ESMO expert consensus statements on the screening and management of financial toxicity in patients with cancer.

BACKGROUND: Financial toxicity, defined as both the objective financial burden and subjective financial distress from a cancer diagnosis and its treatment, is a topic of interest in the assessment of the quality of life of patients with cancer and their families. Current evidence implicates financial toxicity in psychosocial, economic and other harms, leading to suboptimal cancer outcomes along the entire trajectory of diagnosis, treatment, supportive care, survivorship and palliation. This paper presents the results of a virtual consensus, based on the evidence base to date, on the screening and management of financial toxicity in patients with and beyond cancer organized by the European Society for Medical Oncology (ESMO) in 2022. METHODS: A Delphi panel of 19 experts from 11 countries was convened taking into account multidisciplinarity, diversity in health system contexts and research relevance. The international panel of experts was divided into four working groups (WGs) to address questions relating to distinct thematic areas: patients with cancer at risk of financial toxicity; management of financial toxicity during the initial phase of treatment at the hospital/ambulatory settings; financial toxicity during the continuing phase and at end of life; and financial risk protection for survivors of cancer, and in cancer recurrence. After comprehensively reviewing the literature, statements were developed by the WGs and then presented to the entire panel for further discussion and amendment, and voting. RESULTS AND DISCUSSION: A total of 25 evidence-informed consensus statements were developed, which answer 13 questions on financial toxicity. They cover evidence summaries, practice recommendations/guiding statements and policy recommendations relevant across health systems. These consensus statements aim to provide a more comprehensive understanding of financial toxicity and guide clinicians globally in mitigating its impact, emphasizing the importance of further research, best practices and guidelines.

Exploring patient experiences with a telehealth approach for the PRO-ACTIVE trial intervention in head and neck cancer patients.

INTRODUCTION: Following the COVID-19 directive to cease non-essential services, a rapid shift was made in the delivery of Speech Language Pathology (SLP) dysphagia management in the 3-arm, randomized PRO-ACTIVE trial. To inform future programs, this study explored patients' experiences with telehealth when the planned in-person SLP intervention was moved to a telehealth modality. METHODS: A theory-guided qualitative descriptive approach was used. Willing participants who had received at least one telehealth swallowing therapy session participated in a one-time semi-structured interview. Interview transcripts were subjected to a standard qualitative content/theme analysis. Researchers reviewed all transcripts and used a multi-step analysis process to build a coding framework through consensus discussion. Summaries and key messages were generated for each code. RESULTS: Eleven participants recounted their telehealth experiences and reported feeling satisfied, comfortable and confident with the session(s). They identified that previous experience with teleconferencing, access to optimal technical equipment, clinician skill, and caregiver assistance facilitated their telehealth participation. Participants highlighted that telehealth was beneficial as it reduced commuting time, COVID-19 exposure and fatigue from travel; and also allowed caregiver participation particularly during COVID. In comparing their in-person SLP sessions to telehealth sessions, limitations were also identified, including: lack of previous experience with and/or poor access to technology, and less opportunity for personalization. Participants indicated that use of phone alone was less preferred than an audio/video platform. DISCUSSION: Patients reported that overall, telehealth sessions did not compromise their learning experience when compared to in-person sessions. Patients benefited from use of telehealth in several ways despite some limitations of the use of technology. Patient feedback about telehealth provides an important perspective that may be critical to inform best practices for care delivery.

The PRO-ACTIVE trial protocol: a randomized study comparing the effectiveness of PROphylACTic swallow InterVEntion for patients receiving radiotherapy for head and neck cancer.

