Philip McLoone

University of Glasgow, Glasgow, Scotland, United Kingdom

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Publications (19)83.21 Total impact

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    ABSTRACT: Critical illness may be a potential determinant of cancer outcomes and geographic variations, but its role has not been described before. To determine the incidence of admission to intensive care units (ICUs) within 2 years following cancer diagnosis. This was a retrospective observational study using cancer registry data in 4 datasets from 2000 to 2009 with linked ICU admission data from 2000 to 2011, in the West of Scotland region of the United Kingdom (population, 2.4 million; all 16 ICUs within the region). All 118 541 patients (≥16 years) diagnosed as having solid (nonhematological) cancers. Their median age was 69 years, and 52.0% were women. Demographic and clinical variables associated with admission to an ICU and death in an ICU. A total of 118 541 patients met the study criteria. Overall, 6116 patients (5.2% [95% CI, 5.0%-5.3%]) developed a critical illness and were admitted to an ICU within 2 years. Risk of critical illness was highest at ages 60 to 69 years and higher in men. The cumulative incidence of critical illness was greatest for small intestinal (17.2% [95% CI, 13.3%-21.8%]) and colorectal cancers (16.5% [95% CI, 15.9%-17.1%]). The risk following breast cancer was low (0.8% [95% CI, 0.7%-1.0%]). The percentage who died in ICUs was 14.1% (95% CI, 13.3%-15.0%), and during the hospital stay, 24.6% (95% CI, 23.5%-25.7%). Mortality was greatest among emergency medical admissions and lowest among elective surgical patients. The risk of critical illness did not vary by socioeconomic circumstances, but mortality was higher among patients from deprived areas. In this study, about 1 in 20 patients experienced a critical illness resulting in ICU admission within 2 years of cancer diagnosis. The associated high mortality rate may make a significant contribution to overall cancer outcomes.
    08/2015; DOI:10.1001/jamaoncol.2015.2855
  • Z Wang · P McLoone · D S Morrison
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    ABSTRACT: Background:Cancer survivors may be particularly motivated to improve their health behaviours.Methods:We compared health behaviours and obesity in cancer survivors with the general population, using household survey and cancer registry data.Results:Cancer survivors were more likely than those with no history of cancer to eat fruit and vegetables (ORadj 1.41, 95% CI 1.19-1.66), less likely to engage in physical activity (ORadj 0.79, 95% CI 0.67-0.93) and more likely to have stopped smoking (ORadj 1.25, 95% CI 1.09-1.44).Conclusions:Most health-related behaviours were better in cancer survivors than the general population, but low physical activity levels may be amenable to health promotion interventions.British Journal of Cancer (2014), 1-4. doi:10.1038/bjc.2014.598 www.bjcancer.com.
    British Journal of Cancer 11/2014; 112(3). DOI:10.1038/bjc.2014.598 · 4.82 Impact Factor
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    ABSTRACT: Dear Editor,We thank Vincent et al. [1] for their interest in our work. They suggest that three additional papers should be considered in our systematic review of survival in solid cancer patients following intensive care admission [2]. Two of the papers suggested indeed meet the inclusion criteria. The paper by Kim et al. [3] was published in print the same week as our literature search was performed, and as a consequence did not appear in our search results. The paper by Hwang et al. [4] was not identified by our search strategy. Both papers report survival outcomes for patients with lung cancer who were admitted to the ICU, the first in a cohort of 97 patients with stage IIIB/IV lung cancer and the second in a cohort of 95 patients with lung cancer (of whom 75 % had stage IIIB/IV disease). ICU mortality was reported in 57 and 53.6 %, respectively. While these figures are higher than the 40.1 % average pooled mortality for ICU patients with lung cancer reported in our systematic revi ...
