Background In developed countries, more men are diagnosed with prostate cancer than any other can... more Background In developed countries, more men are diagnosed with prostate cancer than any other cancer. These men, and many others - including those with raised PSA test results and/or urinary symptoms - will have undergone a prostate biopsy. Although evidence is accumulating on the psychological impact of other diagnostic procedures, little is known about prostate biopsy. This study aimed to: quantify prevalence of, and identify factors associated with, procedure-related distress in men undergoing prostate biopsies. Method 811 men received questionnaires 4-6 weeks post-biopsy in four cancer centres (Republic of Ireland, 4; Northern Ireland, 2). Procedure-related distress was measured using the Impact of Event Scale and a score of ≥9 considered significant distress. Logistic regression was used to identify significant predictors of distress. Results 335 men completed questionnaires. Overall 49% had significant distress; this was higher in men with confirmed cancer (59%) and those stil...
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 6, 2018
To review and interpret existing qualitative literature on the experiences of couples affected by... more To review and interpret existing qualitative literature on the experiences of couples affected by prostate cancer (PCa). A metasynthesis was carried out which included a systematic search of seven databases between 2000 and 2016. A modified version of Noblit and Hare's meta-ethnographic approach was used to synthesise qualitative study findings and inform overarching interpretations. Thirty-seven studies focusing on the experiences of men with PCa and their partner dyad were included producing seven interconnected constructs. The construct accepting change vs seeking continuity reflects the range of ways individuals within the dyad and couples adjust to the diagnosis. Cultivating connection vs disengaging illustrates how couples seek to manage the impact of PCa and its treatment on their relationship, which may lead to a threatened identity, including sexual insecurities. Shielding me, you and us reflects the ways in which couples strive to protect themselves as individuals and/...
Objectives To summarize black and minority ethnic (BME) patients' and partners experiences of pro... more Objectives To summarize black and minority ethnic (BME) patients' and partners experiences of prostate cancer by examining the findings of existing qualitative studies. Methods We undertook a systematic metasynthesis of qualitative studies using a modified version of Noblit and Hare's "meta-ethnography" approach, with a 2000-2015 search of 7 databases. Results Thirteen studies of men from US and UK BME groups were included. We explored constructs with BME-specific features. Health care provider relationships, formation of a spiritual alliance with God (which enhanced the participants' feeling of empowerment and ability to cope with the cancer), and living on for others (generally to increase cancer awareness), often connected to spiritual regrowth, were the 3 constructs most commonly reported. A magnified effect from erectile dysfunction was also common. Initially, this affected men's disclosure to others about their cancer and their sexual problems, but eventually men responded by shifting their conceptualizations of masculinity to sustain self and social identities. There was also evidence of inequality resulting from financial constraints and adversity that necessitated resilience in coping. Conclusions The prostate cancer experience of BME men and their partners is affected by a complex intersection of ethnicity with other factors. Health care services should acknowledge this. If providers recognize the men's felt masculinities, social identities, and spiritual beliefs and their shifting nature, services could be improved, with community as well as individual benefits. More studies are needed in diverse ethnic groups.
An estimate of cancer deaths and incidence for the years 1997 and 2002, taking account of current... more An estimate of cancer deaths and incidence for the years 1997 and 2002, taking account of current trends and population projections for Northern Ireland is presented below. These numbers will be of value to those planning services and, in particular, for those implementing the report "Cancer Services - Investing for the Future". Cancer deaths are expected to rise by almost 13% to 4056 by the year 2002. Marked rises are expected in the number of deaths from cancer of the lung, oesophagus, kidney, bladder and prostate with smaller rises in deaths from breast and pancreatic cancer. The fall in stomach cancer is expected to continue as is the trend of lower deaths from cervical cancer. Deaths from cancer of the colon and rectum are expected to remain static. Estimates of cancer incidence currently and for the years 1997 and 2002 are also included. The impact of tobacco use by the population, which poses a current and future serious threat to public health is highlighted.
Background: Randomized controlled trials have demonstrated significant reductions in colorectal c... more Background: Randomized controlled trials have demonstrated significant reductions in colorectal cancer incidence and mortality associated with polypectomy. However, little is known about whether polypectomy is effective at reducing colorectal cancer risk in routine clinical practice. The aim of this investigation was to quantify colorectal cancer risk following polypectomy in a large prospective population-based cohort study.Methods: Patients with incident colorectal polyps between 2000 and 2005 in Northern Ireland were identified via electronic pathology reports received to the Northern Ireland Cancer Registry. Patients were matched to the Northern Ireland Cancer Registry to detect colorectal cancer and deaths up to December 31, 2010. Colorectal cancer standardized incidence ratios (SIR) were calculated and Cox proportional hazards modeling applied to determine colorectal cancer risk.Results: During 44,724 person-years of follow-up, 193 colorectal cancer cases were diagnosed among ...
