Staff Profiles

Modules taught

Tackling Cancer

Living with Cancer in Contemporary Society

Dissertation Module Co-ordinator

Supervision

Postgraduate Research Tutor, Community and Health Sciences Doctoral Programme, Faculty Health and Life Sciences

Current students:

Nicole Collaco

Lyndel Moore

Michael Mawhinney

Georgias Saltauras

John Curtin

Carolina Casanas i Comabella

Completions:

Marta Wanat (2016)

Lauren Matheson (2016)

Research interests

Research interests include: understanding and addressing the needs of those living with and beyond cancer and their family members; the role of primary care in the delivery of cancer care; professional and patient education.

Research group membership

Member of Oxford Institute of Nursing, Midwifery and Allied Heatlh Research (OxINMAHR).

Supportive Care Research Group Lead.

Research grants and awards

Research Grants

• Cancer Life Affirming Support in Primary Care (CLASP).  NIHR Programme Grant for Applied Research (2016-2021).  Co-applicant.
• Life After Prostate Cancer Diagnosis (LAPCD).  Prostate Cancer UK / Movember (2014-2017).  Co-investigator.
• MAMMO-50 - Mammographic surveillance in breast cancer patients aged 50 years or older. HTA (2013-2018) Co-applicant
• Cancer survivorship – costs, inequalities and post-treatment follow-up. Building capacity to meet the challenges to the health service and society. Health Services Board, Ireland, 2012-2014. (Collaborator)
• Quality of life and follow-up care for men with prostate cancer: a questionnaire survey and pilot randomised controlled trial of a nurse-led psycho-educational intervention delivered in primary care (PROSPECTIV). Prostate Cancer UK 2012-2015
• The late effects of pelvic radiotherapy: assessing the needs of long term survivors. 2010-2012
• The health and supportive care needs of long term cancer survivors and their partners. Collaborative study with University of Oxford. Jointly funded by Cancer Research UK, Oxford Brookes University. 2007-10
• The role of primary care teams in early follow-up of patients diagnosed with cancer - perspectives of patients, family members and primary health care professionals. Macmillan Cancer Support , 2008-10
• A psychosocial evaluation of familial ovarian cancer screening. BUPA Foundation (2006-2010). Collaborative study led by University of Cardiff.

Journal articles

• Matheson L, Nayoan J, Rivas C, Brett J, Wright P, Butcher H, Gavin A, Glaser A, Watson E, Wagland R, 'A Qualitative Exploration of Prostate Cancer Survivors Experiencing Psychological Distress: Loss of Self, Function, Connection, and Control'
  Oncology Nursing Forum 47 (3) (2020) pp.318-330
  ISSN: 0190-535X
  Abstract

  Purpose: To explore the experiences of men with prostate cancer identified as having psychological distress and to identify factors influencing distress.

  Participants and setting: 28 men with prostate cancer diagnosed 18-42 months earlier, identified as having psychological distress on survey measures. 

  Methodologic approach: Semi-structured telephone interviews were conducted. Thematic analysis using a Framework approach was used. 

  Findings:  Men with psychological distress had strong perceptions of ‘loss’ towards a) self (identity, sexuality/masculinity, self-confidence), b) function (physical, activities), c) connection (relational, social, community) and d) control (future, emotional). Psychological vulnerability appeared heightened in particular groups of men. Maladaptive strategies of emotional concealment, help-seeking avoidance and withdrawal appeared to contribute to distress. 

  Implications for nursing: Distress in men with prostate cancer is multifaceted. Men with distress should be identified and offered support. Nursing and/or peer-led interventions are required.   

  Knowledge Translation: 

  1. A significant minority of men with prostate cancer report distress 18-42 months following diagnosis. Screening tools for psychological difficulties may help identify men in need of further support.

  2. The author’s conceptual model highlights pre-existing and treatment related factors, as well as maladaptive coping strategies influencing distress. Greater support with restoring self-identity and confidence is needed. 

  3. Nurse-led patient education and information on managing psychological and physical concerns, as well as sign-posting to peer support, community or online support groups is required. 

  Website 
• Wilding S, Downing A, Selby P, Cross W, Wright P, Watson EK, Wagland R, Kind P, Donnelly D, Hounsome L, Mottram R, Allen M, Kearney T, Butcher H, Gavin A, Glaser A, 'Decision regret in men living with and beyond non-metastatic prostate cancer in the UK: a population-based patient-reported outcome study'
  Psycho-Oncology 29 (5) (2020) pp.886-893
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract

  Objective: Clinical options for managing non-metastatic prostate cancer (PCa) vary. Each option has associated side-effects leading to difficulty in decision-making. This study aimed to assess the relationship between patient involvement in treatment decision-making and subsequent decision regret (DR), and quantify the impact of health-related quality of life (HRQL) outcomes on DR.
  Methods: Men living in the United Kingdom, 18-42 months post-diagnosis of PCa were identified from cancer registration data and sent a questionnaire. Measures included the Decision Regret Scale (DRS), Expanded Prostate cancer Index Composite short form (EPIC-26), EQ-5D-5L and an item on involvement in treatment decision-making.  Multivariable ordinal regression was utilised with DR categorised as none, mild or moderate/severe regret. 
  Results: 17,193 men with stage I-III PCa completed the DRS: 36.6% reported no regret, 43.3% mild regret and 20.0% moderate/severe regret. The odds of reporting DR were greater if men indicated their views were not taken into account (OR=6.42, 95%CI 5.39-7.64) or were involved ‘to some extent’ in decision-making (OR=4.63, 95%CI 4.27-5.02), compared to men who were ‘definitely’ involved.  After adjustment, including for involvement, men reporting moderate/big problems with urinary, bowel or sexual function were more likely to experience regret compared to men with no/small problems.  Better HRQL scores were associated with lower levels of DR. 
  Conclusions: This large-scale study demonstrates the benefit of patient involvement in treatment decision-making for non-metastatic PCa.  However, men experiencing side-effects and poorer HRQL report greater DR.  Promoting engagement in clinical decision-making represents good practice and may reduce the risk of subsequent regret.
  

  Website 
• Watson E, Brett J. Hay H, Witwicki C, Perris A, Poots A, Sizmur S, Soonawalla Z, Tallet A, 'The experiences and supportive care needs of UK patients with pancreatic cancer: a cross-sectional questionnaire survey'
  BMJ Open 9 (11) (2019)
  ISSN: 2044-6055 eISSN: 2044-6055
  Abstract

  Objectives. Patients diagnosed with pancreatic cancer have the poorest survival prognosis of any cancer.  This survey aimed to describe their experiences of care and supportive care needs to inform future service provision. Design. Cross-sectional questionnaire survey of pancreatic cancer patients in the UK. Setting. Individuals at any stage along the care pathway were recruited via five NHS sites in the UK, and online, from January to June 2018. Participants. 274 individuals completed the questionnaire (78% (215) were completed online). Approximately half of participants were diagnosed within the last year (133/274).  Of 212 providing gender details, 82 were male and 130 female. Ninety percent (192/213) described themselves as White British. Primary Outcome Measures. Experiences of communication and information; involvement in treatment decisions; supportive care needs. Results. Communication with, and care received from, clinical staff were generally reported positively. However, 29% (75/260) of respondents did not receive enough information at diagnosis, and 10% (25/253) felt they were not involved in decisions about their treatment, but would have liked to be.   Supportive care needs were greatest in psychological and physical/daily living domains.  49% (108/221) respondents reported one or more moderate/high unmet needs within the last month, of which the most commonly reported were: dealing with uncertainty about the future; fears about the cancer spreading; not being able to do things they used to; concerns about those close to them; lack of energy; anxiety; feelings of sadness and feeling down/depressed. Experiences were poorer, and unmet supportive care needs greater, in patients with unresectable disease. Conclusions. Patients with pancreatic cancer have unmet information and support needs across the cancer trajectory. Psychological and physical support appear to be the biggest gaps in care.  Needs should be assessed and supportive care interventions implemented from the point of diagnosis, and monitored regularly to help patients live as good a quality of life as possible.
  

  Website 
• Wagland R, Nayoan J, Matheson L, Rivas C, Brett J, Collaco N, Alexis O, Gavin A, Glaser AW, Watson E., 'Adjustment strategies amongst black African and black Caribbean men following treatment for prostate cancer: findings from the Life After Prostate Cancer Diagnosis (LAPCD) study'
  European Journal of Cancer Care (2019)
  ISSN: 0961-5423 eISSN: 1365-2354
  Abstract

  Objective: To explore adjustment strategies adopted by Black African (BA) and Black Caribbean (BC) men in the UK as a response to the impact of PCa diagnosis and treatment effects.
  Methods: Men were recruited through the UK-wide ‘Life After Prostate Cancer Diagnosis’ (LAPCD) survey. Telephone interviews were conducted with men (n=14) with BA and BC backgrounds between 18-42 months post-diagnosis. Data were analysed using a Framework approach.  
  Results: Most men (n=12) were born outside the UK, were married (n=9) and employed (n=9). Median age was 66 years (range: 55-85). Six overarching themes emerged: a strong reliance upon faith beliefs; maintaining a ‘positive’ front; work as distraction; non-disclosure of diagnosis even amongst family members, influenced by stigma and masculinity concerns; active awareness-raising amongst a minority, and; support-seeking from close community. A few men emphasised a need to ‘pitch’ awareness-raising messages appropriately. Potential links existed between faith beliefs, presenting a positive front, community support-seeking and local awareness-raising.
  Conclusion: The provision of patient-centred care requires cultural sensitivity. Interventions that challenge stigma and mens’ reluctance to disclose problems associated with PCa and treatment may encourage help-seeking for symptom support. Research is needed to determine how best awareness-raising messages should be conveyed to black men.  
  

  Website 
• Matheson L, Wilding S, Wagland R, Nayoan J, Rivas C, Downing A, Wright P, Brett J, Kearney T, Cross W, Glaser A, Gavin A, Watson E, 'The psychological impact of being on a monitoring pathway for localised prostate cancer: a UK-wide mixed methods study'
  Psycho-Oncology 28 (7) (2019) pp.1567-1575
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract

  Objective. To address concerns over the psychological impact of being on a monitoring pathway following prostate cancer (PCa) diagnosis, this study compared the psychological status of men on active surveillance (AS) or watchful waiting (WW) with men on active treatment (AT), and explored psychological adjustment in men on AS/WW. Methods. Cross-sectional survey of UK men diagnosed with PCa 18-42 months previously (n=16,726, localised disease at diagnosis) and telephone interviews with 24 men on AS/WW. Psychological outcomes were measured using two validated scales (Short Warwick-Edinburgh Mental-Well-being Scale; Kessler Psychological Distress Scale). Univariable and multivariable analyses compared outcomes between men on AS/WW and AT. Thematic analysis of interviews was undertaken, informed by a previously developed theory of adjustment to cancer. Results. 3,986 (23.8%) respondents were on AS/WW. Overall, psychological outcomes were similar or better in men on AS/WW compared to those receiving AT (SWEMWBS: Poor well-being; 12.3% AS/WW vs 13.9% AT, adjusted OR=0.86, 95% CI 0.76-0.97; K6: severe psychological distress; 4.6% vs 5.4%, adjusted OR=0.90, 95% CI 0.74-1.08). Interviews indicated most men on AS/WW had adjusted positively. Men with poorer well-being were less able to accept, reframe positively and normalise the diagnosis, described receiving insufficient information and support, and a lack of confidence in their health-care professionals. Conclusions. Most men on AS/WW cope well psychologically. Men making treatment decisions should be given this information. Psychological health should be assessed to determine suitability for AS/WW, and at monitoring appointments. A clear action plan and support from healthcare professionals is important.
  

  Website 
• Wright P, Wilding S, Watson E, Downing A, Selby P, Hounsome L, Wagland R, Brewster DH, Huws D, Butcher H, Mottram R, Kearney T, Allen M, Gavin A, Glaser A., 'Key factors associated with social distress after prostate cancer: results from the United Kingdom Life After Prostate Cancer Diagnosis study'
  Cancer Epidemiology 60 (2019) pp.201-207
  ISSN: 1877-7821
  Abstract

  Background

  More men are living following a prostate cancer (PCa) diagnosis. They may need support to maximize the quality of their survival. Physical and psychological impacts of PCa are widely documented. Less is known about social impacts. We aimed to identify key factors associated with social distress following PCa.

  Methods

  The Life After Prostate Cancer Diagnosis study is a UK national cross-sectional survey of men 18–42 months post diagnosis of PCa. Men (n = 58 930) were invited to participate by their diagnosing cancer centre including 82% of English NHS Trusts (n = 111) and 100% of all Health Boards in Northern Ireland (n = 5), Scotland (n = 14) and Wales (n = 6). Social distress was measured using the Social Difficulties Inventory (SDI-21), 16 item Social Distress scale with men assigned to ‘socially distressed’/‘not socially distressed’ groups, according to published guidelines. Clinical and sociodemographic variables were collected from self-report and cancer registries.

  Results

  Response rate 60.8% (n = 35 823) of whom 97% (n = 29 351) completed the Social Distress scale (mean age = 71.2; SD = 7.88). The proportion of ‘socially distressed’ men was 9.4%. Multivariable logistic regression analysis revealed unemployment versus employment (odds ratio (OR): 11.58 [95% CI 9.16–14.63]) and ≥3 co-morbidities versus none (OR: 5.37 [95% CI 4.61–6.27]) as key associations. Others were Androgen Deprivation Therapy, External Beam Radiotherapy in combination with another treatment, age, prior mental health problems and living in a socio-economically deprived area.

  Conclusion

  Most men following PCa are socially resilient. A simple checklist could help clinicians identify men at risk of social distress.

  Website 
• Donnelly DW, Gavin A, Downing, Hounsome L, Kearney T, McNaire E, Allan D, Huws DW, Wright P, Selby PJ, Kind P, Watson E, Wagland R, Wilding S, Butcher H, Mottram R, Allen M, McSorley O, Sharp L, Mason MD, Cross WR, Catto JWF, Glaser AW, 'Regional variations in quality of survival among men with prostate cancer across the United Kingdom'
  European Urology 76 (2) (2019) pp.228-237
  ISSN: 0302-2838 eISSN: 1421-993X
  Abstract

  Purpose: Prostate cancer incidence, treatment and survival rates vary throughout the United Kingdom (UK) but little is known about regional differences in quality of survival. 

  Objective: To investigate variations in patient-reported outcomes between UK countries and English Cancer Alliances.

  Design, setting and participants: A cross-sectional postal survey of prostate cancer survivors diagnosed 18-42 months previously.

  Outcome measurements and statistical analysis: Urinary, bowel, sexual problems and vitality were patient reported using the EPIC-26 questionnaire. General health was also self-assessed. Regional variations were identified using multivariable log-linear regression. 

  Results and limitations: 35,823 men responded; 60.8% of those invited. Self-assessed health was significantly lower than the UK average in Wales and Scotland. Respondents reported more urinary incontinence in Scotland, more urinary irritation/obstruction in Scotland and Northern Ireland (NI), poorer bowel function in Scotland and NI, worse sexual function in Scotland, and reduced vitality/hormonal function in Scotland, Wales and NI.

  Self-assessed health was poorer than the English average in South Yorkshire and North-East & Cumbria, with more urinary incontinence in North-East & Cumbria and Peninsula, greater sexual problems in West Midlands and poorer vitality in North-East & Cumbria and West Midlands. Limitations include difficulty identifying clinically significant differences and limited information on pre-treatment conditions.

  Conclusions: Despite adjustment for treatment, clinical and socio-demographic factors, quality of survival among prostate cancer survivors varied by area of residence. Adoption of best practice from areas performing well could support enhanced survival quality in poorer performing areas, particularly with regards bowel problems and vitality, where clinically relevant differences were reported.
  

  Patient summary: We conducted a UK-wide survey of patient’s quality of life after treatment for prostate cancer. Outcomes were found to vary depending upon where patients live. Different service providers need to ensure that all prostate cancer patients receive the same follow up care.

  Website 
• Saltaouras G, Lightowler H, Coe S, Brett J, Watson E, 'Availability and quality assessment of online nutrition information materials for pelvic cancer patients in the UK'
  European Journal of Cancer Care 28 (4) (2019)
  ISSN: 0961-5423 eISSN: 1365-2354
  Abstract

  Written information can be an essential source of support in the promotion of lifestyle changes after a cancer diagnosis. This study aimed to identify and assess the quality of available online Patient Information Materials (PIMs) in relation to diet and nutrition for pelvic cancer patients. The online sources of the National Health Service, cancer centres and charitable organisations throughout the UK were searched. Content was assessed using an evidence-based checklist, and readability with two validated formulas. Consumer feedback was sought through Patient and Public Involvement (PPI) groups. Forty PIMs were identified; four were designed specifically for pelvic cancers (bladder, bowel, prostate) and 36 were generic (relevant for all cancers). Most PIMs had a good content score, with PIMs from charities scoring higher overall than PIMs from cancer centres [32 (4) Vs 23 (11), P<0.001]. Seventy-three percent of PIMs had a readability score within acceptable levels (6th-8th grade; reading ability of 11-14 year-olds). PPI contributors found most PIMs useful and comprehensive but lacking specific information needed to meet individual needs. There is limited availability of online PIMs for cancer survivors and even fewer tailored to pelvic cancers. Most materials have comprehensive content and acceptable readability. Some PIMs may require improvement
  

  Website 
• Amy Downing, Penny Wright, Luke Hounsome, Peter Selby, Sarah Wilding, Eila Watson, Richard Wagland, Paul Kind, David W Donnelly, Hugh Butcher, James WF Catto, William Cross, Malcolm Mason, Linda Sharp, David Weller, Galina Velikova, Eilis McCaughan, Rebecca Mottram, Majorie Allen, Therese Kearney, Oonagh McSorley, Dyfed W Huws, David H Brewster, Emma McNair, Anna Gavin*, Adam W Glaser* *, 'Quality of life in men living with advanced and localised prostate cancer: A United Kingdom population-wide patient-reported outcome study of 30,000 men'
  Lancet Oncology 20 (3) (2019) pp.436-447
  ISSN: 1470-2045 eISSN: 1474-5488
  Abstract

  Background. Little is known about the health-related quality of life (HRQL) of men living with advanced prostate cancer.  We report population-wide functional outcomes and HRQL in men with all stages of prostate cancer, and identify implications for healthcare delivery. Methods. Men alive 18-42 months after diagnosis of prostate cancer were identified through cancer registration data.  A postal survey was administered which contained validated measures to assess a) functional outcomes (EPIC-26 plus use of interventions for sexual dysfunction) and b) generic HRQL (EQ-5D-5L & self-assessed health). Log-linear and binary logistic regression models were used to compare functional outcomes and HRQL across diagnostic stage and self-reported treatment groups. Findings. 35,823 (60.8%) men responded.  Stage was known for 85.8%; 19,599 (63.8%) stage I/II, 7,209 (23.4%) stage III, 3,925 (12.8%) stage IV.   Functional outcomes: Poor sexual function was common (81.0%), regardless of stage, and over half of men (55.8%) received no intervention for this.  Differences in urinary and bowel morbidity were greater with respect to treatment than stage.  In men treated with androgen deprivation therapy (ADT), 30.7% reported moderate/big problems with hot flushes, 29.4% with lack of energy and 22.5% with weight gain.  HRQL: Overall self-assessed health was similar in men with stage I-III disease, and whilst reduced in those with stage IV cancer, 23.5% with metastatic disease reported no problems on any EQ-5D dimension. Interpretation. Men diagnosed with advanced disease do not report markedly different HRQL outcomes to those diagnosed with localised disease, although substantial problems with hormonal function and fatigue are reported amongst men treated with ADT.  Sexual dysfunction is common and the majority of men are not offered helpful intervention or support.  Service improvements around sexual rehabilitation and measures to reduce the impact of ADT are required.

