TitlePresentation typeCancersAuthorsPresenterConference/meeting titleVenueEvent datePublication dateJournalIssuePage numbersVolumePublication fileExternal linkRelated staffAbstract
Cancer: global & Irish perspectivesOral presentationAll invasiveO'Connor MO'Connor MUniversity College Cork;Lecture Series on Principles & Practice of Public Health (BSc in Public Health)UCC7 Mar 2017Mar 2017https://www.ncri.ie/sites/ncri/files/presentations/BScPublicHealthCancerMOC.pptxDr Mairead O'Connor
Physical after-effects of colposcopy and related procedures and their inter-relationships with distress: a longitudinal survey studyPoster presentationCervix uteriO’Connor M, O’Brien K, Waller J, Gallagher P,D’arcy T, Flannelly G, Martin CM, McRae J, Prendiville W, Ruttle C,White C,Pilkington L,O’Leary J,Sharp L O'Connor MIrish Society for Gynaecological Oncology Annual Scientific Meeting 2016Dublin, Ireland2 Dec 2016 to 3 Dec 2016Feb 2017http://www.isgo.ie/Dr Mairead O'ConnorBackground: Colposcopy has been, and is likely to remain, the cornerstone of follow-up for women with abnormal screening results. In addition to experiencing psychological after-effects of colposcopy, some women may also experience physical after-effects. In a longitudinal study, we estimated prevalence of post-colposcopy physical after-effects and investigated associations with distress.Methods: Surveys were mailed to women at 4-, 8- and 12-months post-colposcopy. Details of physical after-effects (pain, bleeding, discharge) experienced post-colposcopy were collected at 4-months. Colposcopy-specific distress was measured at all three time points using the Process Outcome Specific Measure. Linear mixed effects regression models were used to identify relationships between physical after-effects and distress over the 12-month follow-up period, adjusting for socio-demographic and clinical variables.Results: 584 women were recruited (response rate=73%, 59%, 52% at 4, 8 and 12 months respectively). 80% of women reported ≥1 physical after-effect and multiple physical after-effects were common (3 after-effects=28%). Distress scores declined over time. Over the follow-up period, women who experienced two physical after-effects had on average a distress score that was 2.20 points higher than those who experienced none. Women who experienced all three physical after-effects had on average a 4.58 higher distress score than those who experienced no physical after-effects. Women who were unaware of the possibility of experiencing after-effects had heightened distress.Conclusions: The prevalence of physical after-effects of colposcopy and related procedures is high. The novel findings of inter-relationships between experiencing multiple physical after-effects, and awareness of the possibility of after-effects, and post-colposcopy distress may be relevant to the development of interventions to alleviate post-colposcopy distress.
Psychological impact of HPV testing: 'Bridging the gap between what we know and what we need to know'Oral presentationCervix uteriO'Connor M, Waller J, Gallagher P, O'Leary J, Martin C, Sharp LO'Connor MCERVIVA National HPV Awareness SymposiumTrinity Biomedical Sciences Institute, TCD, Dublin27 Jan 2017Jan 2017Dr Mairead O'Connor
Development of a theory-based intervention to alleviate psychological distress of follow-up procedures for cervical abnormalitiesOral presentationCervix uteriO'Connor M, Waller J, Gallagher P, Martin C, O'Leary J, Sharp LO'Connor MUK Society for Behavioural Medicine 12th Annual Scientific MeetingCardiff1 Dec 2016 to 2 Dec 2016Dec 2016Dr Mairead O'Connor
Physical after‐effects of colposcopy and their interrelationships with psychological distress: a longitudinal studyOral presentationCervix uteriO'Connor M, O'Brien K, Waller J, Gallagher O, D'Arcy T, Flannelly G, Martin CM, Prendiville W, O'Leary JJ, Sharp LO'Connor M18th International Psycho Oncology Society CongressDublin, Ireland17 Oct 2016 to 21 Oct 2016Oct 2016PsychooncologySupplement 33-19225Dr Mairead O'Connor, Dr Katie O'Brien
What can we do to increase cervical cancer screening uptake among older women? Understanding the views of older womenPoster presentationCervix uteriO'Connor M, O'Brien K, McRae J, Martin CM, O'Leary JJ, Sharp LO'Connor M18th International Psycho Oncology Society CongressDublin, Ireland17 Oct 2016 to 21 Oct 2016Oct 2016PsychooncologySupplement 33-19225Dr Mairead O'Connor, Dr Katie O'Brien
Caution in time-to-event models where a pre-event state modifies time-varying exposureOral presentationAll invasiveBrown C, Barron T IBrown C2nd Annual Conference of the SPHeRE NetworkRoyal College of Surgeons, Dublin, Ireland29 Feb 2016Feb 2016https://www.ncri.ie/sites/ncri/files/presentations/SPHeRE%202016%20-%20Brown%20-%20Caution%20in%20time-to-event%20models.pdfhttp://www.sphereprogramme.ie/drupal/?q=secondconferenceMr Chris BrownBackground: In cancer outcome studies it is important to distinguish between effects of pre- and post-diagnostic exposures. A common approach to this is conduct a single analysis of fixed and time-varying exposures with naïve mutual adjustment. However, if changes in prognosis (i.e. recurrence) influence post-diagnostic exposure, this may introduce collider stratification bias (CSB). We conducted a simulation study to quantify the influence of CSB in studies of drug exposures and cancer outcomes. Methods: We simulated event times for 2000 observations with binomial pre-diagnostic exposure: p=0.25, null hazard ratio (HR)=1 (max time:5.5 years, event rate: 0.02%/day). Subsequently we generated a time-varying continuation of post-diagnostic exposure with fixed start/stop probabilities (start=10%/year, top=3%/year). To illustrate CSB we modified stop probabilities in the year prior to death by a pre-death probability factor (PDPF) 1x-5x. HR for pre-diagnostic (Pre-HR) and post-diagnostic (Post-HR) exposures were estimated using Cox regression. Results: In 50 simulated datasets, models with no PDPF had mean Post-HR=1.01, Pre-HR=1.01. Where stop probability was doubled (PDPF=2) effects were clear (Post-HR=0.78, Pre-HR=1.37). In the extreme (realistic) scenario (PDPF=5) effects were substantial (Post-HR=0.29, Pre-HR=2.11). Conclusions: In scenarios where post-diagnostic exposure is modified by changes in prognosis, naïve adjustment leads to spurious effect observations for pre-/post-diagnostic exposures.
Pre-testing with cognitive interviews highlights unanticipated decision making in a DCEPoster presentationAll invasive, Colorectal, ProstatePearce AM, Watson V, Gallagher P, Timmons A, Sharp LAlison PearceHealth Economics Study Group Meeting Winter 2016Manchester, UK6 Jan 2016 to 8 Jan 2016Jan 2016https://www.ncri.ie/sites/ncri/files/presentations/HESG%202016%20FINAL%20-%202016-01-04.pdfhttp://www.population-health.manchester.ac.uk/healtheconomics/HESG2016/Dr Alison Pearce, Dr Aileen Timmons, Prof Linda SharpBackground: Cognitive interviewing uses theories of cognitive psychology and survey methodology to understand how respondents perceive and interpret survey questions. There have been few examples of cognitive interviewing in developing discrete choice experiments (DCEs). Our aim was to use cognitive interviewing to explore two aspects of decision making: a cheap-talk script to reduce hypothetical bias, and the reality and complexity of opt-out options vs forced choices.Methods: We conducted ‘think aloud’ cognitive interviews with 17 prostate and colorectal cancer survivors completing a rigorously developed DCE of preferences for cancer follow-up services. The DCE contained 8 choice sets each with 8 attributes, including cost. The survey also included: a cheap-talk script, both forced choice and opt-out choice sets, and debriefing questions for comprehension, engagement and attribute non-attendance (ANA). An iterative analysis process was completed by two researchers using a framework approach, assessing decision making within and across participants.Results: Preliminary analysis suggests the cheap-talk script has little impact on individuals’ hypothetical bias, primarily because the cost attribute was often ignored. The realism of the opt-out was affected by respondents’ prior experiences of cancer follow-up. It emerged that many debriefing question responses, particularly ANA, were contradictory to the decision making within choice sets.Conclusion: Our study tested aspects of decision making that have not been explored using cognitive interviewing, and demonstrates the insight gained from pre-testing. In cancer survivors considering follow-up options, the cheap-talk script did not have the anticipated effect, costs were ignored, and responses to debriefing questions may be misleading.Note: This poster was awarded 'Best Poster Presentation' at the HESG Winter 2016 meeting.
The burden of cancer in emerging economies: Productivity loss as an alternative perspectiveOral presentationAll invasivePearce AM, Hanly P, Sharp L, Soerjomataram IPearce AISPOR 18th Annual European CongressMilan, Italy7 Nov 2015 to 11 Nov 2015Nov 2015Value Health7A33618https://www.ncri.ie/sites/ncri/files/presentations/ISPOR%20Presentation%20-%20Pearce%20-%202015-11-09.pdfhttp://www.ispor.org/event/index/2015milanDr Alison PearceBackground: When people die due to cancer, their contribution to society through paid work, called production, is lost. Previous estimates of cancer-related lost production have focussed on developed countries. However, developing nations account for approximately 70% of the world’s annual cancer deaths. We estimate the value of lost productivity due to cancer mortality in the rapidly emerging economies of Brazil, Russia, India, China and South Africa (BRICS) and compare it to the UK.Methods: Based on the Human Capital Approach, we valued the lost productivity associated with premature cancer deaths in BRICS countries and the UK in 2012. We used GLOBOCAN estimates of cancer deaths by country, sex and age group, along with OECD and national data for workforce participation, unemployment, and wage rates. Sensitivity analyses examined the impact of changing assumptions about wages, life expectancy and discounting.Results: The total cost of cancer-related lost productivity in the UK in 2012 was €3 billion, and in the BRICS countries combined was over €24 billion. Losses were highest in China (€12.9 billion) and lowest in South Africa (€0.9 billion). When adjusted by number of deaths, lost productivity (per death) were highest in South Africa (€19,000), the UK (€19,000), and Brazil (€14,000) and lowest in India (€3,000). There were large differences between countries in terms of lost productivity when examined by gender, age and cancer. For example, the cancers contributing highest productivity losses were lung cancer in Russia (22% of total), South Africa (14%), Brazil (13%) and the UK (11%), stomach cancer in India (11%), and liver cancer in China (31%).Discussion: In many developing countries cancer now kills more people than AIDS, malaria and tuberculosis combined, however resources have not shifted correspondingly. Valuing cancer-related lost productivity provides policy-makers with an additional perspective on priorities for cancer prevention and control.Note: This presentation was awarded 'Best New Investigator Presentation'  at the Annual European Congress of the International Society for Pharmacoeconomics and Outcomes Research.
Cancer And Premature Mortality In Ireland: An Employer’s Perspective Following The Friction Cost ApproachPoster presentationAll invasiveHanly P, Pearce A, Sharp LHanly PISPOR 18th Annual European CongressMilan, Italy9 Nov 2015 to 11 Nov 2015Nov 2015Value Health7A46518http://www.ispor.org/event/index/2015milanDr Alison Pearce
Psychological impact of cervical cancer screening: findings from the CERVIVA studies Invited oral presentationCervix uteriO'Connor M, Waller J, Gallagher P, O'Leary JJ, Martin C, Sharp LO'Connor MCervicalCheck Colposcopy Forum 2015National Cancer Control Programme, King's Inns House, 200 Parnell Street20 Nov 2015Nov 2015Dr Mairead O'Connor
Productivity losses for cancer-related mortality in Ireland: Projecting from 2011 to 2030Poster presentationAll invasivePearce AM, Bradley C, Hanly P, Thomas AA, O'Neill C, Molcho M, Sharp L, on behalf of the ICE Award InvestigatorsLinda SharpNational Cancer Research Institute Cancer Conference 2015Liverpool, UK1 Nov 2015 to 3 Nov 2015Nov 2015https://www.ncri.ie/sites/ncri/files/presentations/NCRI%20Conference%202015_0.pdfhttp://conference.ncri.org.uk/Dr Alison Pearce, Prof Linda SharpBackground: When individuals stop working due to cancer this represents a loss to society – the loss of productivity. The aim of this analysis was to estimate productivity losses associated with premature mortality from all cancers and from the 20 highest mortality cancers in Ireland in 2011, and project these losses until 2030.Methods: An incidence-based method was used to estimate the cost of cancer deaths between 2011 and 2030 using the Human Capital Approach. National data were used for cancer mortality rates, population growth, life expectancy, labour force participation, unemployment and average earnings. Paid work and unpaid household activities were included. Sensitivity analyses estimated the impact of assumptions around future cancer mortality rates, retirement ages, wage growth (0% to 3.5%) and discount rates (0% to 6%).Results: The 233,000 projected deaths from all invasive cancers in Ireland between 2011 and 2030 will result in productivity losses valued at €73 billion; €13 billion in paid work and €60 billion in household activities. The most costly cancers are lung (€14.4 billion), colorectal and breast cancer (€8.3 billion each). However, when viewed as productivity losses per cancer death, testis (€364,000 per death), cervix (€155,000 per death) and brain cancer (€136,000 per death) are most costly because they affect working age individuals. An annual 1% reduction in mortality over 20 years reduces the present value of paid productivity lost due to cancer by €11 billion.Conclusions: Society incurs substantial productivity losses as a result of cancer-related mortality, particularly when household production is included. These results highlight that reducing incidence and mortality of high incidence cancers is important, but so too are interventions and policies to reduce the impact in low incidence cancers, that negatively impact the workforce. Our estimates provide valuable evidence to inform resource allocation decisions in cancer prevention and control.
