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ABSTRACT: BACKGROUND: Ovarian cancer has the highest mortality rate of all gynaecologic cancers. Faced with poor prognoses, stressful treatment effects and a high likelihood of recurrence, survivors must confront significant physical and psychological morbidities that negatively impact health-related quality of life. Frequently reported side effects include cancer-related fatigue, peripheral neuropathy, and psychological distress. Exercise and cognitive behavioral therapy interventions have counteracted such adverse effects in other cancer populations. OBJECTIVE: To investigate the feasibility and benefits of a 24-week home-based exercise intervention, coordinated with 12 weeks of cognitive behavioral therapy (two sessions per month), developed for two types of patients diagnosed with epithelial ovarian cancer: 1) those undergoing primary treatment with adjuvant chemotherapy after primary surgery; 2) those on surveillance after completing treatment within the last 2 years. METHODS: Participants were recruited from the Gynaecologic Oncology Clinic. Eligible participants completed baseline assessments and were provided with home-based exercise equipment. Cognitive behavioral therapy was provided every other week for patients via telephone. Assessments were completed at baseline (T1), 3 months (T2) and 6 months (T3). RESULTS: 19 of the 46 eligible patients approached were enrolled, with 7 patients in the treatment group and 12 in the surveillance group. There was a significant within group increase in peak VO2 from baseline to 6 months: F(2,16) = 5.531, p = 0.015, partial eta2 = 0.409. CONCLUSION: The combined 6-month exercise-cognitive behavioral therapy intervention was associated with significant increases in aerobic fitness in epithelial ovarian cancer patients assessed. These improvements were similar regardless of whether the patient was receiving chemotherapy or under surveillance.
Journal of Ovarian Research 04/2013; 6(1):21. · 2.57 Impact Factor
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ABSTRACT: BACKGROUND: Prior to the 2009 H1N1 Influenza pandemic, public health authorities in Canada and elsewhere prepared for the future outbreak, partly guided by an ethical framework developed within the Canadian Program of Research on Ethics in a Pandemic (CanPREP). We developed a telephone-based survey based on that framework, which was delivered across Canada in late 2008. In June, 2009, the WHO declared pandemic Phase 6 status and from the subsequent October (2009) until May 2010, the CanPREP team fielded a second (revised) survey, collecting another 1,000 opinions from Canadians during a period of pre-pandemic anticipation and peri-pandemic experience. METHODS: Surveys were administered by telephone with random sampling achieved via random digit dialing. Eligible participants were adults, 18 years or older, with per province stratification approximating provincial percentages of national population. Descriptive results were tabulated and logistic regression analyses used to assess whether demographic factors were significantly associated with outcomes, and to identify divergences (between the pre-pandemic and intra-pandemic surveys). RESULTS: N = 1,029 interviews were completed from 1,986 households, yielding a gross response rate of 52% (AAPOR Standard Definition 3). Over 90% of subjects indicated the most important goal of pandemic influenza preparations was saving lives, with 41% indicating that saving lives solely in Canada was the highest priority and 50% indicating saving lives globally was the highest priority. About 90% of respondents supported the obligation of health care workers to report to work and face influenza pandemic risks excepting those with serious health conditions which that increased risks. Strong majorities favoured stocking adequate protective antiviral dosages for all Canadians (92%) and, if effective, influenza vaccinations (95%). Over 70% agreed Canada should provide international assistance to poorer countries for pandemic preparation, even if resources for Canadians were reduced. CONCLUSIONS: Results suggest Canadians trust public health officials to make difficult decisions, providing emphasis is maintained on reciprocity and respect for individual rights. Canadians also support international obligations to help poorer countries and associated efforts to save lives outside the country, even if intra-national efforts are reduced.