Background The COVID-19 pandemic has placed an inexorable strain on endoscopy services worldwide,... more Background The COVID-19 pandemic has placed an inexorable strain on endoscopy services worldwide, affecting the diagnosis of oesophago-gastric (OG) cancer and Barrett’s oesophagus (BO). As coronavirus infection rates rose many professional bodies advised that all endoscopy, except emergency and essential procedures be stopped immediately. We sought to quantify the decline in OG cancer and BO diagnoses following implementation of British Society of Gastroenterology (BSG) guidance related to COVID-19 and the psychosocial effects on BO patients. Methods We examined OG cancer and BO diagnoses in Northern Ireland from March-September 2020 and compared them with the three-year average number of patients during the same time period (corresponding to weeks 10-37) between 2017-2019 by utilising Northern Ireland Cancer Registry (NICR) data. The psychosocial impact of COVID-19 was assessed using an online survey, which included validated WHOQOL-BREF and EQ-5D-5L quality of life measures, and ...
A systematic review suggests that 25% of oesophageal adenocarcinomas (OAC) are 'missed' a... more A systematic review suggests that 25% of oesophageal adenocarcinomas (OAC) are 'missed' at index endoscopy for Barrett's oesophagus (BO); however, this included few population-based studies and may be an overestimate. The objective of this article is to quantify the 'missed' rates of high-grade dysplasia (HGD) and OAC at index BO endoscopy. Patients from the Northern Ireland BO register diagnosed between 1993 and 2010 ( = 13,159) were linked to the Northern Ireland Cancer Registry to identify patients who developed OAC or HGD. Logistic regression analysis compared characteristics of 'missed' vs 'incident' HGD/OAC, defined as diagnoses within 3-12 months vs >1 year after incident BO, respectively. A total of 267 patients were diagnosed with HGD/OAC ≥3 months after BO diagnosis, of whom 34 (12.7%) were potentially 'missed'. The proportion of 'missed' HGD/OAC was 25% among BO patients with low-grade dysplasia (LGD) and 9% among non...
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 8, 2017
We investigated associations between treatment decision making (TDM) and global health-related-qu... more We investigated associations between treatment decision making (TDM) and global health-related-quality-of-life (gHRQoL) among prostate cancer (PCa) survivors. Postal questionnaires were sent to 6559 PCa survivors 2-18 years post-diagnosis, identified through population-based cancer registries in Ireland. The Control Preference Scale was used to investigate respondents' 'actual' and 'preferred' role in TDM. The TDM experience was considered 'congruent' when actual and preferred roles matched and 'incongruent' otherwise. The EORTC QLQ-C30 was used to measure gHRQoL. Multivariate linear regression was employed to investigate associations between (i) actual role in TDM, (ii) congruence in TDM, and gHRQoL. The response rate was 54% (n = 3348). The percentages of men whose actual role in TDM was active, shared or passive were 36, 33 and 31%, respectively. Congruence between actual and preferred roles in TDM was 58%. Actual role in TDM was not associated...
As the incidence of prostate cancer has, until recently, increased in most developed countries, t... more As the incidence of prostate cancer has, until recently, increased in most developed countries, the rates of prostate biopsies, required for histological diagnosis, will also have increased. Little is known about the physical after-effects of prostate biopsy outside randomised control trials. We investigate reports on the physical effect of prostate biopsy undertaken in men in routine practice. A self-completed questionnaire was given to men living in the Republic of Ireland (RoI) or Northern Ireland 4 to 6 weeks after prostate biopsy. Men were asked about whether they experienced specific physical after-effects postbiopsy (raised temperature/pain/bleeding/erectile dysfunction/urinary retention) and, if so, their severity and duration, and any associated health care uses. Binomial and ordinal logistic regression was used to investigate factors associated with postbiopsy after-effects (presence/absence) and number of after-effects reported, respectively. Postbiopsy after-effects were...
Many men undergo prostate biopsies each year. Most data on consequences of prostate biopsy for me... more Many men undergo prostate biopsies each year. Most data on consequences of prostate biopsy for men pertain to physical after-effects and/or come from clinical trial populations. We quantified prevalence of, and identified factors associated with, procedure-related distress in men having prostate biopsies in routine clinical practice. Men who had undergone prostate biopsy for follow-up of a raised prostate specific antigen test result and/or abnormal digital rectal examination in six centres in Ireland completed questionnaires. Biopsy-related psychological distress was measured using the Impact of Event Scale (IES). An IES score ≥9 was considered significant biopsy-related distress. Logistic regression was used to identify predictors of significant distress. 335 men completed questionnaires. Overall 49% had significant biopsy-related distress; this was higher in men whose biopsy result indicated cancer (59%) and those who did not have a definitive result (54%) than those with a negat...
