclusions: Cancer impacts daily activities and leisure, as well as paid work. These roles are important for cancer survivors' quality of life, suggesting support to return to these activities may be an important component of survivorship care. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses topics within the issue including a descriptive study of palliative care patients in Western Australia, a role of geriatric assessment in cancer patients and a descriptive study of women living with breast cancer in Thailand.

Objective: Patients with rare cancers may experience different unmet needs than those with common cancer. The objective of this systematic review was to (1) investigate unmet supportive care needs of rare cancer patients throughout the disease trajectory and (2) identify predictive factors for these unmet needs. Methods: PubMed, PsycINFO and CINAHL were searched for publications (January 2011 to March 2021) focusing on unmet needs of patients with rare cancer. Two reviewers independently selected studies, extracted data and performed quality assessment. Findings were synthesised. Results: The search yielded 4,598 articles, of which 59 articles met eligibility criteria and 57 were of medium or high quality. Rare cancer patients most frequently reported unmet needs in the healthcare system and information domain (up to 95%), followed by the psychological domain (up to 93%) and the physical and daily living domain (up to 80%). Unmet needs were mainly reported in the posttreatment phase. The most frequently identified predictors were higher anxiety, younger age and higher neuroticism. Conclusion: Patients with rare cancer have unmet needs throughout their disease trajectory. Supportive care needs of rare cancer patients should be addressed individually, depending on the rare cancer subdomain and phase of disease and from diagnosis onwards. [ABSTRACT FROM AUTHOR]

Objective: We investigated treatment and survival by clinical and sociodemographic characteristics for service evaluation using linked data. Method: Data on invasive female breast cancers (n = 13,494) from the South Australian Cancer Registry (2000–2014 diagnoses) were linked to hospital inpatient, radiotherapy and universal health insurance data. Treatments ≤12 months from diagnosis and survival were analysed, using adjusted odds ratios (aORs) from logistic regression, and adjusted sub‐hazard ratios (aSHRs) from competing risk regression. Results and conclusion: Five‐year disease‐specific survival increased to 91% for 2010–2014. Most women had breast surgery (90%), systemic therapy (72%) and radiotherapy (60%). Less treatment applied for ages 80+ vs <50 years (aOR 0.10, 95% CI 0.05–0.20) and TNM stage IV vs stage I (aOR 0.13, 95% CI 0.08–0.22). Surgical treatment increased during the study period and strongly predicted higher survival. Compared with no surgery, aSHRs were 0.31 (95% CI 0.26–0.36) for women having breast‐conserving surgery, 0.49 (95% CI 0.41–0.57) for mastectomy and 0.42 (95% CI 0.33–0.52) when both surgery types were received. Patients aged 80+ years had lower survival and less treatment. More trial evidence is needed to optimise trade‐offs between benefits and harms in these older women. Survival differences were not found by residential remoteness and were marginal by socioeconomic status. [ABSTRACT FROM AUTHOR]