BMC Public Health 03/2013; 13(1):271. · 2.00 Impact Factor
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ABSTRACT: OBJECTIVES: A small positive association has been consistently demonstrated between perceived breast cancer risk and mammography use. Evidence specific to women with familial breast cancer risk has not been previously reviewed. METHODS: A literature search was conducted. 186 studies were identified for abstract/full-text review, of which 10 articles were included. Manual searching identified 10 additional articles. Twenty articles examining the association between perceived breast cancer risk and adherence to mammography, clinical breast examination (CBE) or breast self-examination (BSE) guidelines among women with familial breast cancer risk were reviewed. Studies were classified according to screening modality, categorized by finding and ordered by year of publication. Studies assessing mammography were further classified according to the applied method of measuring perceived risk. RESULTS: Our review found a weak positive association between higher perceived risk and adherence to mammography guidelines among women with familial breast cancer risk. Consistent associations between perceived risk and adherence to CBE and BSE guidelines were not observed. CONCLUSIONS: Our ability to understand the relationship between perceived breast cancer risk and adherence to breast screening guidelines is limited, because most previous research is cross-sectional. Future studies with prospective methodologies that use consistent measurement methods and are adequately powered are warranted.
Breast (Edinburgh, Scotland) 01/2013; · 2.09 Impact Factor
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ABSTRACT: Androgen deprivation therapy (ADT) for prostate cancer (PCa) has side effects that significantly impair health-related quality of life (HRQOL). Exercise ameliorates many side effects of ADT but different modalities, particularly in the home-based setting, have not been well-studied. In this study we randomly assigned 66 PCa survivors receiving ADT to 6 months of home-based aerobic or resistance training. Psychosocial wellbeing and physical fitness were measured at baseline, 3 and 6 months, and then 6 months post-intervention. Intention-to-treat analyses showed that fatigue and HRQOL were not significantly different between groups; however, in a per-protocol analysis the resistance exercise training group demonstrated clinically significant improvements in HRQOL. Differential within-groups effects on physical fitness were also observed at various time-points. At all time-points, the aerobic training group engaged in significantly more physical activity than the resistance training group; a finding that should be further examined given evidence-based guidelines for activity volume in cancer survivors.
Journal of Aging and Physical Activity 12/2012;
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ABSTRACT: To determine family physician perspectives regarding the acceptability and effectiveness of 2 interventions-a targeted, mailed invitation for screening to patients, and family physician audit-feedback reports-and on the colorectal cancer (CRC) screening program generally. This information will be used to guide program strategies for increasing screening uptake.
Qualitative study.
Ontario.
Family physicians (n = 65).
Seven 1-hour focus groups were conducted with family physicians using teleconferencing and Web-based technologies. Responses were elicited regarding family physicians' perspectives on the mailing of invitations to patients, the content and design of the audit-feedback reports, the effect of participation in the pilot project on daily practice, and overall CRC screening program function.
Key themes included strong support for both interventions and for the CRC screening program generally. Moderate support was found for direct mailing of fecal occult blood testing (FOBT) kits. Participants identified potential pitfalls if interventions were implemented outside of patient enrolment model practices. Participants expressed relatively strong support for colonoscopy as a CRC screening test but relatively weak support for FOBT.
Although the proposed interventions to increase the uptake of CRC screening were highly endorsed, concerns about their applicability to non-patient enrolment model practices and the current lack of physician support for FOBT will need to be addressed to optimize intervention and program effectiveness. Our study is highly relevant to other public health programs planning organized CRC screening programs.