BACKGROUND: Swallowing therapy is commonly provided as a treatment to lessen the risk or severity of dysphagia secondary to radiotherapy (RT) for head and neck cancer (HNC); however, best practice is not yet established. This trial will compare the effectiveness of prophylactic (high and low intensity) versus reactive interventions for swallowing in patients with HNC undergoing RT. METHODS: This multi-site, international randomized clinical trial (RCT) will include 952 adult patients receiving radiotherapy for HNC and who are at high risk for post-RT dysphagia. Participants will be randomized to receive one of three interventions for swallowing during RT: RE-ACTIVE, started promptly if/when dysphagia is identified; PRO-ACTIVE EAT, low intensity prophylactic intervention started before RT commences; or, PRO-ACTIVE EAT+EXERCISE, high intensity prophylactic intervention also started before RT commences. We hypothesize that the PRO-ACTIVE therapies are more effective than late RE-ACTIVE therapy; and, that the more intensive PRO-ACTIVE (EAT + EXERCISE) is superior to the low intensive PRO-ACTIVE (EAT). The primary endpoint of effectiveness is duration of feeding tube dependency one year post radiation therapy, selected as a pragmatic outcome valued equally by diverse stakeholders (e.g., patients, caregivers and clinicians). Secondary outcomes will include objective measures of swallow physiology and function, pneumonia and weight loss, along with various patient-reported swallowing-related outcomes, such as quality of life, symptom burden, and self-efficacy. DISCUSSION: Dysphagia is a common and potentially life-threatening chronic toxicity of radiotherapy, and a priority issue for HNC survivors. Yet, the optimal timing and intensity of swallowing therapy provided by a speech-language pathologist is not known. With no clearly preferred strategy, current practice is fraught with substantial variation. The pragmatic PRO-ACTIVE trial aims to specifically address the decisional dilemma of when swallowing therapy should begin (i.e., before or after a swallowing problem develops). The critical impact of this dilemma is heightened by the growing number of young HNC patients in healthcare systems that need to allocate resources most effectively. The results of the PRO-ACTIVE trial will address the global uncertainty regarding best practice for dysphagia management in HNC patients receiving radiotherapy. TRIAL REGISTRATION: The protocol is registered with the US Patient Centered Outcomes Research Institute, and the PRO-ACTIVE trial was prospectively registered at ClinicalTrials.gov , under the identifier NCT03455608 ; First posted: Mar 6, 2018; Last verified: Jun 17, 2021. Protocol Version: 1.3 (January 27, 2020).

The efficacy, challenges, and facilitators of telemedicine in post-treatment cancer survivorship care: an overview of systematic reviews.

BACKGROUND: Telemedicine services have been increasingly used to facilitate post-treatment cancer survivorship care, including improving access; monitoring health status, health behaviors, and symptom management; enhancing information exchange; and mitigating the costs of care delivery, especially since the COVID-19 pandemic. To inform guidance for the use of telemedicine in the post-COVID era, the aim of this overview of systematic reviews (SRs) was to evaluate the efficacy of, and survivor engagement in, telemedicine interventions in the post-treatment survivorship phase, and to consider implementation barriers and facilitators. METHODS: PubMed, Cochrane CENTRAL, CINAHL, Embase, and Web of Science databases were searched. SRs that examined the use of telemedicine in the post-treatment phase of cancer survivorship, published between January 2010 and April 2021, were included. Efficacy data were synthesized narratively. Implementation barriers and facilitators were synthesized using the Consolidated Framework for Implementation Research. RESULTS: Twenty-nine SRs were included. A substantive body of evidence found telemedicine to benefit the management of psychosocial and physical effects, particularly for improving fatigue and cognitive function. There was a lack of evidence on the use of telemedicine in the prevention and surveillance for recurrences and new cancers as well as management of chronic medical conditions. This overview highlights a range of diverse barriers and facilitators at the patient, health service, and system levels. CONCLUSIONS: This review highlights the benefits of telemedicine in addressing psychosocial and physical effects, but not in other areas of post-treatment cancer survivorship care. This large review provides practical guidance for use of telemedicine in post-treatment survivorship care.

Polyclonal Regulatory T Cell Therapy for Control of Inflammation in Kidney Transplants.

Early subclinical inflammation in kidney transplants is associated with later graft fibrosis and dysfunction. Regulatory T cells (Tregs) can reverse established inflammation in animal models. We conducted a pilot safety and feasibility trial of autologous Treg cell therapy in three kidney transplant recipients with subclinical inflammation noted on 6-month surveillance biopsies. Tregs were purified from peripheral blood and polyclonally expanded ex vivo using medium containing deuterated glucose to label the cells. All patients received a single infusion of ~320 × 106 (319, 321, and 363.8 × 106 ) expanded Tregs. Persistence of the infused Tregs was tracked. Graft inflammation was monitored with follow-up biopsies and urinary biomarkers. Nearly 1 × 109 (0.932, 0.956, 1.565 × 109 ) Tregs were successfully manufactured for each patient. There were no infusion reactions or serious therapy-related adverse events. The infused cells demonstrated patterns of persistence and stability similar to those observed in non-immunosuppressed subjects receiving the same dose of Tregs. Isolation and expansion of Tregs is feasible in kidney transplant patients on immunosuppression. Infusion of these cells was safe and well tolerated. Future trials will test the efficacy of polyclonal and donor alloantigen-reactive Tregs for the treatment of inflammation in kidney transplants.