Effect of pre-diagnostic NSAID use on ovarian cancer survivalOral presentationOvaryBrown C, Barron T I, Bennett K, Sharp LBrown CNational Cancer Research Institute (NCRI) Cancer Conference 2015 Liverpool, UK6 Nov 2015Nov 2015https://www.ncri.ie/sites/ncri/files/presentations/NCRI%202015%20-%20NSAIDs%20and%20ovarian%20cancer%20survival.pdfhttp://conference.ncri.org.uk/Mr Chris Brown, Prof Linda SharpBackground There is some evidence in breast, colorectal and prostate cancer that patients who use nonsteroidal anti-inflammatory (NSAID) drugs have better survival. There is conflicting evidence of benefit in ovarian tumours. Our objective was to determine the association of pre-diagnostic NSAID use with survival in ovarian cancer patients in Ireland. Method Women diagnosed with invasive ovarian cancer (ICD-10 code C56) between 2001-2011 were identified in a retrospective cohort study from the National Cancer Registry. Those with continuous eligibility for a (means-tested) medical card in the year immediately prior to diagnosis were identified and linked to community prescription records. Any NSAID prescription in the year prior to diagnosis was determined. Date and cause of death was sourced from linked death-certificates. Association between exposure and cause-specific survival (end of follow-up: 31/12/2012) was estimated using Cox regression (adjusted for: age, smoking, marital status, year of diagnosis, urban/rural, local area deprivation, ovarian cancer stage and grade, surgery at diagnosis). Secondary analysis accounting for competing risks was conducted. Analysis by type of NSAID (aspirin/other) was pre-planned. Results Of 3097 invasive ovarian cancers diagnosed 2001-2011, 1823 (59%) had had a medical card history for at least one year prior to diagnosis and, of these, 1123 (62%) had some exposure to NSAIDs in that year. 78% of women in the cohort had died by 31/12/2012 (median follow-up=5.8years). Pre-diagnostic NSAID use was associated with improved ovarian cancer-specific survival (AHR=0.84, 95%CI 0.74, 0.96) as well as other causes (AHR=0.62, 95%CI 0.42, 0.93). Adjusting for competing risks, NSAID use was no longer significant (cancer-specific: 0.90 (0.78, 1.05), other causes: 0.75, (0.5, 1.11)). Effects were similar for aspirin and other NSAIDs. Conclusion In this, the largest ever study of NSAID use in ovarian cancer, we observed an association between pre-diagnostic NSAID use and cancer specific survival. The association was no longer observed after adjusting for competing risks. Acknowledgements Project funding, Health Research Board Ireland; Registry funding, Department of Health Ireland.
Cancer-related productivity losses in emerging economiesOral presentationAll invasiveA Pearce, P Hanly, L Sharp, P Gupta, F Bray, YL Qiao, SM Wang, A Barchuk, I SoerjomataramP GuptaInternational Association of Cancer Registries Annual Conference 2015Mumbai, India7 Oct 2015 to 10 Oct 2015Oct 2015https://www.ncri.ie/sites/ncri/files/presentations/Pearce%20-%20IACR%20presentation%20-%202015-10-08.pdfhttp://www.iacr2015.org/Dr Alison Pearce, Prof Linda SharpBackground: When people die due to cancer, their contribution to society through paid work, called production, is lost. Previous estimates of cancer-related lost production have focussed on developed countries. However, developing nations bear a high burden of cancer, accounting for approximately 70% of the world’s annual cancer deaths. The aim of this analysis was to estimate the value of lost productivity due to cancer mortality in the rapidly emerging economies of Brazil, Russia, India, China and South Africa (BRICS).Methods: Based on the Human Capital Approach, we estimated the costs of lost productivity associated with premature cancer deaths in BRICS countries in 2012. We used GLOBOCAN estimates of cancer deaths by country, sex and age group, along with OECD and national data for workforce participation, unemployment, and wage rates. Sensitivity analyses examined the impact of changing assumptions about wages, life expectancy and discounting within the estimates.Results: The total cost of cancer-related lost productivity in BRICS countries in 2012 was over €24 billion and was highest in China (€12.9 billion) and lowest in South Africa (€0.9 billion). When adjusted by number of deaths, lost productivity (per death) was highest in South Africa (€19,000), followed closely by Brazil (€14,000) and was lowest in India (€3,000). There were large differences between the countries in terms of lost productivity when examined by gender, age and cancer site. For example, the cancers contributing highest productivity losses were lung cancer in Russia (22% of total), South Africa (14%) and Brazil (13%), stomach cancer in India (11%), and liver cancer in China (31%).Discussion: In many developing countries cancer now kills more people than AIDS, malaria and tuberculosis combined, however resources have not shifted correspondingly. Valuing cancer-related lost productivity can provide policy-makers with an additional perspective when identifying priorities for cancer prevention and control.
Role of tumour histology in beta blocker association with ovarian cancer survivalPoster presentationOvaryBrown C, Barron T I, Bennett K, Sharp LSharp L2nd Ovarian Cancer Forum of IrelandEnniskillen, Co Fermanagh9 Oct 2015 to 10 Oct 2015Oct 2015https://www.ncri.ie/sites/ncri/files/presentations/OCFI%202015%20-%20Histology%20impact%20on%20beta-blocker%20association%20with%20survival%2020151007.pdfhttp://dx.doi.org/10.6084/m9.figshare.1570931Mr Chris Brown, Prof Linda SharpBackground There is evidence in breast, colorectal and prostate cancer that patients who use beta-blocker (BB) medication have better cancer outcomes. There is conflicting evidence of similar benefits in ovarian tumours. We investigated whether tumour histology played a role in the association between BB use and survival within Irish ovarian cancer patients. Methods Women diagnosed with invasive ovarian cancer (ICD code: C56) between 2001-2011 were identified from the National Cancer Registry Ireland. Those with continuous eligibility for a (means-tested) medical card in the year immediately prior to diagnosis were identified and linked to pharmacy claim records. Any BB exposure (WHO ATC: C07) in the year prior to diagnosis was determined. Associations between exposure and ovarian cause-specific survival (OvCSS) and all other causes was estimated using Cox regression (until follow-up 31/12/2012) adjusted for age, smoking, marital status, diagnosis year, urban/rural residence, deprivation, stage, grade, and surgery at diagnosis. Adjusted hazard ratios (AHR) and 95% CI are presented. Tumour histology was a pre-planned subgroup (test for interaction) and was classified as: serous carcinoma, adenocarcinoma, other carcinoma all remaining (unknown and other histology) tumours were grouped. Results Of 3097 invasive ovarian cancers diagnosed 2001-2011, 1823 (59%) had a medical card for at least one year prior to diagnosis. Of these, 432 (24%) had some BB exposure in that year. 78% of women in the cohort had died by 31/12/2012 (median follow-up 5.8 years). Pre-diagnostic use was not associated with improved OvCCS (AHR=1.08, 95%CI 0.93,1.23) or other-cause survival (AHR=1.39, 95%CI 0.92, 2.09). Tumour histology did not modify the association (Table 1, interaction p= 0.16). Conclusions: In this large study of beta-blocker use in ovarian cancer, we observed no effect overall or for modification of histology on cancer-specific survival. Acknowledgements Project funding, Health Research Board; Registry funding, Department of Health.
Effect of drug class on association of beta-blocker with ovarian cancer survivalOral presentationOvaryBrown C, Barron T I, Bennett K, Sharp LBrown C2nd Irish Association of Pharmacologists ConferenceUCC, Cork16 Oct 2015Oct 2015https://www.ncri.ie/sites/ncri/files/presentations/IAP2015%20-%20Brown%20-%20Effect%20of%20drug%20class%20on%20association%20of%20beta-blocker%20with%20ovarian%20cancer%20survival.pdfMr Chris Brown, Prof Linda SharpBackground: There is evidence in breast, colorectal and prostate cancer that patients who use beta-blocker (BB) medication have better cancer outcomes. There is conflicting evidence of similar benefits in ovarian tumours. We investigated whether type of drug effected association between BB use and survival within Irish ovarian cancer patients. Method: Women diagnosed with invasive ovarian cancer (ICD code: C56) between 2001-2011 were identified from the National Cancer Registry Ireland. Those with continuous eligibility for a (means-tested) medical card in the year immediately prior to diagnosis were identified and linked to pharmacy claim records. Any BB exposure (WHO ATC: C07) in the year prior to diagnosis was determined. Associations between exposure and ovarian cause-specific survival (OvCSS) and all other causes was estimated using Cox regression (until follow-up 31/12/2012) adjusted for age, smoking, marital status, diagnosis year, urban/rural residence, deprivation, stage, grade, and surgery at diagnosis. Adjusted hazard ratios (AHR) and 95% CI are presented. Class of medication was a pre-planned subgroup and patients were classified as having exposure to: selective, non-selective, neither (reference category) or both. Results: Of 3097 invasive ovarian cancers diagnosed 2001-2011, 1823 (59%) had a medical card for at least one year prior to diagnosis. Of these, 432 (24%) had some BB exposure in that year. 78% of women in the cohort had died by 31/12/2012 (median follow-up 5.8 years). Pre-diagnostic use was not associated with improved OvCCS (AHR=1.08, 95%CI 0.93,1.23) or other-cause survival. Exposure to selective drugs (AHR=1.11, 95%CI 0.95,1.30) was not significantly different to that of non-selective drugs (AHR=0.88, 95%CI 0.56,1.38), drug class interaction p=0.55. Conclusions: In this large study of beta-blocker use in ovarian cancer, we observed no modification of association by drug class on cancer-specific survival.
Comparing the costs of three prostate cancer follow-up strategies: A cost-minimisation analysis (iHEA)Oral presentationProstatePearce AM, Ryan F, Thomas AA, Timmons A, Drummond FJ, Sharp LPearce A2015 International Health Economics Association CongressMilan, Italy12 Jul 2015 to 15 Jul 2015Jul 2015https://www.healtheconomics.org/congress/Dr Alison Pearce, Dr Aileen Timmons, Dr Frances Drummond, Prof Linda SharpIntroduction: Prostate cancer follow-up is traditionally provided by clinicians in a hospital setting. Growing numbers of prostate cancer survivors means this model of care may not be economically sustainable, and a number of alternative approaches have been suggested.Objectives: The aim of this study was to develop an economic model to compare the costs of three alternative strategies for prostate cancer follow-up in Ireland – the European Association of Urology (EAU) guidelines, the National Institute of Health Care Excellence (NICE) guidelines and current practice defined using results of a survey of health professionals in Ireland.Methods: A cost minimisation analysis was performed using a Markov model with three arms (EAU guidelines, NICE guidelines and current practice) comparing follow-up for a cohort of 1000 men aged 66 with prostate cancer treated with curative intent. Transition probabilities were taken from EQ-5D-5L scores from two cross-sectional surveys of prostate cancer survivors in Ireland, published rates of biochemical relapse, and Irish life tables. The model took a healthcare payer’s perspective over a 10 year time horizon with discounting at 5% per annum.One-way sensitivity analyses assessed the impact of altering the definition of a physical or psychosocial problem requiring treatment, altering medical card eligibility, scaling costs to the Irish setting and the discount rate. In addition, probabilistic sensitivity analysis was conducted to explore the impact on the cost estimates of varying all of the probability parameters and the cost of a PSA test simultaneously.Results: Current practice was the least cost efficient arm of the model, the NICE guidelines were most cost efficient (74% of current practice costs) and the EAU guidelines intermediate (92% of current practice costs). For the 2562 new cases of prostate cancer diagnosed in 2009, the Irish healthcare system could have saved €842,000 over a 10 year period if the NICE guidelines were adopted.Although the sensitivity analyses altered the magnitude of the cost of follow-up per survivor for each alternative, none resulted in a change of decision that current practice was the least cost-efficient option. The current practice arm was most sensitive to changing the proportion of primary care visits paid for by the healthcare system, while the NICE guideline was most sensitive to altering the percentage of patients assumed to have a physical or psychosocial problem requiring treatment.Conclusions: This is the first study investigating costs of prostate cancer follow-up in the Irish setting.  These results suggest potential for significant savings within the Irish healthcare system associated with implementation of alternative models of prostate cancer follow-up care, in particular the increasing involvement of general practice. 