    Intensive Care Medicine 11/2014; 41(1). DOI:10.1007/s00134-014-3539-6 · 5.54 Impact Factor
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    ABSTRACT: One in seven patients admitted to intensive care units (ICU) has a cancer diagnosis but evidence on their expected outcomes after admission has not been synthesised. Systematic literature review of solid cancer adult patients admitted to ICU from 2000 onwards using EMBASE and MEDLINE electronic databases. There were 48 papers identified that reported survival in ICU patients with solid cancers. ICU mortality was reported in 35 studies comprising a total sample of 25,339 patients and ranging from 4.5 to 85 %. The average mortality of the distribution of reported mortality rates within ICU was 31.2 % (95 % CI 24.0-39.0 %). Hospital mortality was reported in 31 studies across a total sample of 74,061 patients. The average hospital mortality was 38.2 % (33.8-42.7 %) and ranged from 4.6 to 76.8 %. Poorer physiological score, invasive mechanical ventilation and poor functional status were associated with higher mortality. Several factors have been associated with poor survival in ICU cancer patients; however, primary research is still needed to describe outcomes in cancer patients with sufficient case mix and treatment details to be of prognostic value to clinicians.
    Intensive Care Medicine 09/2014; 40(10). DOI:10.1007/s00134-014-3471-9 · 5.54 Impact Factor
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    Aishah Coyte · David S Morrison · Philip McLoone
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    ABSTRACT: There is evidence that cancer survivors are at increased risk of second primary cancers. Changes in the prevalence of risk factors and diagnostic techniques may have affected more recent risks. We examined the incidence of second primary cancer among adults in the West of Scotland, UK, diagnosed with cancer between 2000 and 2004 (n = 57,393). We used National Cancer Institute Surveillance Epidemiology and End Results and International Agency for Research on Cancer definitions of multiple primary cancers and estimated indirectly standardised incidence ratios (SIR) with 95% confidence intervals (CI). There was a high incidence of cancer during the first 60 days following diagnosis (SIR = 2.36, 95%CI = 2.12 to 2.63). When this period was excluded the risk was not raised, but it was high for some patient groups; in particular women aged <50 years with breast cancer (SIR = 2.13, 95%CI = 1.58 to 2.78), patients with bladder (SIR = 1.41, 95%CI = 1.19 to 1.67) and head & neck (SIR = 1.93, 95%CI = 1.67 to 2.21) cancer. Head & neck cancer patients had increased risks of lung cancer (SIR = 3.75, 95%CI = 3.01 to 4.62), oesophageal (SIR = 4.62, 95%CI = 2.73 to 7.29) and other head & neck tumours (SIR = 6.10, 95%CI = 4.17 to 8.61). Patients with bladder cancer had raised risks of lung (SIR = 2.18, 95%CI = 1.62 to 2.88) and prostate (SIR = 2.41, 95%CI = 1.72 to 3.30) cancer. Relative risks of second primary cancers may be smaller than previously reported. Premenopausal women with breast cancer and patients with malignant melanomas, bladder and head & neck cancers may benefit from increased surveillance and advice to avoid known risk factors.
    BMC Cancer 04/2014; 14(1):272. DOI:10.1186/1471-2407-14-272 · 3.32 Impact Factor
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    ABSTRACT: Introduction: Patients with cancer may require intensive care (ICU) due to drug-related toxicity, organ dysfunction, or surgical complications. In the past, admission of cancer patients to the ICU was considered controversial due to the high mortality rates in this group of patients. More recently this effect appears to be diminishing possibly due to improvements in patient selection and supportive care. However, studies of patients with cancer include a large proportion of surgical patients in whom ICU outcomes are favourable. We therefore aimed to describe the ICU cancer population and to assess outcomes in cancer patients admitted to ICU with a medical diagnosis. Methods: We used routinely collected data from West of Scotland ICUs linked to Scottish Cancer registry to identify patients (aged 16 or over) admitted to ICU between 1st January 2000 and 31st December 2011. Patients who had a diagnosis of a malignant cancer (excluding non-melanoma skin cancer) within the previous 5-years were identified. We compared these patients to patients without cancer. Non-cancer patients had no diagnosis of cancer between 1984 and date discharged from ICU. Results: 49451 individual patients were admitted to an ICU during the study period. A malignant neoplasm had been diagnosed in 9704 (20%). The majority were diagnosed in the year prior to admission (7704, 85%). The number of admissions by major cancer type were as follows - colorectal 4223 (41% of admissions with cancer), stomach 692 (7%), lung 669 (6%), oesophageal 588 (6%) and bladder 425 (4%). 