Introduction: Mastectomy patients' satisfaction with reconstructive options has not been examined. Methods: A national study measured 18‐month satisfaction with reconstructive options and collected case‐mix and reconstructive offer and uptake data on breast cancer patients having mastectomy with or without immediate reconstruction (IR) in England between January 2008 and March 2009. Multivariable logistic regression examined the relationship between satisfaction, age, IR offer and uptake, and clinical suitability. Results: Of 4796 patients, 1889 were not offered IR, 1489 declined an offer and 1418 underwent it. Women not offered IR were more likely older, obese or smokers and had higher ASA grades, ECOG scores, tumour burdens and adjuvant chemotherapy and radiotherapy likelihoods (9% of lowest suitability group offered IR; 81% in highest suitability group). 83.7% were satisfied with their reconstructive options, varying significantly by IR offer and uptake (76.1% for those not offered IR; 85.8% for those who declined IR; 91.7% following IR). Older women and women deemed more suitable for IR were more often satisfied (p‐values <0.001). Conclusions: Satisfaction varied by offer and uptake status, age and suitability score. Clinicians should target equity for women deemed unsuitable by exploring their needs and desired outcomes, standardising operative fitness assessments and utilising shared decision‐making aids. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship between dysphagia and sarcopenia in patients with head and neck cancer (HNC). Methods: A cross‐sectional, prospective study, sample by convenience, including men with HNC during their initial oncologic evaluation. Patients answered questionnaires (demographic data, lifestyle habits, disease characteristics and the Short International Physical Activity Questionnaire). Swallowing capacity, bioelectrical impedance (BIA), handgrip strength (HGS) and physical performance test (Timed Up and Go test) were evaluated. Sarcopenia was diagnosed following the European Working Group on Sarcopenia and Foundation for the National Institute of Health criterion. Results: 71 men, elderly (66.9 ± 6.25 years) and adults (53.17 ± 3.66 years), were divided into the dysphagic group (DG, 44) and the non‐dysphagic group (NDG, 27). The DG presented lower body mass index (BMI), lower skeletal muscle mass and a higher number of sarcopenic individuals than the NDG (p < 0.05). The degree of dysphagia was associated with weight loss (p = 0.006) but not with sarcopenia (p = 0.084) in the DG. The multivariate analysis showed that age, percentage of weight loss and BMI interfered with pre‐sarcopenia, and only age influenced sarcopenia (p < 0.005). Conclusion: Patients with dysphagia had a high prevalence of sarcopenia in the pre‐treatment phase, related to age. [ABSTRACT FROM AUTHOR]

Emergency department visits and hospitalisations (ED+H) during systemic therapy are undesirable for both patients and the health system. We undertook a systematic literature review and meta‐analysis to evaluate the frequency of unplanned all‐cause and treatment‐related ED+H among adults receiving adjuvant or palliative‐intent systemic therapy for all cancers. Randomised controlled trials (RCT) and observational studies (OS) reporting ED+H were identified from Medline and EMBASE from inception to June 2016. Quality was assessed using modified STROBE, CONSORT or PRISMA guidelines, depending on study type. A total of 112 OS (308,662 patients) and 26 RCTs (16,081 patients) met inclusion criteria. Most articles focused on palliative treatment (59%) delivered as first‐line, in breast, lung and colorectal cancers. Only 20 articles reported ED frequency. Treatment‐related and all‐cause hospitalisations were more common in routine practice than in RCTs (29% vs. 16% and 42% vs. 28% respectively); frequency varied by treatment intent and tumour site. Methodological issues were common, particularly poor definition of the at‐risk period. Hospitalisations are common, especially in unselected populations, but few articles report this and do so poorly. Routine, standardised reporting of ED+H during chemotherapy should be included in RCT reports and evaluated in routine care following adoption of new treatments. [ABSTRACT FROM AUTHOR]

Information and support needs increase emotional distress and can impede cancer survivors’ adjustment. To investigate the information and support needs of Dutch cancer survivors, the Cancer Survivors’ Unmet Needs measure (CaSUN) was translated into Dutch and applied in two Dutch studies with cancer survivors (N = 255; N = 467). The CaSUN‐NL entailed the original five CaSUN scales, extended with respectively a returning to work and lifestyle scale. This study aimed to determine the psychometric properties of the CaSUN‐NL. To assess validity, a maximum likelihood factor analysis was employed. Construct validity was analysed using Pearson's and Spearman's correlation coefficients. To assess reliability, test–retest (Kappa coefficient) and internal consistency (Cronbach's alpha) values were determined. Factor analysis revealed the original five factors. Test–retest reliability was low (r ≤ .15, 93% retest response). Internal consistency values were high (Cronbach's alpha = 0.92–0.94), except for lifestyle. Significant correlations were found between total number of unmet needs with anxiety (r = .55), depression (r = .49), negative adjustment (r = .50), quality of life (r = −.52) and age (r = −.24). The CaSUN‐NL is valid and reliable to investigate the unmet information and support needs of Dutch cancer survivors. [ABSTRACT FROM AUTHOR]