Statin use after colorectal cancer diagnosis may improve survival but evidence from observational... more Statin use after colorectal cancer diagnosis may improve survival but evidence from observational studies is conflicting. The anti-cancer effect of statins may be restricted to certain molecular subgroups. In this population-based cohort study, the interaction between p53 and 3-hydroxy-3-methylglutaryl coenzyme-A reductase (HMGCR) expression, KRAS mutations, and the association between statin use and colon cancer survival was assessed. The cohort consisted of 740 stage II and III colon cancer patients diagnosed between 2004 and 2008. Statin use was determined through clinical note review. Tissue blocks were retrieved to determine immunohistochemical expression of p53 and HMGCR in tissue microarrays and the presence of KRAS mutations in extracted DNA. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for colorectal cancer-specific and overall survival. Statin use was not associated with improved cancer-specific survival in t...
To investigate effects on men's health and well-being of higher prostate cancer (PCa) investi... more To investigate effects on men's health and well-being of higher prostate cancer (PCa) investigation and treatment levels in similar populations. PCa survivors in Ireland where the Republic of Ireland (RoI) has a 50% higher PCa incidence than Northern Ireland (NI). A cross-sectional postal questionnaire was sent to PCa survivors 2-18 years post-treatment, seeking information about current physical effects of treatment, health-related quality of life (HRQoL; EORTC QLQ-C30; EQ-5D-5L) and psychological well-being (21 question version of the Depression, Anxiety and Stress Scale, DASS-21). Outcomes in RoI and NI survivors were compared, stratifying into 'late disease' (stage III/IV and any Gleason grade (GG) at diagnosis) and 'early disease' (stage I/II and GG 2-7). Responses were weighted by age, jurisdiction and time since diagnosis. Between-country differences were investigated using multivariate logistic and linear regression. 3348 men responded (RoI n=2567; NI n=7...
Objective Fear of recurrence (FOR) is a key concern among survivors of all cancers. In prostate c... more Objective Fear of recurrence (FOR) is a key concern among survivors of all cancers. In prostate cancer, FOR varies with health and treatment type, but little is known about how survivors' appraisals of their treatment, and in particular, their level of regret over treatment decisions may affect this. Methods A total of 1229 prostate cancer survivors between 2-and 5-years postdiagnosis were invited to complete a postal questionnaire including a FOR scale, Decisional Regret Scale, and the European Organization for Research and Treatment of Cancer QLQ C30 health-related quality of life (HRQoL) instrument. Multiple regression analysis explored the impact of 3 blocks of factors on FOR: (1) demographic characteristics and disease extent, (2) primary treatment received and health status (treatment side effects and HRQoL), and (3) treatment appraisals, specifically satisfaction with information received regarding treatment and level of regret experienced over treatment decisions. Results The final multivariable model explained 27% of variance on FOR. Significant correlates of lower FOR included having localised disease, having undergone an invasive treatment, as well as health status (higher HRQoL and fewer ongoing side effects). Beyond this, appraisals of treatment significantly contributed to the model: More decisional regret and lower satisfaction with information received were associated with higher FOR. Conclusion These findings suggest that FOR may be mitigated by providing survivors with more information regarding treatment choices and the treatment itself so that men can make well-informed decisions and experience less future regret. Sensitivity analysis for variables predicting FOR among prostate cancer survivors is not suspected of having a recurrence.
Background: Understanding men's experience of prostate biopsy is important as the procedure is co... more Background: Understanding men's experience of prostate biopsy is important as the procedure is common, invasive and carries potential risks. The psychological aspects of prostate biopsy have been somewhat neglected. The aim of this study was to explore the level of regret experienced by men after prostate biopsy and identify any associated factors. Methods: Men attending four clinics in Republic of Ireland and two in Northern Ireland were given a questionnaire to explore their experience of prostate biopsy. Regret was measured on a Likert scale asking men how much they agreed with the statement "It [the biopsy] is something I regret." Results: Three hundred thirty-five men responded to the survey. The mean age was 63 years (SD ±7 years). Three quarters of respondents (76%) were married or co-habiting, and (75%) finished education at primary or secondary school level. For just over two thirds of men (70%) their recent biopsy represented their first ever prostate biopsy. Approximately one third of men reported a diagnosis of cancer, one third a negative biopsy result, and the remaining third did not know their result. Two thirds of men reported intermediate or high health anxiety. 5.1% of men agreed or strongly agreed that they regretted the biopsy. Conclusions: Level of regret was low overall. Health anxiety was the only significant predictor of regret, with men with higher anxiety reporting higher levels of regret than men with low anxiety (OR = 3.04, 95% CI 1.58, 5.84). Men with high health anxiety may especially benefit from careful counselling before and after prostate biopsy.