17% of cancer patients were admitted from a medical specialty compared to 50% of non-cancer patients. Of the patients admitted with a medical diagnosis, median age of patients with cancer was 65 (IQR 57-73) vs 56 (41-69) years for patients without cancer and median APACHE II score was 20 (9-27) vs 18 (10-25). The proportion of medical cancer and non-cancer patients in which organ support was provided was by invasive mechanical ventilation (71% vs 75%); vasoactive drug therapy (58% vs 46%); renal replacement therapy (20% vs 14%). The proportion of cancer patients with greater than one supported organ was 53% compared to 43% of patients without cancer. Mortality in ICU among medical cancer patients was 37.9% (95% CI 35.7 - 40.1%) compared to 25.8% (25.2 - 26.4%) in non-cancer patients. ICU mortality among cancer patients who did not receive organ support was 6.2% (1.7-15.0%) and 4.7% (3.3-6.4%) for non-cancer patients. Among patients who received three organ support mortality was 60.0% (45.1 - 73.6%) and 49.4% (44.9 -53.9%) among cancer and non-cancer patients respectively. Conclusions: Cancer patients admitted to ICU from a medical specialty tend to be older and have higher severity of illness scores. As a result there is a higher requirement for multi-organ support. Irrespective of the number of organs supported ICU mortality is higher among those patients with cancer.
    43rd Annual Critical Care Congress; 12/2013
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    ABSTRACT: Introduction: Most admissions to Intensive Care (ICU) are unplanned and associated with acute illness, however, co-morbidities also have an impact on survival. Patients with colorectal cancer represent the largest group of cancer patients admitted to ICU. It is unknown which factors are important at determining survival, and whether it is the features associated with the underlying malignancy or the acute illness that has the largest impact upon prognosis. Methods: We used routinely collected data from West of Scotland ICUs linked to Scottish Cancer registry data to identify patients (aged 16 and over) who had been admitted to ICU between 1st January 2000 and 31st December 2011 and who had a diagnosis of colorectal cancer (ICD10 coding C18-C20) within the previous five years. We used multivariable logistic regression analysis to identify factors associated with ICU outcome. Results: During the study period 3650 patients with colorectal cancer were admitted to ICU. Thirteen percent had two or more admissions. The majority of patients (93%) were admitted from surgical specialties with 78% admitted immediately post-operatively. Of those who had undergone a surgical procedure, 34% were performed as an emergency. Median time from diagnosis to ICU admission was 43 (IQR 14-104) days. Median age 71 (IQR 64-78) years; APACHE II score 13 (IQR 0-19); 59% were men. Duke's tumour staging was 12% A, 34% B, 32% C and 10% D with 12% unknown. Organ support was provided by invasive mechanical ventilation (51% of patients), vasoactive drug therapy (51%), and renal replacement therapy (9%). The proportion of patients receiving no, one, two, or three organ support were 35%, 26%, 31%, and 8%. Mortality in ICU was 14.8% (13.0 to 16.7%) among emergency patients, 3.1% (2.3 to 4.0%) among elective patients and 27.1% (24.2 to 30.0%) among non-surgical patients. ICU mortality among Dukes stage A was 9.1% (6.7 to 11.9%), B 11.1% (9.5 to 12.8%), C 11.4% (9.7 to 13.2%), and D 13.9% (10.7 to 17.5%). Mortality was 21.6% (18.0 to 25.5%) among patients with unknown stage. ICU mortality by the number of organs supported was 0.9% (0.1 to 3.2%) for no organ support, 4.8% (2.1 to 9.2%) for one organ support, 20.3% (14.9 to 26.6%) for two organ support, and 39.6% (25.8 to 54.7%) for three organ support. Age, severity score, tumor stage, emergency surgery, being a non-surgical patient and organ support were each independently associated with mortality during ICU when modeled by multivariable logistic regression. Conclusions: Mortality among colorectal cancer patients admitted to ICU was most strongly associated with severity of illness, admitting specialty (surgical or medical), nature of surgery, and number of organs supported during the stay. Tumor stage was independently associated with mortality during ICU stay but showed a smaller differential across stage categories compared to other patient characteristics.