Canadian family physician Medecin de famille canadien 10/2012; 58(10):e570-7. · 1.19 Impact Factor
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ABSTRACT: BACKGROUND: Recent reports suggest meditation practice improves attentional performance and emotional regulation. The process of meditation apparently increases activation in the prefrontal cortex (PFC) and stimulates the reticular nucleus of the thalamus, implicating the production and delivery of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). GABAergic inhibitory interneurons have a central role in cortical inhibition (CI), modulating cortical excitability and neural plasticity. OBJECTIVE/HYPOTHESIS: Changes in CI, after completion of a single meditation session, were investigated and compared to a non-meditating control activity. METHODS: Transcranial magnetic stimulation (TMS), a non-invasive method of examining CI, was used to evaluate changes before and after a 60 min meditation session. Seventy right-handed healthy subjects (n = 35 meditators, n = 35 non-meditators) were assessed using TMS related measures of cortical silent period (CSP) and short intra cortical inhibition (SICI), with stimulation of the motor cortex coordinated with EMG recording of peripheral hand muscles. RESULTS: For the meditators, CSP and SICI were measured before and after meditation sessions while age-sex matched healthy control subjects were identically assessed after a non-meditating activity (television watching). The meditators showed a statistically significant increase in CSP after meditation compared to non-meditators after an equivalent period of television watching (P = 0.02) while no significant between-group differences were observed in the SICI. CONCLUSION: These findings indicate meditation processes are linked to GABAergic cortical inhibition, a mechanism previously implicated in improved cognitive performance and enhanced emotional regulation.
Brain Stimulation 09/2012; · 3.76 Impact Factor
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ABSTRACT: Although few studies have linked cognitive variables with adherence to mammography screening in women with family histories of breast and/or ovarian cancer, research studies suggest cognitive phenomena can be powerful adherence predictors.
This prospective study included 858 women aged 30 to 71 years from the Ontario site of the Breast Cancer Family Registry with at least one first-degree relative diagnosed with breast and/or ovarian cancer. Data on beliefs about breast cancer screening and use of mammography were obtained from annual telephone interviews spanning three consecutive years. Self-reported mammogram dates were confirmed with medical imaging reports. Associations between beliefs about breast cancer screening and adherence with annual mammography were estimated using polytomous logistic regression models corrected for familial correlation. Models compared adherers (N = 329) with late-screeners (N = 382) and never-screeners (N = 147).
Women who believed mammography screening should occur annually were more likely to adhere to annual screening recommendations than women who believed it should happen less often (OR: 5.02; 95% CI: 2.97-8.49 for adherers versus late-screeners; OR: 6.82; 95% CI: 3.29-14.16 for adherers versus never-screeners). Women who believed mammography screening should start at or before age 50 (rather than after) (OR: 9.72; 95% CI: 3.26-29.02) were significantly more likely to adhere when compared with never-screeners.
Study results suggest that women with a family history of breast cancer should be strongly communicated recommendations about initial age of screening and screening intervals as related beliefs significantly predict adequate adherence.
BMC Public Health 07/2012; 12:518. · 2.00 Impact Factor
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ABSTRACT: This study assessed a Web-based cognitive-behavioral therapy (CBT) for maladaptive perfectionism, investigating perfectionism, anxiety, depression, negative automatic thoughts, and perceived stress.
Participants were undergraduate students defined as maladaptive perfectionists through a screening questionnaire at an urban university. The data were collected from July 2009 to August 2010.
Forty-seven maladaptive perfectionists were randomly assigned to a 12-week CBT or a wait-list control group and assessed via questionnaires at pre- and postintervention. Statistical procedures included t tests, Pearson correlations, and analysis of covariance.
At the postintervention measure, the CBT group demonstrated significant decreases in anxiety sensitivity and negative automatic thoughts compared to the control group. Within the CBT group, changes in perfectionism scores were significantly correlated with positive changes in depression, anxiety, stress, and automatic thoughts.
The treatment group improved on psychological outcomes, demonstrating the effectiveness of a Web-based CBT for perfectionism in a university setting.
Journal of American College Health 07/2012; 60(5):357-66. · 1.45 Impact Factor
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ABSTRACT: The present study assessed the effectiveness of a web-based psycho-educational intervention protocol for decreasing levels
of perfectionism and psychological distress. Different levels of therapeutic intervention (no treatment, general stress management
intervention, general stress management intervention plus cognitive behavioral intervention) were provided to perfectionistic
participants over a 10-week period. It was found via a longitudinal structural equation model that higher levels of therapeutic
intervention predicted greater improvements in perfectionism and psychological distress. Further, amount of improvement in
trait perfectionism and perfectionistic automatic thoughts was highly related to amount of improvement in psychological distress.