  Website 
• Cavers D, Habets L, Cunningham-Burley S, Watson E, Banks E, Campbell C, 'Living with and beyond cancer with comorbid illness: a qualitative systematic review and evidence synthesis.'
  Journal Cancer Survivorship (2019)
  Abstract

  Purpose 

  To identify the qualitative evidence on the experience of cancer and comorbid illness from the perspective of patients, carers and health care professionals to identify psycho-social support needs, experience of health care, and to highlight areas where more research is needed. 

  Methods 

  A qualitative systematic review following PRISMA guidance. Relevant research databases were searched using an exhaustive list of search terms. Two reviewers independently screened titles and abstracts and discussed variations. Included articles were subject to quality appraisal before data extraction of article characteristics and findings. Thomas and Harden’s thematic synthesis of extracted findings was undertaken. 

  Results

  Thirty-one articles were included in the review, covering a range of cancer types and comorbid conditions; with varying time since cancer diagnosis and apparent severity of disease for both cancer and other conditions. The majority of studies were published after 2010 and in high income countries. Few studies focused exclusively on the experience of living with comorbid conditions alongside cancer; such that evidence was limited. Key themes identified included the interaction between cancer and comorbid conditions, symptom experience, illness identities and ageing, self-management and the role of primary and secondary care. 

  Conclusions 

  In addition to a better understanding of the complex experience of cancer and comorbidity, the review will combine with research prioritisation work with consumers to inform an interview study with the defined patient group. 

  Implications for Cancer Survivors

  Expanding this evidence base will help to illuminate developing models of cancer patientcentred follow-up care for the large proportion of patients with comorbid conditions
  

  Website 
• Wagland R, Nayoan J, Matheson L, Rivas C, Brett J, Downing A, Wilding S, Butcher H, Gavin A, Glaser A W, Watson E, '"Very difficult for an ordinary guy": Factors influencing the quality of treatment decision-making amongst men diagnosed with localised and locally advanced prostate cancer: findings from a UK-wide mixed methods study'
  Patient Education and Counseling 102 (4) (2019) pp.797-803
  ISSN: 0738-3991 eISSN: 1873-5134
  Abstract

  Objectives. To explore the experience of treatment decision-making (TDM) amongst men diagnosed with stage 1-3 prostate cancer. Methods. Mixed-methods study incorporating UK wide cross-sectional postal survey of men 18-42 months post-diagnosis and semi-structured interviews with a subsample (n=97), including men who received both radical treatments and active surveillance. Interview data was analysed using a Framework approach. Findings. Within the context of TDM, ‘drivers’ included men’s preferences for decision-making responsibility or clinical direction, relative treatment intrusiveness or desire for excision, and work, personal and social life priorities; ‘facilitators’ were mechanisms such as shared decision-making utilised by clinicians to enact, but also sometimes challenge drivers. Drivers and facilitators can conflict, challenging patient empowerment. Men frequently undertook greater TDM responsibility than they desired, with no clinical recommendations; others reported receiving conflicting clinical recommendations. Information on potential side effects was often reported as inadequate. Unchallenged preferences, absence of clinical recommendations and inadequate preparation for side effects sometimes led to decision regret. Conclusions. TDM should involve men exercising preferences and priorities in discussion with clinicians. Men are not empowered when required to take more TDM responsibility than desired or when their potentially inappropriate preferences are unchallenged. Clinicians should ensure patients do not receive conflicting recommendations.

  Website 
• Brett J, Boulton M, Watson E, 'Development of an e-health app to support women prescribed adjuvant endocrine therapy (AET) after treatment for breast cancer'
  Patient Preference and Adherence 12 (2018) pp.2639-2647
  ISSN: 1177-889X eISSN: 1177-889X
  Abstract

  Background. Adjuvant endocrine therapy (AET) is prescribed to women for 5–10 years after treatment for estrogen receptor positive (ER+ve), early-stage breast cancer. AET has proven effectiveness in reducing the risk of recurrence of breast cancer and mortality. However, adherence is known to be suboptimal with around 20% discontinuing by 2 years and up to 50% discontinuing by 5 years. Interventions are needed to support women taking AET after breast cancer. The aim of this study was to develop and pilot test an e-health app for this population. Methods. Two focus groups (n=15) and five interviews were conducted with women following treatment for early-stage breast cancer to assess the likely acceptability of an e-health app and to inform the content (Phase I). Following development of a prototype e-health app, a simple heuristic usability test was completed by five women in order to identify any design usability problems (Phase II). A further 18 women used the app for 1 month between July and August 2016, after which they were interviewed by telephone to collect their experiences and views of the app (Phase III). Results. The prototype e-health app included evidence-based information on effectiveness of AET, an electronic side-effects diary, a peer support forum, a repeat prescription reminder, suggested strategies for facilitating adherence and managing any side effects that occur, and a link to further evidence and useful organizations for further information and support. The app was received positively by women. Women found the app useful as it emphasized the importance of taking AET, helped them manage their side effects and provided details of support organizations, while offering empathy and exchange of suggestions for self-management strategies through the peer support forum. Conclusion. Overall, findings suggest that this novel e-health app has potential as a feasible medium for promoting adherence to AET. Future research should evaluate the efficacy of the app in supporting women and promoting adherence.
  

  Website 
• Collaco N, Wagland R, Alexis O, Gavin A, Glaser A, Watson KE, 'The challenges on the family unit faced by younger couples affected by prostate cancer: A qualitative study'
  Psycho-Oncology 28 (2) (2018) pp.329-335
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract

  Objective. The number of younger men being diagnosed with Prostate cancer (PCa), (aged ≤65) is increasing. It is recognised that PCa and treatment side effects can have a significant impact on quality of life. This study explores the challenges faced by younger couples affected by PCa with dependent children (under 18 years) or young adults (18-29 years) in their families. Methods. Twenty-three men with PCa and their partners were interviewed (separately) by telephone. Participants were recruited from respondents to the Life After Prostate Cancer Diagnosis (LAPCD) national survey. Men were three to five years post-diagnosis, and following a range of treatment pathways. Data were analysed using the Framework approach. Results. Younger couples affected by PCa felt challenged by issues relating to their parental role and the dynamics within the family. Five main themes emerged: difficult conversations about PCa diagnosis; parental perceptions of the impact of diagnosis on children; parental responses to the impact of PCa on the family; shielding, coping and normalising strategies; and levels of support. Conclusions. A diagnosis of PCa can cause significant disruption to the family unit and the quality of life of its members. Support programmes offering guidance to children/young adults affected by PCa in their family, and addressing the concerns of parents may help families to better adapt. Encouraging clinical professionals to initiate conversations with younger couples about their children may be a way forward in directing appropriate support. Further research is needed to elucidate appropriate, effective supportive interventions.
  

  Website 
• Bennett D, KearneyT, Donnelly DW, Downing A, Wright P, Wilding S, Wagland R, Watson E, Glaser A, Gavin A., 'Factors influencing job loss and early retirement in working men with prostate cancer—findings from the population-based Life After Prostate Cancer Diagnosis (LAPCD) study'
  Journal Cancer Survivorship 12 (5) (2018) pp.669-678
  ISSN: 1932-2259 eISSN: 1932-2267
  Abstract

  Purpose. To investigate factors associated with job-loss and early retirement in men diagnosed with prostate cancer (PCa) 18-42 months previously. Methods. Men ≤60 years at diagnosis who completed the Life After Prostate Cancer Diagnosis (LAPCD) survey were identified. Men who moved from employment at diagnosis to unemployment (EtoU) or retirement (EtoR) at survey (18-42 months post-diagnosis) were compared to men remaining in employment (EtoE). Socio-demographic, clinical and patient reported factors were analysed in univariable and multivariable analysis. Results. There were 3,218 men (81.4%) in the EtoE, 245 (6.2%) in EtoU and 450 (11.4%) in the EtoR groups. Men with stage IV disease (OR=4.7 95%CI 3.1–7.0, relative to Stage I/II) and reporting moderate/big bowel (OR=2.5, 95%CI 1.6–3.9) or urinary problems (OR=2.0, 95%CI 1.4–3.0) had greater odds of becoming unemployed. Other clinical (≥1 comorbidities, symptomatic at diagnosis) and socio-demographic (higher deprivation, divorced/separated), living in Scotland or Northern Ireland [NI]) factors were predictors of becoming unemployed. Men who were older, from NI, with Stage IV disease and with caring responsibilities had greater odds of retiring early. Self-employed and non-white men had lesser odds of retiring early. Conclusion. PCa survivors who retire early following diagnosis do not report worse urinary or bowel problems compared to men remaining in employment. However, we identified clinical and socio-demographic factors which increased unemployment risk in PCa survivors. Implications for Cancer Survivors. Targeted support and engagement with PCa survivors at risk of unemployment, including their families and employers, is needed.

  Website 
• Corbett T, Cheetham T, Andre Matthias Müller AMM, Slodkowska-Barabasz J, Wilde L, Krusche A, Richardson A, Foster C, Watson E, Little P, Yardley L, Bradbury K, 'Exploring cancer survivors’ views of health behavior change: “Where do you start, where do you stop with everything?”'
  Psycho-Oncology 27 (7) (2018) pp.1816-1824
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract OBJECTIVE. Physical activity (PA) and a healthy diet can improve the well-being of cancer survivors. However, cancer survivors often do not engage in these behaviours. This study aimed to explore barriers and facilitators to engaging in these behaviours following cancer treatment. METHODS. During the development of a Web-based intervention to enhance health-related quality of life in cancer survivors, 32 people who had completed treatment for breast, colon, or prostate cancer were presented with an intervention for PA and healthy eating. In-depth think-aloud and semi-structured interviewing techniques were used to elicit perceptions of both behaviours. Data were analysed using thematic analysis. RESULTS. Some individuals reported implementing positive health behaviour changes to maintain health and prevent recurrence, or to help them to move forward after cancer. However, others reported feeling abandoned, and many did not report an intention to engage in lifestyle changes. Individuals discussed contextual and health-related barriers that were specifically linked to their situation as post-treatment cancer survivors: individuals described uncertainty about how to implement adaptive changes and perceived a lack of support from health care providers. Others viewed behaviour change as unnecessary or undesirable, with some arguing that non-modifiable factors contributed more to their cancer diagnosis than lifestyle-related factors. CONCLUSIONS. For many participants in this study, the period that follows treatment for cancer did not represent a "teachable moment." A variety of complex and heterogeneous factors appeared to impact motivation and may limit cancer survivors from engaging with diet and PA changes.Website 
• Collaco N, Rivas C, Matheson L, Nayoan J, Wagland R, Alexis O, Gavin A, Glase A, Watson E, 'Prostate cancer and the impact on couples: a qualitative metasynthesis.'
  Supportive Care in Cancer 26 (6) (2018) pp.1703-1713
  ISSN: 0941-4355 eISSN: 1433-7339
  Abstract

  Purpose: To review and interpret existing qualitative literature on the experiences of couples affected by prostate cancer (PCa).
  Methods: 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.
  Results: 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/or each other from the impact of PCa. Being a partner and its challenges highlights the responsibilities partners assume and the impact of their supporting role. Yet, partners sometimes report feeling unsupported and side-lined both by the man they are caring for and by healthcare professionals. Couples often recognise the value of facing PCa together.
  Conclusions: PCa affects both members of the dyad as individuals, as well as the couple’s relationship. How best to support couples and how to overcome difficulties in expressing their concerns to one another requires further consideration. Healthcare professionals should endeavour to employ a couple-focused approach where appropriate.

  
  Website 
• Donnelly DW, Donnelly C, Kearney T, Weller D, Sharp L, Downing A, Wilding S, Wright P, Kind P, Catto JWF, Cross WR, Mason MD, McCaughan E, Wagland R,Watson E, Mottram R, Allen M, Butcher H, Hounsome L, Selby P, Huws D,Brewster DH, McNair E, Rivas C,Nayoan J, Horton M, Matheson L, Glaser AW, Gavin A., 'Urinary, bowel and sexual health in older men from Northern Ireland'
  BJU International 122 (5) (2018) pp.845-857
  ISSN: 1464-4096 eISSN: 1464-410X
  Website 
• Watson EK, Shinkins B, Matheson L, Burns RM, Frith E, Neal D, Hamdy F, Walter FM, Weller D, Wilkinson C, Faithfull S, Sooriakumaran P, Kastner C, Campbell C, Neal RD, Butcher H, Matthews M, Perera R, Wolstenholme J, Rose P., 'Supporting prostate cancer survivors in primary care: Findings from a pilot trial of a nurse-led psycho-educational intervention (PROSPECTIV)'
  European Journal of Oncology Nursing 32 (2018) pp.73-81
  ISSN: 1462-3889 eISSN: 1532-2122
  Abstract Purpose. This study sought to test the acceptability and feasibility of a nurse-led psycho-educational intervention (NLPI) delivered in primary care to prostate cancer survivors, and to provide preliminary estimates of the effectiveness of the intervention. Methods. Men who reported an ongoing problem with urinary, bowel, sexual or hormone-related functioning/vitality on a self-completion questionnaire were invited to participate. Participants were randomly assigned to the NLPI plus usual care, or to usual care alone. Recruitment and retention rates were assessed. Prostate-related quality of life, self-efficacy, unmet needs, and psychological morbidity were measured at baseline and 9 months. Health-care resource use data was also collected. An integrated qualitative study assessed experiences of the intervention. Results. 61% eligible men (83/136) participated in the trial, with an 87% (72/83) completion rate. Interviews indicated that the intervention filled an important gap in care following treatment completion, helping men to self-manage, and improving their sense of well-being. However, only a small reduction in unmet needs and small improvement in self-efficacy was observed, and no difference in prostate-related quality of life or psychological morbidity. Patients receiving the NLPI recorded more primary care visits, while the usual care group recorded more secondary care visits. Most men (70%; (21/30)) felt the optimal time for the intervention was around the time of diagnosis/before the end of treatment. Conclusions. Findings suggest a nurse-led psycho-educational intervention in primary care is feasible, acceptable and potentially useful to prostate cancer survivors.Website 
• Brett J, Fenlon D, Boulton, M Hulbert-Williams NJ, Walter FM, Donnelly P, Lavery B, Morgan A, Morris C, Watson E, 'Factors associated with intentional and unintentional non-adherence to Adjuvant Endocrine Therapy following breast cancer'
  European Journal of Cancer Care 27 (1) (2018)
  ISSN: 0961-5423 eISSN: 1365-2354
  Abstract Adherence to adjuvant endocrine therapy (AET) following breast cancer is known to be suboptimal despite its known efficacy in reducing recurrence and mortality. This study aims to investigate factors associated with non-adherence and inform the development of
  interventions to support women and promote adherence. A questionnaire survey to measure
  level of adherence, side effects experienced, beliefs about medicine, support received and socio-demographic details was sent to 292 women 2-4 years post breast cancer diagnosis. Differences between non-adherers and adherers to AET were explored, and factors associated with intentional and unintentional non-adherence are reported. Approximately one quarter of respondents, 46 (22%), were non-adherers, comprising 29 (14%) intentional non-adherers and 17 (8%) unintentional non-adherers. Factors significantly associated with intentional non-adherence were: the presence of side effects (p<0.03), greater concerns about AET (p<0.001), and a lower perceived necessity to take AET (p<0.001). Half of the sample (105/211) reported that side effects had a moderate or high impact on their quality of life. Factors associated with unintentional non-adherence were: younger age (<65), (p<0.001), post-secondary education (p=0.046), and paid employment (p=0.031). There are distinct differences between intentional non-adherence and unintentional non-adherence. Differentiation between the two types of non-adherence may help tailor support and advice interventions. 
  Website 
• Brett J, Boulton M, Fenlon D, Hulbert-Williams NJ, Walter FM, Donnelly P, Lavery B, Morgan A, Morris C, Watson E, 'Adjuvant endocrine therapy after breast cancer: A qualitative study of factors associated with adherence'
  Patient Preference and Adherence 12 (2017) pp.291-300
  ISSN: 1177-889X eISSN: 1177-889X
  Abstract Introduction : Despite evidence of the efficacy of Adjuvant Endocrine Therapy (AET) in reducing the risk of recurrence and mortality after treatment for primary breast cancer, adherence to AET is suboptimal. This study aimed to explore factors that influence adherence and non-adherence to adjuvant endocrine therapy (AET) following breast cancer to inform the development of supportive interventions.
  Methods: Interviews were conducted with 32 women who had been prescribed AET, 2-4 years following their diagnosis of breast cancer,. Both adherers (n=19) and non-adherers (n=13) were recruited. The analysis was conducted using the Framework approach.
  Results: Factors associated with adherence were: Managing side effects including information and advice on side effects, and taking control of side effects, Supportive relationships, and Personal influences. Factors associated with non-adherence were: Burden of side effects, Feeling unsupported, Concerns about long term AET use, Re-gaining normality, including valuing quality of life over length of life, and Risk perception
  Conclusions: Provision of timely information to prepare women for the potential side effects of AET and education on medication management strategies are needed, including provision of timely and accurate information on the efficacy of AET in reducing breast cancer recurrence, and on potential side effects and ways to manage these should they arise. . Trust in the doctor-patient relationship and clear patient pathways for bothersome side effects and concerns with AET are important. Training and education around AET for GPs should be considered alongside novel care pathways such as primary care nurse cancer care review, and community pharmacist follow-up.Website 
• Brett J, Hulbert-Williams N, Fenlon D, Boulton M, Walter FM, Donnelly P, Lavery B, Morgan A, Morris C, Horne R, Watson E, 'Psychometric properties of the Beliefs about Medicine Questionnaire (BMQ)-AET for Women taking Adjuvant Endocrine Therapies (AET) following early-stage breast cancer'
  Health Psychology Open 4 (2) (2017) pp.1-8
  ISSN: 2055-1029 eISSN: 2055-1029
  Abstract Objectives: To evaluate the Beliefs about Medicine Questionnaire to explore adherence to adjuvant endocrine therapy after treatment for breast cancer (BMQ-AET). Method: Factor structure of the BMQ-AET was explored alongside internal consistency, convergent validity and acceptability.
  Results: The BMQ-AET Specific Scale fitted the original 10 item model. Internal consistency of the BMQ-AET was much improved compared to the original BMQ and convergent validity showed predicted direction of correlation, although correlation with BMQ-AET concerns scale was low. Acceptability was good. Conclusions: The evaluation of the BMQAET is encouraging, and could facilitate future research around adherence to AET.
  Website 
• Corbett TK, Singh K, Payne L, Bradbury K, Foster C, Watson E, Richardson A, Little P, Yardley L, 'Understanding acceptability of and engagement with web-based interventions aiming to improve quality of life in cancer survivors: a synthesis of current research'
  Psycho-oncology 27 (1) (2017) pp.22-33
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract Purpose. This review sought to summarize existing knowledge in order to inform the development of an online intervention that aims to improve quality of life after cancer treatment.
  Methods. To inform our intervention, we searched for studies relating to web-based interventions designed to improve QoL in adults who have completed primary treatment for breast, prostate and colorectal cancer (as these are three of the most common cancers and impact a large number of cancer survivors). We included a variety of study designs (qualitative research, feasibility/pilot trials, randomised trials, and process evaluations) and extracted all available information regarding intervention characteristics, experiences, and outcomes. Data were synthesised as textual (qualitative) data and analysed using thematic analysis.
  Results. Fifty-seven full text articles were assessed for eligibility and 16 papers describing nine interventions were analysed. Our findings suggest that cancer survivors value interventions that offer content specific to their changing needs and are delivered at the right stage of the cancer trajectory. Social networking features do not always provide added benefit, and behaviour change techniques need to be implemented carefully to avoid potential negative consequences for some users.
  Conclusions. Future work should aim to identify appropriate strategies for promoting health behaviour change, as well as the optimal stage of cancer survivorship to facilitate intervention delivery.
  Clinical Implications. The development of web-based interventions for cancer survivors requires further exploration to better understand how interventions can be carefully designed to match this group’s unique needs and capabilities. User involvement during development may help to ensure that interventions are accessible, perceived as useful, and appropriate for challenges faced at different stages of the cancer survivorship trajectory.
  Website 
• Adam R, de Wit N, Groome P, Helsper C, McBride M, Watson E, Wind J, 'Increased survival means increasing roles for primary care after cancer diagnosis'
  British Journal of General Practice 67 (661) (2017) pp.349-349
  ISSN: 0960-1643
  Website 
• Burns RM, Wolstenholme J, Shinkins B, Frith E, Matheson L, Rose PW, Watson E, 'Including health economic analysis in pilot studies: lessons learned from a cost-utility analysis within the PROSPECTIV pilot study'
  Global & Regional Health Technology Assessment Northern Europe 4 (1) (2017)
  ISSN: 2283-5733 eISSN: 2283-5733
  Abstract