Challenges and insights in implementing coordinated care between oncology and primary care providers: a Canadian perspective.

We report here on the current state of cancer care coordination in Canada and discuss challenges and insights with respect to the implementation of collaborative models of care. We also make recommendations for future research. This work is based on the findings of the Canadian Team to Improve Community-Based Cancer Care Along the Continuum (canimpact) casebook project. The casebook project identified models of collaborative cancer care by systematically documenting and analyzing Canadian initiatives that aim to improve or enhance care coordination between primary care providers and oncology specialists. The casebook profiles 24 initiatives, most of which focus on breast or colorectal cancer and target survivorship or follow-up care. Current key challenges in cancer care coordination are associated with establishing program support, engaging primary care providers in the provision of care, clearly defining provider roles and responsibilities, and establishing effective project or program planning and evaluation. Researchers studying coordinated models of cancer care should focus on designing knowledge translation strategies with updated and refined governance and on establishing appropriate protocols for both implementation and evaluation.

Factors influencing adherence to cancer treatment in older adults with cancer: a systematic review.

BACKGROUND: Cancer is a disease that mostly affects older adults. Treatment adherence is crucial to obtain optimal outcomes such as cure or improvement in quality of life. Older adults have numerous comorbidites as well as cognitive and sensory impairments that may affect adherence. The aim of this systematic review was to examine factors that influence adherence to cancer treatment in older adults with cancer. PATIENTS AND METHODS: Systematic review of the literature published between inception of the databases and February 2013. English, Dutch, French and German-language articles reporting cross-sectional or longitudinal, intervention or observational studies of cancer treatment adherence were included. Data sources included MEDLINE, EMBASE, PsychINFO, Cumulative Index to Nursing and Allied Health (CINAHL), Web of Science, ASSIA, Ageline, Allied and Complementary Medicine (AMED), SocAbstracts and the Cochrane Library. Two reviewers reviewed abstracts and abstracted data using standardized forms. Study quality was assessed using the Mixed Methods Appraisal Tool 2011. RESULTS: Twenty-two manuscripts were identified reporting on 18 unique studies. The quality of most studies was good. Most studies focused on women with breast cancer and adherence to adjuvant hormonal therapy. More than half of the studies used data from administrative or clinical databases or chart reviews. The adherence rate varied from 52% to 100%. Only one qualitative study asked older adults about reasons for non-adherence. Factors associated with non-adherence varied widely across studies. CONCLUSION: Non-adherence was common across studies but little is known about the factors influencing non-adherence. More research is needed to investigate why older adults choose to adhere or not adhere to their treatment regimens taking into account their multimorbidity.

A mixed-methods cohort study to determine perceived patient benefit in providing custom breast prostheses.

BACKGROUND: Of all mastectomy patients, 90% will use an external prosthesis where the standard of care uses a stock prosthesis that is purchased "off the shelf." Our objectives were to determine patient demand for and perceived value of a custom breast prosthesis. The information obtained will influence future research and program direction. METHODS: We asked 65 women who had undergone lumpectomy or mastectomy to participate before exploring rehabilitation options. The quantitative outcome measures were the European Organisation for Research and Treatment of Cancer QLQ-C30 general and -BR23 breast cancer-specific quality of life questionnaires, and the Ambulatory Oncology Patients Satisfaction Tool. The QLQ results were analyzed using the Mann-Whitney U-test. Results of the satisfaction tool were compared using the Fisher exact and chi-square tests. A descriptive qualitative approach-involving in-depth interviews exploring the experiences of the women-was used to establish the perceived value of the services to the patients. The analysis of the interview transcripts was conducted using a standardized content method to describe the experiences of the women. RESULTS: All the women had had previous experiences with a conventional prosthesis, and they reported that wearing a custom prosthesis was more satisfying for them. They reported comfort and ease in wearing it, coupled with a sense of feeling less like a victim. Comparison of the QLQ and patient satisfaction scores showed no significant difference between the women wearing the conventional prosthesis and those wearing the custom prosthesis. CONCLUSIONS: The qualitative data provide a strong case in support of the new device. Patient demand, perceived benefit, and experience wearing the prosthesis were documented. Suggestions for improvements in the device and in the program operations were gathered and will influence future development of this service.