The findings attest to the potential usefulness of a web-based intervention that combines a general stress management intervention
with a cognitive behavioral intervention.
Journal of Rational-Emotive and Cognitive-Behavior Therapy 04/2012; 26(3):151-167.
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ABSTRACT: Several lines of evidence suggest that cognitive behavioral therapy (CBT) is an effective treatment for depression and anxiety disorders. Evidence suggests that the therapeutic effects of CBT are related to neurophysiologic changes in the cortex, particularly γ-aminobutyric acid (GABA) potentiation. Transcranial magnetic stimulation (TMS) represents a noninvasive method of measuring cortical inhibition, which is a neurophysiologic mechanism associated with the pathophysiology of several psychiatric disorders.
To demonstrate the effectiveness of a 12-week CBT intervention compared with a wait list control group measuring cortical inhibition in participants with pathologic perfectionism. Participants within the CBT group would demonstrate increases in cortical inhibition and improvements on clinical outcomes relative to the wait list control group.
Twenty-four right-handed perfectionists were randomly assigned to a 12-week CBT intervention or a wait list control group. Cortical inhibition was measured at pre- and postintervention with TMS paradigms specifically short-interval cortical inhibition and the cortical silent period, which index GABAA and GABAB receptor-mediated inhibitory neurotransmission, respectively.
The CBT group demonstrated a significant potentiation of the cortical silent period when compared with the wait list control group. The CBT group demonstrated a decrease in anxiety sensitivity and automatic thoughts relative to the control group.
These findings demonstrate that CBT tailored for perfectionism is accompanied by an increase in cortical inhibition of the motor cortex and positive changes on clinical outcomes. These findings provide compelling evidence for an association between positive CBT effects and a potentiation of GABAergic inhibitory neurotransmission.
Brain Stimulation 01/2012; 5(1):44-54. · 3.76 Impact Factor
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ABSTRACT: Background. Few prospective studies have examined associations between breast cancer worry and screening behaviours in women with elevated breast cancer risks based on family history. Methods. This study included 901 high familial risk women, aged 23-71 years, from the Ontario site of the Breast Cancer Family Registry. Self-reported breast screening behaviours at year-one followup were compared between women at low (N = 305), medium (N = 433), and high (N = 163) levels of baseline breast cancer worry using logistic regression. Nonlinear relationships were assessed using likelihood ratio tests. Results. A significant non-linear inverted "U" relationship was observed between breast cancer worry and mammography screening (P = 0.034) for all women, where women at either low or high worry levels were less likely than those at medium to have a screening mammogram. A similar significant non-linear inverted "U" relationship was also found among all women and women at low familial risk for worry and screening clinical breast examinations (CBEs). Conclusions. Medium levels of cancer worries predicted higher rates of screening mammography and CBE among high-risk women.
Journal of Cancer Epidemiology 01/2012; 2012:545062.
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ABSTRACT: This study assessed the effectiveness of a web-based cognitive behavioral intervention (CBT) in reducing perfectionism and psychological distress in post-secondary students. Participants assessed as high in perfectionism (n=77) were randomized to one of three 10-week, web-based, intervention conditions (no treatment [NT], general stress management [GSM], or CBT). Results indicated the CBT condition was effective in reducing perfectionism, and supported a pattern of significantly greater improvement than observed in participants in the GSM or NT conditions. While both CBT and GSM demonstrated capacities to significantly reduce distress, for CBT participants changes in perfectionism were significantly correlated with changes in depression and anxiety. Results offer support for the effectiveness of web-based CBT in positively affecting perfectionist-related problems. Given the considerable proportion of individuals who suffer from perfectionism-related distress, the intervention's apparent effectiveness, cost-effectiveness and ease of dissemination warrant future replication studies.