  Purpose. To assess feasibility and health economic benefits and costs as part of a pilot study for a nurse-led, psychoeducational intervention (NPLI) for prostate cancer in order to understand the potential for cost effectiveness as well as contribute to the design of a larger scale trial.

  Methods. Men with stable prostate cancer post-treatment were recruited from two cancer centres in the UK. Eighty-three men were randomised to the NLPI plus usual care or usual care alone (UCA) (42 NLPI and 41 UCA); the NLPI plus usual care was delivered in the primary-care setting (the intervention) and included an initial face-to-face consultation with a trained nurse, with follow-up tailored to individual needs. The study afforded the opportunity to undertake a short-term within pilot analysis. The primary outcome measure for the economic evaluation was quality of life, as measured by the EuroQol five dimensions questionnaire (EQ-5D) (EQ-5D-5L) instrument. Costs (£2014) assessed included health-service resource use, out-of-pocket expenses and losses from inability to undertake usual activities.

  Results. Total and incremental costs varied across the different scenarios assessed, with mean cost differences ranging from £173 to £346; incremental effect, as measured by the change in utility scores over the duration of follow-up, exhibited wide confidence intervals highlighting inconclusive effectiveness (95% CI: -0.0226; 0.0438). The cost per patient of delivery of the intervention would be reduced if rolled out to a larger patient cohort.

  Conclusions. The NLPI is potentially cost saving depending on the scale of delivery; however, the results presented are not considered generalisable.

  Website 
• Cavers D, Cunningham-Burley S, Watson E, Banks E, Campbell C, 'Experience of living with cancer and comorbid illness: protocol for qualitative systematic review'
  BMJ Open 7 (5) (2017)
  ISSN: 2044-6055
  Abstract Introduction. There is an increasing number of people living with and beyond cancer, whose experience is further complicated by additional long-term health conditions in the context of an ageing population. The supportive care needs of this growing patient group should be recognised and addressed. There is a need to explore the experience of living with cancer and comorbid illness in order to develop optimal models of patient-centred care. This protocol describes a systematic review that aims to identify the qualitative evidence relating to the experience of cancer and comorbid illness for patients, informal carers and professionals, and to highlight areas where more research is needed.
  Methods and analysis. A systematic review following PRISMA guidance will be undertaken. Medline, Embase, CINAHL, PsycINFO, ASSIA, Sociological Abstracts, Web of Science, SCOPUS, OpenGrey and ProQuest Dissertations and Theses Global databases will be systematically searched for articles relevant to patient, carer and professional experiences. Two independent reviewers will screen articles for inclusion and evaluate them according to the Critical Appraisal Skills Programme tool. Extracted data will be combined using recognised methods of qualitative synthesis to offer new insights into the topic area and for a patient-centred model of care.
  Ethics and dissemination. The review does not require formal ethical review as no direct patient contact or patient identifiable data is used. Conduct of the review has been approved internally by the University of Edinburgh Centre for Population Health Sciences Ethics Review Committee. Results of the review will be published in a generalist peerreviewed journal and presented at a relevant conference in addition to informing subsequent empirical work by the authors on this topic area.Website 
• Matheson L, Watson E, Nayoan J, Wagland R, Glaser A, Gavin A, Wright P, Rivas C, 'A qualitative metasynthesis exploring the impact of prostate cancer and its management on younger, unpartnered and gay men'
  European Journal of Cancer Care 26 (6) (2017)
  ISSN: 0961-5423 eISSN: 1365-2354
  Abstract Prostate cancer (PCa) can negatively impact on men’s sexual, urinary and emotional
  functioning, affecting quality of life. Most men with PCa are older (>= 65 years), married
  and heterosexual and little is known about the impact on men who are younger, unpartnered
  or gay. We aimed to synthesise existing qualitative research on these three groups of men.
  A systematic metasynthesis was undertaken that included data on the unique impacts of PCa
  on younger (<65 years) (n=7 papers), unpartnered (n=17 papers), or gay or bisexual men
  (n=11 papers) using a modified meta-ethnographic approach. The three overarching
  constructs illustrated the magnified disruption to men’s biographies, that included:
  marginalisation, isolation and stigma– relating to men’s sense of being ‘out of sync’; the
  burden of emotional and embodied vulnerabilities and the assault on identity– illustrating
  the multiple threats to men’s work, sexual and social identities; shifting into different
  communities of practice– such as the shift from being part of a sexually active community to
  celibacy. These findings suggest that PCa can have a particular impact on the quality of life
  of younger, unpartnered, and gay men. This has implications for the provision of tailored
  support and information to these potentially marginalised groups.
  Website 
• Downing A, Wright P, Wagland R, Watson E, Kearney T, Mottram R, Allen M, Cairnduff V, MsSorley O, Butcher H, Hounsome L, Donnelly C, Selby P, Kind P Cross W, Catto J, Huws D, Brewster D, McNair E, Matheson L, Rivas C, Nayoan J, Horton M, Corner J, Verne J, Gavin A, Glaser A, 'Life after prostate cancer diagnosis: protocol for a UK-wide patient-reported outcomes study'
  BMJ OPEN 6 (12) (2017)
  ISSN: 2044-6055
  Abstract Background: Prostate cancer and its treatment may impact physically, psychologically and
  socially; affecting the health-related quality of life (HRQL) 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.
   
  Methods and analysis: Postal surveys will be sent to prostate cancer survivors (18-42
  months post-diagnosis) in all four 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 (PROM) has been developed using
  generic and specific instruments with proven psychometric properties and relevance in
  national and international studies. The outcome data will be linked with administrative health
  data (e.g. treatment information from hospital data). To ensure detailed understanding of
  issues of importance, qualitative interviews will be undertaken with a sample of men who
  complete the survey across the UK (n=~150) along with a small number of partners/spouses
  (n=~30).
   
  Ethics and dissemination: The study has received the following approvals: Newcastle &
  North Tyneside 1 Research Ethics Committee (15/NE/0036), Health Research Authority
  Confidentiality Advisory Group (15/CAG/0110), NHS Scotland Public Benefit and Privacy
  Panel (0516-0364), Office of Research Ethics Northern Ireland (16/NI/0073) and NHS R&D
  approval from Wales, Scotland and Northern Ireland. Using traditional and innovative
  methods, the results will be made available to men and their partners/spouses, the funders,
  the NHS, social care, voluntary sector organisations and other researchers. 
   
  Website 
• Brett J, Watson E, Boulton M, Stoner N, 'To explore the use of an android app to promote adherence to Adjuvant Endocrine Therapy following breast cancer'
  PsychoOncology 25 (S3) (2016) pp.141-141
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract [Abstracts of the 2016 World Congress of Psycho-oncology, 17-21 October 2016, Dublin, Ireland]Website 
• Matheson L, Boulton M, Lavender V, Collins G, Mitchell-Floyd T, Watson E, 'The experiences of young adults with Hodgkin lymphoma transitioning to survivorship: a grounded theory study'
  Oncology Nursing Forum 43 (5) (2016) pp.E195-E204
  ISSN: 0190-535X
  Abstract
  Objectives: To explore the experiences of young adults with Hodgkin lymphoma during the first year following the end of initial treatment.
  Research approach: A qualitative grounded theory study.
  
  
  Setting: Interviews with patients recruited from three cancer centres in England.
  
  
  Participants: 10 Hodgkin lymphoma survivors (4 men and 6 women, 21-39 years old) recruited as part of a larger study of 28 young adult cancer survivors.
  Methodologic approach: Semi-structured interviews conducted approximately two months following treatment completion and follow-up interviews conducted 7 months later.  Our grounded theory of positive psychosocial adjustment to cancer (Matheson et al., 2016)provided the conceptual framework.
  Findings:  Positive reframing, informal peer support, acceptance and normalisation helped young adults dismantle the threats of Hodgkin lymphoma over the course of treatment but they described losing a sense of security following treatment completion. Greater age-specific information to enable better preparation for the future was desired regarding body image, fertility, sexual relationships, work and socialising.
  Conclusions: Informal support mechanisms such as peer support and patient navigator interventions might be useful ways to further support young adults around treatment completion.
  Interpretation for practice: Positive psychosocial adjustment to cancer survivorship in young adults is facilitated by having informal peer support, being able to positively reframe, accept and normalize their experience and being prepared for the future.
  Website 
• Rivas C, Matheson L, Nayoan J, Glaser A, Gavin A, Wright P, Watson E, Wagland R, 'Ethnicity and the prostate cancer experience: a qualitative metasynthesis'
  Psycho-Oncology 25 (10) (2016) pp.1147-1156
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract Objectives: To summarise black and minority ethnic (BME) patients' and partners experiences of prostate cancer (PCa) 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 seven databases.
   
  Results: Thirteen studies of men from US and UK BME groups were included. We explored constructs with BME-specific features. Healthcare 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 three 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 conceptualisations 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. Healthcare services should acknowledge this. If providers recognise 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. 
  Website 
• Watson E, Shinkins B, Frith E, Neal D, Hamdy F, Walter F, Weller D, Wilkinson C, Faithfull S, Wolstenholme J, Sooriakumaran P, Kastner C, Campbell C, Neal R, Butcher H, Matthews M, Perera R, Rose P, 'Symptoms, unmet needs, psychological well-being and health status in survivors of prostate cancer: implications for redesigning follow-up.'
  BJU International 117 (6B) (2016) pp.E10-E19
  ISSN: 1464-4096 eISSN: 1464-410X
  Abstract OBJECTIVE. To explore ongoing symptoms, unmet needs, psychological wellbeing, self-efficacy and overall health status in survivors of prostate cancer.
  
  PATIENTS AND METHODS. An invitation to participate in a postal questionnaire survey was sent to 546 men, diagnosed with prostate cancer 9-24 months previously at two UK cancer centres. The study group comprised men who had been subject to a range of treatments: surgery, radiotherapy, hormone therapy and active surveillance. The questionnaire included measures of prostate-related quality of life (Expanded Prostate cancer Index Composite 26-item version, EPIC-26); unmet needs (Supportive Care Needs Survey 34-item version, SCNS-SF34); anxiety and depression (Hospital Anxiety and Depression Scale, HADS), self-efficacy (modified Self-efficacy Scale), health status (EuroQol 5D, EQ-5D) and satisfaction with care (questions developed for this study). A single reminder was sent to non-responders after 3 weeks. Data were analysed by age, co-morbidities, and treatment group.
  
  RESULTS. In all, 316 men completed questionnaires (64.1% response rate). Overall satisfaction with follow-up care was high, but was lower for psychosocial than physical aspects of care. Urinary, bowel, and sexual functioning was reported as a moderate/big problem in the last month for 15.2% (n = 48), 5.1% (n = 16), and 36.5% (n = 105) men, respectively. The most commonly reported moderate/high unmet needs related to changes in sexual feelings/relationships, managing fear of recurrence/uncertainty, and concerns about the worries of significant others. It was found that 17% of men (51/307) reported potentially moderate-to-severe levels of anxiety and 10.2% (32/308) reported moderate-to-severe levels of depression. The presence of problematic side-effects was associated with higher psychological morbidity, poorer self-efficacy, greater unmet needs, and poorer overall health status.
  
  CONCLUSION. While some men report relatively few problems after prostate cancer treatment, this study highlights important physical and psycho-social issues for a significant minority of survivors of prostate cancer. Strategies for identifying those men with on-going problems, alongside new interventions and models of care, tailored to individual needs, are needed to improve quality of life.Website 
• Matheson L, Rivas C, Nayoan J, Wagland R, Glaser A, Gavin A, Wright P, Watson E, 'Marginalised men with prostate cancer: a qualitative metasynthesis exploring the impact on younger, gay and unpartnered men with prostate cancer (Abstracts of the British Psychosocial Oncology Society 2016 Annual Conference. Oral presentations)'
  Psycho-Oncology 25 (Supplement 1) (2016) pp.4-4
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract

  Background: Prostate cancer can have a detrimental impact on men’s quality of life, especially sexual, urinary and emotional functioning. As prostate cancer survivors are often older and married, little is known about the unique impact on younger, unpartnered or gay survivors.

  Aims: We aimed to synthesise existing qualitative research on these three groups of men (younger, unpartnered or gay).

  Methods: A focused metasynthesis was conducted on qualitative studies that included data on the impacts on either younger (<65 years) (n=14 papers), unpartnered (n=11 papers), or gay (n=7 papers) prostate cancer survivors. This was part of a wider systematic review of qualitative studies (2000 to 2015) investigating the impacts on prostate survivors and their partners (n=148 papers).

  Results: Third order concepts were developed for the three different groups of survivors. Four overarching themes were constructed:  stigma and separateness – relating to men’s sense of being isolated and ‘out of sync’; the challenge of renegotiating disrupted identities ­– illustrating the multiple threats to men’s work, home, sexual and social identities; the magnified threat to quality of life: emotional and embodied vulnerability – highlighting how these men have specific support and information needs; disrupting and accelerating the future: an unwanted burden – highlighting the disruption caused to men’s futures, including the shadow cast over future relationships and feeling forced into premature old age.

  Conclusions: This highlights the unique and shared experiences of younger, single and gay prostate cancer survivors. Areas where these potentially more vulnerable survivors may require additional support and information are highlighted.  