    43rd Annual Critical Care Congress; 12/2013
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    ABSTRACT: Introduction: There is increasing concern that cancer patients receive inappropriate active treatment in the last few weeks of life. One in 7 patients admitted to Intensive Care Units (ICU) has a cancer diagnosis but the evidence on their expected outcomes after admission has not been synthesised. Methods: Systematic literature review and meta-analysis on outcomes of solid cancer adult patients admitted to ICU from 2000 onwards using PRISMA reporting guidelines and STROBE assessment criteria. EMBASE and MEDLINE electronic databases searched with independent review by two researchers. Results: Of 33 studies identified, 17 reported outcomes in mixed solid cancers from Europe, South America and North America. Mean ages range 47-70 years; 10/17 general ICUs. ICU mortality range 14.3-57.2%, pooled estimate 33.5% (95% CI 22.9% to 44.1%, n=4066). Hospital mortality range 19.0-76.8%, pooled estimate 53.1% (95% CI 39.4% to 66.9%, n=1499). 11 studies described survival in lung cancer patients after ICU admission. ICU mortality range 20-49%, pooled 38.8% (95% CI 31.7% to 45.9%, n=725); hospital mortality range 40-61%, pooled 52.8% (95% CI 46.8% to 58.9%, n=637). Heterogeneity between studies was high and none reported sex-specific or cancer stage-specific outcomes. Acute physiology scores were correlated with poorer survival. Small numbers of additional studies identified described outcomes after ICU admission in patients with breast, colorectal, head and neck, gynaecological, oesophageal and pancreatic cancers. Conclusions: Published research on outcomes of cancer patients after ICU admission is heterogeneous and lacks sufficient clinical information to guide decision-making. As the number of patients potentially requiring ICU support will continue to rise, primary research is needed to describe outcomes in cancer patients with sufficient casemix and treatment details to be of prognostic value to clinicians.
    43rd Annual Critical Care Congress; 12/2013
  • 43rd Annual Critical Care Congress; 12/2013
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    ABSTRACT: Background Community pharmacies may offer an accessible way of delivering weight-management programmes but there have been few trials that use clinically significant weight loss outcomes, objective measures of weight and follow-up to 12 months. We aimed to evaluate weight change among patients who used the Counterweight weight management programme delivered by community pharmacies. Methods The Counterweight Programme was introduced into community pharmacies in Fife, Scotland in 2009 for patients with a BMI ≥ 30 kg/m2 or a BMI ≥ 2830 kg/m2 with a co-morbidity in localities in which Counterweight was not available at GP practices. The aim was to achieve an energy deficit of 500-600 kcal per day. Counterweight specialist dietitians delivered training, support and patient information materials to community pharmacies. Patient weight was measured by pharmacy staff at each weight management session. Weight data recorded at each weight management session were used to estimate weight change and attendance at 3, 6 and 12 months. Results Between March 2009 and July 2012, 458 patients were enrolled by the community pharmacies. Three-quarters of patients were women, mean age was 54 (SD 7.4) years and mean BMI 36.1 (SD 5.9) kg/m2. Of 314 patients enrolled for at least 12 months, 32 (10.2% on an intention to treat basis) had achieved the target weight loss of ≥5%; this was 41.6% of those who attended at 12 months representing a mean weight loss of 4.1 kg. Using Last Observation Carried Forward, 15.9% achieved the target weight loss within 12 months of enrolling. There was no significant effect of sex, baseline BMI or age on weight loss. Conclusions The Counterweight pharmacy programme has a similar effectiveness to other primary care based weight management programmes and should be considered as part of a range of services available to a community to manage overweight and obesity.