Health-related quality of life in women after colposcopy: Results from a patient surveyOral presentationCervix uteriÓ Céilleachair A, O'Connor M, O'Leary J, Martin C, Sharp LMr Alan Ó Céilleachair2015 International Health Economics Association CongressMilan, Italy12 Jul 2015 to 15 Jul 2015Jul 2015https://www.healtheconomics.org/congress/Mr Alan Ó Céilleachair, Dr Mairead O'Connor, Prof Linda SharpBackground: Information concerning the health-related quality of life consequences of colposcopy is limited. As health care providers look to re-evaluate cervical cancer screening strategies and protocols to reflect vaccinated populations in the coming years, we present evidence from a patient survey.Methods: Questionnaire packs covering anxiety, worry and health-related quality of life were mailed to women four months following an initial colposcopy at two large Dublin hospitals. Health-related quality of life was measured using the EQ-5D. Socio-demographic, clinical and treatment variables were examined for associations with health-related quality of life.Results: In total, 429 women were recruited (response rate=73%). Of these, 415 completed the EQ-5D in full. The mean index ED-5D score for the sample was 0.90 (sd=0.16). Third level education (0.93 versus 0.88, F<0.001) and possession of a medical card or GP visit card (0.93 versus 0.83, F>0.0001) were associated with higher mean EQ-5D index score while being a current smoker (0.86 versus 0.92, F<0.001), being employed/self-employed (0.86 versus 0.92, F<0.001) or suffering from depression (0.68 for those currently suffering from depression versus 0.94 in those who had never suffered from depression, F>0.0001) were all associated with lower mean EQ-5D index scores. Of the treatment and clinical factors, mean index EQ-5D score was lower in those women whose referral cytology was “high-grade” rather than “low grade” (0.86 versus 0.91, F=0.0056). With respect to treatments received, women who underwent loop electrical excision (LLETZ) had the lowest mean EQ-5D index scores compared to women who received other treatments (0.86, versus 0.92 in those who received colposcopy only, F=0.0220).Conclusions: A number of socio-demographic, treatment and clinical factors were found to be associated with health-related quality of life in our study. As research emerges in the coming years with respect evolving practice in cervical cancer screening programmes, consideration should be given to these factors.
Predictors of anxiety and specific worries after colposcopy within cervical cancer screening: A 12- month longitudinal studyPoster presentationCervix uteriO’Connor M, O’Leary E, Waller J, Gallagher P, Martin CM, O’Leary JJ, D’arcy T, Prendiville W, Flannelly G, Sharp LO'Connor MInternational Cancer Network Screening Meeting 2015Rotterdam, The Netherlands2 Jun 2015 to 4 Jun 2015Jun 2015Dr Mairead O'Connor, Mr Eamonn O'Leary, Prof Linda Sharp
Associations between pre- and post-diagnostic use of beta-blockers and ovarian cancer survivalOral presentationOvaryBrown C, Barron T I, Bennett K, Sharp LBrown C21st National Cancer Intelligence Network (NCIN) Cancer Outcomes Conference 2015Europa Hotel, Belfast, United Kingom8 Jun 2015 to 10 Jun 2015Jun 2015Eur J Cancer CareS11-2324https://www.ncri.ie/sites/ncri/files/presentations/NCIN%20S10%20Chris%20Brown%20-%20Associations%20between%20the%20use%20of%20betablockers%20and%20ovarian%20cancer%20survival.pdfhttp://www.qub.ac.uk/sites/NCIN2015/Mr Chris Brown, Prof Linda SharpBackground: There is evidence in breast, colorectal and prostate cancer that patients who use beta-blocker (BB) medication have better cancer outcomes. There is some evidence of similar benefits in ovarian tumours. We investigated whether BB use was associated with improved survival within Irish ovarian cancer patients. Method: Women diagnosed with invasive ovarian cancer (ICD code: C56) between 2001–2011 were identified from the National Cancer Registry Ireland. Those with continuous eligibility for a (means-tested) medical card in the year immediately prior to diagnosis were identified and linked to community prescription records. Any BB exposure (WHO ATC: C07) in the year prior to diagnosis was determined. Associations between exposure and ovarian cause-specific survival (OvCSS) and other causes until follow-up 31/12/2012 was estimated using Cox regression adjusted for: age, smoking, marital status, diagnosis year, urban/rural residence,deprivation, stage, grade, and surgery at diagnosis. Secondary analysis accounting for competing risks was conducted. Time-varying regression with ever/never status (6 month lag) was used to evaluate post-diagnostic BB use. Results: Of 3097 invasive ovarian cancers diagnosed 2001–2011, 1823 (59%) had a medical card for at least one year prior to diagnosis. Of these, 432 (24%) had some BB exposure in that year. 78% of women in the cohort had died by 31/12/2012 (median follow-up 5.8 years). Pre-diagnostic use was not associated with improved OvCCS (AHR = 1.08, 95% CI 0.93,1.23) or other-cause survival (AHR = 1.39, 95% CI 0.92,2.09). Results were similar adjusting for competing risks. Post-diagnostic BB use was associated improved OvCSS (AHR = 0.80, 95% CI 0.65, 0.99) but not other-cause survival(AHR = 1.61, 95% CI 0.85, 3.03). Conclusions: In this, one of the largest ever studies of beta-blocker use in ovarian cancer, we observed a post- (but not pre-) diagnostic association between exposure and cancer-specific survival.This analysis is being replicated in Northern Ireland and English populations. Acknowledgements: Project funding, Health Research Board; Registry funding, Department of Health.
Comparing the costs of three prostate cancer follow-up strategies: A cost-minimisation analysis (MASCC)Oral presentationProstatePearce AM, Ryan F, Timmons A, Thomas AA, Drummond F, Sharp L, and the ICE Survivorship InvestigatorsSharp LMASCC/ISOO International Symposium on Supportive Care in CancerCopenhagen, Denmark25 Jun 2015 to 27 Jun 2015Jun 2015https://www.ncri.ie/sites/ncri/files/presentations/LS%20MASCC%20June2015%20v1%20Slides.pdfhttp://mascc2015.kenes.com/Dr Alison Pearce, Dr Aileen Timmons, Dr Frances Drummond, Prof Linda SharpIntroduction: Prostate cancer follow-up is traditionally provided by clinicians in a hospital setting. Growing numbers of prostate cancer survivors means this model of care may not be economically sustainable, and a number of alternative approaches have been suggested.Objectives: The aim of this study was to develop an economic model to compare the costs of three alternative strategies for prostate cancer follow-up in Ireland – the European Association of Urology (EAU) guidelines, the National Institute of Health Care Excellence (NICE) guidelines and current practice.Methods: A cost minimisation analysis was performed using a Markov model with three arms (EAU guidelines, NICE guidelines and current practice) comparing follow-up for men with prostate cancer treated with curative intent. The model took a healthcare payer’s perspective over a 10 year time horizon.Results: Current practice was the least cost efficient arm of the model, the NICE guidelines were most cost efficient (74% of current practice costs) and the EAU guidelines intermediate (92% of current practice costs). For the 2562 new cases of prostate cancer diagnosed in 2009, the Irish healthcare system could have saved €760,000 over a 10 year period if the NICE guidelines were adopted.Conclusions: This is the first study investigating costs of prostate cancer follow-up in the Irish setting.  While economic models are designed as a simplification of complex real world situations, these results suggest potential for significant savings within the Irish healthcare system associated with implementation of alternative models of prostate cancer follow-up care. Note: This presentation was awarded 'Young Investigator of the Year' at the Annual Meeting on Supportive Care in Cancer' conference. 
Trends in, and predictors of, anxiety and specific worries following colposcopy: a 12 month longitudinal studyOral presentationCervix uteriO’Connor M, O’Leary E, Waller J, Gallagher P, Martin CM, O’Leary JJ, D’arcy T, Prendiville W, Flannelly G, Sharp L, on behalf of the Irish Cervical Screening Research Consortium (CERVIVA)O'Connor MThe Ireland-Northern Ireland – National Cancer Institute Cancer Consortium Conference 2015Queen's University Belfast10 May 2015 to 13 May 2015May 2015Dr Mairead O'Connor, Mr Eamonn O'Leary, Prof Linda Sharp
A meta-analytic approach to large scale competing risks regressionOral presentationAll invasiveBrown CBrown C35th Conference on Applied Statistics in IrelandCork, Ireland11 May 2015 to 13 May 2015May 2015https://www.ncri.ie/sites/ncri/files/presentations/Chris%20Brown%20-%20CASI%202015%20-%20A%20Meta-analytic%20Approach%20to%20Large%20Scale%20Competing%20Risks%20Regression.pdfhttp://dx.doi.org/10.6084/m9.figshare.1419599Mr Chris BrownIn survival analysis, competing risks regression is necessary when estimating effects on specific causes. Regression implementations are computationally intensive: Kirby et. al. (2013) showed that modelling a sample size of 100,000 can take 72 hours to compute. This paper illustrates an alternative to their proposed sampling strategy to improve speed - dividing the complete dataset into computationally manageable sub-groups, computing separate estimates then combining these to estimate the overall effect. This is illustrated with an 80,000 case simulation, and shows that sub-groups of 4,000 reduce computation from 3 hours to less than 2 minutes without substantial loss in accuracy. The National Cancer Registry contains detailed records on all tumours diagnosed in Ireland since 1994. There are currently over 500,000 records in the registry. Competing risks regression (Fine and Gray 1999) is often required to analyse effects of variables on cumulative incidence of cancer-specific death. Conducting a competing risk analysis on the complete registry is not computationally feasible. Competing risk data was simulated using the method of Beyersman et al. (2009). Configuration included 1 covariate and 2 event types, resulting in a sub-distribution hazard ratio (SHR) for cause A = 2.745. A dataset with 80,000 cases was simulated and systematically divided into sub-groups of sizes 1,000 to 20,000. Estimates were pooled using inverse-variance weighting and compared with that observed in the complete data. PSHREG (Kohl et al. 2014) in SAS was used to for all estimates. The SHR estimated on the complete dataset was 2.74, 95% CI (2.656, 2.838) in 178 minutes. All pooled sub-group estimates were within 0.45% of SHR based on complete data (coefficient: 0.45%, standard error: 0.01%). In this scenario, time to compute was shortest (79 seconds) with 20 groups of 4,000 cases, which was 135 times faster than the analysis on the complete dataset. This pooled estimate matched those from complete data to 2 decimal places 2.74, 95% CI (2.653, 2.835). Dividing a large dataset into sub-groups enabled drastically improved computation time. There was less than 0.5% error in all estimates. In this simulation, time to compute increased for subgroups larger than 4,000. The optimal number of sub-groups depends on observed rates of events, competing risks and censoring, as well as computing hardware. The largest feasible sub-group size should be selected.