  Website 
• Brett J, Watson E, Boulton M, Fenlon D, Williams NH, Donnelly P, Walter F, Lavary B, Morgan A, Morris C, 'Exploring adherence to adjuvant endocrine therapy (AET) following treatment for breast cancer'
  Psycho-Oncology 25 (Supplement 1) (2016)
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract BACKGROUND: Suboptimal adherence to adjuvant endocrine therapy (AET) after breast cancer has been widely reported. Low adherence to AET comes with consequent increased risk of cancer recurrence and mortality, reduced QALYs and increased medical costs. The aim of this study was to explore factors affecting adherence and non-adherence to AET following breast cancer to inform interventions to support women with long-term use. METHODS: Women prescribed AET after breast cancer were recruited 2 to 4 years after initiating treatment.Thirty-two semi-structured interviews were conducted with non-adherers (n = 13) and adherers (n = 19). Digital recordings were transcribed verbatim and analysed usingthe Framework Approach. The analysis was underpinnedby the Necessity-Concerns Framework (Horne 2013) RESULTS: Non-adherence was influenced by unmanaged side-effect profile, lack of support and follow-up to promote continued use, lack of belief in the merits of taking AET for5 years, misunderstanding around the importance of continuous use, concerns over ongoing toxicity of drugs following chemotherapy and/or radiotherapy regimens and influence of negative views from friends, family and online forums. Adherence was influenced by limited impact of side-effect profile on daily life, trust in health professionals initiating treatment, feeling supported in ongoing AET therapy, good knowledge of reasons for ongoing AET therapy, influence of family and friends in importance of ongoing AET therapy. CONCLUSIONS: Reasons for adherence or non-adherenceto AET are variable and complex. Interventions are required to ensure women are well informed and supported to continue with AET where appropriate, thereby reducing breast cancer-related morbidity and mortality.Website 
• Scanlon K, Finnegan-John J, Manzi D, Watson E, Brett J, 'Identifying research priorities in breast cancer survivorship: a user perspective'
  Psycho-Oncology 25 (3-3) (2016)
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract Meeting AbstractWebsite 
• Rivas C, Matheson L, Nayoan J, Glaser A, Gavin A, Wright P, Watson E, 'Special considerations in the management and experience of prostate cancer in less studied ethnic groups: a qualitative metasynthesis'
  Psycho-Oncology 25 (19-19) (2016)
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract Background: Most qualitative studies exploring the impact of prostate cancer on men and their
  partners consider the dominant ethnic groups in the USA, UK, Scandinavia and Australia, with
  generally concordant findings. Other ethnic groups are likely to have different experiences.
  Aims: To explore the impact of prostate cancer and its treatment on men and their partners from
  the less studied ethnic groups.
   
  Methods: Using meta-ethnography and textual narrative we synthesised peer reviewed qualitative interview-based studies dated 2000-2015 focused on less well reported ethnic groups, as a subsynthesis of a comprehensive metasynthesis on the impact of prostate cancer.
  
  Results: Twenty-two papers (15 studies) covering 11 ethnic groups were analysed. Nine studies
  considered black and minority ethnic groups in the UK and USA, with the remainder in Brazil, the Pacific Islands, Israel, Turkey and Japan. We collected first and second order themes from the studies to develop conceptual third order themes with the following specific to the US and UK minority groups and Pacific Islanders: A spiritual continuum: from the will of God to God as helpmate; One more obstacle in the lifelong fight against adversity; Developing sensitive talk with a purpose (on disclosing the cancer to informal networks in culturally appropriate ways). Themes from the other studies were similar to those in the overall metasynthesis.
  
  Conclusions: Healthcare for prostate cancer should take account of contextually and culturally
  specific coping mechanisms and psychosocial factors in minority ethnic groups. More studies are needed in diverse ethnic groups.
• Stanciu MA, Morris C, Makin M, Watson E, Bulger J, Evans R, Hiscock J, Hoare Z, Edwards RT, Neal RD, Wilkinson C, 'A pilot randomised controlled trial of personalised care after treatment for prostate cancer (TOPCAT-P): nurse-led holistic-needs assessment and individualised psychoeducational intervention: study protocol'
  BMJ Open 5 (6) (2015) pp.e008470-
  ISSN: 2044-6055
  Abstract INTRODUCTION. Prostate cancer is common and the incidence is increasing, but more men are living longer after diagnosis, and die with their disease rather than of it. Nonetheless, specific and substantial physical, sexual, emotional and mental health problems often lead to a poor quality of life. Urology services increasingly struggle to cope with the demands of follow-up care, and primary care is likely to play the central role in long-term follow-up. The present phase II trial will evaluate the feasibility and acceptability of a nurse-led, person-centred psychoeducational intervention, delivered in community or primary care settings.
  
  METHODS AND ANALYSIS. Prostate cancer survivors diagnosed in the past 9-48 months and currently biochemically stable will be identified from hospital records by their treating clinician. Eligible men would have either completed radical treatment, or would be followed up with prostate specific antigen monitoring and symptom reporting. We will recruit 120 patients who will be randomised to receive either an augmented form of usual care, or an additional nurse-led intervention for a period of 36 weeks. Following the health policy in Wales, the intervention is offered by a key worker, is promoting prudent healthcare and is using a holistic needs assessment. Outcome measures will assess physical symptoms, psychological well-being, confidence in managing own health and quality of life. Healthcare service use will be measured over 36 weeks. Feedback interviews with patients and clinicians will further inform the acceptability of the intervention. Recruitment, attrition, questionnaire completion rates and outcome measures variability will be assessed, and results will inform the design of a future phase III trial and accompanying economic evaluation.
  
  ETHICS AND DISSEMINATION. Ethics approval was granted by Bangor University and North Wales REC (13/WA/0291). Results will be reported in peer-reviewed publications, at scientific conferences, and directly through national cancer and primary care networks.
  
  TRIAL REGISTRATION NUMBER. ISRCTN 34516019.Website 
• Walter FM, Usher-Smith JA, Yadlapalli S, Watson E, 'Caring for people living with, and beyond, cancer: an online survey of GPs in England.'
  British Journal of General Practice 65 (640) (2015) pp.e761-e768
  ISSN: 0960-1643
  Abstract BACKGROUND\nIncreasing numbers of people are living with, and beyond, cancer. They are at risk of long-term morbidity and premature mortality due to the consequences of their disease and its treatment. Primary care can contribute to providing ongoing care.\nAIM\nTo determine the current practice and views of GPs in England regarding cancer survivorship care.\nDESIGN AND SETTING\nOnline survey of a sample of 500 GPs, stratified by NHS region in England.\nMETHOD\nThe survey included questions adapted from prior surveys assessing physician knowledge and attitudes regarding care of patients with cancer.\nRESULTS\nIn total, 500 GPs responded; approximately half reported often providing care to people living beyond cancer for treatment-related side effects (51%), psychological symptoms (65%), and lifestyle advice (55%). Only 29% felt very confident managing treatment-related side effects compared with 46% and 65% for psychological symptoms and lifestyle advice respectively. Half reported usually receiving cancer treatment summaries and survivorship care plans but most of the sample felt these would improve their ability to provide care (76%). Only 53% were convinced of the usefulness of cancer care reviews. Although most felt that primary and specialist care should share responsibility for managing bone (81%) and cardiovascular (77%) health consequences, fewer than half reported often taking previous history of cancer or cancer treatment into consideration when assessing bone health; only one-fifth did this in relation to cardiovascular health. Most responders were interested in receiving education to improve their knowledge and expertise.\nCONCLUSION\nGPs have a potentially important role to play in caring for people following cancer treatment. This study has highlighted areas where further support and education are needed to enable GPs to optimise their role in cancer survivorship care.Website 
• Rubin G, Berendsen A, Crawford SM, Dommett R, Earle C, Emery J, Fahey T, Grassi L, Grunfeld E, Gupta S, Hamilton W, Hiom S, Hunter D, Lyratzopoulos G, Macleod U, Mason R, Mitchell G, Neal RD, Peake M, Roland M, Seifert B, Sisler J, Sussman J, Taplin S, Vedsted P, Voruganti T, Walter F, Wardle J, Watson E, Weller D, Wender R, Whelan J, Whitlock J, Wilkinson C, de Wit N, Zimmermann C, 'The expanding role of primary care in cancer control.'
  Lancet Oncology 16 (12) (2015) pp.1231-1272
  ISSN: 1470-2045 eISSN: 1474-5488
  Abstract The nature of cancer control is changing, with an increasing emphasis, fuelled by public and political demand, on prevention, early diagnosis, and patient experience during and after treatment. At the same time, primary care is increasingly promoted, by governments and health funders worldwide, as the preferred setting for most health care for reasons of increasing need, to stabilise health-care costs, and to accommodate patient preference for care close to home. It is timely, then, to consider how this expanding role for primary care can work for cancer control, which has long been dominated by highly technical interventions centred on treatment, and in which the contribution of primary care has been largely perceived as marginal. In this Commission, expert opinion from primary care and public health professionals with academic and clinical cancer expertise—from epidemiologists, psychologists, policy makers, and cancer specialists—has contributed to a detailed consideration of the evidence for cancer control provided in primary care and community care settings. Ranging from primary prevention to end-of-life care, the scope for new models of care is explored, and the actions needed to effect change are outlined. The strengths of primary care—its continuous, coordinated, and comprehensive care for individuals and families—are particularly evident in prevention and diagnosis, in shared follow-up and survivorship care, and in end-of-life care. A strong theme of integration of care runs throughout, and its elements (clinical, vertical, and functional) and the tools needed for integrated working are described in detail. All of this change, as it evolves, will need to be underpinned by new research and by continuing and shared multiprofessional development.Website 
• Wanat M, Boulton M, Watson E, 'Patients’ experience with cancer recurrence: A meta-ethnography.'
  Psycho-Oncology 25 (3) (2015) pp.242-252
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract Objective
  Recurrence is a difficult stage in the cancer journey as it brings to the fore the life-threatening nature of the illness. This meta-ethnography examines and synthesises the findings of qualitative research regarding patients' experience of cancer recurrence.
   
  Methods
  A systematic search of the qualitative studies published between January 1994 to April 2014 was undertaken. Seventeen relevant papers were identified, and a meta-ethnography was conducted.
   
  Results
  Six third-order concepts were developed to capture patients' experiences: experiencing emotional turmoil following diagnosis, which described the emotional impact of diagnosis and the influence of previous experiences on how the news were received; experiencing otherness, encompassing changed relationships; seeking support in the health care system, describing the extent of information needs and the importance of the relationship with health care professionals; adjusting to a new prognosis and uncertain future, highlighting the changes associated with uncertainty; finding strategies to deal with recurrence, describing ways of maintaining emotional well-being and regaining a sense of control over cancer; and facing mortality, describing the difficulties in facing death-related concerns and associated consequences.
   
  Conclusions
  This meta-ethnography clarifies the fundamental aspects of patients' experience of recurrence. It suggests that health care professionals can promote a positive experience of care and help lessen the psychosocial impact of recurrence by providing information in an approachable way and being sensitive to their changing needs. It also points to the importance of supporting patients in adopting strategies to regain a sense of control and to address their potential mortality and its impact on loved ones.
  Website 
• Matheson L, Boulton M, Lavender V, Protheroe A, Brand S, Wanat M, Watson E, 'Dismantling the present and future threats of testicular cancer: a grounded theory of positive and negative adjustment trajectories'
  Journal of Cancer Survivorship 10 (1) (2015) pp.194-205
  ISSN: 1932-2259 eISSN: 1932-2267
  Abstract

  Purpose
  Testicular cancer commonly affects men in the prime of their lives. While survival rates are excellent, little previous research has examined men’s experiences of adjustment to survivorship. We aimed to explore this issue in younger testicular cancer survivors.
  

  
  Methods
  In-depth qualitative interviews were conducted with testicular cancer survivors over     two time points approximately 6 months apart in the year following treatment                completion. Interviews were analysed using a grounded theory approach.

  Results
  The sample included 18 testicular cancer survivors between 22 and 44 years (mean age 34). A grounded theory was developed, which explained the process of positive adjustment over the first year following the treatment completion in terms of men’s ability    to dismantle the present and future threats of cancer, involving the key transitions of    gaining a sense of perspective and striving to get on with life and restore normality.          These were facilitated by six key processes. The processes that explained a negative adjustment trajectory are also presented.

  Conclusions
  These findings contribute to the understanding of the psychosocial impact of testicular cancer on younger men’s lives and have implications for the provision of support to      testicular cancer survivors. Further investigation into the feasibility of one-on-one peer     support interventions is warranted, as well as informal support that respects men’s          desire for independence.

  Implications for Cancer Survivors
  Understanding the processes involved in adjustment highlights ways in which health professionals can offer support to those struggling to adjust through challenging illness   beliefs, encouraging emotional disclosure and facilitating peer mentoring.

  Website 
• Boulton M, Adams E, Horne A, Durrant L, Rose P, Watson E, 'A qualitative study of cancer survivors’ responses to information on the long term and late effects of pelvic radiotherapy one to eleven years post treatment'
  European Journal of Cancer Care 24 (5) (2015) pp.734-747
  ISSN: 0961-5423 eISSN: 1365-2354
  Abstract

  As more patients survive cancer for longer, the long term and late effects of treatments become increasingly important issues for cancer survivors and providing information to enable survivors to recognise and manage them becomes increasingly pressing challenges for health care professionals.  The aim of this study was to explore the experiences of cancer survivors regarding information given on potential long term and late effects of pelvic radiotherapy.  Semi-structured interviews were conducted with 28 cancer survivors who had had radiotherapy to the pelvic area for a range of cancers 1 to 11 years previously. Participants were recruited using maximum variation sampling from a larger questionnaire survey of patients treated at one hospital.  Interviews were recorded, transcribed and analysed using Framework.  Participants recognised the value of information to reassure and to inform action but also its potentially undesirable effects to frighten or raise anxieties about future problems and its inherent limitations in meeting their wider needs.  They identified the timing, amount of information and context in which it was given as of particular importance. Information based on personal experience was also valued.  These findings highlight the importance of appropriate, individualised information during treatment, at hospital discharge and subsequently in primary care.

   

  Website 
• Dunn JA, Donnelly PK, Marshall A, Wilcox M, Watson E, Young A, Balmer C, Ramirez M, Hartup S, Maxwell AJ, Evans AJ, Evans AJ, 'Follow-up in early breast cancer--a surgical and radiological perceptive'
  Clinical oncology (Royal College of Radiologists (Great Britain)) 26 (2014) pp.625-629
  ISSN: 0936-6555
  Abstract EditorialWebsite 
• Matheson L, Boulton M, Lavender V, Collins G, Protheroe A, Watson E, '"Dismantling the threats of cancer: regaining a sense of security, perspective and normality" : a substantive theory of psychosocial adjustment in younger adult cancer survivors (Poster Abstracts of the IPOS 16th World Congress)'
  PSYCHO-ONCOLOGY 23 (Supplement 3) (2014) pp.354-355
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract BACKGROUND: Cancer in younger adulthood disrupts typical developmental milestones, such as parenthood, careers, education and romantic relationships. However, few studies have explored in-depth the processes involved in positive and negative psychosocial adjustment to cancer in this age group. Testicular cancer (TC) and Hodgkin’s lymphoma (HL) typically affect younger adults yet have received relatively little research attention. This study aimed to develop a new theory of psychosocial adjustment to cancer in younger adults with these specific cancers. METHOD: Patients who had completed treatment for TC or HL were recruited from 3 hospitals in England through invitation from the clinical team. Qualitative, semi-structured  interviews were conducted with 25 patients (18 TC and 7 HL), between 20 and 45 years old (21 male and 4 female). Interviewswere conducted within 6 months of treatment completion and again 6–12 months later (n=17, todate), totalling 42 interviews. Participants were interviewed at home, work or in a public cafe, and lasted between 40 and 120 minutes. A Grounded Theory methodology was used to analyse the data. RESULTS: A  positive  psychosocial adjustment transition depended on the ability to “dismantle and relinquish cancer threats” and “regain a sense ofsecurity, perspective and normality.” Firstly, the process of “gaining a sense of perspective” involved; resolving the discrepancy between assumptions and experience, weighing up the significance of cancer,acceptance, utilising peer support, finding a senseof coherence, holding onto positive illness beliefs and making comparisons. Additionally, “striving toget on with life and restoring normality” meant;guarding against psychological threats, accepting anew body normality, accepting the need to “waitand  see”  over  fertility,  and  constructing  an enhanced sense of personhood. CONCLUSIONS:This theory highlights the key processes involved inpositive adjustment “transitions” during early survivorship. Importantly, comparisons with the few patients more negatively adjusted who struggled to dismantle the threats of cancer, highlights how vulnerable patients may be supported better to achieve successful positive transitions in different areas.Whilst most expressed few unmet needs, younger adults exhibited preferences to receive and givemore “informal” psychosocial support, particularly through peer mentoring, and often rejected the ideaof formalised psychological support or online support. Evidently, interventions which enable the preservation of values of independence and autonomy to self-manage are vital for younger adults. RESEARCH  IMPLICATIONS: Further  studies which test this substantive theory of psychosocial adjustment  in  larger  and diverse samples are needed, particularly regarding the processes associated with negative adjustment. In addition, research could investigate whether targeting concepts associated with positive adjustment identified in themodel through psychosocial interventions could promote better adjustment. Importantly, studies which explore the efficacy and feasibility of peer support interventions for younger adults are also warranted.  CLINICAL  IMPLICATIONS: Thestudy has implications for the development of psychosocial  interventions  aimed  at  supporting patients who struggle to positively adjust. The findings suggest ways that nurses could promote adjustment through addressing negative illness beliefs,helping patients to “gain perspective” and preparing patients for post treatment challenges, such asknowing “what is normal.” Finally, having opportunities to reflect helped patients to “make sense,”so one-to-one peer mentoring may be appropriateas  well  as  less  formalised  support  programs.Website 
• Watson E, Rose P, Frith E, Hamdy F, Neal D, Kastner C, Russell S, Walter FM, Faithfull S, Wolstenholme J, Perera R, Weller D, Campbell C, Wilkinson C, Neal R, Sooriakumaran P, Butcher H, Matthews M, 'PROSPECTIV : a pilot trial of a nurse-led psychoeducational intervention delivered in primary care to prostate cancer survivors: study protocol for a randomised controlled trial'
  BMJ open 4 (5) (2014) pp.1-9
  ISSN: 2044-6055
  Abstract BACKGROUND. Prostate cancer survivors can experience physical, sexual, psychological and emotional problems, and there is evidence that current follow-up practices fail to meet these men's needs. Studies show that secondary and primary care physicians see a greater role for primary care in delivering follow-up, and that primary care-led follow-up is acceptable to men with prostate cancer.
  
  METHODS AND ANALYSIS. A two-phase study with target population being men who are 9-24 months from diagnosis. Phase 1 questionnaire aims to recruit 300 men and measure prostate-related quality of life and unmet needs. Men experiencing problems with urinary, bowel, sexual or hormonal function will be eligible for phase 2, a pilot trial of a primary care nurse-led psychoeducational intervention. Consenting eligible participants will be randomised either to intervention plus usual care, or usual care alone (40 men in each arm). The intervention, based on a self-management approach, underpinned by Bandura's Social Cognitive Theory, will provide advice and support tailored to these men's needs and address any problems they are experiencing. Telephone follow-up will take place at 6 months. Study outcomes will be measured by a questionnaire at 7 months. Phase 1 will allow us to estimate the prevalence of urinary, sexual, bowel and hormone-related problems in prostate cancer survivors and the level of unmet needs. 'Usual care' will also be documented. Phase 2 will provide information on recruitment and retention, acceptability of the intervention/outcome measures, effect sizes of the intervention and cost-effectiveness data, which is required to inform development of a larger, phase 3 randomised controlled trial. The main outcome of interest is change in prostate-cancer-related quality of life. Methodological issues will also be addressed.
  
