Vegetables, fruits, legumes and prostate cancer: a multiethnic case-control study.

The evidence for a protective effect of vegetables, fruits, and legumes against prostate cancer is weak and inconsistent. We examined the relationship of these food groups and their constituent foods to prostate cancer risk in a multicenter case-control study of African-American, white, Japanese, and Chinese men. Cases (n = 1619) with histologically confirmed prostate cancer were identified through the population-based tumor registries of Hawaii, San Francisco, and Los Angeles in the United States and British Columbia and Ontario in Canada. Controls (n = 1618) were frequency-matched to cases on ethnicity, age, and region of residence of the case, in a ratio of approximately 1:1. Dietary and other information was collected by in-person home interview; a blood sample was obtained from control subjects for prostate-specific antigen determination. Odds ratios (OR) were estimated using logistic regression, adjusting for age, geographic location, education, calories, and when indicated, ethnicity. Intake of legumes (whether total legumes, soyfoods specifically, or other legumes) was inversely related to prostate cancer (OR for highest relative to lowest quintile for total legumes = 0.62; P for trend = 0.0002); results were similar when restricted to prostate-specific antigen-normal controls or to advanced cases. Intakes of yellow-orange and cruciferous vegetables were also inversely related to prostate cancer, especially for advanced cases, among whom the highest quintile OR for yellow-orange vegetables = 0.67 (P for trend = 0.01) and the highest quintile OR for cruciferous vegetables = 0.61 (P for trend = 0.006). Intake of tomatoes and of fruits was not related to risk. Findings were generally consistent across ethnic groups. These results suggest that legumes (not limited to soy products) and certain categories of vegetables may protect against prostate cancer.     

The development and impact of insomnia on cancer survivors: a qualitative analysis

Objectives: To conduct the first qualitative analysis of the development and impact of insomnia on a cohort of cancer survivors. Methods: Twenty‐one cancer survivors with a history of chronic insomnia contributed to four focus groups held at the University of Glasgow Sleep Research Centre. Participants' perceptions of the onset, evolution and effects of insomnia were elicited and qualitatively explored using content analysis. Results: Most participants reported insomnia onset following cancer diagnosis. Participants who had a pre‐existing insomnia reported that cancer diagnosis significantly aggravated their sleep complaint. Active cancer treatment was a major contributor to poor sleep quality due to the disruption of normal daily routines. This poor sleep pattern became persistent once active treatment had ceased and participants reported becoming particularly concerned about their sleep when they were discharged into follow‐up cancer care. The impact of insomnia was significant for all participants in the study and six major areas emerged as being particularly affected; mood, physical health, relationships, sleep quality, sleep‐related behaviour and cognition. Conclusions: The majority of cancer survivors in this study developed disturbed sleep as a result of cancer diagnosis and their sleep disruption was exacerbated by active cancer treatment. Insomnia also had a significant impact upon quality of life and these effects persisted long beyond the cessation of active anti‐cancer therapy. Early identification of insomnia symptoms in cancer care settings must be a priority to ensure that sleep disturbance is not overlooked or poorly managed. Copyright © 2010 John Wiley & Sons, Ltd.     

Diagnostic and therapeutic delays among a multiethnic sample of breast and cervical cancer survivors

BACKGROUND:

Several publications reporting on health disparities document that ethnic minorities disproportionately experience delays in healthcare access, delivery, and treatment. However, few studies examine factors underlying access and receipt of healthcare among cancer survivors from the patient perspective. This study explores diagnostic and therapeutic care delays among a multiethnic sample of breast and cervical cancer survivors and examines contextual factors influencing diagnostic and therapeutic care delays.

METHODS:

Population‐based sampling and a cross‐sectional design were used to recruit 1377 survivors (breast cancer, n = 698; cervical cancer, n = 679). This multiethnic sample included 449 European American, 185 African American, 468 Latina American, and 275 Asian American survivors.