    BMC Public Health 03/2013; 13(1):282. DOI:10.1186/1471-2458-13-282 · 2.32 Impact Factor
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    ABSTRACT: There is no established primary care solution for the rapidly increasing numbers of severely obese people with body mass index (BMI) > 40 kg/m(2). This programme aimed to generate weight losses of ≥15 kg at 12 months, within routine primary care. Feasibility study in primary care. Patients with a BMI ≥40 kg/m(2) commenced a micronutrient-replete 810-833 kcal/day low-energy liquid diet (LELD), delivered in primary care, for a planned 12 weeks or 20 kg weight loss (whichever was the sooner), with structured food reintroduction and then weight-loss maintenance, with optional orlistat to 12 months. Of 91 patients (74 females) entering the programme (baseline: weight 131 kg, BMI 48 kg/m(2), age 46 years), 58/91(64%) completed the LELD stage, with a mean duration of 14.4 weeks (standard deviation [SD] = 6.0 weeks), and a mean weight loss of 16.9 kg (SD = 6.0 kg). Four patients commenced weight-loss maintenance omitting the food-reintroduction stage. Of the remaining 54, 37(68%) started and completed food reintroduction over a mean duration of 9.3 weeks (SD = 5.7 weeks), with a further mean weight loss of 2.1 kg (SD = 3.7 kg), before starting a long-term low-fat-diet weight-loss maintenance plan. A total of 44/91 (48%) received orlistat at some stage. At 12 months, weight was recorded for 68/91 (75%) patients, with a mean loss of 12.4 kg (SD = 11.4 kg). Of these, 30 (33% of all 91 patients starting the programme) had a documented maintained weight loss of ≥15 kg at 12 months, six (7%) had a 10-15 kg loss, and 11 (12%) had a 5-10 kg loss. The indicative cost of providing this entire programme for wider implementation would be £861 per patient entered, or £2611 per documented 15 kg loss achieved. A care package within routine primary care for severe obesity, including LELD, food reintroduction, and weight-loss maintenance, was well accepted and achieved a 12-month-maintained weight loss of ≥15 kg for one-third of all patients entering the programme.
    British Journal of General Practice 02/2013; 63(607):115-24. DOI:10.3399/bjgp13X663073 · 2.36 Impact Factor
  • Philip McLoone · David S Morrison
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    ABSTRACT: OBJECTIVE: To estimate the potential to reduce childhood obesity through targeted interventions of overweight households. DESIGN: Cross-sectional nationally representative samples of the Scottish population. Setting: Households in Scotland during 2008 and 2009. Participants: A total of 1651 households with parents and children aged 2-15 years. MAIN OUTCOME MEASURES: The WHO cut-off points for adult body mass index (BMI): overweight (25 to <30 kg/m(2)) and obese (≥30 kg/m(2)). Overweight and obesity in childhood respectively defined as a BMI 85th to <95th percentile and ≥95th percentile based on 1990 reference centiles. RESULTS: Thirty-two percent (600/1849) of children and 75% (966/1290) of adults were overweight or obese. Seventy-five percent (1606/2128) of all children lived with a parent who was overweight or obese. Among obese children, 58% (185/318) lived with an obese parent. The population attributable risk percentage of child obesity associated with parental obesity was 32.5%. Targeting obese households would require substantial falls in adult weight and need to reach 38% of all children; it might achieve a reduction in the prevalence of childhood obesity of 14% in these households (from 26% to 12%). Targeting parents with BMI ≥ 40 might reduce the overall prevalence of child obesity by 9%. Such an intervention would require large weight loss, consistent with approaches used for morbidly obese adults; it would involve 4% of all children and lead to a reduction in the prevalence of obesity in these households from 57% to 16%. CONCLUSIONS: Family-based interventions for obesity would be most efficiently targeted at obese children whose parents are morbidly obese.
    The European Journal of Public Health 12/2012; DOI:10.1093/eurpub/cks175 · 2.46 Impact Factor
  • M E J Lean · C Katsarou · P McLoone · D S Morrison
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    ABSTRACT: Objective:To document changes in body mass index (BMI) and waist circumference (WC) over a 10-year period 1998-2008, in representative surveys of adults.Subjects:Adults aged 18-72 in the Scottish Health Surveys conducted in 1998, 2003 and 2008 were divided, separately for men and women, into eleven 5-year age bands. 'Synthetic birth-cohorts' were created by dividing participants into thirteen 5-years-of-birth bands (n=20 423). Weight, height and WC were objectively measured by trained observers.Results:Subjects with data available on BMI/WC were 7743/6894 in 1998, 5838/4437 in 2003 and 4688/925 in 2008 with approximately equal gender distributions. Mean BMI and waist were both greater in successive surveys in both men and women. At most specific ages, people were consistently heavier in 2008 than in 1998 by about 1-1.5 BMI units, and WCs were greater by about 2-6 cm in men and 5-7 cm in women. Greater increases were seen at younger ages between 1998 and 2003 than between 2003 and 2008, however increases continued at older ages, particularly in waist. All birth-cohorts observed over the 10 years 1998-2008 showed increases in both BMI and waist, most marked in the younger groups. The 10-year increases in waist within birth-cohorts (mean 7.4 cm (8.1%) in men and 8.6 cm (10.9%) in women) were more striking than in BMI (mean 1.8 kg m(-2) (6.6%) in men and 1.5 kg m(-2) (6.4%) in women) were particularly steep in older women.Conclusion:People were heavier and fatter in 2003 than those of the same age in 1998, with less marked increases in WC between 2003 and 2008 than between 1998 and 2003. There were proportionally greater increases in WC than in BMI, especially in older women. This suggests a disproportionate increase in body fat, compared with muscle, particularly among older women.International Journal of Obesity advance online publication, 4 September 2012; doi:10.1038/ijo.2012.122.