  ETHICS AND DISSEMINATION. Ethics approval has been gained (Oxford REC A 12/SC/0500). Findings will be disseminated in peer-reviewed journals, at conferences, through user networks and relevant clinical groups.
  
  TRIAL REGISTRATION NUMBER. ISRCTN 97242511.Website 
• Duffy SW, Mackay J, Thomas S, Anderson E, Chen THH, Ellis I, Evans G, Fielder H, Fox R, Gui G, Macmillan D, Moss S, Rogers C, Sibbering M, Wallis M, Warren R, Watson E, Whynes D, Allgood P, Caunt J, 'Evaluation of Mammographic Surveillance Services in Women Aged 40-49 Years With a Moderate Family History of Breast Cancer: a Single-arm Cohort Study'
  Health Technology Assessment 17 (11) (2013) pp.1-114
  ISSN: 1366-5278
  Abstract

  BACKGROUND:

  Women with a significant family history of breast cancer are often offered more intensive and earlier surveillance than is offered to the general population in the National Breast Screening Programme. Up to now, this strategy has not been fully evaluated.

  OBJECTIVE:

  To evaluate the benefit of mammographic surveillance for women aged 40-49 years at moderate risk of breast cancer due to family history. The study is referred to as FH01.

  DESIGN:

  This was a single-arm cohort study with recruitment taking place between January 2003 and February 2007. Recruits were women aged < 50 years with a family history of breast or ovarian cancer conferring at least a 3% risk of breast cancer between ages 40 and 49 years. The women were offered annual mammography for at least 5 years and observed for the occurrence of breast cancer during the surveillance period. The age group 40-44 years was targeted so that they would still be aged < 50 years after 5 years of surveillance.

  SETTING:

  Seventy-four surveillance centres in England, Wales, Scotland and Northern Ireland.

  PARTICIPANTS:

  A total of 6710 women, 94% of whom were aged < 45 years at recruitment, with a family history of breast cancer estimated to imply at least a 3% risk of the disease between the ages of 40 and 50 years.

  INTERVENTIONS:

  Annual mammography for at least 5 years.

  MAIN OUTCOME MEASURES:

  The primary study end point was the predicted risk of death from breast cancer as estimated from the size, lymph node status and grade of the tumours diagnosed. This was compared with the control group from the UK Breast Screening Age Trial (Age Trial), adjusting for the different underlying incidence in the two populations.

  RESULTS:

  As of December 2010, there were 165 breast cancers diagnosed in 37,025 person-years of observation and 30,556 mammographic screening episodes. Of these, 122 (74%) were diagnosed at screening. The cancers included 44 (27%) cases of ductal carcinoma in situ. There were 19 predicted deaths in 37,025 person-years in FH01, with an estimated incidence of 6.3 per 1000 per year. The corresponding figures for the Age Trial control group were 204 predicted deaths in 622,127 person-years and an incidence of 2.4 per 1000 per year. This gave an estimated 40% reduction in breast cancer mortality (relative risk = 0.60; 95% confidence interval 0.37 to 0.98; p = 0.04).

  CONCLUSIONS:

  Annual mammography in women aged 40-49 years with a significant family history of breast or ovarian cancer is both clinically effective in reducing breast cancer mortality and cost-effective. There is a need to further standardise familial risk assessment, to research the impact of digital mammography and to clarify the role of breast density in this population.

  Website 
• Adams E, Hill E, Watson E, 'Fertility Preservation in Cancer Survivors: a National Survey of Oncologists Current Knowledge, Practice and Attitudes'
  British Journal of Cancer 108 (2013) pp.1602-1615
  ISSN: 0007-0920 eISSN: 1532-1827
  Abstract

  BACKGROUND:

  Around 1 in 10 of all cancer cases occur in adults of reproductive age. Cancer and its treatments can cause long-term effects, such as loss of fertility, which can lead to poor emotional adjustment. Unmet information needs are associated with higher levels of anxiety. US research suggests that many oncologists do not discuss fertility. Very little research exists about fertility information provision in the United Kingdom. This study aimed to explore current knowledge, practice and attitudes among oncologists in the United Kingdom regarding fertility preservation in patients of child-bearing age.

  METHODS:

  A national online survey of 100 oncologists conducted online via medeconnect, a company which has exclusive access to the doctors.net.uk membership of GMC registered doctors.

  RESULTS:

  Oncologists saw fertility preservation (FP) as mainly a women's issue, and yet only felt knowledgeable about sperm storage, not other methods of FP; 87% expressed a need for more information. Most reported discussing the impact of treatment on fertility with patients, but only 38% reported routinely providing patients with written information, and 1/3 reported they did not usually refer patients who had questions about fertility to a specialist fertility service. Twenty-three per cent had never consulted any FP guidelines. The main barriers to initiating discussions about FP were lack of time, lack of knowledge, perceived poor success rates of FP options, poor patient prognosis and, to a lesser extent, if the patient already had children, was single, or could not afford FP treatment.

  CONCLUSION:

  The findings from this study suggest a deficiency in UK oncologist's knowledge about FP options and highlights that the provision of information to patients about FP may be sub-optimal. Oncologists may benefit from further education, and further research is required to establish if patients perceive a need for further information about FP options.

  Website 
• Wanat M, Watson E, Boulton M, 'When cancer comes back: experiences of patients and their partners (Abstracts of the British Psychosocial Oncology Society Conference. Oral presentations)'
  Psycho-oncology 22 (Supplement 1) (2013) pp.17-17
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract BACKGROUND: Cancer recurrence is a difficultstage of the cancer journey as it challenges patients’ hopes that cancer can be cured and emphasises thelife-threatening nature of the illness. It can also be associated with more pain, physical difficulties andlimited social interactions. The impact on partners at this time is also significant. Colorectal cancer is the third most common cancer type in the UnitedKingdom with similar numbers of new cases per year for men and women. Yet, little is known of theexperiences of patients and their partners at the time of recurrence, and what needs they have. THIS STUDY AIMS: •To explore the psycho-social impact of a recur-rence of colorectal cancer on the daily lives ofpatients and their spouses/partners and howthey cope with it •To identify the information and supportivecare needs of patients and spouses/partners atthe time of recurrence METHOD: Semi-structured interviews are being conducted with patients with colorectal cancerrecurrence and their partners separately after diagnosis as well as treatment completion. Data will beanalysed using IPA (Interpretative Phenomenological Approach). RESULTS: Preliminary findingsfrom the interviews with the patients / partners will be discussed. CONCLUSIONS: Recommendations set by NICE on supportive and palliative care highlight that by sharing their experiences, patient scan influence planning and service delivery. This study will contribute to our understanding of the experiences of patients and their partners in this difficult time and will help to inform the further development of health care services to support them.Website 
• Wanat M, Watson E, Boulton M, Wee B, '"It is not that easy to switch off to it - the second time round": experiences of patients with a recurrent bowel cancer and their partners (Abstracts of the IPOS 15th World Congress of Psycho-Oncology)'
  Psycho-oncology 22 (Supplement 3) (2013) pp.316-316
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract BACKGROUND: Cancer recurrence is a difficult stage of the cancer journey as it challenges patients’ hopes that cancer can be cured and emphasises the life threatening nature of illness. It is often associated with physical and psychological difficulties. The impact on partners at this time is also significant. This study aims to explore the psycho-social impact of recurrence of colorectal cancer on the daily lives of patients and their spouses/partners and how they cope with it. METHOD: Twelve patients with a diagnosis of bowel cancer recurrence and their partners will be recruited from 4 hospitals in the UK as well as online communities (recruitment in progress). Semi-structured interviews are being conducted separately with patients who have had a recurrence and their partners/spouses, within 1–2 months after diagnosis. Data are being analysed using IPA (Interpretative Phenomenological Analysis). RESULTS: Preliminary findings from the interviews suggest that patients and partners experience a range of emotions including
  shock and despair when diagnosed with cancer recurrence as they often thought that they managed to “beat the cancer”. The experience of initial diagnosis provides a reference point for their experiences of recurrence as both patients and partners often compare the initial and the subsequent diagnosis. Continuity in relationship with clinical team was found reassuring for patients especially when breaking bad news. Family members provide both emotional and practical support for patients but they often feel that they lack support from health care professionals. CONCLUSIONS: Recommendations on supportive care in colorectal cancer
  highlight the need to provide care for patients throughout the cancer journey. However, we still
  have a limited understanding of the issues patients with bowel cancer face when they experience a recurrence of the disease. Partners are important source of support for patients yet their supportive needs are often not attended to. This study contributes to our understanding of the experiences of patients and their partners at this difficult time and will help to inform the further development of health care services to support them. RESEARCH IMPLICATIONS: This study provides an insight into patients and partners experiences’ of bowel cancer recurrence as to date relatively little psychosocial research has focused on this period, especially in comparison to the medical literature. However, more work is needed on the experiences of patients’ with active and advanced disease across different cancer sites. Future studies should also explore what interventions are best suited to address the information and supportive needs of patients and their partners. CLINICAL IMPLICATIONS: While continuity of care may act as buffer in their experience of recurrence, receiving a diagnosis of secondary cancer can still be a traumatic
  experience for patients.The role of Clinical Nurse Specialist was especially highlighted in providing both emotional and practical support. When providing patients and families with information about prognosis, practitioners need to strike a balance between being realistic and maintaining hope, as it may have an impact on their experiences throughout cancer journey.Website 
• Turner D, Adams E, Boulton M, Harrison S, Khan N, Rose P, Ward A, Watson E K, 'Partners and close family members of long term cancer survivors: health status, psychosocial well-being and unmet supportive needs'
  Psycho-Oncology 22 (1) (2013) pp.12-19
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract

  Background: A cancer diagnosis can have a profound impact on partners and close familymembers of patients. Little is currently known about the long-term impact.Objectives: The objective of this study is to describe health status, levels of anxiety and depression,unmet supportive care needs and positive outcomes in the partners/family members ofbreast, prostate and colorectal cancer survivors 5-16 years post-diagnosis.Methods: Patients in a linked study were asked to invite a partner or other close family memberto complete a self-administered postal questionnaire. Data were analysed by cancer site andtime since diagnosis. Matched comparisons were made between cancer patients in the linkedstudy and their partners.Results: An expression of interest was received from 330 partners/family members, and 257questionnaires (77.9%) were returned. Health status and levels of anxiety and depression werecomparable with population norms. Respondents reported an average of 2.7 unmet needs from34 possible options. Hospital parking, information about familial risk, help managing fear ofrecurrence and coordination of care were the most cited unmet needs. There was little variationin health status, psychological morbidity and unmet needs by cancer site or time since diagnosis.Concordance between patients and partners was low for anxiety but higher with respect topositive outcomes and some unmet needs.Conclusions: Most partners/family members of long-term cancer survivors report fewongoing issues. However, a small proportion (<10%) have high levels of anxiety and/or moderateor strong unmet needs. Strategies for identifying this group and addressing their needs arerequired, while allowing the majority to resume normal life.

  Website 
• Adams E, Boulton MG, Horne A, Rose PW, Durrant L, Collingwood M, Oskrochi R, Davidson SE, Watson EK, 'The effects of pelvic radiotherapy on cancer survivors: symptom profile, psychological morbidity and quality of life.'
  Clinical Oncology 26 (1) (2013) pp.10-17
  ISSN: 0936-6555
  Abstract

   

  Aims
  As cancer survival rates continue to increase, it is important to maximise the quality of life of cancer survivors. Pelvic radiotherapy is a common cancer treatment. Bladder, bowel and sexual dysfunction are recognised side-effects of treatment, and yet relatively little is known of the extent to which they remain problems in the longer term when patients are often managed by primary care, nor of the psychological impact of symptoms and effects on quality of life. Therefore, the aims of this study were to estimate the prevalence of bladder, bowel and sexual dysfunction late effects in a sample of cancer survivors; assess the impact of time since treatment on symptom prevalence; and explore the relationship between symptoms, psychological morbidity and quality of life.
   
  Materials and methods
  A questionnaire was given to a sample of cancer survivors treated in Oxford who had pelvic radiotherapy 1–11 years previously. The questionnaire measured patient-reported toxicity (Common Toxicity Criteria of Adverse Events/Late Effects of Normal Tissues – Subjective, Objective, Management and Analytic Measure), psychological morbidity (Hospital Anxiety and Depression Scale) and quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30).
   
  Results
  In total, 418 (57.1%) completed questionnaires were received. Moderate/severe problems with bowel, urinary and sexual functioning were relatively common: bowel urgency (59% women, 45% men); urine urgency (49% women, 46% men); ability to have a sexual relationship affected (24% women, 53% men). Symptoms were just as frequent in those 6–11 years after treatment as in those 1–5 years after treatment. Symptom severity was significantly associated with poorer overall quality of life and higher levels of depression.
   
  Conclusions
  Late effects are common among long-term cancer survivors who have had pelvic radiotherapy, and are associated with reduced quality of life and psychological morbidity. It is imperative due attention is paid to this issue during the follow-up phase – both in secondary and primary care. Health care professionals providing follow-up care need to be aware of the importance of assessing and monitoring symptoms, and need to be adequately informed on the most appropriate management strategies.
  Website 
• Lifford, K K, Fraser L, Rosenthal A, Rogers M, Lancastle D, Phelps C, Watson E, Clements A, 'Withdrawal from familial ovarian cancer screening for surgery: Findings from a psychological evaluation study (PsyFOCS)'
  Gynecologic Oncology 124 (1) (2012) pp.158-163
  ISSN: 0090-8258
  Abstract

  Objective. A prospective psychological evaluation study of familial ovarian cancer screening (PsyFOCS) is underway in partnership with the UK Familial Ovarian Cancer Screening Study (UK FOCSS Phase 2). One of the aims of PsyFOCS is to examine factors associated with withdrawal from the UK FOCSS prior to the onset of 4-monthly screening. Method. 1999 of 3224 women completed a baseline questionnaire. 110 (5.5%) women withdrew from screening prior to their first routine Phase 2 screen, of which 73 (66.4% of withdrawals) had withdrawn because they had undergone removal of their ovaries and fallopian tubes (withdrawn group). The comparison group consisted of 1868 women who remained on screening. The baseline questionnaire included measures of cancer-specific distress, anxiety, depression and illness perceptions. Results. Logistic regression analysis indicated that having had prior annual (Phase 1) screening (OR = 13.34, p<.01), past experience of further tests (OR = 2.37, p<.01) and greater cancer-specific distress (OR = 1.38, p<.01) were associated with withdrawal for surgery. Belief in ageing as a cause of ovarian cancer was also associated with withdrawal (OR = 1.32, p = .05). Conclusion. These cross-sectional data suggest that withdrawal from familial ovarian cancer screening may be influenced by both clinical and psychological factors. These may reflect women's experience of the drawbacks of screening and increased concern about ovarian cancer risk, as well as having opportunities to consider surgery as an alternative risk management strategy whilst using screening as an interim measure.

  Website 
• Harrison S, Watson E, Ward A, Khan N, Turner D, Adams E, Forman D, Roche M, 'Cancer survivors' experiences of discharge from hospital follow-up'
  European Journal of Cancer Care 21 (3) (2012) pp.390-397
  ISSN: 0961-5423 eISSN: 1365-2354
  Abstract

  Discharge from hospital follow-up is a key time point in the cancer journey. With recommendations for earlier discharge of cancer survivors, attention to the discharge process is likely to become increasingly important. This study explored cancer survivors' experiences of discharge from hospital follow-up. Survivors of breast, colorectal and prostate cancer (n = 1275), 5-16 years post diagnosis were approached to take part in a questionnaire survey. The questionnaire included questions about discharge status, provision of time/information prior to discharge, feelings at discharge and satisfaction with how discharge was managed. Completed questionnaires were returned by 659 survivors (51.7%). Approximately one-third of respondents were not discharged from follow-up 5-16 years post diagnosis. Of those discharged, a substantial minority reported insufficient time (27.9%), information (24.5-45.0%) or adverse emotions (30.9%) at the time of discharge. However, 90.6% of respondents reported satisfaction with how discharge from hospital follow-up was managed. Despite high levels of satisfaction, discharge of cancer survivors from hospital follow-up could be improved with the provision of additional time, information and support. Better structuring of the final hospital appointment or a review appointment in primary care at this time could help to ensure that discharge from hospital follow-up is managed optimally for cancer survivors.

  Website 
• Watson E, Rose P, Neal R, Hulbert-Williams N, Donnelly P, Hubbard G, Elliott J, Campbell C, 'Personalised cancer follow-up: risk stratification, needs assessment or both?'
  British Journal of Cancer 106 (1) (2012) pp.1-5
  ISSN: 0007-0920 eISSN: 1532-1827
  Abstract

  There are approximately 2 million people now living with or beyond cancer in the UK (Maddams et al, 2009) and this number is increasing. Cancer survivors can experience physical, psychological and social consequences as a result of the disease and the treatments received (Jefford et al, 2008; Foster et al, 2009). The effects may be immediate, some of which will resolve and others may persist and become long-term. Late effects can also occur and the interval between the end of treatment and onset can range from a few weeks (e.g. lymphoedema after axillary node removal) to several years (e.g. heart disease following radiotherapy to the chest area). Problems will be individual to each patient due to a unique combination of circumstances including the site and stage of the cancer, the type of treatment(s) given, the age of the patient, genetic factors, concomitant co-morbidities, family and social circumstances, and personality traits.

  The recent National Cancer Survivorship Initiative (NCSI) acknowledges the range of issues which cancer survivors may face, and highlights the need for health professionals to organise care accordingly (NCSI, 2010a). The recent NCSI Research Priorities Report (NCSI, 2010b) identified two areas of priority for research to inform practice: the establishment of large cohort studies (to determine the range and frequency of problems following treatment) and the development of risk stratification tools. However, the report did not develop a detailed definition of risk stratification nor did it elucidate what outcomes risk stratification should address.