Psychotherapy Research 11/2011; 22(2):194-207. · 1.75 Impact Factor
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Gary Naglie,
David B Hogan,
Murray Krahn,
B Lynn Beattie,
Sandra E Black,
Chris Macknight,
Morris Freedman,
Christopher Patterson,
Michael Borrie,
Howard Bergman,
Anna Byszewski,
David Streiner,
Jane Irvine, Paul Ritvo,
Janna Comrie,
Matthew Kowgier,
George Tomlinson
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ABSTRACT: To assess whether the core symptoms of Alzheimer disease (AD) consistently predict patient self-rated quality of life (QOL) as assessed by a variety of QOL measures in a large national sample of AD patients.
Cross-sectional.
Fifteen dementia and geriatric clinics across Canada.
Community-living patients with AD (n = 370) with Mini-Mental State Exam (MMSE) scores greater than 10.
Patients rated their QOL by using two utility indexes, the European QOL-5 Dimensions and the Quality of Well-Being Scale, a global QOL Visual Analog Scale, and the disease-specific QOL-AD instrument. Cognition was assessed with the AD Assessment Scale-Cognitive subscale and MMSE, function with the Disability Assessment for Dementia, and behavioral and psychological symptoms with the Neuropsychiatric Inventory and the Geriatric Depression Scale (GDS). One-way analysis of variance and fully adjusted multiple linear regression were used to assess the relationship between core dementia symptoms and QOL ratings.
The QOL measures had only small-to-moderate correlations with each other. For all QOL measures, patient ratings were significantly lower among patients with more depressive symptoms. In multivariable analyses, the GDS score was the only significant independent predictor of patient self-ratings for all four QOL measures.
Self-rated symptoms of depression were a consistent independent predictor of patient-rated QOL across diverse QOL measures, while performance-based measures of cognition and informant-based functional status were not. These findings confirm the importance of identifying and treating depression in patients with AD and endorse the use of measures of self-rated depressive symptoms and QOL as outcomes in AD clinical trials.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 10/2011; 19(10):881-90. · 3.35 Impact Factor
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Gary Naglie,
David B Hogan,
Murray Krahn,
Sandra E Black,
B Lynn Beattie,
Christopher Patterson,
Chris Macknight,
Morris Freedman,
Michael Borrie,
Anna Byszewski,
Howard Bergman,
David Streiner,
Jane Irvine, Paul Ritvo,
Janna Comrie,
Matthew Kowgier,
George Tomlinson
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ABSTRACT: To assess whether the core symptoms of Alzheimer disease (AD) and caregiver factors consistently predict family caregiver ratings of patient quality of life (QOL) as assessed by a variety of QOL measures in a large national sample.
: Cross-sectional.
Fifteen dementia and geriatric clinics across Canada.
: Family caregivers (n = 412) of community-living patients with AD of all severities.
Caregiver ratings of patient QOL using three utility indexes, the European Quality of Life-5 Dimensions, Quality of Well-Being Scale and Health Utilities Index; a global QOL visual analogue scale; a disease-specific measure, the Quality of Life-Alzheimer's Disease; and a generic health status measure, the Short Form-36. Patient cognition was assessed with the cognitive subscale of the Alzheimer's Disease Assessment Scale and Mini-Mental State Examination, function with the Disability Assessment for Dementia, and behavioral and psychological symptoms with the Neuropsychiatric Inventory and the Geriatric Depression Scale. Caregiver burden was assessed with the Zarit Burden Interview and caregiver depression with the Center for Epidemiologic Studies Depression scale. One-way analysis of variance and fully adjusted multiple linear regression were used to assess the relationship between patient dementia symptom and caregiver variables with QOL ratings.
In multivariable analyses, caregiver ratings of patient function and depressive symptoms were the only consistent independent predictors of caregiver-rated QOL across the QOL measures.