    International journal of obesity (2005) 09/2012; 37(6). DOI:10.1038/ijo.2012.122 · 5.39 Impact Factor
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    ABSTRACT: Tea may be a potentially modifiable and highly prevalent risk factor for the most common cancer in men, prostate cancer. However, associations between black tea consumption and prostate cancer in epidemiological studies have been inconsistent, limited to a small number of studies with small numbers of cases and short follow-up periods and without grade-specific information. We conducted a prospective cohort study of 6,016 men who were enrolled in the Collaborative Cohort Study between 1970 and 1973 and followed up to December 31, 2007. We used Cox proportional hazards models to investigate the association between tea consumption and overall as well as grade-specific risk of prostate cancer incidence. Three hundred and eighteen men developed prostate cancer in up to 37 years of follow-up. We found a positive association between consumption of tea and overall risk of prostate cancer incidence (P = 0.02). The association was greatest among men who drank ≥ 7 cups of tea per day (HR: 1.50, 95% CI: 1.06 to 2.12), compared with the baseline of 0-3 cups/day. However, we did not find any significant association between tea intake and low- (Gleason <7) or high-grade (Gleason 8-10) prostate cancer incidence. Men with higher intake of tea are at greater risk of developing prostate cancer, but there is no association with more aggressive disease. Further research is needed to determine the underlying biological mechanisms for the association.
    Nutrition and Cancer 06/2012; 64(6):790-7. DOI:10.1080/01635581.2012.690063 · 2.47 Impact Factor
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    ABSTRACT: Higher consumption of coffee intake has recently been linked with reduced risk of aggressive prostate cancer (PC) incidence, although meta-analysis of other studies that examine the association between coffee consumption and overall PC risk remains inconclusive. Only one recent study investigated the association between coffee intake and grade-specific incidence of PC, further evidence is required to understand the aetiology of aggressive PCs. Therefore, we conducted a prospective study to examine the relationship between coffee intake and overall as well as grade-specific PC risk. We conducted a prospective cohort study of 6017 men who were enrolled in the Collaborative cohort study in the UK between 1970 and 1973 and followed up to 31st December 2007. Cox Proportional Hazards Models were used to evaluate the association between coffee consumption and overall, as well as Gleason grade-specific, PC incidence. Higher coffee consumption was inversely associated with risk of high grade but not with overall risk of PC. Men consuming 3 or more cups of coffee per day experienced 55% lower risk of high Gleason grade disease compared with non-coffee drinkers in analysis adjusted for age and social class (HR 0.45, 95% CI 0.23-0.90, p value for trend 0.01). This association changed a little after additional adjustment for Body Mass Index, smoking, cholesterol level, systolic blood pressure, tea intake and alcohol consumption. Coffee consumption reduces the risk of aggressive PC but not the overall risk.