  The purpose of this paper, prepared by members of the Survivorship Sub-group of the National Cancer Research Institute Primary Care Clinical Studies Group, is therefore to further define the term risk stratification in relation to cancer survivorship; to propose a framework for risk stratification; and to consider what research is required to support its implementation. The focus of our paper is on stratifying risk in relation to the late effects of diagnosis and treatment. We do not therefore address prognostic risk stratification, a topic for which there is already a large body of literature.

  Website 
• Adams E, Boulton M, Rose PW, Lund S, Richardson A, Wilson S, Watson EK, 'A qualitative study exploring the experience of the partners of cancer survivors and their views on the role of primary care'
  Supportive Care in Cancer 20 (11) (2012) pp.2785-2794
  ISSN: 0941-4355 eISSN: 1433-7339
  Abstract Purpose
   
  The partners of cancer survivors may experience distress, anxiety, fear and uncertainty whilst also caring for and supporting a partner who is ill. As they concentrate on the cancer survivor’s needs, their own needs may remain unaddressed. Primary care staff may be well placed to support partners as they are generally accessible and may have a better knowledge of the patient’s background and family relationships. However, their current involvement in the cancer survivor’s and partner’s cancer-related care is unclear. This study aimed to describe the experience of the partners of cancer survivors in dealing with cancer-related issues in the first 3 years post-diagnosis, their use of primary care services in relation to these issues and the barriers in doing so and their views on the role that primary care could potentially play in supporting them as carers during this period.
   
  Methods
   
  Semi-structured interviews with 22 partners of cancer survivors diagnosed within the last 3 years and recruited through six GP practices in the Thames Valley Region of the UK were analysed using the ‘framework’ approach to thematic analysis.
   
  Results
   
  Three issues were identified as of particular concern to partners: providing practical support, providing emotional support and managing their own health and well-being. Few partners had sought or received support from primary care specifically for cancer-related issues, indicating confidentiality, lack of knowledge of family relationships and the greater need of the cancer survivor as barriers. Most partners would welcome a proactive approach from primary care and felt that this would provide an opportunity to discuss issues they were concerned about.
   
  Conclusions
   
  Needs and concerns of the partners of cancer survivors in caring for patients are often not addressed. There is a scope for primary care to elicit these needs and provide greater support. Changes to clinical practice in primary care could lead to greater involvement of and to better outcomes for cancer survivors and their partners. A proactive approach to patients and their partners or other close family members at the time of diagnosis through an offer of support and the inclusion in a designated review appointment at the end of initial treatment would be useful.
  Website 
• Brain K E, Lifford K J, Fraser L, Rosenthal A N, Rogers M, Lancastle D, Phelps C, Watson E K, Clements A, Menon U, 'Psychological outcomes of familial ovarian cancer screening: No evidence of long-term harm'
  Gynecologic Oncology 127 (3) (2012) pp.556-563
  ISSN: 0090-8258
  
• O'Brien R, Rose P, Campbell C, Weller D, Neal R, Wilkinson C, Mcintosh H, Watson E, '"I wish I'd told them": A qualitative study examining the unmet psychosexual needs of prostate cancer patients during follow-up after treatment'
  Patient Education and Counseling 84 (2) (2011) pp.200-207
  ISSN: 0738-3991
  Abstract

  Objective: To gain insight into patients' experiences of follow-up care after treatment for prostate cancer and identify unmet psychosexual needs. Methods: Semi-structured interviews were conducted with a purposive sample of 35 patients aged 5982 from three UK regions. Partners were included in 18 interviews. Data were analyzed using constant comparison. Results: (1) Psychosexual problems gained importance over time, (2) men felt they were rarely invited to discuss psychosexual side effects within follow-up appointments and lack of rapport with health care professionals made it difficult to raise problems themselves, (3) problems were sometimes concealed or accepted and professionals' attempts to explore potential difficulties were resisted by some, and (4) older patients were too embarrassed to raise psychosexual concerns as they felt they would be considered 'too old' to be worried about the loss of sexual function. Conclusion: Men with prostate cancer, even the very elderly, have psychosexual issues for variable times after diagnosis. These are not currently always addressed at the appropriate time for the patient. Practice implications: Assessments of psychosexual problems should take place throughout the follow-up period, and not only at the time of initial treatment. Further research examining greater willingness or reluctance to engage with psychosexual interventions may be particularly helpful in designing future interventions.

  Website 
• Rose P, Watson E, Jenkins L, 'Aspirin for prevention of cancer and cardiovascular disease'
  British Journal of General Practice 61 (587) (2011) pp.412-415
  ISSN: 0960-1643
  Abstract Aspirin was discovered in 1897 and marketed initially as an analgesic. Over the years it has been used for other purposes including the prevention of both arterial and venous thrombosis, and as an anti-inflammatory drug. More recently there has been interest in the use of aspirin for primary and secondary prevention of cancer.
   
  A recent study published in the Lancet,1 showing impressive benefits of low dose aspirin in reducing both cancer mortality and all-cause mortality, received a lot of press publicity. The Daily Mail for example, claimed ‘Aspirin really can beat cancer’.2 No doubt following this publicity many primary care doctors have been asked the question ‘Doctor, should I be taking aspirin?’. In this article we discuss how this latest publication fits in with previous evidence, and the clinical implications of the findings in relation to the primary prevention of cancer.
  Website 
• Harrison S, Watson E, Ward A, Khan N, Turner D, Adams E, Forman D, Roche M, Rose P, 'Primary health and supportive care needs of long-term cancer survivors: a questionnaire survey'
  Journal of Clinical Oncology 29 (15) (2011) pp.2091-2098
  ISSN: 0936-6555
  Abstract

  Purpose There are 1.2 million long-term cancer survivors in the United Kingdom. Existing research on the health and supportive care needs of these survivors is sparse and inconclusive. This study investigated health status, psychological morbidity, and supportive care needs in long-term cancer survivors in the United Kingdom. Methods Five to 16 years after diagnosis, 1,275 eligible survivors of breast, colorectal, and prostate cancers were approached to participate in a questionnaire survey. The questionnaire explored health status (European Quality of Life-5 Dimensions), psychological morbidity (Hospital Anxiety and Depression Scale), and supportive care needs (Cancer Survivors' Unmet Needs Measure). Data were analyzed by type of cancer and time since diagnosis. Logistic regression was used to identify predictors of unmet supportive care needs. Results The response rate was 51.7% (659 survivors). Overall health status and levels of psychological morbidity were consistent with population norms. At least one unmet supportive care need was reported by 47.4% of survivors, but overall numbers of unmet needs were low (mean, 2.8; standard deviation, 4.8). The most frequently endorsed unmet need was for help to manage concerns about cancer recurrence. Trait anxiety (P < .001), nondischarged status (P < .01), dissatisfaction with discharge (P < .01), and receipt of hormonal therapy (P < .01) were predictive of unmet supportive care needs. Conclusion The findings suggest a majority of long-term breast, colorectal, and prostate cancer survivors who have no signs of recurrence report good health and do not have psychological morbidity or large numbers of unmet supportive care needs. A minority of long-term survivors may benefit from ongoing support. The identification and support of those long-term survivors with ongoing needs is a key challenge for health care professionals.

  Website 
• Watson E, O'Brien R, Campbell C, Weller D, Neal R, Wilkinson C, Rose P, 'Views of health professionals on the role of primary care in the follow-up of men with prostate cancer'
  Family Practice 28 (6) (2011) pp.647-654
  ISSN: 0263-2136
  Abstract

  Background. Follow-up care for prostate cancer has traditionally been led by secondary care in hospital out-patient clinics. As the number of men with prostate cancer increases and secondary care resources face pressure, alternative follow-up models are being sought. Current National Institute for Health and Clinical Excellence guidance recommends follow-up outside the hospital setting for patients who are stable 2 years following radical treatment and for those undergoing 'watchful waiting'. Objective. To describe current practice in a sample of relevant health care professionals and to seek their views on the role of primary care in prostate cancer follow-up. Methods. Semi-structured telephone interviews with 38 UK health care professionals, from both secondary and primary care. Transcripts were analysed using the constant comparative method. Results. There are marked variations in current follow-up practice around the country, with hospital-based follow-up ranging from 6 months to lifetime. The predominant, although not universal, view expressed was that there is both scope and support for primary care to play a greater role, particularly for men with stable disease. This was qualified by the need for supporting education, including guidance on interpretation of prostate-specific antigen values, introduction of robust follow-up systems in primary care, easy access back into secondary (hospital) care, a mechanism for ensuring follow-up data can still be collected for audit purposes and appropriate resourcing. Conclusions. If primary care is to play a significant role in providing high-quality follow-up care for men with prostate cancer, then steps need to be taken to address the barriers to increased primary care involvement identified by this study.

  Website 
• Watson E, Rose P, Loftus R, Devane C, 'Cancer survivorship: the impact on primary care'
  British Journal of General Practice 61 (592) (2011) pp.693-694
  ISSN: 0960-1643
  Abstract Debate & analysis articleWebsite 
• Khan N, Watson E, Rose P, 'Primary care consultation behaviours of long-term, adult survivors of cancer in the UK'
  British Journal of General Practice 61 (584) (2011) pp.197-199
  ISSN: 0960-1643
  Abstract The population of cancer survivors is growing, and GPs have an increasing role in their care. The General Practice Research Database was used to compare consultation rates between cancer survivors and controls. Breast and colorectal cancer survivors had one more consultation per year compared with controls up to 5 years after diagnosis; rates then converged at 10 years post-diagnosis. Prostate cancer survivors consistently consulted up to three more times per year than controls. These increased consultation rates are leading to an impact on service capacity. Website 
• Adams E, Boulton M, Rose P, Lund S, Richardson A, Wilson S, Watson E, 'Views of cancer care reviews in primary care: a qualitative study'
  British Journal of General Practice 61 (585) (2011) pp.274-275
  ISSN: 0960-1643
  Abstract

  Background The Quality and Outcomes Framework (QOF) providesan incentive for practices to establish a cancer registerand conduct a review with cancer patients within 6 months of diagnosis, but implementation is unknown. Aim To describe: (1) implementation of the QOF cancer care review; (2) patients" experiences of primary care over the first 3 years following a cancer diagnosis; (3) patients" views on optimal care; and (4) the views of primary care professionals regarding their cancer care. Design of study Qualitative study using thematic analysis and a framework approach. Setting Six general practices in the Thames Valley area. Method Semi-structured interviews with cancer patients and focus groups with primary care teams. Results Thirty-eight adults with 12 different cancer types were interviewed. Seventy-one primary care team members took part in focus groups. Most cancer care reviews are conducted opportunistically. Thirty-five patients had had a review; only two could recall this. Patients saw acknowledgement of their diagnosis and provision of general support as important and not always adequately provided. An active approach and specific review appointment would legitimise the raising of concerns. Primary care teams considered cancer care to be part of their role. GPs emphasised the importance of being able to respond to individual patients" needs and closer links with secondary care to facilitate a more involved role. Conclusion Patients and primary care teams believe primary care has an important role to play in cancer care. Cancer care reviews in their current format are not helpful, with considerable scope for improving practice in this area. An invitation to attend a specific appointment at the end of active treatment may aid transition from secondary care and improve satisfaction with follow-up in primary care.

  Website 
• Khan N, Ward A, Rose P, Watson E, 'Consulting and prescribing behaviour for anxiety and depression in long-term survivors of cancer in the UK'
  European Journal of Cancer 46 (18) (2010) pp.3339-3344
  ISSN: 0959-8049
  Abstract

  Introduction Cancer survivors may experience long-term depression or anxiety, however, there is little previous research on the use of services in this area. We explored consultation and prescribing behaviour for depression and anxiety amongst cancer survivors in British primary health care. Methods This study uses data on 26,213 survivors of breast, colorectal and prostate cancer at least 5 years post-diagnosis, matched to four controls without cancer, from the UK General Practice Research Database. We compared consultations for depression and anxiety, and prescribing for anti-depressants and anxiolytics between cancer survivors and controls. Results Multivariate, matched regression models showed no difference in consulting for depression or anxiety between any cancer survivors and matched controls. However, breast cancer (odds ratio (OR) 1.16, 95% confidence interval (CI) 1.10-1.22) and prostate cancer survivors (OR 1.31, 95% CI 1.16-1.47) were more likely to receive a prescription for an antidepressant. Breast cancer survivors (IRR 2.49, 95% CI 1.82-3.42) and prostate cancer survivors (IRR 2.84, 95% CI 1.94-4.17) who died received significantly more antidepressants than controls who died. There were no differences in anxiolytic prescribing for colorectal and prostate cancer survivors compared to controls. However, breast cancer survivors nearing the end of life received a greater number of anxiolytic prescriptions compared to controls (IRR 1.84, 95% CI 1.36-2.49). Conclusions In this cohort of cancer survivors, there were no differences in consultation behaviour for depression and anxiety compared to controls. However, breast and prostate cancer survivors access more antidepressants, and those nearing the end of life received the highest volume of prescriptions. Breast cancer survivors at the end of life also receive more anxiolytics.

  Website 
• Khan N, Carpenter L, Watson E, Rose P, 'Cancer screening and preventative care among long-term cancer survivors in the United Kingdom'
  British Journal of Cancer 102 (7) (2010) pp.1085-1090
  ISSN: 0007-0920 eISSN: 1532-1827
  Abstract

  BACKGROUND: Long-term cancer survivors in the United Kingdom are mostly followed up in a primary care setting by their general practitioner; however, there is little research on the use of services. This study examines whether cancer survivors receive adequate screening and preventative care in UK primary care. PATIENTS AND METHODS: We identified a cohort of long-term survivors of breast, colorectal and prostate cancer with at least a 5-year survival using the General Practice Research Database, with controls matched for age, gender and practice. We compared adherence with cancer screening and the use of preventative care between cancer survivors and controls. RESULTS: The cancer survivors' cohort consisted of 18 612 breast, 5764 colorectal and 4868 prostate cancer survivors. Most cancer survivors receive cancer screening at the same levels as controls, except for breast cancer survivors who were less likely to receive a mammogram than controls (OR = 0.78, 95% CI: 0.66-0.92). Long-term cancer survivors received comparable levels of influenza vaccinations and cholesterol tests, but breast (OR 0.81, 95% CI: 0.74-0.87) and prostate cancer survivors (OR = 0.70, 95% CI: 0.57-0.87) were less likely to receive a blood pressure test. All survivors were more likely to receive bone densitometry. CONCLUSIONS: The provision and uptake of preventive care in a primary care setting in the United Kingdom is comparable between the survivors of three common cancers and those who have not had cancer. However, long-term breast cancer survivors in this cohort were less likely to receive a mammogram.

  Website 
• O'Brien R, Rose P, Campbell C, Weller D, Neal R, Wilkinson C, Watson E, 'Experiences of follow-up after treatment in patients with prostate cancer: a qualitative study'
  BJU International 106 (7) (2010) pp.998-1003
  ISSN: 1464-4096 eISSN: 1464-410X
  Abstract

  ABSTRACT To develop an understanding of experiences of follow-up in patients with prostate cancer, to seek explanations as to why men's needs might not be well met, and explore views on the possible role of primary care in follow-up. The experiences of these patients, and views on the delivery of follow-up care, have been relatively neglected compared to those diagnosed with other cancers. PATIENTS AND METHODS In all, 35 patients were recruited from 20 practices across three regions in the UK. Maximum variation was sought by purposely sampling by age (59-82 years), treatment, length (0.75-14 years) and mode of follow-up. RESULTS Patients' descriptions of the content and organization of follow-up showed the shortcomings of follow-up, which included system failings causing patients to be lost to follow-up, and unmet psychosexual needs. Patients were mainly positive about the prospect of follow-up taking place outside the hospital setting. However, some expressed concerns about current follow-up practices and suggested several improvements that need considering if primary care were to take a greater role. CONCLUSION This study identified some general deficiencies with the current system of follow-up, and our data indicate that primary care could have a role in addressing some of these.

  Website 
• Adams E, McCann L, Armes J, Richardson A, Stark D, Watson E, Hubbard G, 'The experiences, needs and concerns of younger women with breast cancer: a meta-ethnography'
  Psycho-Oncology (2010)
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract

  Objective: This meta-ethnography synthesises the evidence on the experiences, needs and concerns of younger women with breast cancer. Methods: Using a method called"reciprocal translation" we developed a conceptual model to reflect the local and social contexts, issues, processes, needs and concerns of importance in this literature. Findings: Key findings relate to the particular point in the life-course at which young women with breast cancer stand. Issues for these women relate to feeling different as a result of cancer, fear of recurrence, feeling"out of sync" and altered embodied subjectivity. Young women with breast cancer use three processes to integrate the changes that cancer brings, namely, balancing, normalising and changing. Our conceptual model also highlights young women" s needs, primarily for support, information, childcare, counselling and spiritual support. Areas of reproduction, fertility and sexuality were also of particular concern. The included papers have methodological limitations that impact on our findings, such as opportunistic data analyses, lack of theoretical frameworks and limited reference to socio-cultural factors. Conclusion: The conceptual model developed as a result of this meta-ethnography provides a basis for practitioners to address these young women" s concerns more adequately and comprehensively.

  Website 
• McIntosh H M, Neal R D, Rose P, Watson E, Wilkinson C, Weller D, Campbell C, 'Follow-up care for men with prostate cancer and the role of primary care: a systematic review of international guidelines'
  British Journal of Cancer 100 (12) (2009) pp.1852-1860
  ISSN: 0007-0920 eISSN: 1532-1827
  Abstract

  The optimal role for primary care in providing follow-up for men with prostate cancer is uncertain. A systematic review of international guidelines was undertaken to help identify key elements of existing models of follow-up care to establish a theoretical basis for evaluating future complex interventions. Many guidelines provide insufficient information to judge the reliability of the recommendations. Although the PSA test remains the cornerstone of follow-up, the diversity of recommendations on the provision of follow-up care reflects the current lack of research evidence on which to base firm conclusions. The review highlights the importance of transparent guideline development procedures and the need for robust primary research to inform future evidence-based models of follow-up care for men with prostate cancer.