Do ovarian cancer patients using statins have better outcomes?Poster presentationOvaryBrown C, Barron T I, Bennett K, Sharp LBrown CAll Ireland Cancer Consortium Conference 2015Riddel Hall, Queen's University Belfast11 May 2015 to 13 May 2015May 2015https://www.ncri.ie/sites/ncri/files/presentations/Chris%20Brown%20%28NCRI%29%20-%20AICC%20-%20Do%20ovarian%20cancer%20patients%20using%20statins%20have%20better%20outcomes.pdfhttp://dx.doi.org/10.6084/m9.figshare.1419616Mr Chris Brown, Prof Linda SharpBackground: There is evidence in breast, colorectal and prostate cancer that patients who use statins have better cancer outcomes. There is biological evidence of similar benefits in ovarian tumour cells. We investigated whether stain use was associated with survival in ovarian cancer patients in Ireland. Methods: Women diagnosed with invasive ovarian cancer (C56) between 2001-2011 were identified from the National Cancer Registry. Those with at least one year medical card history (means tested) pre-diagnosis were identified and linked to community prescription records. Any statin use (ATC code: C10AA,C10B) in the year prior to diagnosis was determined. Association between statin use and cause-specific survival (end of follow-up: 31/12/2012) was estimated using Cox regression (adjusted for: age, smoking, marital status, year of diagnosis, urban/rural, local area deprivation, stage, grade, surgery at diagnosis). Secondary analysis accounting for competing risk was conducted. Results: Of 3097 invasive ovarian cancers diagnosed 2001-2011, 1823 (59%) had had a medical card history for at least one year prior to diagnosis and, of these, 490 (27%) had some exposure to statin in the year prior to diagnosis. 78% of women in the cohort had died by 31/12/2012 (median follow-up=5.8years). Pre-diagnostic statin use was not associated with ovarian cancer-specific survival (HR=1.06, 95%CI 0.92, 1.23) but was associated with better survival for other causes (HR=0.57, 95%CI 0.36, 0.93). When adjusting for competing risks, statin use was significantly associated with increased risk of ovarian cancer-specific death (HR=1.20, 95%CI 1.03, 1.40, p=0.02). Conclusion: In this, the largest ever study of statin use in ovarian cancer, we observed an association between pre-diagnostic statin use and cancer survival when adjusting for competing risks. Further work is being conducted to verify these results in United Kingdom populations. Research is needed to better understand the mechanisms by which prediagnosis statin use might influence cancer survival.
Thyroid cancer in Ireland: a 10-year review of the National Cancer RegistryOral presentationThyroidLennon P, Deady S, Healy, M-L, Kinsella J, Timon C, O’Neill JPLennon P17th European Congress of EndocrinologyDublin, Ireland16 May 2015 to 20 May 2015May 2015http://www.endocrine-abstracts.org/ea/0037/ea0037EP910.htmDr Sandra DeadyIntroduction: The increased incidence of thyroid cancer is driven mainly by a large increase in papillary thyroid cancer (PTC). The number of patients that succumb to the disease has remained stable. The aim of our study is to analyze the incidence and mortality of thyroid cancer in Ireland. Methods and design: A retrospective analysis of the National Cancer Registry was undertaken, between 1st of January 1998 and the 31st December 2007. The Kaplan–Meier method was used to determine overall survival using Stata 13 software. Results: A total of 949 patients were diagnosed, 781 (82.2%) were well-differentiated thyroid cancers (papillary 565, follicular 177, Hurtle cell 39) whilst there were 44 medullary thyroid cancers and 61 anaplastic thyroid cancers. The female to male ratio was 3:1, with a median overall age of 47. This was significantly lower in women at 45, then men at 52 (P=0.0000). The incidence of thyroid cancer increased from 1.43/100 000 to 3.61/100 000. This increase was in the mainly attributed to PTC, rising from 0.63 to 2.46/100 000. The number of deaths from the disease remained stable at 0.63–0.59/100 000. There was no survival difference between those under going total thyroidectomy vs thyroid lobectomy for PTC (hazard ratio 0.868, 95% CI 0.598–1.26, P=0.457). Conclusions: These results correlate with studies that demonstrate that although an increase in incidence of thyroid has been found, the number of patients dying from the disease has remained stable. This emphasises the need for a new treatment paradigm of risk stratification in order to ensure maximum benefit for the patient.
Psychological impact of HPV testing in cervical screeningInvited oral presentationCervix uteriO'Connor M, Murphy J, Costello L, Sharp LO'Connor MUCL/King's College London Joint MSc Masterclass on HPVUCL, London21 Nov 2014Dec 2014Dr Mairead O'Connor, Prof Linda Sharp
Health-related quality of life of prostate cancer survivors up to fifteen years post-diagnosis. Results from an all-Ireland survey (the PiCTure study)Oral presentationProstateDrummond FJ, Kinnear H, O'Leary E, Donnelly D, Gavin A, Sharp LDrummond FJPROMs SummitLondon, UK3 Dec 2014Dec 2014Dr Frances Drummond
Effect of active follow-up on survival estimates in a sample of cancer registry casesOral presentationAll invasiveBrown C, Kelleher T, Dwane F, Walsh PM, Chambers M, Sharp L, Comber HBrown CEuropean Network of Cancer Registries Scientific MeetingIspra (Varese) Italy12 Nov 2014 to 14 Nov 2014Nov 2014https://www.ncri.ie/sites/ncri/files/presentations/ENCR%202014%20-%20Chris%20Brown%20-%20NCRI%20followup%20sample.pdfhttp://www.encr.eu/index.php/general-informationMr Chris Brown, Ms Tracy Kelleher, Ms Fiona Dwane, Dr Paul Walsh, Prof Linda Sharp, Dr Harry ComberBackground & IntroductionMany population-based cancer registries rely mainly on passive follow-up to estimate survival. This assumes that registered persons not matched to mortality records are alive at the time-point to which all records have been completely collated. The approach enables unbiased estimates provided all deaths are properly recorded and matched and that there is no emigration of cancer patients. We undertook active follow-up on a sample of cases and approximated the impact that this may have on survival estimates.Materials & MethodsAll patients in the National Cancer Registry Ireland (NCRI) with malignant tumours (excluding non-melanoma skin cancers (NMSC)) diagnosed in the years 1994-2005 were selected. 2000 patients were randomly selected from all patients presumed alive with no activity recorded by the registry beyond 31/12/2008. In June 2012, status of these patients was determined by a government social security department source and via letters to general practitioners (GPs). Observed survival and follow-up distributions of the sampled cohort were computed. Bootstrap simulation was used to extrapolate results from the sample to other presumed alive cases and estimate the plausible impact of active follow-up compared to passive.Results168,252 patients were identified with malignant (ex-NMSC) tumours registered 1994-2005. Of these 35% (58,693) were presumed alive in June 2012. 42,034 of these patients had no activity beyond 2008. From the 2000 sampled patients an updated status was obtainable for 63%. There were 68 deaths detected by the government department and 52 further deaths via GPs. Some detected deaths would have eventually been reported through normal sources. 12 patients were reported as having emigrated. 1, 5, 10 year observed survival estimates for the sampled cohort were 99, 97, 93%. Simulation estimated observed survival based on follow-up as being 2.5% lower than that based on the passive approach in the wider cohort.ConclusionsThere were a number of unreported deaths detected which result in slightly lower survival estimates. Further work will examine the impact by age and on relative survival. Few patients were detected as having emigrated but this could increase in the future. Active follow-up is a resource intensive process but efforts could be targeted to maximise impact. The NCRI is funded by Department of Health Ireland and research support is provided by the Heath Research Board.
Prostate cancer treatment decision making: Results from all-Ireland PiCTure (Prostate Cancer Treatment, your decision) studyOral presentationProstateDrummond FJ, O'Leary E, Kinnear H, Gavin A, Sharp LDrummond FJENCR Scientific Meeting and General AssemblyIspra12 Nov 2014 to 14 Nov 2014Nov 2014Dr Frances Drummond
Men's experiences of prostate cancer care: the influence of the clinical nurse specialistOral presentationProstateHennessy M, O’Leary E, Comber H, Drummond FJ, Sharp LHennessy MIrish Society of Urology Annual MeetingKillarney, Ireland25 Sep 2014 to 26 Sep 2014Sep 2014BJU IntS236-37114Ms Marita Hennessy, Mr Eamonn O'Leary, Dr Harry Comber, Dr Frances Drummond, Prof Linda Sharp
Men's experience of prostate biopsy in Ireland: Results from the all-Ireland PiCTure studyOral presentationProstateDrummond FJ, Kinnear H, Gavin A, O'Leary E, Durkan G, Galvin D, Smyth G, Kiely S, McGarvey C, White S, Sharp LDrummond FJISUKillarney, Ireland25 Sep 2014 to 26 Sep 2014Sep 2014
Prostate cancer treatment and health related quality of life in prostate cancer survivors: results from all-Ireland PiCTure (Prostate Cancer Treatment, your decision) studyOral presentationProstateDrummond FJ, O'Leary E, Kinnear H, Gavin A, Sharp LDrummond FJIrish Cancer Society Research DayDublin Ireland18 Sep 2014Sep 2014Dr Frances Drummond
Functioning, symptom burden and health related quality-of-life in prostate cancer survivors. Results from all-Ireland PiCTure (Prostate Cancer Treatment, your decision) studyOral presentationProstateDrummond FJ, Kinnear H, O'Leary E, Donnelly C, Gavin A, Sharp LDrummond FJICS Survivorship Research DayDublin, Ireland18 Sep 2014Sep 2014
Prostate cancer treatment and health related quality of life in prostate cancer survivors: results from all-Ireland PiCTure (Prostate Cancer Treatment, your decision) studyPoster presentationProstateDrummond FJ, O'Leary E, Kinnear H, Gavin A, Sharp LDrummond FJIrish Cancer Society Research DayDublin, Ireland18 Sep 2014Sep 2014Dr Frances Drummond
Psychological well-being of medium and long-term prostate cancer survivors. Results from all-Ireland PiCTure (Prostate Cancer Treatment, your decision) studyPoster presentationProstateDrummond FJ, O'Leary E, Kinnear H, Gavin A, Sharp LICS Survivorship Research DayDublin, Ireland18 Sep 2014Sep 2014
Factors influencing men's experiences of prostate cancer. PiCTure (Prostate Cancer Treatment, your decision) studyPoster presentationProstateDrummond FJ, Kinnear H, Craven-Lynn A, Gavin A, Sharp LICS Survivorship Research DayDublin, Ireland18 Sep 2014Sep 2014
Men's experience of prostate biopsy in Ireland: Results from the all-Ireland PiCTure studyOral presentationProstateDrummond FJ, Kinnear K, Gavin A, O'Leary E, Durkan G, Galvin D, Smyth G, Kiely S, McGarvey C, White S, Dunne E, Sharp LDrummond FJIrish Society of Urology MeetingKillarney, Ireland25 Sep 2014 to 26 Sep 2014Sep 2014Dr Frances Drummond
Projecting productivity losses due to premature mortality from cancer 2010 - 2030Oral presentationAll invasivePearce AM, Bradley C, Hanly P, O'Neill C, Sharp L on behalf of the ICE study investigatorsAlison PearceIrish Society of New EconomistsNUIG Galway4 Sep 2014 to 5 Sep 2014Sep 2014Dr Alison Pearce, Prof Linda SharpBackground: Over 40% of those diagnosed with cancer in Ireland are of working age and these numbers are likely to grow. Productivity losses due to cancer represent a major burden to cancer survivors, their families, their employers and society.Aim: The aim of this research is to estimate national productivity losses associated with premature mortality from all invasive cancers in 2010, and project these until 2030. The secondary objective is to explore the impact of different assumptions within the model on the estimates of productivity loss associated with premature mortality from cancer.Methods: Based on the Human Capital Approach, an incidence-based method will be used to estimate the costs of cancer deaths that occurred and are predicted to occur between 2010 and 2030. The projected years of productive life lost will be multiplied by age and gender specific annual gross earnings to generate monetary estimates, with annual gross earnings adjusted for discounting, wage growth, workforce participation rates and unemployment rates.Sensitivity analysis will investigate the impact of assumptions such as the rate of employment in older age groups, the inclusion of household productivity, reductions in mortality in the future and the discount rate.Results: The analysis is currently underway. Early results suggest that in 2010 the annual productivity cost from cancer mortality in the base model was over €500 million. Results will be presented for the remainder of the analysis, including the projection of these costs to 2030, and the results of sensitivity analysis examining the impact of assumptions around working age, household productivity and improvements in cancer mortality.Conclusions: The costs to society of lost productivity due to cancer related premature mortality are significant. By producing estimates which project losses into the future, policy makers can plan to meet future needs.