The utility of publicly reported cancer treatment wait time information for patients and health care providers.

AIMS: To determine the utility of web-based radiation wait time information for patients and health care providers in decision-making. To revise the information using a simulated laboratory environment and to re-evaluate the new web-based information. MATERIALS AND METHODS: An online 'pop-up' survey on the Cancer Care Ontario (CCO) website measured user satisfaction. Qualitative data were gathered through patient focus groups and physician interviews. On the basis of the analysis, the website was revised and usability testing conducted. The information was re-evaluated by end-users through survey methodology. RESULTS: The majority accessing the wait time website were patients and family members. The modal age of use of the website was 31-50 years. Patients found the information more helpful after redesign than health professionals, but both found the language less easy to understand, highlighting the need to continuously evaluate the effectiveness of the website. Patients did not identify themselves as consumers of wait time information. Their expectation was that physicians would determine the urgency for treatment and would ensure timely access to care. Physicians reported that they did not use the CCO website on wait times and would not use the data for decision-making. Referrals were based on urgency of care and usual referral patterns. Referral patterns did not shift to centres with shorter wait times. CONCLUSIONS: The results of this study did not confirm the usefulness of the web-based wait time information for patients and physicians as a resource on how to obtain timely access to radiation treatment. Patients relied on their physician to manage their access to treatment according to the urgency of their clinical condition. Physicians preferred their established referral process rather than referring their patients to centres with shorter wait times. As patients become more computer savvy, it will be interesting to see if they increasingly become consumers of web-based wait time information.

An examination of cancer patients' monthly 'out-of-pocket' costs in Ontario, Canada.

Ontario cancer patients' monthly out-of-pocket costs (OOPC) were assessed to determine whether these costs were problematic. A self-administered questionnaire was administered to breast (n = 74), colorectal (n = 70), lung (n = 68) and prostate (n = 70) cancer patients between October 2001 and April 2003. It measured categorical OOPC, which were analysed using linear regression modelling, to determine whether any of a variety of independent variables influenced OOPC. Monthly OOPC (mean, range) were: parking/fares ($47, $0-450), devices ($46, $0-2350), prescription drugs ($45, $0-1400), accommodation ($43, $0-1500), complementary and alternative medicine ($29, $0-5000), vitamins ($25, $0-400), homemaking ($14, $0-1000), family care ($12, $0-1200), homecare ($2, $0-330) and other ($8, $0-250), with the total averaging $213 ($0-5230). Imputed travel mileage costs added $372 ($0-6180). Most patients were well served by the current healthcare programmes. In multivariate analysis, variables influencing several OOPC categories were: tumour site, hospitalization, age, and number of clinic trips. Travel costs proved the most problematic, with patients under 65 years and without insurance more likely to have high OOPC. Education and income were not reliable predictors for high OOPC. Many of these costs were for items not traditionally covered by public healthcare financing systems, raising important issues around defining 'medically necessary' care and the role of government.

Qualitative assessment of patient experiences related to extended pelvic resection for rectal cancer.

BACKGROUND: Patients with locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) represent a complex management challenge. While there is potential for cure in a subset of patients, the cost in terms of morbidity can be high. Few descriptions of the physical, psychological, social, and emotional experiences of these patients exist. METHODS: Face-to-face interviews were completed with ten LARC and LRRC patients treated with multimodal therapy that included surgery. Patient opinions and experiences were explored in depth until information redundancy and common themes were delineated using qualitative research methods. Clinical information was obtained from the database. RESULTS: Nine of the ten patients were male, seven had LARC, and the median age was 71. Six themes were identified from the patient interviews. Themes reflected patients' highly focused desire to seek wellness and cure, but also revealed misunderstanding of their disease biology, probability of cure, therapeutic options, and treatment morbidity. CONCLUSIONS: Patient experiences confirm that this is challenging treatment to complete, and that patient understanding of pre-operative information is incomplete. Our findings underscore the need for a multidisciplinary approach when managing this patient population, with emphasis on both supportive care needs and the technically skilled delivery of surgery, chemotherapy, and radiotherapy.

Absorption and metabolism of octanoate by the rat colon in vivo: concentration dependency and influence of alternative fuels.