Prostate cancer and its treatment may impact physically, psychologically and socially; affecting ... more Prostate cancer and its treatment may impact physically, psychologically and socially; affecting the health-related quality of life of men and their partners/spouses. The Life After Prostate Cancer Diagnosis (LAPCD) study is a UK-wide patient-reported outcomes study which will generate information to improve the health and well-being of men with prostate cancer. Postal surveys will be sent to prostate cancer survivors (18-42 months postdiagnosis) in all 4 UK countries (n=∼70 000). Eligible men will be identified and/or verified through cancer registration systems. Men will be surveyed twice, 12 months apart, to explore changes in outcomes over time. Second, separate cohorts will be surveyed once and the design will include evaluation of the acceptability of online survey tools. A comprehensive patient-reported outcome measure has been developed using generic and specific instruments with proven psychometric properties and relevance in national and international studies. The outcome ...
Over 80% of the nearly 1 million men diagnosed with prostate cancer annually worldwide present wi... more Over 80% of the nearly 1 million men diagnosed with prostate cancer annually worldwide present with localised or locally advanced non-metastatic disease. Risk stratification is the cornerstone for clinical decision making and treatment selection for these men. The most widely applied stratification systems use presenting prostate-specific antigen (PSA) concentration, biopsy Gleason grade, and clinical stage to classify patients as low, intermediate, or high risk. There is, however, significant heterogeneity in outcomes within these standard groupings. The International Society of Urological Pathology (ISUP) has recently adopted a prognosis-based pathological classification that has yet to be included within a risk stratification system. Here we developed and tested a new stratification system based on the number of individual risk factors and incorporating the new ISUP prognostic score. Diagnostic clinicopathological data from 10,139 men with non-metastatic prostate cancer were avai...
Cancer is a major public health issue in Northern Ireland with one in three of the population dev... more Cancer is a major public health issue in Northern Ireland with one in three of the population developing some form of the disease by the time they reach 75 years. However in many ways cancer is a misunderstood disease with the common perception that it is unavoidable and almost always fatal. In this paper we give an overview of the cancer burden in Northern Ireland, focusing on the many aspects of cancer mortality including the distribution by cancer type, trends over time and variations by geographic area and socioeconomic factors. Cancer mortality patterns are put into context alongside incidence levels and survival, and differences with the situation in the UK and Republic of Ireland are highlighted.
This is the second collaborative report of the Northern Ireland Cancer Registry and the National ... more This is the second collaborative report of the Northern Ireland Cancer Registry and the National Cancer Registry (Ireland). As with the first report, All-Ireland Cancer Statistics 1994-96, data from both registries have been merged and integrated to profile and assess the cancer incidence and mortality on the island of Ireland as a whole. As an update, the focus of analysis in this report is on data for 1998-2000, although trends are computed from 1994 forward. S Sc co op pe e a an nd d p pu ur rp po os se e The reader should note that there have been considerable changes in the design and focus of this report compared to the first. The most substantive of these is the scope. Unlike its predecessor, this report focuses on those major cancer sites that are life-threatening and: • Represent a substantial burden to the general population and can be prevented or cured, or • Are of particular interest to the public, researchers and policy makers. Among the former are colorectal, breast, lung, prostate, stomach, and oesophageal cancers, as well as melanoma of the skin. Among the latter are childhood cancer and lymphoma. Together, these constitute an average of about 12400 cancers per year or approximately 65% of the 19350 average annual total of life-threatening cancer cases. More than half of all cancer cases come from just three of these sites-two of which are the same for both sexes. For men they are prostate, lung and colorectal cancers. For women, they are breast, colorectal and lung cancers.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 23, 2015
Many men with prostate cancer are asymptomatic, diagnosed following prostate specific antigen (PS... more Many men with prostate cancer are asymptomatic, diagnosed following prostate specific antigen (PSA) testing. We investigate whether mode of detection, i.e. 'PSA detected' or 'clinically detected', was associated with psychological wellbeing among prostate cancer survivors. A cross-sectional postal questionnaire was administered in 2012 to 6559 prostate cancer (ICD10 C61) survivors up to 18 years post-diagnosis, identified through population-based cancer registries in Ireland. Psychological wellbeing was assessed using the Depression Anxiety Stress Scale-21. Logistic regression was used to investigate associations between mode of detection and depression, anxiety and stress, adjusting for socio-demographic and clinical confounders. The response rate was 54 % (3348/6262). Fifty-nine percent of survivors were diagnosed with asymptomatic PSA-tested disease. Prevalence of depression (13.8 vs 20.7 %; p < 0.001), anxiety (13.6 vs 20.9 %; p < 0.001) and stress (8.7 vs ...