Men's experience of prostate cancer in Ireland: results from a nationwide, population-based, surveyPoster presentationProstateHennessy M, O'Leary E, Comber H, Drummond FJ, Sharp LHennessy MIrish Cancer Society Survivorship Research DayDublin19 Sep 2014Sep 2014https://www.ncri.ie/sites/ncri/files/presentations/PiCTure2_Poster-ICSSurvivorshipResearchDay2014_20140918-V1%201.pdfhttp://www.cancer.ie/research/events/survivorship-research-day/2014#sthash.jTENXLVd.dpbsMs Marita Hennessy, Mr Eamonn O'Leary, Dr Harry Comber, Dr Frances Drummond, Prof Linda Sharp
A comparison of the Human Capital and Friction Cost approaches to estimating the productivity costs associated with head and neck cancerOral presentationHead & neckPearce AM, Timmons A, Hanly P, O'Neil C, Sharp L, on behalf of the SUN Investigators and the ICE Award InvestigatorsPearce A10th World Congress in Health Economics (iHEA and ECHE Joint Congress)Dublin12 Jul 2014 to 16 Jul 2014Jul 2014https://www.healtheconomics.org/congress/2014/Dr Alison Pearce, Dr Aileen Timmons, Dr Paul Walsh, Prof Linda SharpAim:  There is a growing literature comparing the application of the Human Capital Approach (HCA) and the Friction Cost Approach (FCA) to health economic calculations of productivity losses. However, the implications of choosing one model over another in comparing sub-groups of individuals (e.g. by gender or age) have not been examined. This study calculated the lost productivity associated with head and neck cancer (HNC) using both the HCA and FCA, and examined the implications of using each approach for the comparison of socio-demographic and clinical groups.Methods:  The study used survey data from a sample of individuals in Ireland employed at the time of HNC diagnosis. The survey included questions about the nature of work and working hours pre- and post-diagnosis. These data were combined with average wage rates specified by age and occupation type in Ireland from the Central Statistics Office. The costs of temporary and permanent work absence, reduced working hours and premature mortality were estimated up to age 65 years using both the HCA and FCA. National Cancer Registry Ireland data and Irish life tables were used to estimate premature mortality rates associated with HNC. National data sources were used to identify estimates of workforce participation and wage growth rates. Friction periods were assigned based on occupational group, and ranged from 9.9 to 13.3 weeks. Future costs were discounted at 4%. Comparisons by socio-demographic and clinical variables, including gender, age, occupation, medical card status, cancer stage and treatment, were performed to examine the impact of selecting one method over another on group differences.Results:  There were 251 survivors of head and neck cancer in the survey sample who were employed at the time of diagnosis. Total productivity losses per person of working age and employed at the time of HNC diagnosis were €253,800 using the HCA and €6,800 using the FCA. The primary driver of productively losses in the HCA was premature mortality (38% of total loss), while in the FCA it was temporary time off (73%). When comparing sub-groups of socio-demographic and clinical variables, the FCA produced proportionately smaller differences between groups than the HCA for age and education. For example, using HCA older individuals (over 50 years) had 52% the productivity losses of younger individuals (50 years and under), while it was 114% using FCA. In contrast, gender, occupation type, medical card status and radiotherapy status had FCA results which accentuated differences between the subgroups, in comparison with the HCA results. For example, females had 99% the productivity losses of males using HCA, but 85% using FCA.Conclusions:  The productivity losses following HNC diagnosis can be significant, and as expected the methodology used has a large impact on the overall estimate. However, the methodology selected may also influence the observed differences between the productivity impacts of cancer on different socio-demographic and clinical groups. The FCA may provide more generalisable results, while the HCA may be more appropriate for comparing sub-groups. The purpose of calculating productivity losses should inform the choice of methodology.
Patterns and predictors of workforce participation in cancer survivors 6-months and 12-months post-diagnosisPoster presentationBreast, Colorectal, ProstateSharp L, O'Driscoll D, O'Leary E, Higney K, Bradley C.NCIN Cancer Outcomes ConferenceBirmingham, UK9 Jun 2014 to 10 Jun 2014Jun 2014https://www.ncri.ie/sites/ncri/files/presentations/NCIN%20CaRE%20study%20poster%202014%20-%20with%20QR%20code.pdfhttp://www.ncin.org.uk/news_and_events/conferences/Prof Linda Sharp, Mr Eamonn O'Leary
Smoking at diagnosis is an independent prognostic factor for survival in head and neck cancer: findings from a large, population-based, studyPoster presentationHead & neckSharp L, McDevitt J, Carsin A-E, Brown C, Comber HNCIN Cancer Outcomes ConferenceBirmingham, UK9 Jun 2014 to 10 Jun 2014Jun 2014https://www.ncri.ie/sites/ncri/files/presentations/NCIN%20smoking%20%20survival%20HNC%202014%20-%20with%20QR%20code_0.pdfhttp://www.ncin.org.uk/news_and_events/conferences/Prof Linda Sharp, Dr Joe McDevitt, Mr Chris Brown, Dr Harry Comber
Surgery type and length of stay in head and neck cancer patients: a population based studyPoster presentationHead & neckMcDevitt J, De Camargo Cancela M, Sharp LNCIN Cancer Outcomes ConferenceBirmingham, UK9 Jun 2014 to 10 Jun 2014Jun 2014http://www.ncin.org.uk/news_and_events/conferences/Dr Joe McDevitt, Prof Linda SharpBackground: In-patient hospital care constitutes the majority of the cost of cancer treatment borne by the health services.  Surgical excision, where appropriate, is the main treatment modality in the management of head and neck cancer (HNC). We investigated predictors of post-surgical hospital length-of-stay (LOS) in HNC.Methods: From NCRI  and hospital in-patient enquiry (HIPE) records, we identified patients diagnosed 2002-2010 with primary tumours of the oral cavity (ICD03, C02-04, C050, C06), pharynx (C01, C051-052, C09, C100,C102, C103, C11-C13) or larynx (C32, C101) who underwent tumour-directed surgery with or without neck dissection (ICD9-CM, 24, 25, 27-30, 40, 76) in a public hospital. LOS was calculated as days elapsed between dates of procedure and discharge. Associations between patient-related (e.g. age, marital, smoking status, comorbidities, deprivation, health insurance status), tumour-related (e.g. stage, grade) and health service-related (e.g. hospital volume, type of surgery, radiotherapy) variables and LOS were investigated using negative binomial regression with adjustment for clustering.Results: Half (1,651/3,279) of HNC patients had tumour-directed surgery.  17% of these underwent more than one surgical procedure. Procedures were classified as: neck dissection only (22%), mouth/pharyngectomy (27%), laryngectomy (24%), mouth/pharyngectomy+neck dissection (12%), mandibulectomy/maxillectomy (10%), laryngectomy+neck dissection (5%). Median LOS was 10 days (range: 1-289, mean: 19).  In multivariate analysis, the strongest predictors of longer LOS were: (1) Undergoing a procedure requiring a tracheostomy, e.g., neck dissection only: median LOS= 8 days; neck dissection+laryngectomy+tracheostomy: median LOS=38 days, incident rate ratio (IRR) 3.0 (95%CI: 2.5-3.7).   (2) Post-operative infection, i.e., no infection: median LOS=8 days; infection: median LOS=34 days, IRR=2.3, 95%CI 2.0-2.6). Other significant predictors of longer LOS were ancillary gastrostomy, advanced stage, emergency admission.Conclusions: Median LOS was longer than for some other cancers probably, in part, reflecting the complex nature of the surgery and the patients’ health status. Indeed, the significant predictors of longer LOS largely reflect procedure complexity. The strong association between LOS and infection, a preventable complication, warrants further investigation.  
Using routine prescribing data to identify comorbidities in ovarian cancer patientsOral presentationOvaryBrown C, Sharp L, Bennett K, Barron IBrown CNCIN Cancer Outcomes ConferenceBirmingham, UK9 Jun 2014 to 10 Jun 2014Jun 2014https://www.ncri.ie/sites/ncri/files/presentations/Brown_NCIN%20Presentation_2014.pdfhttp://www.ncin.org.uk/news_and_events/conferences/Mr Chris Brown, Prof Linda SharpBackground: Although certain comorbid conditions may predict treatment receipt and survival in cancer patients, most cancer registries do not routinely collect data on comorbidities. Registries increasingly have access to community prescribing data.  A number of algorithms exist for estimation of comorbidities based on prescription history, including RxRisk1 (the updated Chronic Disease Score) and the number of distinct prescription classes2 (DMC).   We evaluated the utility of using prescribing data to identify comorbidities in ovarian cancer patients in Ireland. Method: Free healthcare within the Irish public healthcare system is restricted to holders of general medical services (GMS) cards, eligibility for which is based on means-test and age. Prescription records were linked, using probabilistic matching methods, to primary ovarian cancers (ICD10 C56) diagnosed 2001-2010.  Degree of comorbidities was estimated, using RxRisk and DMC, based on prescriptions in the year prior to cancer diagnosis. The scores were evaluated for prognostic value on  treatment (within 12m) and overall survival using logistic and Cox regression respectively.Results: 1,542 (50%) of the 3,097 incident ovarian cancers had GMS prescriptions in the year prior to diagnosis.  Among these women, RxRisk comorbidities with highest prevalence were: gastric acid (39%),hypertension (36%), antiplatelet related (31%) and hyperlipidaemia (31%).  Other common categories (>20%) were: pain, inflammatory pain, and ischaemic heart disease.  The median simultaneous comorbidity categories was 3 (range 0-12). The median number of DMCs was 11 (range 1-48). Neither the number of conditions nor RxRisk index were associated with chemotherapy receipt or cancer-directed surgery. RxRisk predicted survival (HR=1.03, 95%CI 1.01,1.05) as did DMC (HR=1.01, 95%CI 1.00,1.02).  Among common comorbidities, depression, hyperlipidaemia and reactive airway diseases could adversely affect survival.Conclusion: Comorbidities can be estimated from linked prescribing data and have some prognostic value in predicting survival after ovarian cancer diagnosis.Acknowledgements: Health Research Board (HRA_HSR/2012/30)References:1.            Fishman, et al. Risk adjustment using automated ambulatory pharmacy data: the RxRisk model. Med Care. 2003 Jan;41(1):84–99.2.            Schneeweiss et al. Performance of comorbidity scores to control for confounding in epidemiologic studies using claims data. Am J Epidemiol. 2001 Nov 1;154(9):854–64.  
Risk of poor psychological wellbeing of medium and long-term prostate cancer survivors is increased in men who were symptomatic at diagnosis. Results from and all-Ireland surveyPoster presentationProstateDrummond FJ, Kinnear H, O'Leary E, Gavin A, Sharp LDrummond FJNational Cancer Intelligence NetworkLiverpool, UK9 Jun 2014 to 10 Jun 2014Jun 2014Dr Frances Drummond
Health-related quality of life in prostate cancer survivors does not change significantly with time since diagnosis.Poster presentationProstateDrummond FJ, Kinnear H, Gavin A, O'Leary E, Donnelly D, Sharp LInternational Association of Cancer Registries and North American Association of Central Cancer Registries Conference; Capitalizing on Cancer Surveillance - Data for Improved Cancer ControlOttawa, Ontario, Canada26 Jun 2014 to 28 Jun 2014Jun 2014
'Men talk' our experience of using a Freephone number with a postal questionnairePoster presentationProstateDrummond FJ, Kinnear K, Gavin A, Sharp LDrummond FJInternational Agency for Research on Cancer (IARC)Ottawa, Canada26 Jun 2014 to 28 Jun 2014Jun 2014Dr Frances Drummond
'Men talk' our experiences of using a freephone number with a postal surveyPoster presentationProstateDrummond FJ, Kinnear H, Craven-Lynn A, Gavin A, Sharp LAssociation of Cancer Registries and North American Association of Central Cancer Registries Conference; Capitalizing on Cancer Surveillance - Data for improved Cancer ControlOttawa, Ontario, Canada26 Jun 2014 to 28 Jun 2014Jun 2014
Health-related quality of life in prostate cancer survivors decreased with time since diagnosisPoster presentationProstateDrummond FJ, Kinnear K, O'Leary E, Gavin A, Sharp LDrummond FJInternational Agency for Research on Cancer (IARC)Ottawa, Canada26 Jun 2014 to 28 Jun 2014Jun 2014Dr Frances Drummond
Risk of poor psychological well-being of medium- and long-term prostate cancer survivors by mode of presentation. Results from an all-Ireland survey Poster presentationProstateDrummond FJ, Kinnear K, Gavin A, O'Leary E, Donnelly D, Sharp LNational Cancer Intelligence Network Cancer Outcomes Conference 2014 - the power of information Birmingham, UK9 Jun 2014 to 10 Jun 2014Jun 2014
Using registry data to estimate productivity losses due to premature mortality and reduced workforce participation following head and neck cancerPoster presentationHead & neckPearce AM, Timmons A, Hanly P, Walsh P, O'Neill C, Sharp L, on behalf of the SUN Study Investigators and ICE Award InvestigatorsLinda SharpNCIN Cancer Outcomes ConferenceBirmingham, UK9 Jun 2014 to 10 Jun 2014Jun 2014https://www.ncri.ie/sites/ncri/files/presentations/Cancer%20Outcomes%202014_0.pdfhttps://www.phe-events.org.uk/hpa/frontend/reg/thome.csp?pageID=109785&eventID=262&eventID=262Dr Alison Pearce, Dr Aileen Timmons, Dr Paul Walsh, Prof Linda SharpBackground: Valuing the loss to society of an individual’s reduced workforce participation due to cancer, including premature mortality, can inform policy development and service delivery. The aim of this analysis was to use cancer registry and survey data to estimate productivity losses due to premature mortality and reduced workforce participation following head and neck cancer (HNC).  Method: The human capital approach to valuing productivity losses was used. National Cancer Registry survival data for all HNC cancer types and stages along with Irish life table data were used to estimate premature mortality rates. In addition, a sample of HNC survivors were identified from the National Cancer Registry and invited to participate in a survey which included questions about workforce participation.  To estimate the value of lost productivity due to premature mortality, the years of potential life lost (YPLL) was calculated using the annual probability of excess mortality to age 65 years and then multiplied by the average annual wage over the remaining working life, adjusted for growth and discounting. Reduced workforce participation through temporary time off work, reduced working hours or permanent workforce departure were calculated by multiplying the average wage by the time out of the workforce. Results: The premature mortality costs associated with head and neck cancer were estimated to be €98,000 per person working at the time of HNC diagnosis. Reduced workforce participation was valued at an additional €156,000 per person working at the time of HNC diagnosis.Conclusion: The productivity costs associated with HNC are significant. An awareness of the societal costs associated with cancer allows policy makers an additional perspective on the burden of disease, allowing priority setting for service provision, prevention strategies and staff training. This analysis demonstrates the value of registry data for health economic analyses.