BACKGROUND: Compared with short and long chain fatty acids, medium chain fatty acids (MCFAs) have been shown to provide the highest colonic absorption of substrate carbon. Moreover, colonic epithelial cells fulfil their basic energy requirements as easily from MCFAs as from short chain fatty acids. AIMS: To further characterise octanoate as a colonic luminal substrate, we determined in vivo the influence of (i) substrate concentration and (ii) alternative luminal fuels, on rat colonic transport and metabolism. METHODS: Segments of rat proximal colon (8 cm) were cannulated and perfused for 100 min with (14)C labelled octanoate. The right colic vein was also cannulated and venous blood analysed for total (14)C, (14)CO(2), and metabolites by scintillation counting and high performance liquid chromatography. RESULTS: Tracer appearance in mesenteric blood stabilised after 20-40 minutes of perfusion. Increasing luminal octanoate concentrations from 2 to 40 mM resulted in linear increases in total carbon absorption. Maximum CO(2) production was reached near 10 mM. A substantial proportion of octanoate was absorbed without being metabolised (59-94%). The luminal presence of a mixture of alternative fuels had no influence on either octanoate transport or metabolism. CONCLUSIONS: This study demonstrated substantial concentration dependent colonic absorption of octanoate, rendering this MCFA a potential and much needed high energy substrate for patients with compromised small bowel function. Moreover, octanoate meets the basic energy requirements of colonic epithelial cells in vivo as well as butyrate. This study also demonstrates the divergence of in vitro and in vivo data regarding fatty acid absorption and metabolism in the colonic epithelium.

Perspectives on living with ovarian cancer: older women's views.

PURPOSE/OBJECTIVES: To describe the perspectives of older women regarding their experiences living with ovarian cancer. DESIGN: Retrospective survey. SETTING: Canada. SAMPLE: 146 women, 61 years of age or older, diagnosed with ovarian cancer. METHODS: Questionnaire distributed by oncologists and nurses in 26 cancer clinics across Canada to eligible patients during a six-week period. MAIN RESEARCH VARIABLES: Patient problems experienced, help received for problems, impact of illness, quality of life, importance of and satisfaction with information received, and helpfulness of others. FINDINGS: Women experienced, on average, 5.2 problems since diagnosis. The most frequently identified problems were side effects (54%), fear of recurrence (45%), bowel difficulties (43%), and difficulty sleeping (36%). Of the women who experienced problems, the proportion who felt they received adequate help ranged from 36%-74%. Approximately half (57%) of these women reported a lifestyle change. A significant difference was observed in quality of life before and after the diagnosis of ovarian cancer (p = 0.0002). When asked about the desire to talk about their difficulties with cancer, only 54% indicated that they wanted to talk. Approximately one-quarter of the women were satisfied with the information they received regarding complementary (25%) and alternative (23%) therapies, and how to speak with other women living with ovarian cancer (28%). Thirty-five percent were satisfied with the information they received about self-help groups. CONCLUSION: Ovarian cancer has a significant impact on older women, and many perceive they are not receiving adequate assistance for problems they experience. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses should conduct comprehensive assessments of the needs of older women with ovarian cancer, refer those who require specialized counseling, and provide information desired by patients with ovarian cancer about available resources.

Community cancer clinics: patients' perspectives.

In response to the challenge of providing care for cancer patients closer to home, community chemotherapy outreach programs are being developed as part of regional cancer care organizations. The purpose of this qualitative study was to gain an understanding of cancer patients' experiences of receiving chemotherapy at community chemotherapy clinics. In total, 28 patients who had received chemotherapy at 13 community-based clinics were interviewed. Qualitative analysis of the interview transcripts revealed two prevalent themes. One theme, called "balancing gains and losses," reflected how patients considered and evaluated two dimensions when making decisions about where best to undergo treatment. The dimensions considered were quality of life versus biomedical expertise. The second theme, called "communication links," reflected patients' perceptions about the continuity of their cancer care. The results of the study suggest that the impact of the delivery of services on patients and their families needs attention.

The experience of women receiving brachytherapy for gynecologic cancer.