  Website 
• Watson E, Rose P W, 'What is the value of routine follow-up after diagnosis and treatment of cancer?'
  British Journal of General Practice 59 (564) (2009) pp.482-483
  ISSN: 0960-1643
  Website 
• Tyndel S, Bankhead C, Henderson B, Brain K, Watson E, Austoker J, PIMMS Study Management Group, 'Mammographic screening for young women with a family history of breast cancer: knowledge and views of those at risk.'
  British Journal of Cancer 99 (7) (2008) pp.1007-12
  ISSN: 0007-0920 eISSN: 1532-1827
  Abstract

  Although the effectiveness of mammography for women under the age of 50 years with a family history of breast cancer (FHBC) has not yet been proven, annual screening is being offered to these women to manage breast cancer risk. This study investigates women's awareness and interpretation of their familial risk and knowledge and views about mammographic screening. A total of 2231 women from 21 familial/breast/genetics centres who were assessed as moderate risk (17-30% lifetime risk) or high risk (>30% lifetime risk) completed a questionnaire before their mammographic screening appointment. Most women (70%) believed they were likely, very likely or definitely going to develop breast cancer in their lifetime. Almost all women (97%) understood that the purpose of mammographic screening was to allow the early detection of breast cancer. However, 20% believed that a normal mammogram result meant there was definitely no breast cancer present, and only 4% understood that screening has not been proven to save lives in women under the age of 50 years. Women held positive views on mammography but did not appear to be well informed about the potential disadvantages. These findings suggest that further attention should be paid to improving information provision to women with an FHBC being offered routine screening.

  Website 
• Khan N, Ward A, Watson E, Austoker J, Rose P, 'Long-term survivors of adult cancers and uptake of primary health services: a systematic review'
  European Journal of Cancer 44 (2) (2008) pp.195-204
  ISSN: 0959-8049
  Abstract Aim The aim of this paper is to systematically review the literature on the use of primary and community care services by long-term survivors of adult cancers. Methods We conducted a systematic search of eight databases and considered papers looking at primary care aspects of surviving cancer at least 3 years past diagnosis. Results Ten eligible papers in four categories: consultation rates in primary care, cancer screening, use of preventative services and chronic disease management. There was no conclusive evidence that cancer survivors have increased rates of consultation in primary care. The studies reported that cancer screening is well managed in survivors. Preventative and chronic care is worse in long-term colorectal cancer survivors compared with long-term breast cancer survivors and controls. Conclusion We found little research, especially outside the United States, relating to the care of long-term cancer survivors in primary care. Future work should examine screening for treatment-specific sequelae and the quality of care for co-morbid disease. Website 
• Tyndel S, Austoker J, Henderson BJ, Brain K, Bankhead C, Clements A, Watson E, PIMMS Study Management Grp, 'What is the psychological impact of mammographic screening on younger women with a family history of breast cancer? : findings from a prospective cohort study (pimms)'
  Breast Cancer Research 10 (Supplement 2) (2008) pp.P91-P91
  ISSN: 1465-5411 eISSN: 1465-542X
  Abstract Poster presentation at the Breast Cancer Research 2008Website 
• Clements A, Tyndel S, Henderson B, Brain K, Watson E, Austoker J, PIMMS Study Management Grp, '"More positive about mammography" : reactions of women to a false positive recall : a qualitative study of women at risk of familial breast cancer'
  Breast Cancer Research 10 (Supplement 2) (2008) pp.S45-S46
  ISSN: 1465-5411 eISSN: 1465-542X
  Abstract Annual mammographic screening from the age of 40 is recommended for women in the UK whose family history places them at a lifetime risk of developing breast cancer of ≥ 1:6 [1]. While the clinical benefits of screening younger women at increased risk are not established, emerging evidence suggests screening may lead to increased survival [2]. However, little is understood of the emotional impact of screening on women with a family history. This is particularly important in view of the increased likelihood of recall for further tests in women under 50 years old compared with those over 50 years old [3]. A recent questionnaire study of the psychological impact of mammographic screening on women under 50 years old with a family history of breast cancer showed that, contrary to expectations, women who were recalled for further tests prior to an all-clear result reported significantly more positive feelings post result about screening than women not recalled [4]. This complementary qualitative study explored the value women placed on having joined a programme of regular screening, and sought to understand the reactions of women who had received an initial all-clear result and who had received an all-clear result following further tests.Website 
• Clements A, Henderson BJ, Tyndel S, Evans G, Brain K, Austoker J, Watson E, PIMMS Study Grp, 'Diagnosed With Breast Cancer While on a Family History Screening Programme: An Exploratory Qualitative Study'
  European Journal of Cancer Care 17 (3) (2008) pp.245-252
  ISSN: 0961-5423 eISSN: 1365-2354
  Abstract Mammographic screening is offered to many women under 50 in the UK who are at moderate or high risk of developing breast cancer because of their family history of the disease. Little is understood about the impact of screening on the emotional well-being of women with a family history of breast cancer. This qualitative study explores the value that women at increased risk placed on screening, both pre- and post-cancer diagnosis and the impact of the diagnosis. In-depth interviews were undertaken with 12 women, aged 35–50, diagnosed with breast cancer while on an annual mammographic screening programme. Women described the strong sense of reassurance gained from screening prior to diagnosis. This faith in screening was reinforced by early detection of their cancer. Reactions to diagnosis ranged from devastation to relief at having finally developed a long-expected condition. Despite their positive attitudes about screening, not all women wanted to continue with surveillance. For some, prophylactic mastectomy was preferable, to reduce future cancer risk and to alleviate anxieties about the detection of another cancer at each subsequent screen. This study illustrates the positive yet diverse attitudes towards mammographic screening in this group of women with a family history of breast cancer.Website 
• Hewitson P, Glasziou P, Watson E, Towler B, Irwig L, 'Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (Hemoccult): an update'
  American Journal of Gastroenterology 103 (6) (2008) pp.1541-1549
  ISSN: 0002-9270
  Abstract BACKGROUND AND AIMS: Reducing mortality from colorectal cancer (CRC) may be achieved by the introduction of population-based screening programs. The aim of the systematic review was to update previous research to determine whether screening for CRC using the fecal occult blood test (FOBT) reduces CRC mortality and to consider the benefits, harms, and potential consequences of screening. METHODS: We searched eight electronic databases (Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, AMED, SIGLE, and HMIC). We identified nine articles describing four randomized controlled trials (RCTs) involving over 320,000 participants with follow-up ranging from 8 to 18 yr. The primary analyses used intention to screen and a secondary analysis adjusted for nonattendance. We calculated the relative risks and risk differences for each trial, and then overall, using fixed and random effects models. RESULTS: Combined results from the four eligible RCTs indicated that screening had a 16% reduction in the relative risk (RR) of CRC mortality (RR 0.84, 95% confidence interval [CI] 0.78-0.90). There was a 15% RR reduction (RR 0.85, 95% CI 0.78-0.92) in CRC mortality for studies that used biennial screening. When adjusted for screening attendance in the individual studies, there was a 25% RR reduction (RR 0.75, 95% CI 0.66-0.84) for those attending at least one round of screening using the FOBT. There was no difference in all-cause mortality (RR 1.00, 95% CI 0.99-1.02) or all-cause mortality excluding CRC (RR 1.01, 95% CI 1.00-1.03). CONCLUSIONS: The present review includes seven new publications and unpublished data concerning CRC screening using FOBT. This review confirms previous research demonstrating that FOBT screening reduces the risk of CRC mortality. The results also indicate that there is no difference in all-cause mortality between the screened and nonscreened populations.Website 
• Woodrow C, Watson E, Rozmovits L, Parker R, Austoker J, 'Public perceptions of communicating information about bowel cancer screening'
  Health Expectations 11 (1) (2008) pp.16-25
  ISSN: 1369-6513
  Abstract Objectives: The National Health Service has recently begun the introduction of a Bowel Cancer Screening Programme (BCSP), offering biennial screening to men and women aged 60-69 years. This study aimed to explore public perceptions regarding the communication of information designed to facilitate informed choice in relation to this new screening programme. Methods Fourteen single sex focus groups were conducted in England with 86 individuals aged 60-69 years. Focus groups were conducted either with individuals who had participated in the pilot phase of the BCSP, or with members of the public living outside the pilot areas. Results The majority of participants expressed positive attitudes towards bowel cancer screening, identifying items highlighting the benefits of the programme as important for others to know. Whilst some believed it was appropriate for information regarding the potentially negative aspects of the programme to be communicated at the outset, others expressed concerns about the generation of anxiety and potential for decreased participation. A number of participants questioned the concept of informed choice, arguing that once in place, a screening programme should be vigorously promoted. Conclusions There is some variation in the type of information favoured by those eligible for bowel cancer screening. This may present challenges for the provision of information aiming to facilitate informed choice in the BCSP. Flexible approaches to information provision that recognize the perceptions of patients may be required. Website 
• Brain K, Henderson B J, Tyndel S, Bankhead C, Watson E, Clements A, Austoker J, 'Predictors of breast cancer related distress following mammography screening in younger women on a family history breast screening programme'
  Psycho-Oncology 17 (12) (2008) pp.1180-1188
  ISSN: 1057-9249 eISSN: 1099-1611
  Abstract Objective: This longitudinal study investigated pre-screening factors that predicted breast cancer-specific distress among 1286 women who were undergoing annual mammography screening as part of a UK programme for younger women (i.e., under 50) with a family history of breast cancer. Methods: Women completed questionnaires one month prior to screening, and one and six months after receiving screening results. Factors measured were breast cancer worry, perceived risk, cognitive appraisals, coping, dispositional optimism, and background variables relating to screening history and family history. Results: Pre-screening cancer worry was the most important predictor of subsequent worry,explaining 56/61% and 54/57% of the variance at one and six months follow-up, respectively. Other salient pre-screening predictors included high perceived risk of breast cancer, appraisals of high relevance and threat associated with the family history, and low perceived ability to cope emotionally. Women who had previously been part of the screening programme and those with a relative who had recently died from breast cancer were also vulnerable to longer-term distress. Afalse positive screening result, pessimistic personality, and coping efforts relating to religion and substance use predicted outcomes of screening at one month follow-up, but were not predictive in the longer-term. Conclusion: Early intervention to ameliorate high levels of cancer-related distress and negative appraisals would benefit some women as they progress through the familial breastscreening programme.Website 

Conference papers

• Brett J, Butcher H, Keenan J, Catton D, Davey Z, Matley F, Watson E, Wright P, Glaser A, Gavin A, 'Evaluating the impact of patient and public involvement (PPI) in the Life After Prostate Cancer Diagnosis (LAPCD) study'
  (2019)
  Abstract

  Background. Insights from patient and public involvement (PPI) can help researchers understand what it is like to live with cancer, and thus make cancer research more relevant to the needs of service users (patients and carers).  Evaluation and reporting of PPI in health studies is important to build a strong evidence base concerning what works for whom and in what circumstances.  We evaluated the impact of PPI in a large national study in the UK exploring Life After Prostate Cancer Diagnosis (LAPCD). Methods. An online survey was mailed to all researchers and service users (N=38) in 2018 at the end of this three year study, followed by semi-structured interviews (n=30).  Analysis of survey and interview data was informed by realist evaluation principles. Results were reported using the GRIPP2 guidelines. Results. Strong contextual factors and robust processes for PPI facilitated positive impacts on the LAPCD study.  Contextual factors included strong leadership of the service user group, commitment and expertise of the service users, clear roles, a positive attitude to involvement from researchers, and sufficient funding for PPI.  Processes included a strong collaboration between the service users and the other research team members developed by embedding the PPI into a work-stream that ran alongside all the other 5 work-streams in the study.   PPI impacts are reported on the design of the study, sense checking of patient information, at team meetings, analysis of qualitative data, paper writing, developing lay summaries, and dissemination of results. The study size and geographical distance sometimes created challenges for both service users and researchers. More formal feedback channels were suggested for future PPI. Conclusion. Well-resourced, carefully planned PPI ensured effective involvement and positive impacts on the LAPCD study. 

  Website 
• Brett J, Matley F, Aveyard P, Davies E, Foxcroft D, Wells M, Nicholson B, Sinclair L, De Silva Minor S, Jake S, Watson E, 'E-cigarettes as a Smoking Cessation aid in Cancer Patients: Health Professionals knowledge, attitude and current practice.'
  (2018)
  Abstract

  Background. The adverse effects of smoking continue after a diagnosis of cancer, increasing risk of treatment-related complications, recurrence, development of second primary cancer, and mortality. E-cigarettes have become increasingly popular, and there is growing evidence of a significant reduction in harm compared to tobacco smoking, providing an alternative approach for smoking cessation in cancer patients.  However, while Public Health England and the Royal College of Physicians support the use of e-cigarettes for smoking cessation, their use remains controversial. Method. This study was a national online survey to investigate UK health professionals’ knowledge, attitudes, and current practice of e-cigarettes as a smoking cessation intervention in cancer patients. 506 health professionals (HPs) completed the survey including GPs (n=103), oncologists (n=102), cancer surgeons (n=100), practice nurses (n=102), cancer nurse specialists (n=99).  The sample was stratified by NHS regions. Results. Twenty nine percent of HPs would not recommend e-cigarettes to cancer patients who smoke, with cancer surgeons and cancer nurse specialists significantly less likely to recommend e-cigarettes.  38% believed colleagues would feel uncomfortable about recommending e-cigarettes to cancer patients.  The majority of respondents reported that e-cigarettes were either banned or only allowed in designated tobacco smoking areas in both primary and secondary care.  46% of HPs reported their organisation did not have guidance on e-cigarettes, with 45% of HPs saying they were unsure. Over half of HPs believed their knowledge was not sufficient to recommend e-cigarettes to cancer patients, and 25% did not know whether e-cigarettes were less harmful than smoking tobacco cigarettes. Conclusion. While UK health policy promotes e-cigarettes as a smoking cessation aid, this has not yet been adopted by local health organisations, causing barriers to and uncertainty around promoting use of e-cigarettes in cancer patients that smoke. Training of health professionals and local adoption of e-cigarette advice are needed.
  

  Website 
• Lauren Matheson, Jo Nayoan, Carol Rivas, Jo Brett, Penny Wright, Amy Downing, Anna Gavin, Adam Glaser, Richard Wagland/Eila Watson, 'Loss of self, function, connection and control: Understanding psychological distress in men with prostate cancer'
  (2018)
  Abstract

  Background/Purpose. A minority of men with prostate cancer (PCa) report significant psychological distress several years post-diagnosis. Greater understanding of the contributing factors that impact on psychological distress is required to understand how such men could be better supported. Methods. Men with prostate cancer diagnosed with PCa 18-42 months previously were recruited through a UK wide survey that included measures of psychological distress (K6, SWEMWBS). In-depth telephone interviews with 179 men were conducted. A sub-sample (n=26) were selected who scored above the ‘caseness’ cut-off on one or more psychological well-being measures. Framework analysis was used. Results. Participants were aged 46-87 years; diagnosed with stage 1-4 PCa and 74% were partnered. Psychological distress in men with PCa centred around a theme of ‘loss’ towards self (identity, sexual/masculine, embodied, confidence), function (embodied, valued activities), connection (social, community, relational) and control (future, body and emotions, disease progression). Men’s causal attributions or exacerbating factors for distress included; existing psychological or physical comorbidities, receiving hormonal treatment, being unpartnered and/or younger, personality traits, financial problems, negative illness perceptions or inadequacies in health care, such as a lack of emotional support by health professionals. Coping styles of emotional concealment, rumination, social withdrawal and help-seeking avoidance also appeared to contribute to ongoing distress. Conclusions. Findings indicate ways that psychologically distressed men with PCa could be better supported by health care teams. Additional emotional support by PCa nurse specialists might be helpful. Further research could develop and test ways of screening and supporting such men. 
  

Other publications

• Matheson L, Boulton M, Lavender V, Watson E, 'The significance of testicular cancer for younger adult survivors: a conceptual model'
  Psycho-oncology 22 (2013) pp.80-81ISSN: 1057-9249 eISSN: 1099-1611
  Abstract

  Background: Testicular Cancer (TC) predominately affects younger men in the prime of their lives. Fortunately, it is the most curable cancer in the UK, with survival rates reaching 96%. Yet little is known about men’s experiences of adjustment and recovery during early survivorship. This study aimed to explore younger men’s evolving experiences of TC over time, the psychosocial impact on their lives, as well as men’s needs during early survivorship.
  
  Methods: A longitudinal qualitative design was chosen. Patients were recruited from several NHS hospitals in the UK. In-depth, semi-structured interviews were conducted within 1-4 months of treatment completion, with TC patients between 20 and 45 year old (n= 11, to date). Interviews were conducted in patient’s homes or place of work and lasted approximately 90 minutes. A Grounded Theory methodology was employed. Longitudinal interviews are currently being conducted at 6 month follow-up (n= 2, to date) and data collection is on-going.
  
  Results: Participants engaged in a process of weighing up the significance of TC; for some, this declined from a major to relatively minor biographical event, particularly if fatherhood was achieved already. TC was often perceived as more significant for partners/family. 