We explored the relationship between unmet care needs, health status, health utility and costs in people treated for melanoma via a cross‐sectional follow‐up survey (N = 455) 3 months to 5 years after complete resection of stage I–III cutaneous malignant melanoma. 51% (n = 232) had unmet care needs. This group had higher mean resource use, estimated conservatively (£28 vs. £10 per person) and worse overall health. Mean health‐related utility index (AQoL6D) was 0.763 (95% CI 0.74; 0.79) in those with self‐reported unmet need vs. 0.903 (0.89; 0.92) in those with no unmet need. Melanoma survivors with unmet need had worse outcomes in terms of anxiety (HADS 6.86 vs. 4.29), depression (HADS 4.29 vs. 2.01), overall quality of life (QoL: FACT‐M 84.2 vs. 96.5). Higher resource use was associated with younger age (rs = −.29, p < .001), older school‐leaving age (rs = .21, p < .001), reduced health utility (rs = −.14, p = .005), higher anxiety (rs = .22, p < .001), higher depression (rs = .16, p = .001) and lower QoL (overall rs = −.24, p < .001; melanoma QoL rs = −.20, p < .001; surgery QoL rs = −.19, p < .001). Lower health outcomes indicate increased service use, suggesting that interventions to address unmet need and improve health outcomes may reduce health costs. Integrated clinical and economic evaluations of interventions that target unmet need in melanoma survivors are required. [ABSTRACT FROM AUTHOR]

We investigated the impact of demographic and disease related factors on non‐participation and dropout in a cluster‐randomised behavioural trial in cancer patients with measurements taken between hospitalisation and 6 months thereafter. The percentages of non‐participation and dropout were documented at each time point. Factors considered to be potentially related with non‐participation and dropout were as follows: age, sex, marital status, education, income, employment status, tumour site and stage of disease. Of 1,338 eligible patients, 24% declined participation at baseline. Non‐participation was higher in older patients (Odds Ratio [OR] 2.1, CI: 0.6–0.9) and those with advanced disease (OR 2.0, CI: 0.1–1.3). Dropout by 6 months was 25%. Dropout was more frequent with increased age (OR 2.8, CI: 0.8–1.2), advanced disease (OR 3.0, CI: 1.0–1.2), being married (OR 2.4, CI 0.7–1.1) and less frequent with university education (OR 0.4, CI −1.3 to −0.8) and middle income (OR 0.4, CI −0.9 to −0.7). When planning clinical trials, it is important to be aware of patient groups at high risk of non‐participation or dropout, for example older patients or those with advanced disease. Trial designs should consider their special needs to increase their rate of participation. [ABSTRACT FROM AUTHOR]

Genitourinary cancers are significant causes of morbidity and mortality around the world. The present review summarises the current literature on suicide and its risk factors among patients with genitourinary cancers. The review was based on relevant articles published in MEDLINE, ProQuest, Psyc INFO, Science Direct and Scopus databases. Patients with prostate cancer represented the most important risk group for suicide, among patients with urogenital cancers. Other risk factors are male gender, older age, white race, advanced disease, living alone and co-existing psychological comorbidities. Findings from the review call for a greater caregiver awareness on psychosocial morbidity and suicidality among genitourinary cancer patients pre- and post-treatment and their early identification, adoption of risk-reduction strategies and prompt referral for expert mental health care. [ABSTRACT FROM AUTHOR]

This systematic review examines variations in outcomes along the breast cancer continuum for Australian women by Indigenous status. Multiple databases were systematically searched for peer-reviewed articles published from 1 January 1990 to 1 March 2015 focussing on adult female breast cancer patients in Australia and assessing survival, patient and tumour characteristics, diagnosis and treatment by Indigenous status. Sixteen quantitative studies were included with 12 rated high, 3 moderate and 1 as low quality. No eligible studies on referral, treatment choices, completion or follow-up were retrieved. Indigenous women had poorer survival most likely reflecting geographical isolation, advanced disease, patterns of care, comorbidities and disadvantage. They were also more likely to be diagnosed when younger, have advanced disease or comorbidities, reside in disadvantaged or remote areas, and less likely to undergo mammographic screening or surgery. Despite wide heterogeneity across studies, an overall pattern of poorer survival for Indigenous women and variations along the breast cancer continuum of care was evident. The predominance of state-specific studies and small numbers of included Indigenous women made forming a national perspective difficult. The review highlighted the need to improve Indigenous identification in cancer registries and administrative databases and identified key gaps notably the lack of qualitative studies in current literature. [ABSTRACT FROM AUTHOR]

