Colorectal cancer screening participation: a systematic review.

BACKGROUND: Colorectal cancer (CRC) is one of the most common cancers in men and women. CRC screening programmes have been implemented in various countries. However, the participation rate remains disappointingly low. For a screening method to be beneficial, high participation rates are essential. Therefore, understanding the factors that are associated with CRC screening and follow-up adherence is necessary. In this systematic review, factors studied in literature were identified that are associated with CRC screening adherence. METHODS: A systematic search in PUBMED, EMBASE and COCHRANE was performed to identify barriers and facilitators for CRC screening adherence. Study characteristics were summarized and analysed. RESULTS: Seventy-seven papers met the inclusion criteria to be applicable for review. Female gender, younger participants, low level of education, lower income, ethnic minorities and not having a spouse were the most frequently reported barriers. Health provider characteristics, such as health insurance and a usual source of care were also frequently reported barriers in CRC screening adherence. Disparities were found in weight, employment status and self-perceived health status. CONCLUSION: Barriers and facilitators of CRC screening participation are frequently reported. Understanding these factors is the first step to possibly modify specific factors to increase CRC screening participation rate.

Long-term effect of a nurse-led psychosocial intervention on health-related quality of life in patients with head and neck cancer: a randomised controlled trial.

BACKGROUND: Head and neck cancer (HNC) patients are prone to have a poor health-related quality of life after cancer treatment. This study investigated the effect of the nurse counselling and after intervention (NUCAI) on the health-related quality of life and depressive symptoms of HNC patients between 12 and 24 months after cancer treatment. METHODS: Two hundred and five HNC patients were randomly allocated to NUCAI (N=103) or usual care (N=102). The 12-month nurse-led NUCAI is problem-focused and patient-driven and aims to help HNC patients manage with the physical, psychological and social consequences of their disease and its treatment. Health-related quality of life was evaluated with the EORTC QLQ-C30 and QLQ H&N35. Depressive symptoms were evaluated with the CES-D. RESULTS: At 12 months the intervention group showed a significant (P<0.05) improvement in emotional and physical functioning, pain, swallowing, social contact, mouth opening and depressive symptoms. At 18 months, global quality of life, role and emotional functioning, pain, swallowing, mouth opening and depressive symptoms were significantly better in the intervention group than in the control group, and at 24 months emotional functioning and fatigue were significantly better in the intervention group. CONCLUSION: The NUCAI effectively improved several domains of health-related quality of life and depressive symptoms in HNC patients and would seem a promising intervention for implementation in daily clinical practice.

Preferences and opinions of patients with Type 2 diabetes on education and self-care: a cross-sectional survey.

OBJECTIVE: To assess the preferences of patients with Type 2 diabetes regarding self-care activities and diabetes education. RESEARCH DESIGN AND METHODS: Questionnaire survey carried out in general practices and outpatient clinics across the Netherlands. OUTCOMES: preferred setting for education, preferred educator, and preferred and most burdensome self-care activity. Multinomial logistic regression analysis assessed associations between outcomes and patient characteristics, preferences and opinions. RESULTS: Data of 994 consecutive individuals were analysed (mean 65 years; 54% male; 97% Caucasian; 21% low education level; 80% primary care). Of these, 19% thought they had poor to average glycaemic control, 61% thought they were over-weight and 32% thought they took too little exercise. Eighty per cent of respondents preferred diabetes education during regular diabetes check-ups. Patients taking insulin preferred education to be given by nurses [odds ratio (OR) 2.45; 95% confidence interval (CI) 1.21-4.96]. Individuals who thought their health to be poor/average preferred education to be given by doctors (OR 1.65; 95% CI 1.08-2.53). Physical exercise was the preferred self-care activity of those who thought they took too little exercise (OR 1.97; 95% CI 1.32-2.93) but was preferred less by patients with mobility problems (OR 0.65; 95% CI 0.43-0.97). Patients with eating disinhibition reported keeping to a healthy diet (OR 4.63; 3.00-7.16) and taking medication (OR 1.66; 95% CI 1.09-2.52) as the most burdensome self-care activities. Age was not an independent determinant of any preference. CONCLUSIONS: When providing education for patients with newly diagnosed Type 2 diabetes, healthcare providers should consider making a tailored education plan, irrespective of the patient's age.

Predictors of choosing life-long screening or prophylactic surgery in women at high and moderate risk for breast and ovarian cancer.

The aim of this study is to summarize published empirical data describing the predictors of adhering to screening practices and choosing to have prophylactic surgery in women at increased risk for breast and ovarian cancer. Pubmed, Psychinfo and Cinahl databases were searched to identify studies on the predictors of adherence to breast and ovarian cancer screening and predictors of having a prophylactic mastectomy or salpingo-oophorectomy. We found 37 empirical studies that met our inclusion criteria. The main predictors of the use of preventive measures are related to DNA test results, socio-demographic characteristics, and psychological outcome measures. It is concluded that there is no unequivocal relationship between age, education, risk perception, or anxiety and adherence to breast and ovarian cancer screening practices. Worrying about cancer is associated with a higher adherence to screening practices.