PURPOSE/OBJECTIVES: To explore and document the lived experience of receiving low-dose rate brachytherapy for gynecologic cancer. DESIGN: Qualitative method based on phenomenology. SETTING: Radiation treatment facility in a cancer-care setting in Toronto, Ontario, Canada. SAMPLE: Ten women between the ages of 36 and 75 (x = 59.2) receiving low-dose rate brachytherapy for cancer of the cervix or endometrium. METHODS: Verbatim data were analyzed manually using Giorgi's method of analyzing qualitative data. FINDINGS: Three themes emerged from the data: (a) women's experiences with brachytherapy were embedded within the complete context in which treatment was given, shaped by personal, environmental, and treatment-related factors, (b) the discomfort that women experienced during brachytherapy was perceived as a totality of symptoms including but not limited to pain, and (c) the brachytherapy experience was characterized by an intense focus on time and tensions embedded in issues related to time. CONCLUSIONS: When dealing with the brachytherapy treatment, women are concerned with the context in which the treatment is provided and the care that is associated with the treatment. Different and unique strategies assist women to get through treatment. Supportive nursing interventions can be implemented easily in the nursing care plan for women undergoing brachytherapy. IMPLICATIONS FOR NURSING PRACTICE: The aspects of nursing care that women perceive as positive, such as competence level of the nurse, symptom management, and providing information in sensory terms, should be strengthened. Alternatively, aspects of nursing care that are perceived negatively by women should be changed. Nurses have to avoid situations that will prolong the time of brachytherapy treatment. Nurses should support women in using coping strategies that assist them in getting through the brachytherapy treatment.

Patient-health care provider communication during chemotherapy treatment: the perspectives of women with breast cancer.

Recognition that communication plays a central role in the provision of quality patient care has led to learning more about interactions between patients and their health care providers. The present study examined interactions between women with breast cancer and their cancer care specialists from the patients' perspective during the time the women underwent chemotherapy treatment. In total 40 women from two regional cancer centers were interviewed about their communication experiences. Prevalent themes identified from analysis of the interview transcripts could be classified into two main categories. One category focused on the nature of the information exchange and included the themes of interaction modes and the power of information. The second category reflected relationship issues and included the themes of roles and responsibilities and connectedness. From their narratives, several patient, professional, and contextual factors could be identified that influenced women's perceptions about the quality of their communication experience.

Self-help groups: oncology nurses' perspectives.

During the past decade in North America, the number of self-help groups for cancer patients has grown dramatically. Nurses' knowledge and attitudes about self-help groups could influence their practice behaviours and the information they provide to cancer patients. However, little is known about oncology nurses' views regarding self-help groups. This study used a cross-sectional survey to gather information about knowledge, attitudes, and practice behaviours of Canadian oncology nurses regarding self-help groups. A total of 676 nurses completed the survey (response rate of 61.3%). The respondents had spent, on average, 21.6 years in nursing and 11.6 years in oncology nursing. Results indicated that a large majority of nurses knew about available self-help groups. Approximately one-fifth of the nurses are speaking frequently about self-help groups with patients (20.7%) and are initiating the conversation on a frequent basis (22.0%). Overall, oncology nurses rated self-help groups as helpful with regards to sharing common experiences (79.5%), sharing information (75.6%), bonding (74.0%), and feeling understood (72.0%). The most frequently identified concern regarding the groups was about misinformation being shared (37.9%), negative effects of associating with the very ill (22.1%), and promoting unconventional therapies (21.2%). Implications from the study suggest that oncology nurses would benefit from learning more about the nature of self-help groups and being able to talk with patients about the self-help experience.

Evaluation of a breast self-examination (BSE) program in a breast diagnostic clinic.

The purpose of this study was to evaluate the short-term effectiveness of a breast self-examination (BSE) teaching program on women's knowledge about BSE, proficiency in performing BSE, and motivation to perform BSE. The program was developed for delivery by nurses in a breast diagnostic clinic, a clinic designed to meet the need for expeditious management of breast disease, current information about breast cancer risk, surveillance, and counselling. A convenience sample of 68 women attending the clinic in a regional cancer centre participated in a pre- and five month post-teaching program evaluation. The Toronto Breast Self Examination Instrument was used as the evaluation tool. There were statistically significant changes following the teaching program in the areas of knowledge about the correct technique for performing BSE, proficiency performing BSE, and confidence about finding changes when performing BSE. No significant changes were observed in motivation to practise BSE, although group scores did improve following the education. Participants found the video presentation and the review of BSE information pamphlets by the nurse to be the most helpful components of the BSE teaching program.