Anne E. Nelson

Reducing Time to Diagnosis Does Not Improve Outcomes for Women With Symptomatic Ovarian Cancer: A Report From the Australian Ovarian Cancer Study Group

PURPOSE To determine if time to diagnosis is associated with stage of disease at diagnosis or survival among women with symptomatic ovarian cancer. METHODS A representative sample of Australian women (n = 1,463) with ovarian cancer diagnosed between 2002 and 2005 who participated in a population-based case-control study were interviewed regarding the events leading to their diagnosis and were observed for mortality for 5 years. RESULTS Of the 1,318 women (90%) who presented to a medical practitioner with symptoms, 55% presented within 1 month, 70% in less than 2 months, and 92% within 6 months of symptom onset. There were no significant differences in the time from symptom onset to first medical practitioner consultation (P = .19) or symptom onset to diagnosis (P = .64) among women with borderline, early (International Federation of Gynecology and Obstetrics [FIGO] stages I to II) or late (FIGO stages III to IV) disease. There was also no association between time to diagnosis and survival; adjusted hazard ratio for long delay (> 12 months from symptom onset to diagnosis) versus short delay (≤ 1 month) was 0.94 (95% CI, 0.68 to 1.30). Women who had asymptomatic cancers diagnosed incidentally (n = 145) were younger and were more likely to have borderline or stage I disease compared with women who had symptomatic ovarian cancer. CONCLUSION The results of this study suggest that, once ovarian cancer is symptomatic, reducing the time to diagnosis would not greatly alter stage of disease at diagnosis or survival.

Australian women’s awareness of breast cancer symptoms and responses to potential symptoms

ObjectivesPoor awareness of breast cancer symptoms has been associated with patient delay in seeking help; thus reduced survival, more aggressive treatment, and fewer treatment choices. The aim of this study was to develop a representative picture of Australian women’s knowledge of symptoms, experienced potential symptoms, and behavioral responses.MethodsA general population sample of approximately 3,000 women aged 30–69 completed a telephone survey; results were compared to previous surveys conducted in 1996 and 2003.ResultsThe most commonly cited potential symptom of breast cancer was a lump in the breast, identified by 86% of respondents (an increase from 75% in 2003). Other commonly mentioned symptoms were discharge from the nipple, pain/soreness, skin puckering, or dimpling; and a change in breast shape. The proportion unable to name any potential symptoms of breast cancer decreased from one in ten in 2003 to approximately one in twenty in 2007. The primary reason for not seeking medical advice in response to a potential symptom was the belief that breast cancer was not present.ConclusionsHealth promotion efforts need to continue to aim at increasing community understanding of potential breast cancer symptoms and encouraging women to act on potential symptoms by seeking medical advice.

Population screening and early detection of ovarian cancer in asymptomatic women.

The National Breast and Ovarian Cancer Centre position statement: ‘Population screening and early detection of ovarian cancer in asymptomatic women’, was developed and agreed following a Forum in February 2009 attended by key Australian stakeholders. The final position statement and supporting background information have been endorsed by key Australian colleges and agencies.

Clinical Practice Guidance for Responding to Suffering in Adults With Cancer

How patients make use of a specialist nurse function in head and neck cancer: an empirical study

Role clarification: an examination of cancer nurses' attitudes towards providing psychosocial support and training needs

The current study aimed to improve the ecological validity of objective cognitive assessment in two ways: (1) by testing prospective memory, a type of cognition that involves remembering to carry out an action when there are distracting ongoing tasks, and (2) by using a virtual reality environment that is more similar to participants’ everyday cognitive challenges than standard neuropsychological tests. The study examined whether prospective memory (PM) performance among breast cancer survivors (BCS) exposed to chemotherapy differed from that seen in a demographically matched control group. Twenty-six female survivors of breast cancer who received chemotherapy that finished 0.5-5 years prior to the time of testing were compared with 25 age- and education-matched women with no history of cancer. Participants completed event-, time- and activity-based PM measures; standardized neuropsychological tests assessing attention and concentration, executive function and verbal memory; and self-report measures of cognitive dysfunction and PM failures. The BCS group showed significantly slower speed of processing on the test of attention and concentration as well as trends towards slower dual task performance. The BCS group reported significantly more cognitive complaints and PM failures than the control group on five of six self-report measures. The groups did not differ on other prospective memory or neuropsychological measures. PM tasks correlated significantly with both standard neuropsychological tasks and with self-reported cognitive function in everyday life. The results provide some evidence for correspondence between more ecologically valid objective measures and self-reported cognitive impairment following chemotherapy treatment. Further research into PM performance in this clinical group appears warranted.