RESULTS:

Latina Americans were more likely to report diagnostic delays (P = .003), whereas African Americans were more likely to report therapeutic delays (P = .007). In terms of cancer type, cervical cancer survivors were more likely to report diagnostic (P = .004) and therapeutic delays (P = .000) compared with breast cancer survivors. “Fear of finding cancer” was the most frequently cited reason for diagnostic delays, and “medical reasons” were most frequently cited for therapeutic delays.

CONCLUSIONS:

Due in part to a higher proportion of diagnostic and therapeutic delays, ethnic minorities endure greater cancer burden, including poorer survival and survivorship outcomes. The medical community must recognize the impact of existing psychological and cultural dimensions on diagnostic care, as well as the personal and healthcare system level barriers that contribute to therapeutic delays. Cancer 2010. © 2010 American Cancer Society.     

Mothers' attitudes towards preventing cervical cancer through human papillomavirus vaccination: a qualitative study.

Prophylactic vaccines against human papillomavirus (HPV) types causing cervical cancer will soon be available. Success of the vaccine relies on parents' willingness to vaccinate their prepubescent daughters. We explored mothers' attitudes towards vaccination. Twenty-four mothers of girls ages 8 to 14 years took part in four focus groups. Discussions covered attitudes to vaccination in general, cancer vaccines, vaccines for sexually transmitted infections (STI), and the HPV vaccine. Discussions were recorded, transcribed, and analyzed thematically. Mothers were broadly provaccination. Some were excited about a cancer vaccine, although there were fears that it might lead to unhealthy behaviors (e.g., smoking). STI vaccines got a mixed reception. Enthusiasm was moderated by concerns about an increase in risky sexual behavior. When provided with information about the HPV vaccine, women were in favor of protecting their daughters from cervical cancer, abnormal Papanicolaou results and, potentially, from cervical screening. Some worried about an increase in promiscuity and risk of other STIs. There was disagreement about the age at which girls should be vaccinated. Although some women thought this question should be medically driven, others were concerned about discussing the vaccine with young girls and preferred to wait until they were older. In conclusion, mothers were broadly in favor of HPV vaccination but had reservations, particularly about vaccinating girls as young as 10. Larger-scale quantitative work is needed to assess acceptability at the population level. If the vaccine is introduced, information provision is likely to be key to ensuring parents understand the rationale for vaccinating at a young age.     

Survivorship: a qualitative investigation of Latinas diagnosed with cervical cancer

Latinas experience high rates of cervical cancer (CCA) in the U.S. This health-related quality of life (HRQOL) qualitative study was conducted with key informant and focus groups (N = 26). The results indicate that overall Latinas experience persistent concerns: Physical challenges including pain, and bladder, bowel, and sexual health problems; medical care barriers (e.g., difficulties accessing quality care, poor patient-physician relationship); functional issues including employment difficulties; and personal concerns including family and relationship burdens. Spiritual, familial, and cultural factors promote coping and well-being but may delay care seeking. In summary, Latinas diagnosed with CCA face a burdensome survivorship experience. Increases in medical and psychosocial services are greatly needed for Latinas to improve cancer outcomes including HRQOL.     

Post-treatment sexual adjustment following cervical and endometrial cancer: a qualitative insight

There is an increasing number of long-term survivors of cervical and endometrial cancer for whom quality of life is of major importance. We interviewed 20 women (aged 19-64) to explore the dynamics and components of post-treatment sexual adjustment and its impact on quality of life. Stratification by treatment received (surgery alone, surgery plus external-beam radiation, surgery plus brachytherapy, and surgery plus external-beam radiation and brachytherapy) and time since treatment (immediately post treatment, during the next 2 years and thereafter) was undertaken, to ensure representation of all relevant experiences and views, and to allow time for any long-term side effects to appear. The NUD*IST software (Non-numerical Unstructured Data by Indexing, Searching and Theorising) was used to assist with the coding of audio-taped, transcribed interviews and to search for themes and segments. While the data supported findings reported in the literature, important new themes emerged in the course of the qualitative analysis. These included: (a). issues related to being 'feminine', (b). the role of intimacy in post-treatment adjustment and (c). the importance of communication between health professionals, patients and partners. A model is presented that integrates these issues and highlights the need for effective interventions to improve post-treatment outcomes. The provision of information, support and modification of rehabilitation devices is suggested.     

