Inequalities in cancer screening participation: examining differences in perceived benefits and barriers.

OBJECTIVE: Inequalities exist in colorectal cancer (CRC) screening uptake, with people from lower socioeconomic status backgrounds less likely to participate. Identifying the facilitators and barriers to screening uptake is important to addressing screening disparities. We pooled data from 2 trials to examine educational differences in psychological constructs related to guaiac fecal occult blood testing. METHODS: Patients (n = 8576) registered at 7 general practices in England, within 15 years of the eligible age range for screening (45-59.5 years), were invited to complete a questionnaire. Measures included perceived barriers (emotional and practical) and benefits of screening, screening intentions, and participant characteristics including education. RESULTS: After data pooling, 2181 responses were included. People with high school education or no formal education reported higher emotional and practical barriers and were less likely to definitely intend to participate in screening, compared with university graduates in analyses controlling for study arm and participant characteristics. The belief that one would worry more about CRC after screening and concerns about tempting fate were strongly negatively associated with education. In a model including education and participant characteristics, respondents with low emotional barriers, low practical barriers, and high perceived benefits were more likely to definitely intend to take part in screening. CONCLUSIONS: In this analysis of adults approaching the CRC screening age, there was a consistent effect of education on perceived barriers toward guaiac fecal occult blood testing, which could affect screening decision making. Interventions should target specific barriers to reduce educational disparities in screening uptake and avoid exacerbating inequalities in CRC mortality.

Interventions to improve exercise behaviour in sedentary people living with and beyond cancer: a systematic review.

BACKGROUND: To systematically review the effects of interventions to improve exercise behaviour in sedentary people living with and beyond cancer. METHODS: Only randomised controlled trials (RCTs) that compared an exercise intervention to a usual care comparison in sedentary people with a homogeneous primary cancer diagnosis, over the age of 18 years were eligible. The following electronic databases were searched: Cochrane Central Register of Controlled Trials MEDLINE; EMBASE; AMED; CINAHL; PsycINFO; SportDiscus; PEDro from inception to August 2012. RESULTS: Fourteen trials were included in this review, involving a total of 648 participants. Just six trials incorporated prescriptions that would meet current recommendations for aerobic exercise. However, none of the trials included in this review reported intervention adherence of 75% or more for a set prescription that would meet current aerobic exercise guidelines. Despite uncertainty around adherence in many of the included trials, the interventions caused improvements in aerobic exercise tolerance at 8-12 weeks (SMD=0.73, 95% CI=0.51-0.95) in intervention participants compared with controls. At 6 months, aerobic exercise tolerance is also improved (SMD=0.70, 95% CI=0.45-0.94), although four of the five trials had a high risk of bias; hence, caution is warranted in its interpretation. CONCLUSION: Expecting the majority of sedentary survivors to achieve the current exercise guidelines is likely to be unrealistic. As with all well-designed exercise programmes, prescriptions should be designed around individual capabilities and frequency, duration and intensity or sets, repetitions, intensity of resistance training should be generated on this basis.

Awareness of cancer risk factors among ethnic minority groups in England.

OBJECTIVE: To explore awareness of cancer risk factors in ethnic minority men and women living in England. STUDY DESIGN: Cross-sectional survey. METHODS: Men and women were recruited from the six largest ethnic minority groups in the UK proportional to the population distribution: Indian (n = 467); Pakistani (n = 333); Bangladeshi (n = 126); Caribbean (n = 252); African (n = 216); and Chinese (n = 106). Participants responded to an open-ended question about cancer risk factors. Analyses were adjusted for age, gender, socio-economic class and language. RESULTS: The most commonly cited cancer risk factors were smoking (55%), diet (20%), genetics (20%), drinking alcohol (19%) and lifestyle (17%). On average, participants who were able to name cancer risk factors (91% of respondents) cited 2.13 factors. There were some differences between broad ethnic groups (Asian, Black and Chinese), but fewer differences within them (e.g. between Indian, Pakistani and Bangladeshi, or African and Caribbean). CONCLUSIONS: Awareness of risk factors (particularly diet and exercise) was lower in this sample than in previous population representative samples in the UK. Interventions aimed at raising awareness of cancer risk factors are likely to be beneficial across the whole ethnic minority population. Any ethnically targeted interventions should consider risk factor awareness levels as well as cancer risk.

Physiotherapy management of axillary web syndrome following breast cancer treatment: discussing the use of soft tissue techniques.

BACKGROUND AND PURPOSE: Axillary web syndrome (AWS) is becoming increasingly recognised as a sequela of breast cancer treatment. There are currently no formal guidelines on which to base therapy interventions. This case study discusses the physiotherapy management of a patient with AWS, highlighting a soft tissue mobilisation approach. CASE DESCRIPTION: A 47-year-old hairdresser experienced sudden loss of shoulder movement and development of axillary cords 22 days after mastectomy and axillary dissection. The management included manual therapy, mostly using soft tissue treatment techniques, combined with education and advice. OUTCOMES: Pre-morbid range of movement was achieved within 11 treatments, spread over 3 weeks. The patient returned to full-time employment after the seventh treatment by a physiotherapist, within 2 weeks of starting treatment, progressing to full range of shoulder movement with no cords or pain by 16 weeks post surgery. DISCUSSION: Previous theories on the pathophysiology of AWS may need to be revised. Physiotherapy intervention for these patients may prove beneficial in limiting subsequent shoulder dysfunction. Further research is needed to develop a standardised treatment approach for AWS.

Perceived barriers to flexible sigmoidoscopy screening for colorectal cancer among UK ethnic minority groups: a qualitative study.

OBJECTIVES: Evidence from existing UK screening programmes indicates disparities in uptake rates between UK ethnic minorities and the white majority population. The aim of this study was to explore barriers to the uptake of flexible sigmoidoscopy (FS) screening among UK ethnic minority populations. Specifically, beliefs about bowel cancer, perceived barriers to the test and ideas about ways to increase uptake were investigated. METHODS: Nine focus groups were conducted with a total of 53 participants from African-Caribbean, Gujarati Indian, Pakistani and white British communities. The topic guide was based on the Health Belief Model. Discussions were subject to framework analysis. RESULTS: Most participants expressed limited awareness of bowel cancer and cited this as a barrier to screening attendance. Anxiety regarding the invasiveness of the test, the bowel preparation and fear of a cancer diagnosis were common barriers across all ethnic groups. Language difficulties, failure to meet religious sensitivities and the expression of culturally influenced health beliefs were all discussed as specific barriers to uptake. Ethnically tailored health promotion and general practitioner involvement were recommended as ways of overcoming such barriers. CONCLUSIONS: The study was the first attempt to qualitatively explore barriers to FS bowel cancer screening in UK ethnic minorities. Most barriers were shared by all ethnic groups but health educators should supplement approaches designed for the majority to incorporate the specific needs of individual minority groups to ensure equitable access.