Background In developed countries, more men are diagnosed with prostate cancer than any other can... more Background In developed countries, more men are diagnosed with prostate cancer than any other cancer. These men, and many others - including those with raised PSA test results and/or urinary symptoms - will have undergone a prostate biopsy. Although evidence is accumulating on the psychological impact of other diagnostic procedures, little is known about prostate biopsy. This study aimed to: quantify prevalence of, and identify factors associated with, procedure-related distress in men undergoing prostate biopsies. Method 811 men received questionnaires 4-6 weeks post-biopsy in four cancer centres (Republic of Ireland, 4; Northern Ireland, 2). Procedure-related distress was measured using the Impact of Event Scale and a score of ≥9 considered significant distress. Logistic regression was used to identify significant predictors of distress. Results 335 men completed questionnaires. Overall 49% had significant distress; this was higher in men with confirmed cancer (59%) and those stil...
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 6, 2018
To review and interpret existing qualitative literature on the experiences of couples affected by... more To review and interpret existing qualitative literature on the experiences of couples affected by prostate cancer (PCa). A metasynthesis was carried out which included a systematic search of seven databases between 2000 and 2016. A modified version of Noblit and Hare's meta-ethnographic approach was used to synthesise qualitative study findings and inform overarching interpretations. Thirty-seven studies focusing on the experiences of men with PCa and their partner dyad were included producing seven interconnected constructs. The construct accepting change vs seeking continuity reflects the range of ways individuals within the dyad and couples adjust to the diagnosis. Cultivating connection vs disengaging illustrates how couples seek to manage the impact of PCa and its treatment on their relationship, which may lead to a threatened identity, including sexual insecurities. Shielding me, you and us reflects the ways in which couples strive to protect themselves as individuals and/...
Objectives To summarize black and minority ethnic (BME) patients' and partners experiences of pro... more Objectives To summarize black and minority ethnic (BME) patients' and partners experiences of prostate cancer by examining the findings of existing qualitative studies. Methods We undertook a systematic metasynthesis of qualitative studies using a modified version of Noblit and Hare's "meta-ethnography" approach, with a 2000-2015 search of 7 databases. Results Thirteen studies of men from US and UK BME groups were included. We explored constructs with BME-specific features. Health care provider relationships, formation of a spiritual alliance with God (which enhanced the participants' feeling of empowerment and ability to cope with the cancer), and living on for others (generally to increase cancer awareness), often connected to spiritual regrowth, were the 3 constructs most commonly reported. A magnified effect from erectile dysfunction was also common. Initially, this affected men's disclosure to others about their cancer and their sexual problems, but eventually men responded by shifting their conceptualizations of masculinity to sustain self and social identities. There was also evidence of inequality resulting from financial constraints and adversity that necessitated resilience in coping. Conclusions The prostate cancer experience of BME men and their partners is affected by a complex intersection of ethnicity with other factors. Health care services should acknowledge this. If providers recognize the men's felt masculinities, social identities, and spiritual beliefs and their shifting nature, services could be improved, with community as well as individual benefits. More studies are needed in diverse ethnic groups.
An estimate of cancer deaths and incidence for the years 1997 and 2002, taking account of current... more An estimate of cancer deaths and incidence for the years 1997 and 2002, taking account of current trends and population projections for Northern Ireland is presented below. These numbers will be of value to those planning services and, in particular, for those implementing the report "Cancer Services - Investing for the Future". Cancer deaths are expected to rise by almost 13% to 4056 by the year 2002. Marked rises are expected in the number of deaths from cancer of the lung, oesophagus, kidney, bladder and prostate with smaller rises in deaths from breast and pancreatic cancer. The fall in stomach cancer is expected to continue as is the trend of lower deaths from cervical cancer. Deaths from cancer of the colon and rectum are expected to remain static. Estimates of cancer incidence currently and for the years 1997 and 2002 are also included. The impact of tobacco use by the population, which poses a current and future serious threat to public health is highlighted.
Background: Randomized controlled trials have demonstrated significant reductions in colorectal c... more Background: Randomized controlled trials have demonstrated significant reductions in colorectal cancer incidence and mortality associated with polypectomy. However, little is known about whether polypectomy is effective at reducing colorectal cancer risk in routine clinical practice. The aim of this investigation was to quantify colorectal cancer risk following polypectomy in a large prospective population-based cohort study.Methods: Patients with incident colorectal polyps between 2000 and 2005 in Northern Ireland were identified via electronic pathology reports received to the Northern Ireland Cancer Registry. Patients were matched to the Northern Ireland Cancer Registry to detect colorectal cancer and deaths up to December 31, 2010. Colorectal cancer standardized incidence ratios (SIR) were calculated and Cox proportional hazards modeling applied to determine colorectal cancer risk.Results: During 44,724 person-years of follow-up, 193 colorectal cancer cases were diagnosed among ...