Marital status associated with ovarian cancer stage, treatment and outcomes?Poster presentationOvaryBrown C, Comber H, Sharp LNCIN Cancer Outcomes ConferenceBirmingham, UK9 Jun 2014 to 10 Jun 2014Jun 2014https://www.ncri.ie/sites/ncri/files/presentations/NCIN%20-%20Ovarian%20cancer%20poster%2020140526_final.pdfhttp://www.ncin.org.uk/news_and_events/conferences/Mr Chris Brown, Dr Harry Comber, Prof Linda SharpBackground: Ovarian cancer is the 4th most common cancer in women in Ireland and their mortality rates are second highest in Europe.  There is growing evidence, across a range of cancer sites, that married cancer patients have better survival.  It is unlikely that marriage elicits biological changes in cancer cells, but there are societal factors which could lead to earlier diagnosis, greater treatment utilisation and improved quality of follow-up for married patients within the health system.  We investigated associations between marital status and stage, treatment receipt and survival in ovarian cancer.Methods: Women, aged ≥20, diagnosed with primary malignant ovarian cancer (IDC10-C56) during 1994-2010 were identified from National Cancer Registry Ireland.  Data extracted was: marital status, stage, treatment received in the first year, date and cause of death,  age, smoking status, occupation, region and area deprivation score.  Logistic regression was used to estimate adjusted effects of marital status on tumour stage (1-3 vs 4).  Effect on treatment uptake was evaluated adjusting for socio-demographic characteristics, stage and grade. Associations between marital status and survival were evaluated using Cox regression, at baseline and beyond a 6-month landmark, adjusting for treatment. Results: The median age of 5022 included women was 64 (range 23-97, IQR 21);  54% were married at diagnosis; 50% were non-smokers; 41% identified as housewives; 30% had stage 4 disease.  Married women were younger, more likely to be a housewife and lived in less deprived areas.   Marriage reduced the odds of stage 4 disease (crude OR=0.88, 95%CI 0.78-1.0), but association disappeared after adjustment for factors above. Overall, 62% of women received cancer-directed surgery.  Married women significantly more often had surgery, even after adjusting for covariates (OR=1.47, 95%CI 1.26, 1.70).   Married women survived longer (median: 31m vs 15m; adjusted HR=0.88, 95%CI 0.81-0.95) but this effect attenuated when conditional survival beyond 6-months was considered (adjusted HR=0.94, 95%CI 0.85-1.04). Conclusions: Among women with ovarian cancer, marriage is not associated with stage at diagnosis but does increase the odds of having treatment.  Associations between marital status and survival are restricted to the initial follow-up period. Acknowledgements: National Cancer Registry receives Department of Health funding.
Comparison of uptake of colorectal cancer screening based on faecal immunochemical testing (FIT) in males and females: a systematic review and meta-analysisOral presentationColorectalClarke N, Osborne A, Kearney P, Sharp LClarke NThe 2014 Controlling Cancer Summit: Advances in Cancer Screening and Prevention ResearchLondon, UK12 May 2014 to 14 May 2014May 2014https://www.ncri.ie/sites/ncri/files/presentations/Cancer%20screening%20conference%20FIT%20review%20pre%20V3%20NC.pptMr Nicholas Clarke, Prof Linda Sharp
Women's differing experiences of distress following colposcopy and related procedures: a qualitative interview studyOral presentationCervix uteriO'Connor M, Waller J, Gallagher P, Martin C, O'Leary J, Sharp LO'Connor M15th World Congress for Cervical Pathology and ColposcopyLondon, UK26 May 2014 to 30 May 2014May 2014Dr Mairead O'Connor, Prof Linda SharpBackground: Women with abnormal cervical cytology may be referred for a colposcopy examination. Distress prior to and during colposcopy has been widely researched. Less is known about psychological wellbeing post-colposcopy and what influences this. This exploratory study aimed to identify factors associated with psychological distress post-colposcopy.Aims: In-depth semi-structured interviews were undertaken with 23 women who had undergone colposcopies +/- related procedures. Interview transcripts were analysed thematically using the Framework Approach.Results: Four groups emerged from analysis: (1) women with short-term distress; (2) women with long-term distress; (3) women with both short- and long-term distress; and (4) women without distress. Group 1 felt unprepared for how their colposcopy would feel and what it entailed. These women experienced distress during the investigation, found the physical experience particularly painful and had often attended the clinic alone. Group 2 had fertility worries, physical after-effects that impacted on their lives, and were still attending the clinic for follow-up. Group 3 had factors that overlapped with those of Groups 1 and 2. Group 4 felt reasonably prepared for the procedure, did not find it as bad as they had anticipated, and were accompanied to the clinic by a spouse/partner/friend.Conclusions: Colposcopy/related procedures can lead to short-term and long-term post-procedural distress among some women. Our results suggest a lack of sensory and procedural preparation, lack of support while attending the clinic, fertility worries and on-going monitoring/follow-up may influence distress. There is an urgent need to develop targeted psycho-educational interventions to help alleviate this distress. 
Bias in prescription data of the Irish ovarian cancer population.Oral presentationOvaryBrown C, Sharp L, Bennett K, Barron IBrown CInternational Society for Pharmacoepidemiology Mid-Year MeetingRotterdam6 Apr 2014 to 8 Apr 2014Apr 2014https://www.ncri.ie/sites/ncri/files/presentations/ISPE%202014%20-%20Chris%20Brown%20-%20GMS%20cards%20in%20NCRI%20ovarian%20cohort.pdfhttps://www.pharmacoepi.org/meetings/midyear14/Mr Chris Brown, Prof Linda SharpBackground: Ireland has a mixed public-private healthcare system. Free healthcare within the public system is restricted to holders of general medical services (GMS) cards, eligibility for which is based on means-test and age. Cards may also be awarded on discretionary grounds due to extreme hardship (e.g. following cancer diagnosis).  One-third of the female population under 70 have a card, and 97% of those aged 70 and older. Community prescribing data is only recorded systematically for card-holders. This restriction likely creates  selection bias in pharmacoepidemiological studies conducted in RoI.  This study  aimed to quantify this bias within women with incident ovarian cancer.Methods: Records for all women diagnosed with invasive ovarian cancer (ICD10 C56) 2001-2010 were linked to GMS card records.  Characteristics of patients with and without cards (both at diagnosis, and after diagnosis) were compared.  Health board of residence, deprivation category, age group at diagnosis, smoking status at diagnosis, employment and marital status were evaluated using logistic regression. Results: Of the 3097 women diagnosed with ovarian cancer 1609 (52%) had a GMS card at the time of diagnosis. Most women with cards (92%) had them for at least >12months prior to diagnosis.  As expected, age >70 strongly predicts card status (card holders, <70: 32%; 70+, 89%).   Within the younger population (<70), all factors evaluated were associated (independently and mutually adjusted) with card status at diagnosis (e.g. adjusted OR smoking 1.23 , 95% CI 1.01, 1.59).  Of the women without cards at diagnosis, 54% go on to receive one post-diagnosis, half of these within 3 months.Conclusion: Medical card coverage at diagnosis within the ovarian cancer population is similar to the general population.  Half of patients without a card at diagnosis receive one subsequently. There is selection bias in linked cancer-prescribing  datasets which needs to be considered when interpreting pharamcoepidemiological analyses. 
Prostate cancer survivors who were symptomatic at diagnosis have an increased risk of poor psychological wellbeing than men who were asymptomatic. Results from an all-Ireland surveyOral presentationProstateDrummond FJ, Kinnear K, O'Leary E, Gavin A, Sharp LBritish Psychosocial Oncology Society Annual ConferencePreston, UK27 Feb 2014 to 28 Feb 2014Feb 2014PsychooncologySupplement S21-1623http://onlinelibrary.wiley.com/doi/10.1111/pon.2014.23.issue-s2/issuetocDr Frances Drummond, Mr Eamonn O'Leary, Prof Linda SharpProstate cancer survivors who were symptomatic at diagnosis have an increased risk of poor psychological wellbeing than men who were asymptomatic. Results from an all-Ireland surveyBackground: Many asymptomatic men are diagnosed with prostate cancer (PCa) following prostate specific antigen (PSA) testing, others are symptomatic.  Rising incidence and survival means more men are living longer with PCa, however, information on long-term psychological wellbeing is lacking.  We explored factors associated with psychological well-being of PCa survivors, including symptoms at diagnosis.Methods: A postal questionnaire was developed and administered in 2012 to 6,647 PCa (ICD10 C61) survivors 2-15 years post-diagnosis, identified through population-based cancer registries in the Republic of Ireland (RoI) and Northern Ireland (NI). "Asymptomatic" men were without symptoms, diagnosed via PSA testing, "symptomatic" men had urinary symptoms.  Psychological well-being was assessed using DASS-21.  Logistic regression was used to investigate predictors of depression, anxiety and stress (any severity). Results: Response was 52%.  Two-thirds of men were asymptomatic.  Depression, anxiety and stress were present in 16.6%, 16.5% and 10.6%, respectively.  In adjusted analysis, depression risk was increased in unmarried men (1.56 95%CI 1.19,2.05), those with co-morbidities (1.62 95%CI 1.29,2.03), current incontinence (1.73 95%CI 1.34,2.24), fatigue (2.46 95%CI 1.95,3.09) and those whose side-effects were worse than expected (2.22  95%CI 1.66,2.97).  Depression risk was higher in symptomatic compared to asymptomatic men (1.30 95%CI 1.04,1.61).  Similar associations were found for anxiety and stress. Conclusions: Groups of PCa survivors, including those with symptoms at diagnosis, are at increased risk of poor psychological health. This suggests that screening survivors for depression, anxiety and stress during follow-up maybe beneficial.  Development of interventions to support survivors' long term psychological wellbeing is required. 
Prostate cancer survivors who were symptomatic at diagnosis have an increased risk of poor psychological wellbeing than men who were asymptomatic. Results from an all-Ireland surveyOral presentationProstateDrummond FJ, Kinnear K, O'Leary E, Gavin A, Sharp LDrummond FJBPOSPreston, UK27 Feb 2014Feb 2014
Distress following colposcopy examination for cervical abnormalities: a qualitative studyPoster presentationCervix uteriO'Connor M, Waller J, Gallagher P, Martin C, O'Leary J, Sharp LO'Connor MBritish Psychosocial Oncology Society Annual ConferencePreston, UK27 Feb 2014 to 28 Feb 2014Feb 2014PsychooncologySupplement S21-1623https://www.ncri.ie/sites/ncri/files/presentations/BPOSposterv3.pdfDr Mairead O'Connor, Prof Linda SharpDistress following colposcopy examination for cervical abnormalities: a qualitative studyBackground: Women who have an abnormal cervical smear test may be referred for a colposcopy examination. Distress prior to and during colposcopy has been widely researched. Less is known about psychological wellbeing post-colposcopy and what influences this. This exploratory study aimed to identify the factors associated with psychological distress post-colposcopy.Aims: Face-to-face semi-structured interviews were conducted with 23 women who had undergone colposcopies at two clinics. Interview transcripts were analysed thematically using the Framework Approach.Results: Four groups emerged from analysis:  (1) women with short-term distress; (2) women with long-term distress; (3) women with both short- and long-term distress; and (4) women without distress. Group 1 felt unprepared for how their colposcopy would feel/what it entailed. They experienced distress while undergoing the investigation, and had often attended the colposcopy alone. Group 2 had fertility worries, physical after-effects that impacted on their lives, and were still attending the clinic for follow-up. Group 3 had factors that overlapped with those of groups 1 and 2. Group 4 felt reasonably prepared for the procedure, did not find it as bad as they had anticipated, and were accompanied to the clinic.Conclusions: Colposcopy can lead to short-term and long-term post-procedural distress. These results suggest a lack of sensory and procedural preparation, lack of support while attending the clinic, fertility worries and still being monitored by the clinic may affect post-colposcopy psychological distress. Targeted psycho-educational interventions to help alleviate distress after colposcopy and related procedures are required.