Health providers may not be aware of their patients' needs or preferences, and patients reluctant to raise their concerns. Consequently, the first step in ensuring quality of care is to ask the patient about the care that they would like. A cross-sectional sample of 244 medical oncology outpatients were surveyed about provider-asking behaviours across six dimensions of patient-centred care defined by the Institute of Medicine. Specifically, were patients asked by clinic staff at the treatment centre about their physical and emotional symptoms, information needs to enable decision-making, preferences for involvement in decision-making, involvement of family and friends, and appointment scheduling. Patients were significantly (Cochran's χ2 (9) = 122.541, P < 0.001) less likely to be asked about emotional symptoms (35% infrequently asked), preferences for the involvement of family and friends (25% infrequently asked), and preferences for involvement in medical decision-making (23% infrequently asked). Only a minority of patients were infrequently asked about their treatment-related information needs (8%), physical symptoms (13% pain, 14% fatigue) and preferences for appointment scheduling (13%). Younger age, not Australian born and greater educational qualifications were associated with being infrequently asked. Improvements to care delivery can be made if clinic staff were to more regularly elicit patient's emotional symptoms, and their preferences for the involvement of family/friends and participation in medical decision-making. [ABSTRACT FROM AUTHOR]

This study examines the prevalence of suspected cervical cancer (established through the use of visual inspection with Lugol's Iodine - VILI) among outpatients attending Surat Municipal Institute of Medical Education & Research Hospital, India. A cross-sectional study was conducted on 356 patients; 178 with an established sexually transmitted disease ( STD) and 178 patients without. Patients with positive results were investigated with cervical biopsy; out of 356 patients, 21.91% patients with STD and 12.35% patients without STD tested positive for VILI respectively ( p = .017). The factors found to be significantly associated with a positive VILI test were STD, marital status, oral contraceptive pill use, a complaint of PV bleeding, white discharge on speculum examination ( PS) and cervical erosion on PS. On applying multiple logistic regression, STD, age of patient in years, parity, OC pill use, a complaint of PV bleeding and cervical erosion on PS were found to be significant predictors of VILI positivity among the patients. STD patients are 2.5 times more likely to test positive for VILI than patients without STD. In Indian populations comparable to ours, opportunistic screening should be considered in gynaecology outpatient clinics for women presenting with complaints related to STDs. [ABSTRACT FROM AUTHOR]

Triple-negative breast cancer ( TNBC) has attracted more attention both clinically and experimentally because of its high-risk biological characteristics and lacking of effective treatment method. The tumour characteristics, patterns of recurrence and metastasis, therapy methods and prognosis in younger TNBC patients have been widely formulated, but the relevant data of the elderly people are lacking. We conducted this retrospective study to compare and analyse the above-related characteristics between the younger and elderly patients with TNBC to estimate the relevance for the elderly TNBC patients. A total of 1489 female patients with primary breast cancer were diagnosed and treated at the department of General Surgery, the Chinese PLA General Hospital, China, from January 2004 to December 2008. In the 1489 patients, 302 patients (20.28%) with TNBC histopathologically confirmed were retrospectively analysed. The 302 TNBC patients were divided into two groups: the younger (<60 years) group and the elderly (≥60 years) group. The relevant characteristics of the two groups were compared. There were no statistically significant differences between the two groups in common clinical data of the patients, clinicopathological features of tumour and the features of local recurrences and metastases of tumour, and the 5-year disease-free survival and overall survival were all significantly higher in the elderly group than those in the younger group, although the elderly group patients accepted significantly less radiotherapy and chemotherapy than the younger group patients. The elderly and younger TNBC patients may belong to different subtypes of TNBC and we probably could take a more conservative and cautious attitude in choosing the post-operative adjuvant treatment for the elderly patients with TNBC. [ABSTRACT FROM AUTHOR]