Background The COVID-19 pandemic has placed an inexorable strain on endoscopy services worldwide,... more Background The COVID-19 pandemic has placed an inexorable strain on endoscopy services worldwide, affecting the diagnosis of oesophago-gastric (OG) cancer and Barrett’s oesophagus (BO). As coronavirus infection rates rose many professional bodies advised that all endoscopy, except emergency and essential procedures be stopped immediately. We sought to quantify the decline in OG cancer and BO diagnoses following implementation of British Society of Gastroenterology (BSG) guidance related to COVID-19 and the psychosocial effects on BO patients. Methods We examined OG cancer and BO diagnoses in Northern Ireland from March-September 2020 and compared them with the three-year average number of patients during the same time period (corresponding to weeks 10-37) between 2017-2019 by utilising Northern Ireland Cancer Registry (NICR) data. The psychosocial impact of COVID-19 was assessed using an online survey, which included validated WHOQOL-BREF and EQ-5D-5L quality of life measures, and ...
A systematic review suggests that 25% of oesophageal adenocarcinomas (OAC) are 'missed' a... more A systematic review suggests that 25% of oesophageal adenocarcinomas (OAC) are 'missed' at index endoscopy for Barrett's oesophagus (BO); however, this included few population-based studies and may be an overestimate. The objective of this article is to quantify the 'missed' rates of high-grade dysplasia (HGD) and OAC at index BO endoscopy. Patients from the Northern Ireland BO register diagnosed between 1993 and 2010 ( = 13,159) were linked to the Northern Ireland Cancer Registry to identify patients who developed OAC or HGD. Logistic regression analysis compared characteristics of 'missed' vs 'incident' HGD/OAC, defined as diagnoses within 3-12 months vs >1 year after incident BO, respectively. A total of 267 patients were diagnosed with HGD/OAC ≥3 months after BO diagnosis, of whom 34 (12.7%) were potentially 'missed'. The proportion of 'missed' HGD/OAC was 25% among BO patients with low-grade dysplasia (LGD) and 9% among non...
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 8, 2017
We investigated associations between treatment decision making (TDM) and global health-related-qu... more We investigated associations between treatment decision making (TDM) and global health-related-quality-of-life (gHRQoL) among prostate cancer (PCa) survivors. Postal questionnaires were sent to 6559 PCa survivors 2-18 years post-diagnosis, identified through population-based cancer registries in Ireland. The Control Preference Scale was used to investigate respondents' 'actual' and 'preferred' role in TDM. The TDM experience was considered 'congruent' when actual and preferred roles matched and 'incongruent' otherwise. The EORTC QLQ-C30 was used to measure gHRQoL. Multivariate linear regression was employed to investigate associations between (i) actual role in TDM, (ii) congruence in TDM, and gHRQoL. The response rate was 54% (n = 3348). The percentages of men whose actual role in TDM was active, shared or passive were 36, 33 and 31%, respectively. Congruence between actual and preferred roles in TDM was 58%. Actual role in TDM was not associated...
As the incidence of prostate cancer has, until recently, increased in most developed countries, t... more As the incidence of prostate cancer has, until recently, increased in most developed countries, the rates of prostate biopsies, required for histological diagnosis, will also have increased. Little is known about the physical after-effects of prostate biopsy outside randomised control trials. We investigate reports on the physical effect of prostate biopsy undertaken in men in routine practice. A self-completed questionnaire was given to men living in the Republic of Ireland (RoI) or Northern Ireland 4 to 6 weeks after prostate biopsy. Men were asked about whether they experienced specific physical after-effects postbiopsy (raised temperature/pain/bleeding/erectile dysfunction/urinary retention) and, if so, their severity and duration, and any associated health care uses. Binomial and ordinal logistic regression was used to investigate factors associated with postbiopsy after-effects (presence/absence) and number of after-effects reported, respectively. Postbiopsy after-effects were...
Many men undergo prostate biopsies each year. Most data on consequences of prostate biopsy for me... more Many men undergo prostate biopsies each year. Most data on consequences of prostate biopsy for men pertain to physical after-effects and/or come from clinical trial populations. We quantified prevalence of, and identified factors associated with, procedure-related distress in men having prostate biopsies in routine clinical practice. Men who had undergone prostate biopsy for follow-up of a raised prostate specific antigen test result and/or abnormal digital rectal examination in six centres in Ireland completed questionnaires. Biopsy-related psychological distress was measured using the Impact of Event Scale (IES). An IES score ≥9 was considered significant biopsy-related distress. Logistic regression was used to identify predictors of significant distress. 335 men completed questionnaires. Overall 49% had significant biopsy-related distress; this was higher in men whose biopsy result indicated cancer (59%) and those who did not have a definitive result (54%) than those with a negat...