Colonoscopy-related distress in individuals undergoing faecal immunochemical testing-based colorectal cancer screeningPoster presentationColorectalSharp L, Shearer N, Lean R, O'Morain C, McNamara DSharp LBritish Psychosocial Oncology Society Annual ConferencePreston, UK27 Feb 2014 to 28 Feb 2014Feb 2014PsychooncologySupplement S21-1623Prof Linda Sharp
Comparison of participation rates between males and females in faecal immunochemical test colorectal cancer screening: a review and meta-analysisPoster presentationColorectalClarke N, Osborne A, Kearney P, Sharp LClarke N10th Annual Cochrane in Ireland ConferenceDublin City University, Dublin24 Jan 2014Jan 2014Mr Nicholas Clarke, Prof Linda Sharp
The impact of HPV-related attitudes on behaviours of GPs and practice nurses: results from ATHENS (A Trial of HPV EducatioN and Support)Oral presentationCervix uteriMcSherry L, Dombrowski S, Francis J, Martin C, O'Leary J, Sharp LSharp L9th UKSBM Annual Scientific MeetingOxford, UK9 Dec 2013 to 10 Dec 2013Dec 2013Ms Lisa McSherry, Prof Linda Sharp
Prevalence and predictors of colonoscopy-related distress in individuals undergoing FIT-based colorectal cancer screening: a population-based studyPoster presentationColorectalSharp L, Shearer N, Leen R, O’Morain C, McNamara D. Irish Society of Gastroenterology Winter MeetingIreland22 Nov 2013 to 23 Nov 2013Nov 2013https://www.ncri.ie/sites/ncri/files/presentations/ISG-2013-Sharp.pdfProf Linda Sharp
An all-Ireland population-based study of past and current physical and psychological side-effects following prostate cancer treatmentsPoster presentationProstateKinnear H, Drummond FJ, Sharp L, Gavin ANational Cancer Research InstituteLiverpool, UK3 Nov 2013 to 6 Nov 2013Nov 2013
Associations between overall care experience ratings and utility and psychological well-being in men recently diagnosed with prostate cancer: findings from a population-based studyPoster presentationProstateHennessy M, O’ Leary E, Comber H, Drummond FJ, Sharp LPearce AISPOR 16th Annual European CongressDublin2 Nov 2013 to 6 Nov 2013Nov 2013https://www.ncri.ie/sites/ncri/files/presentations/ISPOR-2013-Hennessy_0.pdfMs Marita Hennessy, Mr Eamonn O'Leary, Dr Harry Comber, Dr Frances Drummond, Prof Linda SharpOBJECTIVES: Patient experience is increasingly recognised as an important measure of quality of care. A few studies have suggested that patients who report higher levels of satisfaction with care also have higher quality-of-life and higher psychological wellbeing, and are more likely to cooperate with treatment. In Ireland, this area is under-researched. The PiCTure 2 study aimed to assess the care experiences of men recently diagnosed with prostate cancer – the most common cancer among men in Ireland - and investigate associations between experiences and health-related quality-of-life (utility) and psychological wellbeing (depression, anxiety and distress). METHODS: Men diagnosed with invasive prostate cancer (ICD10 C61) 5-20 months prior to study commencement were identified through the National Cancer Registry. The patient experience questionnaire was based on the Prostate Care Questionnaire (Baker et al. 2007), modified for Ireland. Utility and psychological wellbeing were assessed using the EQ5D-5L and Depression Anxiety and Stress Scale (DASS-21). The questionnaire was administered by post to 2,180 men during January-April 2013. EQ5D-5L responses were converted to EQ5D-3L health states and valued with UK valuations. RESULTS: 1,499 valid questionnaires were received (response rate=70%). Men rated their overall care very highly; however, there were variations with those (i) further from diagnosis, (ii) in poorer health, (iii) younger, (iv) with third level education and (v) with private health insurance significantly more likely to report poorer care experiences. Almost half of men reported maximum utility scores; one-fifth had depression, one-fifth anxiety and one-eighth stress. Lower global experience scores were significantly associated with lower utility values and poorer psychological well-being (p
Comparison of participation rates between males and females in faecal immunochemical test colorectal cancer screening: A review and meta-analysisPoster presentationColorectalClarke N, Osborne A, Kearney P, Sharp LIrish Society of Gastroenterology Winter MeetingIreland22 Nov 2013 to 23 Nov 2013Nov 2013https://www.ncri.ie/sites/ncri/files/presentations/ISG-2013-Clarke.pdfMr Nicholas Clarke, Prof Linda Sharp
Time since diagnosis and health related quality of life in prostate cancer survivors in IrelandPoster presentationProstateDrummond FJ, Kinnear H, Craven-Lynn A, Gavin A, Sharp LNational Cancer Research InstituteLiverpool, UK3 Nov 2013Nov 2013
Relationships between health behaviours, medical history, and perceived risk of developing colorectal cancer among screening invites: do these vary between males and females?Poster presentationColorectalClarke N, Sharp L, Shearer N, Leen R, O'Morain C, McNamara DIrish Society of Gastroenterology Winter MeetingIreland22 Nov 2013 to 23 Nov 2013Nov 2013https://www.ncri.ie/sites/ncri/files/presentations/ISG-2013-Clarke-2.pdfMr Nicholas Clarke, Prof Linda Sharp
Association between clinical and socio-demographic factors and methods of detection with psychological well-being among prostate cancer survivorsPoster presentationProstateDrummond FJ, Kinnear H, O'Brien K, Gavin A, O'Neill, Sharp LInternational Psycho-oncology SocietyAmsterdam3 Nov 2013 to 8 Nov 2013Nov 2013
Factors driving inequality in prostate cancer survival: a population-based studyPoster presentationProstateBurns RM, Sharp L, Sullivan FJ, Deady S, Drummond FJ, O'Neill CISPOR 16th Annual European CongressDublin, Ireland2 Nov 2013 to 6 Nov 2013Nov 2013
Workforce participation and productivity losses after head and neck cancerPoster presentationHead & neckPearce AM, Timmons A, Hanly P. O'Neill C, Sharp LPearce A16th International Society for Pharmacoeconomics and Outcomes Research European CongressDublin2 Nov 2013 to 6 Nov 2013Nov 2013Value Health7A41816https://www.ncri.ie/sites/ncri/files/presentations/PEARCE%20ISPOR%202013%20Poster%20-%20SUN%20study.pdfhttp://www.valueinhealthjournal.com/article/S1098-3015(13)02450-9/fulltextDr Alison Pearce, Dr Aileen Timmons, Prof Linda SharpObjectives: There has been no estimate of the productivity losses associated with head and neck cancer (HNC) conducted using bottom-up data, or beyond premature mortality. The aim of this work is to investigate workforce participation, and estimate the productivity losses associated with temporary and permanent work absence, reduced work hours, and premature mortality in individuals with HNC in Ireland. Methods: Survey data were collected from a cancer registry identified cohort of individuals in Ireland diagnosed with head and neck cancer between January 1994 and December 2011. Data collected included employment status at time of diagnosis and workforce participation patterns following diagnosis. These data were combined with population-level survival estimates and national wage data to estimate the value of temporary and permanent work absence, reduced work hours and premature mortality using a Human Capital Approach. Results: Of the survey respondents, 276 were in paid work at the time of diagnosis. 88% had time off following diagnosis, with 63% of these returning to work. The mean (median) time off work was 9 months (6 months), range of 0 to 65 months. 70% of individuals returning to work reported reducing the hours they worked, by an average of 20 hours per week. Preliminary results show the average productivity losses per person associated with temporary and permanent work absence and reduced work hours are €222,000. Productivity losses associated with premature mortality and the results of sensitivity analyses to test discount and wage growth rates will also be presented. Conclusions: Head and neck cancer and its treatment can have a profound impact on workforce participation. This affects not only the individuals’ and their families, but also society in terms of productivity costs. These costs should be considered in economic evaluations of cancer treatments and health service delivery in this population.
Men’s experiences of prostate cancer care in Ireland: Findings from the PiCTure2 studyInvited oral presentationProstateSharp L, Hennessy M, O’ Leary E, Drummond FJ, Comber HSharp LNational Cancer Control Programme Prostate Cancer Quality and Audit ForumDublin9 Nov 2013Nov 2013Prof Linda Sharp, Ms Marita Hennessy, Mr Eamonn O'Leary, Dr Frances Drummond, Dr Harry Comber
Adapting the Prostate Care Questionnaire to measure men’s experiences of prostate cancer care in IrelandOral presentationProstateHennessy M, O’ Leary E, Comber H, Drummond FJ, Sharp LHennessy MPROMs SummitLondon14 Nov 2013Nov 2013https://www.ncri.ie/sites/ncri/files/presentations/Marita_Hennessey-AsAppearsonHealthcareConfsUKWebsite.pdfMs Marita Hennessy, Mr Eamonn O'Leary, Dr Harry Comber, Dr Frances Drummond, Prof Linda SharpAdapting the Prostate Care Questionnaire to measure men’s experiences of prostate cancer care in IrelandObjective: Prostate cancer is the most common cancer in men in developed countries. Incidence in Ireland is the highest in Europe. Patients’ experiences of care are an important indicator of quality of care, but are under-researched in Ireland. The PiCTure2 study aims to assess the care experiences of men recently diagnosed with prostate cancer in Ireland.Developments: A questionnaire was developed from the Prostate Care Questionnaire (Baker et al., 2007). It was pre-tested using cognitive interviewing to modify, as appropriate, for Ireland, which has a mixed public-private healthcare system. Seventeen interviews were conducted with prostate cancer patients (managed by all major treatment modalities) recruited via Urologists and/or Clinical Nurse Specialists at three hospitals during September 2012-January 2013. Men were invited to 'think-aloud' whilst completing the survey; the interviewer used prompts where necessary. Interview recordings were transcribed and analysed thematically.Results:Areas of the survey which required revision included: reasons for undergoing PSA testing; routes for initial presentation, investigation and diagnosis; waiting times; and the routing of men on watchful waiting/active surveillance. Emergent themes from men’s accounts included: breaking the bad news; support (both informational and emotional) from doctors, nurses and spouses/partners; and growth in knowledge but a reliance on ‘experts’ at the outset and how this impacted on their ability to participate in care and decision-making.Conclusions: Cognitive interviews inform survey development and provide rich qualitative data which will add to interpretation of survey findings.Future plans: The survey was revised as required and administered to over 2,000 men recently diagnosed with prostate cancer in Ireland, identified through the population-based National Cancer Registry. Analysis will investigate: (1) men’s experiences of care and variations in this; and (2) associations between experiences and other patient-reported outcome measures such as health-related quality-of-life. The results will be of value to policy-makers, service providers, health professionals and patient support organisations.     