The impact of childhood cancer on the family: a qualitative analysis of strains, resources, and coping behaviors

Clinical research has led to tremendous improvements in treatment efficacy for most childhood cancers; overall 5-year survival is now greater than 75%. Long-term consequences of cure (i.e. adverse medical and psychosocial effects) have only recently begun to emerge as a primary focus of clinical research, including studies of health-related quality of life among survivors. Usually lacking in such efforts, however, is consideration of the impact of the cancer experience on the family, and the influence that the family's response to cancer has on quality of life in the child. From this qualitative analysis of seven focus groups with 45 parents of children a year or more out of cancer treatment, we report those aspects of a child's cancer diagnosis, treatment, and recovery that parents perceived as particularly difficult for their family, and the resources and coping behaviors parents perceived as helpful to their family in dealing with and managing the cancer experience. Using the Family Adjustment and Adaptation Response theoretical model to organize the data, the domains of strains and resources were delineated into themes and sub-themes related to the cancer, child, family, health-care system, and community. Within a third domain, coping, sub-themes were identified within the themes of appraisal-focused, problem-focused, and emotion-focused coping behaviors. Integration of this information should serve to improve future studies of health-related quality of life among children who survive cancer.     

The psycho-social impact of infertility on young male cancer survivors: a qualitative investigation

Intensive treatment regimes that are known to have a potential risk of infertility sometimes have to be given to boys who have aggressive malignant disease. Long-term care must therefore include further discussion of these patients' impaired fertility. This study describes the results of a series of semi-structured interviews with 15 young male cancer survivors regarding their experience of receiving feedback on their probable fertility status. All the interviews were conducted by a psychologist formerly uninvolved with their treatment. The interviews were analysed qualitatively using a grounded theory approach. The findings of the study are organised under four headings: (a) Emotional reaction to news of probable infertility. (b) Coping style adopted. (c) Response to the offer of semen analysis. (d) Implications for clinical practice.The results of this thematic analysis are compared to the wider research literature in oncology and health psychology.     

The association of cigarette smoking with gastric cancer: the multiethnic cohort study

Purpose  

The purpose of this study is to investigate the association of cigarette smoking with gastric cancer.     

Dietary fiber and colorectal cancer risk: the multiethnic cohort study

OBJECTIVE: To investigate the association of dietary fiber with colorectal cancer METHODS: A total of 85,903 men and 105,108 women completed a quantitative food frequency questionnaire in 1993-1996. A total of 1,138 men and 972 women were subsequently diagnosed with adenocarcinoma of the large bowel. Cox proportional hazards models were used to calculate multivariate adjusted relative risks (RR) and 95% confidence intervals (95% CI) for colorectal cancer. RESULTS: High consumers of dietary fiber were more active, less overweight, and less likely to be cigarette smokers than low consumers in both sexes. Fiber was inversely associated with colorectal cancer risk after adjustment for age and ethnicity in men (RR = 0.49; 95% CI, 0.41-0.60, highest vs. lowest quintile) and women (RR = 0.75; 95% CI, 0.61-0.92). After further adjustment for lifestyle and dietary factors, the inverse association remained significant in men (RR = 0.62; 95% CI, 0.48-0.79), but not in women (RR = 0.88; 95% CI, 0.67-1.14). Adjustment for the combination of replacement hormone use with either cigarette smoking or body mass index accounted for the lack of association with fiber in women. CONCLUSION: Dietary fiber was inversely associated with colorectal cancer risk in men, but its relation to replacement hormone use and other factors affected its inverse association in women.     