Treatment of metastatic soft tissue sarcoma ( mSTS) commonly includes multiple lines of chemotherapy, until a decline in performance status precludes further treatment. The primary objective of this study was to describe the lifetime healthcare resource utilisation and cost among mSTS patients with favourable response to chemotherapy. SABINE was a multi-centre ( n = 25), multi-country ( n = 9) retrospective chart review study of mSTS patients with favourable response to chemotherapy following 4 cycles. Healthcare resource utilisation was collected from first line until death or end of follow-up. Costs were analysed by health states (defined by treatment line, chemotherapy use and disease progression) and estimated by multiplying the mean weekly cost per health state by the expected number of weeks spent in each health state. Expected per-patient lifetime medical cost was €65 616 (95% CI: €51 454-€85 003); comprised of IV chemotherapy (31.7%), inpatient care (24.8%), concomitant medication (11.0%), oral chemotherapy (8.9%), outpatient visits (8.8%), radiotherapy (6.3%), hospice (4.0%), imaging (3.7%) and laboratory (0.7%). Weekly costs were 280-330% higher during chemotherapy treatment periods than off-chemotherapy, especially after disease progression. Per-patient costs were highest in the USA and lowest in the Netherlands and UK. The economic burden of mSTS is considerable and the amount of resources devoted to its treatment varies across countries. [ABSTRACT FROM AUTHOR]

The author reflects on the importance of proper selection in administering a safe and effective cancer treatment. Topics discussed include efforts made towards the optimisation of comprehensive geriatric assessments in multidisciplinary cancer care, studies that look into a range of research questions from various angles including the introduction of guidelines on geriatric assessments in oncology and the integration of geriatric oncology as another paradigm of multidisciplinary cancer care.

Much of the literature on informal carers of cancer patients is quantitative and psycho-oncology based. This literature has established that cancer carers experience higher rates of stress, depression and anxiety than their non-caregiving counterparts, with younger female carers reporting higher rates of burden and unmet needs. The reasons behind this variation and variations in support preferences are poorly understood: some carers prefer support groups and others prefer practical support. This study takes a sociological approach to exploring carers' varied experiences. Longitudinal interviews were conducted with 32 carers of a spouse with cancers of varying stages and diagnoses in the Australian Capital Territory. Analysis, informed by the discretionary time literature, shows time-sovereignty illuminates much of the variation in carers' emotional experiences and support preferences. Carers with few competing commitments and less onerous caregiving responsibilities had time to experience and unpack the range of emotions associated with cancer, and reconnect with their spouse. These carers preferred emotion-focused support. In contrast, carers with multiple commitments had little time to themselves and viewed emotions as an indulgence. These carers preferred practical support. A time-sovereignty framework offers health and support professionals a means of understanding carers' varying needs and tailoring support services. [ABSTRACT FROM AUTHOR]

HINZ A., EINENKEL J., BRIEST S., STOLZENBURG J.-U., PAPSDORF K. & SINGER S. (2012) European Journal of Cancer Care 21, 677-683 Is it useful to calculate sum scores of the quality of life questionnaire EORTC QLQ-C30? The aim of this paper is to test the psychometric properties of sum scores of the quality of life questionnaire EORTC QLQ-C30. A sample of cancer patients ( n= 1529) and a sample of the general population ( n= 1185) were tested with the EORTC QLQ-C30, the Hospital Anxiety and Depression Scale and the Multidimensional Fatigue Inventory. Three sum scores of the EORTC QLQ-C30 are defined: a score concerning functioning, a score concerning symptoms and a total score. Compared with the two-item quality of life scale of the EORTC QLQ-C30, the psychometric quality of the total score and the functioning score is superior with respect to reliability, convergent validity and discriminant validity. Cronbach's alpha of the total score is 0.94 (cancer patients) and 0.95 (general population). The effect size discriminating between patients and controls is d= 0.83 for the total score, compared to only 0.50 obtained with the two-item quality of life scale. The results prove that the calculation of sum scores provides useful information for clinicians who are interested in one generalising score of quality of life. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to assess the impact of paediatric benign and malignant solid tumours and its treatment on the health‐related quality of life of children and adolescents who were followed up in a Reference Center in Pediatric Oncology in Rio de Janeiro. Methods: It is a prospective cohort study. Quality of life assessment was performed using the PedsQL™ 4.0 Generic Core Scales and PedsQL™ 3.0 Cancer Module protocols three times: during hospital admission (T1), 6 months after admission (T2) and 1 year after admission (T3). Results: We evaluated 132 patients, 59 men and 73 women, aged 2–17 years. In PedsQL™4.0, the Emotional Functioning scale was the one with the worst scores, while the scores on the Social Functioning scale was the best. In PedsQL™ 3.0, the worst domains were Procedural Anxiety and Worry. Patients with malignant bone tumours had the worst health‐related quality of life. The group who received only surgery had better results. Total scores of PedsQL™4.0 and PedsQL™ 3.0 improved between T1 and T3. Conclusion: Children and adolescents with malignant and benign neoplasms undergo changes in quality of life as a result of the disease and treatment, but an improvement has been observed over time. [ABSTRACT FROM AUTHOR]