Professional delay in head and neck cancer patients: analysis of the diagnostic pathway.

The aim of this study was to identify which factors are related to specialist delay and to determine the length of the diagnostic pathway in head and neck cancer patients. Three hundred and six patients with a carcinoma of the larynx, pharynx or oral cavity were included in the study. Logistic regression analysis was used to identify risk factors for specialist delay. Large (T3-T4) tumors showed significantly less specialist delay than small (T1-T2) tumors (p=0.045, odds ratio [OR]=0.6). Pharyngeal (p=0.00, OR=0.2) and oral carcinomas (p=0.00, OR=0.2) had less specialist delay than glottic carcinomas. Hoarseness was associated with prolonged specialist delay (p=0.00, OR=5.9). Heavy drinking in combination with smoking (p=0.005, OR=0.3), a sore throat (p=0.02, OR=0.4) or having a lesion (p=0.03, OR=0.2) showed a shorter diagnostic period. The duration of the diagnostic process in a general hospital ranged from 0 to 570 days, with a median of 14 days. Only a small group of patients met the ideal management standards in our head and neck clinic. Although prolonged delay was associated with small (glottic) tumors, the diagnostic process takes a fairly long time. The results indicate that continued educational programs for professionals are warranted.

Medical care-seeking and health-risk behavior in patients with head and neck cancer: the role of health value, control beliefs and psychological distress.

Health behavior plays an important role in the development, detection and course of cancer of the head and neck. Relevant health behavior includes prompt medical care seeking, and smoking and drinking cessation after diagnosis. This study examines the relationship between these health behaviors and health value and control beliefs, as well as psychological distress. Two hundred and sixty-four recently diagnosed head and neck cancer patients were interviewed about their health behavior, and they filled in a questionnaire on health beliefs and psychological distress. The results showed that one-quarter (25%) of the patients had waited more than 3 months before seeking medical care, 50% had continued to smoke and 80% had continued to drink after the diagnosis. The patients, particularly those who smoked and drank before diagnosis, reported lower levels of health value and perceived health competence than a general population sample with which they were compared. Patients who engaged in patient delay reported a lack of perceived health competence. Psychological distress and lack of perceived health competence were found to be more common among patients who continued to smoke. The implications of these findings are discussed with regard to interventions aimed at promoting these specific health behaviors.

Reasons for non-standard treatment in elderly patients with advanced head and neck cancer.

Elderly patients with head and neck cancer are less likely to receive standard treatment. This study assessed the influence that age, tumour characteristics, comorbidity, social support, depressive symptoms and quality of life have on treatment choice. One hundred and five patients between 45 and 60 years of age and 78 patients of > or =70 years of age with carcinoma of the oral cavity (stage > or =II), oro- and hypopharynx (stage > or =II) or larynx (stage > or =III) completed a questionnaire on quality of life (EORTC QLQ-C30 and H&N35), depressive symptoms (CES-D) and social support (RSS12-I). In the 45-60 age group, 89% received standard treatment, compared with 62% of the > or =70 age group. A multivariate logistic regression analysis showed that the following factors predicted non-standard treatment: marital status (widowed), advanced tumour stage, comorbidity, less pain, considering the length of life less important than its quality and old age. This study showed that age itself independently influences treatment choice. However, it should be emphasised that the choice of a treatment should be based on a medical assessment and the patient's preferences, not on chronological age.

Psychological factors and patient delay in patients with head and neck cancer.

There is a rising incidence of patients presenting with advanced cancer in the head and neck region. Late presentation may be due to a delay in seeking medical attention, which is sometimes surprisingly long. The aim of the present prospective study was to investigate the association between patient delay and the psychological factors of optimism, health hardiness, overall defensive functioning, coping styles and psychological distress in 277 patients with cancer of the head and neck. Significant correlations were found between patient delay and the psychological factors. Twenty-six percent of the patients waited more than three months before seeking medical attention and they reported less optimism (P = 0.0001), less health hardiness (P = 0.008), less active coping (P = 0.019) and less seeking support as a coping style (P = 0.017) than patients presenting within three months. Excessive drinkers (5+ alcoholic drinks/day) tended to show more delay than patients who did not drink or were moderate drinkers (0-2 drinks/day) or moderate-heavy drinkers (3-4 drinks/day). Together, the psychological factors could explain 25% of the variance of patient delay in excessive drinkers compared with 21% and 6% in moderate-heavy drinkers and non-drinkers to moderate drinkers, respectively. These results suggest that psychological factors affect health-care seeking behaviour. Health education aimed at the risk group of excessive drinkers should take psychological factors into account that influence their health behaviour.

Elderly patients with head and neck cancer: short-term effects of surgical treatment on quality of life.