Caregiver ratings of patient function and depression were consistent independent predictors of caregiver-rated QOL, using a spectrum of QOL measures, while measures of patient cognition and caregiver burden and depression were not. These findings support the continued use of caregiver ratings as an important source of information about patient QOL and endorse the inclusion in AD clinical trials of caregiver-rated measures of patient function, depression, and QOL.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 10/2011; 19(10):891-901. · 3.35 Impact Factor
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ABSTRACT: Community-wide efforts to encourage healthy behaviours must respond to the needs of existing neighbourhoods, especially those where low physical activity (PA) is associated with social, economic, and cultural challenges. This study reports on the effect of direct and snowball sampling strategies and financial incentive levels on the response rates of a built environment and PA survey in a predominately urban, low-SES new-immigrant community. Women residing in the Jane-Finch neighbourhood of Toronto, Ontario were selected to participate by quasi-random sampling, yielding a response rate of 41.5%. The survey completion rate per contact attempt increased 2-fold when incentives were increased from $10 to $20 and a further threefold following the increase from $20 to $30. Snowball sampled respondents were older, less likely to have full-time employment, and had lower educational attainment than directly sampled participants. With appropriate incentives, face-to-face contact, and snowball sampling, survey-based research is feasible within a low-SES, high minority population.
Journal of Immigrant and Minority Health 09/2011; · 1.16 Impact Factor
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ABSTRACT: This study compares adherence to breast and ovarian cancer screening recommendations among a population cohort of women at familial risk of breast and/or ovarian cancer. This cross-sectional study included 1039 first-degree female relatives without breast cancer identified from the Ontario site of the Breast Cancer Family Registry. We compared breast and ovarian cancer screening behaviors, using a telephone-administered questionnaire among three groups of women defined by their familial risk (high, moderate, and low) of breast and/or ovarian cancer. Associations between screening behaviors and familial risk were assessed using multinomial regression models adjusted by familial clustering. Women, 40-49 years of age, at moderate or high familial risk were significantly more likely to have had a screening mammogram within the past 12 months [odds ratio (OR): 2.80; 95% confidence interval (CI): 1.40-5.58], and women of less than 50 years of age were more likely to have a clinical breast examination (OR: 1.84; 95% CI: 1.02-3.31) compared with women at low familial risk. Compared with women at low or moderate familial risk, women at high familial risk were significantly more likely to have ever had a genetic test for the BRCA 1/2 genes (OR: 2.67; 95% CI: 1.76-4.05). Although the overall level of adherence among high-risk women is suboptimal in the community, women at a higher familial risk are adhering more often to cancer screening recommendations than women at a lower familial risk.
European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 06/2011; 20(6):492-500. · 2.21 Impact Factor
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ABSTRACT: Previously, we developed a prostate cancer (PC)-specific health state classification system, the Patient Oriented Prostate Utility Scale (PORPUS). In this study, we developed a scoring system to allow indirect calculation of utilities from the PORPUS.
We interviewed 234 PC outpatients, including those with newly diagnosed and metastatic disease, to obtain rating scale (RS) values on 4 to 6 levels of each of the 10 attributes of the PORPUS, and on 10 corner states (worst level on 1 attribute, best on 9). Patients also completed standard gamble (SG) and RS tasks on 4 multiattribute states (impotence and pain corner states, mild and severe PC symptoms). We used the RS and SG scores for multiattribute states to determine a risk aversion function for mapping values to utilities. We then tested 15 different strategies to estimate the multiattribute utility function (MAUF), using the single attribute disutilities for each level of the 10 PORPUS attributes, and the disutilities for the corner states. The root mean squared error (RMSE) of prediction of the SG on the 4 multiattribute states was used to identify the optimal strategy and scoring system.
The optimal strategy gave an RMSE of 0.06. Comparison of mean MAUF-predicted utilities to directly elicited SG utilities for the 2 multiattribute states from patients in 2 previously published studies (n = 248 and n = 141) supported the validity of the MAUF.
The scoring system together with the PORPUS comprise an indirect utility instrument, the PORPUS-U, which can be used in clinical and research settings.
Medical Decision Making 06/2011; 32(1):11-30. · 2.33 Impact Factor
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ABSTRACT: Increasing demand combined with limited capacity has resulted in long wait times for average-risk adults referred for screening colonoscopy for colorectal cancer. Management of patients on these growing wait lists is an emerging clinical issue.