Background: Oncologists may be particularly at risk of burnout. This systematic literature review and meta‐analysis explores the prevalence of burnout and associated factors in oncologists. Methods: The authors assessed 26 studies that utilised the Maslach Burnout Inventory (MBI) tool to measure burnout. Pooled prevalence rates were calculated via meta‐analysis (MetaXL) using random effects models. Results: Approximately 5,768 oncologists provided burnout data. A significant number experience burnout as highlighted by the pooled prevalence rates for MBI subscales of: emotional exhaustion at 32%; depersonalisation at 24%; and low personal accomplishment at 37%. Eighteen of the studies reported factors found to be significantly associated with high levels of burnout in oncology physicians. These were grouped into demographic differences, individual factors and work factors. Conclusion: Burnout was found to affect a significant proportion of oncologists. Burnout was associated with being single, being younger in age, reduced psychological well‐being, difficulties outside of work, workplace demands and workplace stress. Burnout has considerable implications for oncology physicians and patient safety. Further insight into individual factors, and factors associated with lower burnout would be beneficial. [ABSTRACT FROM AUTHOR]

Objective: Health promotion is a key aspect for health outcomes of prostate cancer (PCa) patients. However, it has been poorly explored among patients following monitoring programmes, for example Active Surveillance (AS). This study aimed to explore PCa patients' perceptions of health promotion during AS. Methods: An explorative qualitative research design was adopted. Four focus groups were used to collected data from 24 men enrolled in the Prostate Cancer Research International: AS (PRIAS) protocol. A thematic analysis with an inductive approach was performed. Results: Participants described promoting health during AS as challenged by mental, age‐related, informational and organisational issues. It was reported as an effort to stay in the present with a positive outlook, despite the worries for the future ("the mental theme"). It was perceived as impacted by being older and having to manage physical and mental struggles related to age ("the life‐course theme"). It depended, in their accounts, on obtaining reliable information and personalised education ("the educational theme"). Finally, it was related on taking responsibility on the care process ("the organisational theme"). Conclusion: This study suggested ways of promoting health during AS that can help healthcare professionals and organisations building a "health‐promoting AS," able to improve overall health outcomes. [ABSTRACT FROM AUTHOR]

Objective: Psychometrically rigorous and comprehensive needs assessment measures for Chinese general cancer caregivers are relatively scarce. We described the development and psychometric evaluation of the Chinese version of the Cancer Support Person's Unmet Needs Survey‐Short Form (SPUNS‐SFC). Methods: A forward–backward translation method was utilised to develop the SPUNS‐SFC. The construct validity, internal consistency, convergent validity and discriminant validity of the SPUNS‐SFC were evaluated. Results: A total of 1,026 Chinese cancer caregivers completed the SPUNS‐SFC. Items 10, 11, 13, 24 and 26 were removed as more than 80% of respondents reported having no unmet needs on these items. Exploratory factor analysis revealed a five‐factor structure, which accounted for 78.47% of the total variance, and consisted of the following domains: information, healthcare access and continuity, personal and emotional needs, worries about the future, and financial needs. Internal consistency of the measure was high, with Cronbach's alpha coefficients ranging from 0.87 to 0.95 for the five domains. The measure illustrated adequate evidence of convergent validity, demonstrated by significant correlations with multiple measures of psychological well‐being. Known‐groups validity was established, as 87.5% of the hypotheses were supported. Conclusion: This study indicates the SPUNS‐SFC is a reliable and valid measure of the unmet needs of Chinese cancer caregivers. [ABSTRACT FROM AUTHOR]