Elderly patients with head and neck cancer are less likely to be treated surgically. However, little is known about surgical outcome and quality of life (QOL) in elderly patients after a major surgery. This prospective study compared the QOL and the surgical outcome of 54 elderly (> or =70 years) and 75 younger patients (45-60 years) with carcinoma of the oral cavity (stage > or = II), pharynx (stage > or = II) or larynx (stage > or = III). Before and 3 months after surgery, the patients completed questionnaires about QOL (EORTC QLQ-C30 and QLQ-H&N35) and depression (CES-D). Before treatment, elderly and younger patients did not differ in QOL. Three months after the treatment, both groups scored worse on most QOL aspects, but there were no significant differences between the elderly and the younger patients. Surgical and systemic complication rates were similar for both the groups. In conclusion, we found no significant differences in the complication rate and QOL aspects between surgically treated elderly and younger patients.

A prospective quality of life study in patients with locally advanced prostate cancer, treated with radiotherapy with or without regional or interstitial hyperthermia.

INTRODUCTION: The aim of this prospective study was to describe quality of life (QoL) in patients with locally advanced prostate carcinoma treated with conventional radiotherapy and to evaluate the influence of adding regional or interstitial hyperthermia. MATERIALS AND METHODS: All patients were irradiated using a CT-planned conventional three field technique, administering 70 Gy to prostate and vesicles. In two different phase I studies, hyperthermia was added to the radiotherapy. Twelve patients were treated with one interstitial hyperthermia treatment, lasting 60 min. Fourteen patients have been treated with five regional hyperthermia treatments, lasting 75 min each. In both hyperthermia studies, the body, bladder and rectum temperatures remained below safety limits. Patients treated with radiotherapy alone (n = 58) or combined with regional (n = 8) or interstitial hyperthermia (n = 12) completed the European Organization for Research and Treatment of Cancer (EORTC) core questionnaire (C30 + 3), the EORTC prostate cancer module (PR25) and the Rand 36 health survey before treatment and 1 and 6 months after completion of treatment. Analysis of Variance (ANOVA) for repeated measurements has been performed to describe the data. RESULTS: All patient groups were comparable concerning patient characteristics. No significant interaction or difference in QoL has been noticed between the two hyperthermia patient groups and the patient group without hyperthermia. Therefore, all groups were analysed together (n = 78) to detect QoL changes in time. A deterioration of QoL has been measured from baseline to 1 month after treatment. Fatigue, pain, urinary symptoms, bowel symptoms and financial difficulties increased significantly. Social, physical and role functioning worsened significantly. No differences in QoL were measured 6 months after treatment compared to the baseline measurement, except for a decrease in sexual activity. CONCLUSIONS: After radiotherapy with or without hyperthermia only a temporary deterioration of QoL occurs, concerning social, psychological and disease related symptoms. Additional hyperthermia does not seem to decrease QoL.

Increasing incidence of advanced stage head and neck tumours.

The aim of this study was to determine whether the incidence of advanced stage (T4) head and neck tumours has increased. We analysed retrospectively 3178 patients diagnosed with oral, pharyngeal or laryngeal cancer in the period 1980-2000 at the University Medical Center Utrecht (UMCU), The Netherlands. There was a statistically significant increase in the proportion of T4 head and neck tumours compared with non-T4 tumours over the period 1980-2000. Linear regression analysis estimated an increase of 0.9% every year. The observed increase in T4 tumours at UMCU shows up in figures from the Netherlands Regional Cancer Registry (IKMN) and the National Cancer Registration (NCR). Although these bodies report for fewer years, this finding refutes the possibility of selected referral to the University Medical Center Utrecht. In conclusion, the number of head and neck cancer patients presenting with an advanced stage carcinoma (T4) has increased over a period of 21 years.

[Rising incidence of invasive (T4) head-neck carcinoma at the Utrecht University Medical Center, 1980-1998]. / Stijgende incidentie van invasieve (T4)-hoofd-halscarcinomen in het Universitair Medisch Centrum Utrecht, 1980-1998.

OBJECTIVE: To determine whether there is an increase in the incidence of diagnosed head and neck tumours at an advanced stage (T4). DESIGN: Secondary data-analysis. METHOD: Data of patients registered in 1980-1998 at the Utrecht University Medical Centre, the Netherlands, were analysed for the relative prevalence of T4 tumours in the oral cavity, pharynx and larynx on the basis of sex, age and tobacco and alcohol usage. The results were compared with figures from the Dutch national cancer registry (1989-1997). RESULTS: Data were collected for 2993 patents (2256 men and 737 women; average age 63 years (SD 12)). Of these 35 had a carcinoma situated on the lips, 1091 in the oral cavity, 1321 in the larynx and 546 in the pharynx. There was an increase in T4 tumours of 12.2% (43/353) of all tumours in 1980-1984 to 27.2% (252/1033) in 1995-1998. Linear regression analysis estimated an increase of 0.9% every year. Selected referral to the Utrecht University Medical Centre was unlikely because the increased incidence of T4 tumours could be recognised in the national cancer registry. There was no change in the sex distribution over the study period. The increase in the 40 to 50-year-old age group was greater than that of the patients aged 80 years and over. T4 tumours were more prevalent than T1 tumours in patients who had smoked 20 or more cigarettes per day or drank more than 4 units of alcohol per day. CONCLUSION: The percentage of cancer patients presenting with an advanced stage (T4) of head-neck tumours increased during the study period.