Statin use after colorectal cancer diagnosis may improve survival but evidence from observational... more Statin use after colorectal cancer diagnosis may improve survival but evidence from observational studies is conflicting. The anti-cancer effect of statins may be restricted to certain molecular subgroups. In this population-based cohort study, the interaction between p53 and 3-hydroxy-3-methylglutaryl coenzyme-A reductase (HMGCR) expression, KRAS mutations, and the association between statin use and colon cancer survival was assessed. The cohort consisted of 740 stage II and III colon cancer patients diagnosed between 2004 and 2008. Statin use was determined through clinical note review. Tissue blocks were retrieved to determine immunohistochemical expression of p53 and HMGCR in tissue microarrays and the presence of KRAS mutations in extracted DNA. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for colorectal cancer-specific and overall survival. Statin use was not associated with improved cancer-specific survival in t...
To investigate effects on men's health and well-being of higher prostate cancer (PCa) investi... more To investigate effects on men's health and well-being of higher prostate cancer (PCa) investigation and treatment levels in similar populations. PCa survivors in Ireland where the Republic of Ireland (RoI) has a 50% higher PCa incidence than Northern Ireland (NI). A cross-sectional postal questionnaire was sent to PCa survivors 2-18 years post-treatment, seeking information about current physical effects of treatment, health-related quality of life (HRQoL; EORTC QLQ-C30; EQ-5D-5L) and psychological well-being (21 question version of the Depression, Anxiety and Stress Scale, DASS-21). Outcomes in RoI and NI survivors were compared, stratifying into 'late disease' (stage III/IV and any Gleason grade (GG) at diagnosis) and 'early disease' (stage I/II and GG 2-7). Responses were weighted by age, jurisdiction and time since diagnosis. Between-country differences were investigated using multivariate logistic and linear regression. 3348 men responded (RoI n=2567; NI n=7...
Objective Fear of recurrence (FOR) is a key concern among survivors of all cancers. In prostate c... more Objective Fear of recurrence (FOR) is a key concern among survivors of all cancers. In prostate cancer, FOR varies with health and treatment type, but little is known about how survivors' appraisals of their treatment, and in particular, their level of regret over treatment decisions may affect this. Methods A total of 1229 prostate cancer survivors between 2-and 5-years postdiagnosis were invited to complete a postal questionnaire including a FOR scale, Decisional Regret Scale, and the European Organization for Research and Treatment of Cancer QLQ C30 health-related quality of life (HRQoL) instrument. Multiple regression analysis explored the impact of 3 blocks of factors on FOR: (1) demographic characteristics and disease extent, (2) primary treatment received and health status (treatment side effects and HRQoL), and (3) treatment appraisals, specifically satisfaction with information received regarding treatment and level of regret experienced over treatment decisions. Results The final multivariable model explained 27% of variance on FOR. Significant correlates of lower FOR included having localised disease, having undergone an invasive treatment, as well as health status (higher HRQoL and fewer ongoing side effects). Beyond this, appraisals of treatment significantly contributed to the model: More decisional regret and lower satisfaction with information received were associated with higher FOR. Conclusion These findings suggest that FOR may be mitigated by providing survivors with more information regarding treatment choices and the treatment itself so that men can make well-informed decisions and experience less future regret. Sensitivity analysis for variables predicting FOR among prostate cancer survivors is not suspected of having a recurrence.
Background: Understanding men's experience of prostate biopsy is important as the procedure is co... more Background: Understanding men's experience of prostate biopsy is important as the procedure is common, invasive and carries potential risks. The psychological aspects of prostate biopsy have been somewhat neglected. The aim of this study was to explore the level of regret experienced by men after prostate biopsy and identify any associated factors. Methods: Men attending four clinics in Republic of Ireland and two in Northern Ireland were given a questionnaire to explore their experience of prostate biopsy. Regret was measured on a Likert scale asking men how much they agreed with the statement "It [the biopsy] is something I regret." Results: Three hundred thirty-five men responded to the survey. The mean age was 63 years (SD ±7 years). Three quarters of respondents (76%) were married or co-habiting, and (75%) finished education at primary or secondary school level. For just over two thirds of men (70%) their recent biopsy represented their first ever prostate biopsy. Approximately one third of men reported a diagnosis of cancer, one third a negative biopsy result, and the remaining third did not know their result. Two thirds of men reported intermediate or high health anxiety. 5.1% of men agreed or strongly agreed that they regretted the biopsy. Conclusions: Level of regret was low overall. Health anxiety was the only significant predictor of regret, with men with higher anxiety reporting higher levels of regret than men with low anxiety (OR = 3.04, 95% CI 1.58, 5.84). Men with high health anxiety may especially benefit from careful counselling before and after prostate biopsy.