    Nutrition Journal 06/2012; 11:42. DOI:10.1186/1475-2891-11-42 · 2.64 Impact Factor
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    ABSTRACT: Aim. To assess the implementation of the Counterweight Programme in 13 Health Boards in Scotland and compare 12-month outcomes with published Counterweight data. Methods. Patients with a body mass index (BMI) >= 30 kg/m(2) or BMI >= 28 kg/m(2) with at least one co-morbidity were screened for the Counterweight Programme. Patients were asked to attend nine structured appointments with a trained Counterweight Programme practitioner over 12 months. Results. Six thousand seven hundred and fifteen patients from 184 general practices, 16 pharmacies and one centralized community-based service in 13 Health Boards, with a mean BMI of 37 kg/m(2) were enrolled in the Counterweight Programme. Twenty-six per cent had a BMI >= 40 kg/m(2). Attendance for patients at 3, 6 and 12 months follow-up was 55%, 37% and 28%. Of those who attended at 12 months, 35.2% had maintained a weight loss of >= 5% compared to 30.7% in the original evaluation. Conclusions. Evaluation of the Counterweight Programme in Scotland demonstrated consistency in characteristics of patients enrolled into the programme. There was evidence of higher loss to follow-up in a population not routinely engaging with primary care but evidence of greater weight losses among those who attended.
    Family Practice 04/2012; 29(Suppl 1):i139. DOI:10.1093/fampra/cmr074 · 1.84 Impact Factor
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    ABSTRACT: High cholesterol may be a modifiable risk factor for prostate cancer but results have been inconsistent and subject to potential "reverse causality" where undetected disease modifies cholesterol prior to diagnosis. We conducted a prospective cohort study of 12,926 men who were enrolled in the Midspan studies between 1970 and 1976 and followed up to 31st December 2007. We used Cox-Proportional Hazards Models to evaluate the association between baseline plasma cholesterol and Gleason grade-specific prostate cancer incidence. We excluded cancers detected within at least 5 years of cholesterol assay. 650 men developed prostate cancer in up to 37 years' follow-up. Baseline plasma cholesterol was positively associated with hazard of high grade (Gleason score≥8) prostate cancer incidence (n = 119). The association was greatest among men in the 2nd highest quintile for cholesterol, 6.1 to < 6.69 mmol/l, Hazard Ratio 2.28, 95% CI 1.27 to 4.10, compared with the baseline of < 5.05 mmol/l. This association remained significant after adjustment for body mass index, smoking and socioeconomic status. Men with higher cholesterol are at greater risk of developing high-grade prostate cancer but not overall risk of prostate cancer. Interventions to minimise metabolic risk factors may have a role in reducing incidence of aggressive prostate cancer.
    BMC Cancer 01/2012; 12(1):25. DOI:10.1186/1471-2407-12-25 · 3.32 Impact Factor
  • K. Shafique · P. McLoone · K. Qureshi · H. Leung · C. Hart · D. Morrison
    Journal of Epidemiology &amp Community Health 08/2011; 65(Suppl 1):A297-A297. DOI:10.1136/jech.2011.142976k.8 · 3.29 Impact Factor
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    Raymond Oliphant · Philip McLoone · David Morrison
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    ABSTRACT: Objective To report the causes of, and ages at, death of subjects in an English colorectal cancer screening trial.Design and settingAnalysis of 78 708 deaths occurring between 1981 and 2008, within the Nottingham randomised controlled trial of biennial faecal occult blood testing.Main outcome measuresCause of death, age at death by sex and by cause.ResultsSignificantly more subjects died from verified colorectal cancer in the trial's control group than in the intervention group (3.2% vs 2.9%). For no other major cause of death was the difference in proportion across the two groups statistically significant. Age at death was lower for cancer than for other principal causes, except for ischaemic heart disease among women. However, mean age at death was higher for colorectal cancer than for other cancers, except for prostate cancer among men. Increasing levels of material deprivation significantly lowered the expected ages at death, independently of cause. For both men and women, the mean age at death from all causes for screening participants was higher than that of controls and non-participants. Mean deprivation was lowest among participants. Of those participating in screening, and dying from colorectal cancer, subjects receiving negative test results lived significantly longer than those who received positive test results. However, if dying from other causes, they died at an earlier age.Conclusions The age at death from colorectal cancer is higher than that of most other cancers. Those accepting a screening invitation live longer than non-participants. In part, this difference is explained by relative deprivation. Among screening participants, the receipt of a positive, as opposed to a negative, test result is associated with a later age at death.
    Gut 12/2010; 60(8):1163-4. DOI:10.1136/gut.2010.233783 · 13.32 Impact Factor