To inform the content and design of a mailed targeted invitation for patients to undergo annual fecal occult blood testing (FOBT) while awaiting colonoscopy.
Focus groups (FGs) with average-risk patients on a wait list for screening colonoscopy at a high-throughput academic outpatient colonoscopy facility were conducted. During each FG session, feedback regarding a range of materials under consideration for the planned intervention was elicited using a semistructured facilitator guide. The FG sessions were recorded and transcribed verbatim, and analyzed using the constant comparative method to identify key themes.
Findings from the three FGs (n=28) suggested that average risk patients on a wait list for screening colonoscopy would be receptive to a targeted intervention recommending they undergo FOBT while waiting. Participants indicated that the invitation to undergo FOBT was an important acknowledgement that they were on an actively managed list, and that a mechanism to ensure that they were correctly triaged while waiting was in place. Several specific suggestions to improve the design of the targeted intervention were obtained.
Results of the present study provide useful information for developing effective strategies to manage average-risk individuals facing long wait times for screening colonoscopy.
Canadian journal of gastroenterology = Journal canadien de gastroenterologie 05/2011; 25(5):248-52. · 1.21 Impact Factor
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ABSTRACT: Few studies have examined the influence of perceived risk on breast screening behaviors among women with an increased familial breast cancer risk. This study included 1019 women aged 20-71 years from the Ontario site of the Breast Cancer Family Registry who had at least one first-degree relative diagnosed with breast and/or ovarian cancer. Information was obtained from a self-administered questionnaire completed at the time of recruitment and a follow-up telephone questionnaire. The associations between breast screening behaviors and perceived risk of developing breast cancer, measured on both a numerical and Likert-type verbal scale, were estimated using logistic regression analyses. Women who rated their risk of developing breast cancer as greater than 50% compared with less than 50% were significantly more likely to have a screening mammogram within the last 12 months (odds ratio: 1.91; 95% confidence interval: 1.15-3.16). Women were significantly more likely to have a screening mammogram (odds ratio: 1.82; 95% confidence interval: 1.17-2.81) in the past 12 months if they rated their risk as above or much above average compared with same as average or below. These findings may inform educational messages for improving risk communication of women at elevated familial breast cancer risk.
European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 04/2011; 20(4):255-62. · 2.21 Impact Factor
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ABSTRACT: To describe patterns of initiation of androgen deprivation therapy (ADT) in a population-based cohort of patients with prostate cancer.
All patients with prostate cancer in Ontario, Canada, who started ≥90 days of ADT at age ≥66 years in 1995-2005 were classified by ADT regimen: medical castration [oestrogen and/or luteinizing hormone-releasing hormone (LHRH) agonist); orchidectomy; antiandrogen monotherapy; combined androgen blockade (CAB) medical (medical castration plus antiandrogen); CAB surgical (orchidectomy plus antiandrogen). Indications for ADT were as follows: neoadjuvant (short-term before prostatectomy or radiation therapy); adjuvant (long-term with prostatectomy or radiation therapy); metastatic disease; biochemical recurrence; primary (localized disease); other. We examined trends in ADT regimen and indication over time.
The number of patients initiating ADT increased from 1995 to 2001 (2106-2916 per year) and declined thereafter to 2200-2300 annually (total n= 26,809). However, prostate cancer prevalence doubled over these years, and the rate of ADT initiation decreased from 16 to 7 per 100 person-years. Patterns varied by regimen and indication. Medical castration increased from 12% of all ADT in 1995 to 47% in 2005; orchidectomy decreased from 17 to 4%. Use for metastatic disease remained stable, but adjuvant therapy increased from <3% of all ADT in 1995 to 13% in 2005. Primary therapy was the most common indication, but decreased over time.
ADT initiation has fallen and marked changes occurred in treatment patterns for prostate cancer. Changes might be driven by increasing awareness of potential harms and costs, and by new evidence supporting ADT for specific indications.
BJU International 03/2011; 108(10):1588-96. · 2.84 Impact Factor