Prostate cancer and its treatment may impact physically, psychologically and socially; affecting ... more Prostate cancer and its treatment may impact physically, psychologically and socially; affecting the health-related quality of life of men and their partners/spouses. The Life After Prostate Cancer Diagnosis (LAPCD) study is a UK-wide patient-reported outcomes study which will generate information to improve the health and well-being of men with prostate cancer. Postal surveys will be sent to prostate cancer survivors (18-42 months postdiagnosis) in all 4 UK countries (n=∼70 000). Eligible men will be identified and/or verified through cancer registration systems. Men will be surveyed twice, 12 months apart, to explore changes in outcomes over time. Second, separate cohorts will be surveyed once and the design will include evaluation of the acceptability of online survey tools. A comprehensive patient-reported outcome measure has been developed using generic and specific instruments with proven psychometric properties and relevance in national and international studies. The outcome ...
Over 80% of the nearly 1 million men diagnosed with prostate cancer annually worldwide present wi... more Over 80% of the nearly 1 million men diagnosed with prostate cancer annually worldwide present with localised or locally advanced non-metastatic disease. Risk stratification is the cornerstone for clinical decision making and treatment selection for these men. The most widely applied stratification systems use presenting prostate-specific antigen (PSA) concentration, biopsy Gleason grade, and clinical stage to classify patients as low, intermediate, or high risk. There is, however, significant heterogeneity in outcomes within these standard groupings. The International Society of Urological Pathology (ISUP) has recently adopted a prognosis-based pathological classification that has yet to be included within a risk stratification system. Here we developed and tested a new stratification system based on the number of individual risk factors and incorporating the new ISUP prognostic score. Diagnostic clinicopathological data from 10,139 men with non-metastatic prostate cancer were avai...
Cancer is a major public health issue in Northern Ireland with one in three of the population dev... more Cancer is a major public health issue in Northern Ireland with one in three of the population developing some form of the disease by the time they reach 75 years. However in many ways cancer is a misunderstood disease with the common perception that it is unavoidable and almost always fatal. In this paper we give an overview of the cancer burden in Northern Ireland, focusing on the many aspects of cancer mortality including the distribution by cancer type, trends over time and variations by geographic area and socioeconomic factors. Cancer mortality patterns are put into context alongside incidence levels and survival, and differences with the situation in the UK and Republic of Ireland are highlighted.
This is the second collaborative report of the Northern Ireland Cancer Registry and the National ... more This is the second collaborative report of the Northern Ireland Cancer Registry and the National Cancer Registry (Ireland). As with the first report, All-Ireland Cancer Statistics 1994-96, data from both registries have been merged and integrated to profile and assess the cancer incidence and mortality on the island of Ireland as a whole. As an update, the focus of analysis in this report is on data for 1998-2000, although trends are computed from 1994 forward. S Sc co op pe e a an nd d p pu ur rp po os se e The reader should note that there have been considerable changes in the design and focus of this report compared to the first. The most substantive of these is the scope. Unlike its predecessor, this report focuses on those major cancer sites that are life-threatening and: • Represent a substantial burden to the general population and can be prevented or cured, or • Are of particular interest to the public, researchers and policy makers. Among the former are colorectal, breast, lung, prostate, stomach, and oesophageal cancers, as well as melanoma of the skin. Among the latter are childhood cancer and lymphoma. Together, these constitute an average of about 12400 cancers per year or approximately 65% of the 19350 average annual total of life-threatening cancer cases. More than half of all cancer cases come from just three of these sites-two of which are the same for both sexes. For men they are prostate, lung and colorectal cancers. For women, they are breast, colorectal and lung cancers.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 23, 2015
Many men with prostate cancer are asymptomatic, diagnosed following prostate specific antigen (PS... more Many men with prostate cancer are asymptomatic, diagnosed following prostate specific antigen (PSA) testing. We investigate whether mode of detection, i.e. 'PSA detected' or 'clinically detected', was associated with psychological wellbeing among prostate cancer survivors. A cross-sectional postal questionnaire was administered in 2012 to 6559 prostate cancer (ICD10 C61) survivors up to 18 years post-diagnosis, identified through population-based cancer registries in Ireland. Psychological wellbeing was assessed using the Depression Anxiety Stress Scale-21. Logistic regression was used to investigate associations between mode of detection and depression, anxiety and stress, adjusting for socio-demographic and clinical confounders. The response rate was 54 % (3348/6262). Fifty-nine percent of survivors were diagnosed with asymptomatic PSA-tested disease. Prevalence of depression (13.8 vs 20.7 %; p < 0.001), anxiety (13.6 vs 20.9 %; p < 0.001) and stress (8.7 vs ...
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Papers by Anna gavin