• Adams E, Hill E, Watson E, 'Reply: Comment on Fertility Preservation in Cancer Survivors: a National Survey of Oncologists Current Knowledge, Practice and Attitudes - Oncologists Must Not Allow Personal Attitudes to Influence Discussions on Fertility Preservation for Cancer Survivor'
  British Journal of Cancer 109 (2013) pp.2021-2022ISSN: 0007-0920 eISSN: 1532-1827
  Website 

Peer-reviewed publications

2016

• Matheson, L, Boulton, M, Lavender, V, Collins, G, Mitchell-Floyd, T & Watson, E. The experiences of young adults with Hodgkin lymphoma transitioning to survivorship: a grounded theory study. Oncology Nursing Forum (2015) In press

2015

• Stanciu MA, Morris C, Makin M, Watson E, Bulger J, Evans R, Hiscock J, Hoare Z, Edwards RT, Neal RD, Wilkinson C.  A pilot randomised controlled trial of personalised care after treatment for prostate cancer (TOPCAT-P): nurse-led holistic needs assessment and indiviudalised psycho-educational intervention: study protocol. BMJ Open. 2015 Jun 25;5(6):e008470. doi: 10.1136/bmjopen-2015-008470
• Walter FM, Usher-smith JA, Yadlapalli S, Watson E.  Caring for people living with, and beyond, cancer: an online survey of GPs in England.  Br J Gen Pract.  2015 Nov;65(640):e761-8. doi: 10.3399/bjgp15X687409.
• Rubin G, Berendsen A,Crawford SM,Dommett R, Earle C, Emery J, Fahey T, Grassi L, Grunfeld E, Gupta S, Hamilton W, Hiom S, Hunter D,Lyratzopoulos G, Macleod U, Mason R, Mitchell G, Neal RD, Peake M, Roland M, Seifert B, Sisler J, SussmanJ,Taplin S,Vedsted P,Voruganti T, Walter F, Wardle J, Watson E, Weller D, Wender R, Whelan J, Whitlock J, Wilkinson C, de Wit N, Zimmermann C.  The expanding role of primary care in cancer control.  Lancet Oncol. 2015 Sep;16(12):1231-72. doi: 10.1016/S1470-2045(15)00205-3.
• Boulton M, Adams E, Horne A, Durrant L, Rose P, Watson E.  A qualitative study of cancer survivors’ responses to information on the long term and late effects of pelvic radiotherapy one to eleven years post treatment.  Eur J Cancer Care (Engl). 2015 Sep;24(5):734-47
• Watson, E., Shinkins, B., Frith, E., Neal, D., Hamdy, F., Walter, F., Weller, D., Wilkinson, C., Faithfull, S., Wolstenholme, J., Sooriakumaran, P., Kastner, C., Campbell, C., Neal, R., Butcher, H., Matthews, M., Perera, R. and Rose, P. (2015), Symptoms, unmet needs, psychological well-being and health status in survivors of prostate cancer: implications for redesigning follow-up. BJU International. doi: 10.1111/bju.13122
• Wanat M, Boulton M, Watson E.  Patients’ experience with cancer recurrence: A meta-ethnography.  Psycho-oncology (2015)Jul 29. doi: 10.1002/pon.3908. [Epub ahead of print]
• Matheson L, Boulton M, Lavender V, Protheroe A, Brand S, Wanat M, Watson E. Dismantling the present and future threats of testicular cancer: a grounde thepry of positive and negative adjustment trajectories.  J Canc Surv (2015) DOI: 10.1007/s11764-015-0466-7
• Watson, E., Shinkins, B., Frith, E., Neal, D., Hamdy, F., Walter, F., Weller, D., Wilkinson, C., Faithfull, S., Wolstenholme, J., Sooriakumaran, P., Kastner, C., Campbell, C., Neal, R., Butcher, H., Matthews, M., Perera, R. and Rose, P. (2015), Symptoms, unmet needs, psychological well-being and health status in survivors of prostate cancer: implications for redesigning follow-up. BJU International. doi: 10.1111/bju.13122

2014

• Dunn JA, Donnelly PK, Marshall A, Wilcox M, Watson E, Young A, Balmer C, Ramirez M, Hartup S, Maxwell AJ, Evans AJ; Mammo-50 trial management group.  Follow-up in early breast cancer - a surgical and radiological perspective.   Clin Oncol (R Coll Radiol). 2014 Oct;26(10):625-9.
• PROSPECTIV – a pilot trial of a nurse-led psychoeducational intervention delivered in primary care to prostate cancer survivors: study protocol for a randomised controlled trial.  Watson E, Rose P, Frith E, Hamdy F, Neal D, Kastner C, Russell S, Walter FM, Faithfull S, Wolstenholme J, Perera R, Weller D, Campbell C, Wilkinson C, Neal R, sooriakumaran P, Butcher H, Matthews M.  BMJ Oen 2014; 4:5 e005186 doi:10.1136/bmjopen-2014-005186
• Adams E, Boulton MG, Horne A, Rose PW, Durrant L, Collingwood M, Oskrochi R, Davidson S, Watson E.  The Effects of Pelvic Radiotherapy on Cancer Survivors: Symptom Profile, Psychological Morbidity and Quality of Life.  Clin Oncol (2014) 26(1): 10-7 doi 10.1016/j.clon.2013.08.003 Epub 2013 Aug 29
• Watson E, Rose P, Hamdy F, Neal D, Kastner C, Russsell S, Walter FM, Faithfull S, Wolstenholme J, Perera R, Weller D, Campbell C, Wilkinson C, Neal R, Sooriakumaran P, Butcher H, Matthews M.  PROSPECTIV—a pilot trial of a nurse-led psychoeducational intervention delivered in primary care to prostate cancer survivors: study protocol for a randomised controlled trial. BMJ Open 2014;4:e005186 doi:10.1136/bmjopen-2014-0051

2013

• Adams E, Boulton MG, Horne A, Rose PW, Durrant L, Collingwood M, Oskrochi R, Davidson S, Watson E.  The Effects of Pelvic Radiotherapy on Cancer Survivors: Symptom Profile, Psychological Morbidity and Quality of Life. Clin Oncol (2013) doi 10.1016/j.clon.2013.08.003 Epub 2013 Aug 29
• Adams E, Hill E and Watson E. Fertility preservation in cancer survivors: a national survey of oncologists’ current knowledge, practice and attitudes. British Journal of Cancer (2013) 108, 1602–1615.
• Turner, D, Adams, E, Boulton, M, Harrison, S, Kahn, N, Rose, P, Ward, A, Watson, E (2013) Partners and close family members of long term cancer survivors: health status, psychosocial well-being and unmet supportive needs. Psycho-Oncology, 22 (1). pp. 12-19.

2012

• Brain KE,Lifford KJ, Fraser L, Rosenthal AN, Rogers MT, Lancastle D, Phelps C, Watson EK, Clements A, Menon U. Psychological outcomes of familial ovarian cancer screening: No evidence of long-term harm, Gynecol Oncol (2012), http://dx.doi.org/10.1016/j.ygyno.2012.08.034
• Watson EK, Rose PW, Neal RD, Hulbert-Williams N, Donnelly P, Hubbard G, Elliott J, Campbell C, Weller D, Wilkinson C. Personalised cancer follow-up: risk stratification, needs assessment or both? Br J Cancer. 2012 Jan 3;106(1):1-5.
• Lifford KJ, Fraser L, Rosenthal A, Rogers MT, Lancastle D, Phelps C, Watson E, Clements A, Iredale R, Jacobs I, Menon U, Brain K. Withdrawn for a familial ovarian cancer screening programme: findings from a psychological evaluation study. Gynecol Oncol. 2012 Jan;124(1):158-63

2011

• Harrison, S, Watson, E, Ward, A, Khan, N, Turner, D, Adams, E, Forman, D, Roche, M, Rose, P (2011) Primary health and supportive care needs of long-term cancer survivors: a questionnaire survey. Journal of Clinical Oncology, 29 (15). pp. 2091-2098.
• Harrison, S.E, Watson E.K., Ward, A., Khan, N.F., Turner, D., Adams, E., Forman, D., Roche, M., Rose P. (2011). Cancer survivors' experiences of discharge from hospital follow-up. European Journal of Cancer Care. doi:10.1111/j.1365-2354.2011.01312.
• Turner D, Adams E, Boulton M, Harrison S, Khan N, Rose P, Ward A, Watson EK. Partners and close family members of long-term cancer survivors: health status, psychosocial well-being and unmet supportive care needs. Psychooncology. 2011 Sep 9. doi: 10.1002/pon.2050. [Epub]
• Adams E, Boulton M Rose PW, Lund S, Richardson A, Wilson S, Watson EK. A qualitative study exploring the experience of the partners of cancer survivors and their views on the role of primary care. Support Care Cancer DOI 10.1007/s00520-012-1400-4
• Watson EK, Rose PW, Loftus R, Devane R. Cancer survivorship: the impact on primary care. Br J Gen Pract. 2011 Nov;61(592
• Lifford KJ, Fraser L, Rosenthal A, Rogers MT, Lancastle D, Phelps C, Watson E, Clements A, Iredale R, Jacobs I, Menon U, Brain K. Withdrawn for a familial ovarian cancer screening programme: findings from a psychological evaluation study. Gynecol Oncol. 2012 Jan;124(1):158-63
• Watson EK, O'Brien R, Campbell C, Weller D, D Neal R, Wilkinson C, W Rose P; on behalf of the Prostate Cancer Follow-Up Study Group. The push towards primary care: views of health professionals on the role of primary care in the follow-up of men with prostate cancer. Fam Pract. 2011 Jun 21. [Epub ahead of print]
• Rose PW, Watson EK, Jenkins LS. Aspirin for prevention of cancer and cardiovascular disease. Br J Gen Pract. 2011 Jun;61(587):412-5.
• Harrison SE, Watson EK, Ward AM, Khan NF, Turner D, Adams E, Forman D, Roche MF, Rose PW. The primary health and supportive care needs of long term cancer survivors. J Clin Oncol. 2011 May 20;29(15):2091-8
• O'Brien R, Rose P, Campbell C, Weller D, Neal RD, Wilkinson C, Mcintosh H, Watson EK. "I wish I'd told them" – a qualitative study examining the unmet psychosocial needs of prostate cancer patients and their partners after treatment. Patient Educ Couns. 2011 Aug;84(2):200-7.
• Watson EK, Sugden EM, Rose PW. Views of primary care physicians and oncologists on cancer follow-up initiatives in primary

Publications from RADAR

• Matheson, L, Watson, E, Nayoan, J, Wagland, R, Glaser, A, Gavin, A, Wright, P, Rivas, C (2017) A qualitative metasynthesis exploring the impact of prostate cancer and its management on younger, unpartnered and gay men. European Journal of Cancer Care [summary page]
• Brett, J, Fenlon, D, Boulton, M, Hulbert-Williams, N, Walter, F, Donnelly, P, Lavery, B, Morgan, A, Morris, C, Watson, E (2016) Factors Associated with Intentional and Unintentional Non-adherence to Adjuvant Endocrine Therapy Following Breast Cancer. European Journal of Cancer Care [summary page]
• Downing, A, Wright, P, Wagland, R, Watson, E, Kearney, T, Mottram, R, Allen, M, Cairnduff, V, McSorley, O, Butcher, H, Hounsome, L, Donnelly, C, Selby, P, Kind, P, Cross, W, Catto, J, Huws, D, Brewster, D, McNair, E, Matheson, L, Rivas, C, Nayoan, J, Horton, M, Corner, J, Verne, J, Gavin, A, Glaser, A (2016) Life After Prostate Cancer Diagnosis: Protocol for a UK-wide patient-reported outcomes study. BMJ OPEN, 6 (12). [summary page]
• Rivas, C, Matheson, L, Nayoan, J, Glaser, A, Wright, P, Watson, E, Wagland, R (2016) Ethnicity and the prostate cancer experience: a qualitative metasynthesis. Psycho-Oncology [summary page]
• Boulton, M, Adams, E, Horne, A, Durrant, L, Rose, P, Watson, E (2015) A qualitative study of cancer survivors’ responses to information on the long term and late effects of pelvic radiotherapy one to eleven years post treatment. European Journal of Cancer Care, 24 (5). pp. 734-747. [summary page]
• Stanciu, M, Morris, C, Makin, M, Watson, E, Bulger, J, Evans, R, Hiscock, J, Hoare, Z, Edwards, R, Neal, R, Wilkinson, C (2015) A pilot randomised controlled trial of personalised care after treatment for prostate cancer (TOPCAT-P): nurse-led holistic-needs assessment and individualised psychoeducational intervention: study protocol. BMJ Open, 5 (6). pp. 1-11. [summary page]
• Walter, F, Usher-Smith, J, Yadlapalli, S, Watson, E (2015) Caring for people living with, and beyond, cancer: an online survey of GPs in England. British Journal of General Practice, 65 (640). pp. e761-e768. [summary page]
• Wanat, M, Boulton, M, Watson, E (2015) Patients’ experience with cancer recurrence: A meta-ethnography. Psycho-Oncology, 25 (3). pp. 242-252. [summary page]
• Watson, E, Rose, P, Frith, E, Hamdy, F, Neal, D, Kastner, C, Russell, S, Walter, F, Faithfull, S, Wolstenholme, J, Perera, R, Weller, D, Campbell, C, Wilkinson, C, Neal, R, Sooriakumaran, P, Butcher, H, Matthews, M (2014) PROSPECTIV -a pilot trial of a nurse-led psychoeducational intervention delivered in primary care to prostate cancer survivors: study protocol for a randomised controlled trial. BMJ OPEN, 4 (5). pp. 1-9. [summary page]
• Adams, E, Boulton, M, Horne, A, Rose, P, Durrant, L, Collingwood, M, Oskrochi, R, Davidson, S, Watson, E (2013) The effects of pelvic radiotherapy on long term cancer survivors: symptom profile, psychological morbidity and quality of life. Clinical Oncology, 26 (1). pp. 10-17. [summary page]
• Turner, D, Adams, E, Boulton, M, Harrison, S, Kahn, N, Rose, P, Ward, A, Watson, E (2013) Partners and close family members of long term cancer survivors: health status, psychosocial well-being and unmet supportive needs. Psycho-Oncology, 22 (1). pp. 12-19. [summary page]
• Harrison, S, Watson, E, Ward, A, Khan, N, Turner, D, Adams, E, Forman, D, Roche, M, Rose, P (2012) Cancer survivors' experiences of discharge from hospital follow-up. European Journal of Cancer Care, 21 (3). pp. 390-397. [summary page]
• Lifford, K, K, Fraser, L, Rosenthal, A, Rogers, M, Lancastle, D, Phelps, C, Watson, E, Clements, A, Iredale, R, Jacobs, I, Menon, U, Brain, K (2012) Withdrawal from familial ovarian cancer screening for surgery: Findings from a psychological evaluation study (PsyFOCS). Gynecologic Oncology, 124 (1). pp. 158-163. [summary page]
• Watson, E, Rose, P, Neal, R, Hulbert-Williams, N, Donnelly, P, Hubbard, G, Elliott, J, Campbell, C, Weller, D, Wilkinson, C (2012) Personalised cancer follow-up: risk stratification, needs assessment or both?. British Journal of Cancer, 106 (1). pp. 1-5. [summary page]
• Harrison, S, Watson, E, Ward, A, Khan, N, Turner, D, Adams, E, Forman, D, Roche, M, Rose, P (2011) Primary health and supportive care needs of long-term cancer survivors: a questionnaire survey. Journal of Clinical Oncology, 29 (15). pp. 2091-2098. [summary page]
• Khan, N, Watson, E, Rose, P (2011) Primary care consultation behaviours of long-term, adult survivors of cancer in the UK. British Journal of General Practice, 61 (584). pp. 197-199. [summary page]
• O'Brien, R, Rose, P, Campbell, C, Weller, D, Neal, R, Wilkinson, C, Mcintosh, H, Watson, E (2011) "I wish I'd told them": A qualitative study examining the unmet psychosexual needs of prostate cancer patients during follow-up after treatment. Patient Education and Councelling, 84 (2). pp. 200-207. [summary page]
• Rose, P, Watson, E, Jenkins, L (2011) Aspirin for prevention of cancer and cardiovascular disease. British Journal of General Practice, 61 (587). pp. 412-415. [summary page]
• Watson, E, O'Brien, R, Campbell, C, Weller, D, Neal, R, Wilkinson, C, Rose, P (2011) Views of health professionals on the role of primary care in the follow-up of men with prostate cancer. Family Practice, 28 (6). pp. 647-654. [summary page]
• Watson, E, Rose, P, Loftus, R, Devane, C (2011) Cancer survivorship: the impact on primary care. British Journal of General Practice, 61 (592). pp. 693-694. [summary page]
• Adams, E, McCann, L, Armes, J, Richardson, A, Stark, D, Watson, E, Hubbard, G (2010) The experiences, needs and concerns of younger women with breast cancer: a meta-ethnography. Psycho-Oncology [summary page]
• Khan, N, Carpenter, L, Watson, E, Rose, P (2010) Cancer screening and preventative care among long-term cancer survivors in the United Kingdom . British Journal of Cancer, 102 (7). pp. 1085-1090. [summary page]
• Khan, N, Ward, A, Watson, E, Rose, P (2010) Consulting and prescribing behaviour for anxiety and depression in long-term survivors of cancer in the UK. European Journal of Cancer, 46 (18). pp. 3339-3344. [summary page]
• O'Brien, R, Rose, P, Campbell, C, Weller, D, Neal, R, Wilkinson, C, Watson, E (2010) Experiences of follow-up after treatment in patients with prostate cancer: a qualitative study. BJU International, 106 (7). pp. 998-11003. [summary page]
• Adams, E, Boulton, M, Watson, E (2009) The information needs of partners and family members of cancer patients: a systematic literature review. Patient Education and Counseling, 77 (2). pp. 179-186. [summary page]
• McIntosh, H M, Neal, R D, Rose, P, Watson, E, Wilkinson, C, Weller, D, Campbell, C (2009) Follow-up care for men with prostate cancer and the role of primary care: a systematic review of international guidelines. British Journal of Cancer, 100 (12). pp. 1852-1860. [summary page]
• Watson, E, Rose, P W (2009) What is the value of routine follow-up after diagnosis and treatment of cancer?. British Journal of General Practice, 59 (564). pp. 482-483. [summary page]
• Brain, K, Henderson, B J, Tyndel, S, Bankhead, C, Watson, E, Clements, A, Austoker, J (2008) Predictors of breast cancer related distress following mammography screening in younger women on a family history breast screening programme. Psycho-Oncology, 17 (12). pp. 1180-1188. [summary page]
• Clements, A, Henderson, B, Tyndel, S, Evans, G, Brain, K, Austoker, J, Watson, E (2008) Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study. European Journal of Cancer Care, 17 (3). pp. 245-252. [summary page]
• Hewitson, P, Glasziou, P, Watson, E, Towler, B, Irwig, L (2008) Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (Hemoccult): an update. American Journal of Gastroenterology, 103 (6). pp. 1541-1549. [summary page]
• Khan, N, Ward, A, Watson, E, Austoker, J, Rose, P (2008) Long-term survivors of adult cancers and uptake of primary health services: a systematic review. European Journal of Cancer, 44 (2). pp. 195-204. [summary page]
• Tyndel, S, Bankhead, C, Henderson, B, Brain, K, Watson, E, Austoker, J, PIMMS Study Management Group, (2008) Mammographic screening for young women with a family history of breast cancer: knowledge and views of those at risk.. British Journal of Cancer, 99 (7). pp. 1007-12. [summary page]
• Woodrow, C, Watson, E, Rozmovits, L, Parker, R, Austoker, J (2008) Public perceptions of communicating information about bowel cancer screening. Health Expectations, 11 (1). pp. 16-25. [summary page]

Areas of expertise

Quantitative and qualitative research methods

Systematic Reviews

Complex intervention trials

Patient involvement in research