Association between ambient air pollution and breast cancer risk: The multiethnic cohort study

Previous studies using different exposure methods to assess air pollution and breast cancer risk among primarily whites have been inconclusive. Air pollutant exposures of particulate matter and oxides of nitrogen were estimated by kriging (NO_x, NO₂, PM₁₀, PM_2.5), land use regression (LUR, NO_x, NO₂) and California Line Source Dispersion model (CALINE4, NO_x, PM_2.5) for 57,589 females from the Multiethnic Cohort, residing largely in Los Angeles County from recruitment (1993–1996) through 2010. Cox proportional hazards models were used to examine the associations between time-varying air pollution and breast cancer incidence adjusting for confounding factors. Stratified analyses were conducted by race/ethnicity and distance to major roads. Among all women, breast cancer risk was positively but not significantly associated with NO_x (per 50 parts per billion [ppb]) and NO₂ (per 20 ppb) determined by kriging and LUR and with PM_2.5 and PM₁₀ (per 10 μg/m³) determined by kriging. However, among women who lived within 500 m of major roads, significantly increased risks were observed with NO_x (hazard ratio [HR] = 1.35, 95% confidence interval [95% CI]: 1.02–1.79), NO₂ (HR = 1.44, 95% CI: 1.04–1.99), PM₁₀ (HR = 1.29, 95% CI: 1.07–1.55) and PM_2.5 (HR = 1.85, 95% CI: 1.15–2.99) determined by kriging and NO_x (HR = 1.21, 95% CI:1.01–1.45) and NO₂ (HR = 1.26, 95% CI: 1.00–1.59) determined by LUR. No overall associations were observed with exposures assessed by CALINE4. Subgroup analyses suggested stronger associations of NO_x and NO₂ among African Americans and Japanese Americans. Further studies of multiethnic populations to confirm the effects of air pollution, particularly near-roadway exposures, on the risk of breast cancer is warranted.     

Between traditional and modern perceptions of breast and cervical cancer screenings: a qualitative study of Arab women in Israel

Arab women have undergone major modernization processes in recent years and the effect of these processes on attitudes to screening should be examined. Fifty-one Israeli Arab women participated in focus groups in five representative communities. The women expressed a combination of traditional beliefs and modern biomedical knowledge concerning risk and preventive factors related to cancer. Special importance was given to birth and breast-feeding as protective factors, integrating modern views with traditional concepts of motherhood as a woman's principal role in society. A major theme on who or what was responsible for one's health emerged, opinions ranging across fate and God's will, physicians and health services, or, as a substantial number of participants asserted, taking personal responsibility for one's health. A related theme that emerged was the perception of cancer as either a punishment or as a test devised by God. Fears of stigma related to breast or gynecological examinations, worries about the spouse's reaction once a lump is detected, and worries regarding the violation of religious and cultural requirements of modesty, were expressed. However, there was firm agreement that although these created emotional difficulties, they were not sufficiently important to cause women to forgo screenings.     

Iranian cancer patients and their perspectives: a qualitative study

The incidence of cancer is continuing to rise in Iran. More people are now surviving cancer. They may require different kinds of care and support from those traditionally available. The expression of needs and how they are met in different cultural contexts can inform local assessment of needs and provide insights for initiatives in holistic cancer care. This study explores Iranian cancer patients' needs from patients' perspective. A qualitative design that consists of interviews, field notes and specified demographic information was used. Thirty participants were interviewed during the summer and autumn of 2009. The study conducted in a cancer research centre (Omid Hospital) in Mashhad, Iran. Interviews were analysed using a content analysis method. The results indicate that Iranian cancer patients are more likely to suffer from the impact of cancer on their daily life than physical symptoms related to the disease and its treatment. Cancer affected several aspects of their daily living, including their financial situation, ability to work and family life. Cost of treatment and psychosocial distress were the two aspects rated by respondents to be the most affected. Iranian cancer patients need holistic care which covers all the influences that affect their personal's life.