Associations between psychological and physical after-effects in women undergoing colposcopy and related procedures for follow-up for an abnormal cervical smearPoster presentationCervix uteriO'Connor M, Murphy J, White C, Ruttle C, Martin C, Flannelly G, von Bunau G, O'Leary J, Pilkington L, Anglim M, Turner M, Farah N, Cleary S, Darcy T, Prendiville W, Sharp L on behalf of the Irish Cervical Screening Research Consortium (CERVIVA)15th International Psycho-Oncology Society World CongressRotterdam4 Nov 2013 to 8 Nov 2013Nov 2013PsychooncologySupplement S3363-37422https://www.ncri.ie/sites/ncri/files/presentations/IPOS-2013-OConnor2-posterpsychphys.pdfDr Mairead O'Connor, Prof Linda SharpAssociations Between Psychological And Physical After-Effects In Women Undergoing Colposcopy And Related Procedures For Follow-up For An Abnormal Cervical Smear Background: If cervical screening is to be effective, women with abnormalities on smear tests require follow-up. One follow-up option is a colposcopy examination. It is known that undergoing colposcopy and related procedures, such as biopsy/treatment, can be distressing for women. Less is known about the psychological and physical after-effects and whether there are associations between the two. We investigated prevalence of women’s psychological and physical after-effects following colposcopy and related procedures and inter-relationships between these. Methods: Women referred for colposcopy following an abnormal smear result completed questionnaires 4 months following their initial colposcopy at two hospitals in Ireland. Anxiety and depression was assessed using the Hospital Anxiety and Depression Scale (HADS; significantly anxiety, HADS subscale score ≥11; significant depression, HADS subscale score ≥8). Specific worries (next smear being abnormal, future fertility worries and concerns about cervical cancer) were measured using the Process Outcome Specific Measure. Details of physical after-effects (pain, bleeding and discharge) experienced following colposcopy and related procedures were collected. Results: 425 of 584 women completed questionnaires (response rate=73%). Prevalence of clinically significant anxiety and depression was 21% and 8% respectively. 69% were worried about their next smear being abnormal, 56% had concerns about future fertility and 36% had worries about cervical cancer. The reported prevalence of pain, bleeding and discharge following colposcopy and related procedures was 56%, 65% and 38%, respectively. Overall, 80% of women reported one or more physical after-effect. Women with significant anxiety were more likely to report pain or have bleeding for >7 days. Women with significant depression were more likely to report having experienced moderate/severe pain. Conclusion: High proportions of women report anxiety and worries 4-months following colposcopy and related procedures. Similarly, high proportions report physical after-effects. To our knowledge, this is the first study to show that there are inter-relationships between these after-effects. Research implications: These findings suggest that ensuring that women are fully informed about the likelihood of physical after-effects may help to minimise anxiety: research is required to determine whether this is the case. Clinical implications: Clinicians and nurses need to be fully aware of the psychological and physical after-effects experienced by women following colposcopy and related procedures, so that they can provide support, reassurance or advice if required by women.Acknowledgement of funding: This research was funded by the Health Research Board, Ireland.  
Time since diagnosis and health related quality of life in prostate cancer survivors in IrelandPoster presentationProstateDrummond FJ, Kinnear H, O'Brien K, Gavin A, Sharp LNational Cancer Research InstituteLiverpool3 Nov 2013 to 6 Nov 2013Nov 2013
Association between clinical and socio-demographic factors and methods of detection with psychological well-being among prostate cancer survivorsPoster presentationProstateDrummond FJ, Kinnear H, O'Leary E, Gavin A, Sharp LDrummond FJIPOS (International Psycho-oncology Society) Rotterdam, Netherlands4 Nov 2013 to 8 Nov 2013Nov 2013Dr Frances Drummond
Prevalence and predictors of anxiety and worry in women after colposcopy: a longitudinal studyPoster presentationCervix uteriO'Connor M, White C, Ruttle C, Flannelly G, von Bunau G, O'Leary J, Pilkington L, Turner M, Farah N, Cleary S, Darcy T, Prendiville W, Murphy J, Sharp L15th International Psycho-Oncology Society World CongressRotterdam4 Nov 2013 to 8 Nov 2013Nov 2013PsychooncologySupplement S3363-37422https://www.ncri.ie/sites/ncri/files/presentations/IPOS-2013-OConnor1-predictorsposter.pdfDr Mairead O'Connor, Prof Linda SharpPrevalence And Predictors Of Anxiety And Worry In Women After Colposcopy: A Longitudinal Study  Background: Organised screening is effective in reducing cervical cancer incidence. Women with abnormal cytology require follow-up and many are referred for a colposcopy examination. Studies have reported raised anxiety levels prior to and during the examination. Less is known about the psychological after-effects, and the issues that concern women. This study aimed to estimate prevalence of anxiety and specific worries at 4, 8 and 12-months post-colposcopy and identify women most at risk of suffering psychological after-effects. Methods: Women referred for colposcopy following an abnormal smear result completed questionnaires 4-, 8- and 12-months following their initial colposcopy at two hospitals in Ireland. Anxiety was assessed by the Hospital Anxiety and Depression Scale (HADS). Worries about future fertility and cervical cancer were assessed by the Process Outcome Specific Measure (POSM). Prevalence of significant anxiety (HADS anxiety subscale score ≥11) and each worry was estimated at each time-point. Multiple logistic regression models were developed to identify predictors of risk of anxiety and each worry. Results: 584 women were recruited (response rate=73%, 59%, 52% at 4, 8, and 12-months). Over 12-months, prevalence of significant anxiety remained steady (21%, 23% and 20% at 4, 8 and 12-months). Worry about future fertility was the most common worry; 56% were worried at 4-months, declining to 47% at 8-months and 39% at 12-months. Cervical cancer worries fell from 36% at 4-months to 23% at 12-months. In multivariate models, being younger and having ever had depression, a lower satisfaction with life/healthcare, no private health insurance, and less social support were significantly associated with increased risks of anxiety and worries post-colposcopy.   Conclusion: High proportions of women attending colposcopy report anxiety or worries afterwards. While worries declined over time, the proportions affected remain high at 12-months.Various socio-demographic and other factors are associated with an increased risk of psychological distress post-colposcopy. Research implications: This study highlights that colposcopy and related procedures can place a significant psychological burden on women. Research into appropriate interventions that target ‘vulnerable’ women and reduce this burden is urgently required. Research is also needed into whether this burden impacts on compliance with follow-up or future cervical screening intentions. Clinical implications: Clinicians and other medical professionals involved in the follow-up of women with abnormal cytology should be aware of the psychological after-effects experienced by women following colposcopy and related procedures. They also need to be aware that certain groups of women are at higher risk of suffering adverse psychological after-effects and may benefit from support.Acknowledgement of funding: This research was funded by the Health Research Board, Ireland.
Strong but not so silent. Experiences of providing a freephone number with a postal survey of prostate cancer survivors.Poster presentationProstateDrummond FJ, Kinnear H, Craven-Lynn A, Gavin A, Sharp LNational Cancer Research InstituteLiverpool, UK3 Nov 2013 to 6 Nov 2013Nov 2013
Predictors of psychological well-being among prostate cancer survivors (pp. 3-99)Poster presentationProstateDrummond FJ, Kinnear K, O'Leary E, Gavin A, Sharp LDrummond FJIPOS (International Psycho-oncology Society) Rotterdam, Netherlands8 Nov 2013Nov 2013https://ipos.conference-services.net/reports/template/onetextabstract.xml?xsl=template/onetextabstract.xsl&conferenceID=3628&abstractID=760788Dr Frances DrummondBackgroundRising incidence and survival means prostate cancer (PCa) is the most prevalent cancer in men in developed countries.  In contrast to 20 years ago, many men with PCa are asymptomatic, diagnosed in primary care through ‘screening' prostate specific antigen tests.   The growing burden and changing routes to diagnosis makes it important to understand how PCa impacts on survivors' wellbeing.  However, information on long-term psychological wellbeing is lacking.  We investigated predictors of psychological well-being among PCa survivors.MethodA postal questionnaire was developed and administered in 2012 to 6,937 PCa (ICD10 C61) survivors 1.5-15 years post-diagnosis, identified through population-based cancer registries in the Republic of Ireland (RoI) and Northern Ireland (NI). Based on self-reported data, "screen-detected" men were defined as those who were asymptomatic and diagnosed via PSA testing, "symptomatic" men had urinary symptoms at diagnosis.  Psychological well-being was assessed using the Depression Anxiety Stress Scales-21.  Logistic regression was used to identify associations between method of diagnosis, clinical and socio-demographic factors and depression, anxiety and stress of any severity.  This preliminary analysis includes the first 1,402 respondents.ResultsResponse was 58%.  Depression, anxiety and stress (any severity) were present in 19%, 14%, 25% of survivors, respectively. 56% were screen-detected.  Method of detection was associated with increased risk of negative emotional states in univariate analyses.  In adjusted analysis, depression risk was increased in unmarried men (OR=1.85,95%CI 1.16-2.96) and those with co-morbidities (OR=1.57,95%CI 1.07-2.29); and reduced in survivors without current incontinence (OR=0.56,95%CI 0.33-0.97) or fatigue (OR=0.58,95%CI 0.36-0.91).  Men undergoing watchful waiting/active surveillance had 5-times higher risk of depression than men treated in other ways (OR=5.01,95%CI 2.32-11.21). Risk did not vary by time-since-diagnosis.  Similar associations were found for anxiety and stress. ConclusionsPrevalence of anxiety and depression was high among PCa survivors.  Although method of detection was not associated with psychological wellbeing, risks of depression, anxiety and stress were increased in men with particular persistent treatment after-effects i.e. incontinence and fatigue, and in men who were being managed by watchful waiting/active surveillance.Research ImplicationsThis study shows evidence of poor psychological health in groups of PCa survivors.  Given that men are living longer with PCa, further research into factors affecting the psychological well-being of long-term PCa survivors is warranted, and development of interventions to support survivors' psychological wellbeing should be developed and rigorously evaluated before implementation.Clinical ImplicationsHealthcare professionals need to be aware of the prevalence of negative emotional states in PSA survivors.  These findings suggest that screening for depression, anxiety and stress should form part of routine follow-up of PCa survivors. Acknowledgement of FundingThis work was funded by the Health Research Board Ireland and the Prostate Cancer Charity UK.
PSA testing in Ireland 2008-2010: a laboratory surveyInvited oral presentationProstateDrummond FJDrummond FJIEQAS Annual Participants' Conference 2013Dublin3 Oct 2013Oct 2013Dr Frances Drummond
Prostate cancer patients' perspectives on quality-of-care: their care experiences, health-related quality-of-life and psychological well-beingPoster presentationProstateHennessy M, O'Leary E, Comber H, Drummond FJ, Sharp LComber H35th International Agency for Research on Cancer Registrations ConferenceBuenos Aires22 Oct 2013 to 24 Oct 2013Oct 2013https://www.ncri.ie/sites/ncri/files/presentations/IACR-2013-Hennessy.pdfMs Marita Hennessy, Mr Eamonn O'Leary, Dr Harry Comber, Dr Frances Drummond, Prof Linda SharpCancer patients' experiences of care are increasingly recognised as an important measure of quality-of-care. The extent to which these experiences impact on patient-reported outcomes, such as health-related quality-of-life (HRQoL), is not well understood. Cancer registries provide a high quality, population-based, sampling frame for studies of patient experiences of care; such studies provide important evidence regarding quality-of-care from the patient's perspective. In this study, care experiences were associated with HRQoL and psychological well-being. These findings, which will be further investigated, provide further rationale for initiatives to improve quality-of-care.
Results from the PiCTure studyInvited oral presentationProstateDrummond FJ,Drummond FJIrish Association of Urology NursesDublin, Ireland11 Oct 2013 to 12 Oct 2013Oct 2013
Cancer risk perception and potential cancer hazard in two Irish communitiesPoster presentationAll invasiveComber H, O'Connor AComber H35th International Agency for Research on Cancer Registrations ConferenceBuenos Aires22 Oct 2013 to 24 Oct 2013Oct 2013https://www.ncri.ie/sites/ncri/files/presentations/IARC-2013-Comber.pdfDr Harry Comber
Breast cancer among young women: clinical characteristics and treatment trends in a population based studyPoster presentationBreastde Camargo Cancela M, Comber H, Sharp L 35th International Association of Cancer Registries ConferenceBuenos Aires22 Oct 2013 to 24 Oct 2013Oct 2013https://www.ncri.ie/sites/ncri/files/presentations/IARC-2013-deCamargoCancela2.pdfDr Harry Comber, Prof Linda Sharp
Surgeon and hospital caseload increase the risk of reoperation after breast-conserving surgery: a population-based studyPoster presentationBreastde Camargo Cancela M, Comber H, Sharp L35th International Association of Cancer RegistriesBuenos Aires22 Oct 2013 to 24 Oct 2013Oct 2013https://www.ncri.ie/sites/ncri/files/presentations/IARC-2013-deCamargoCancela1.pdfDr Harry Comber, Prof Linda Sharp
Men’s experiences of prostate cancer care in Ireland: Insights from the pre-testing of a national surveyPoster presentationProstateHennessy M, Comber H, Drummond FJ, Sharp LSharp LIrish Cancer Society Survivorship Research DayDublin19 Sep 2013Sep 2013http://www.cancer.ie/about-us/events/survivorship-research-dayMs Marita Hennessy, Dr Harry Comber, Dr Frances Drummond, Prof Linda Sharp
Associations between method of detection, clinical and socio-demographic factors and psychological well-being among prostate cancer survivorsOral presentationProstateDrummond FJ, Kinnear K, O'Leary E, Gavin A, Sharp LIrish Society of Urology Annual MeetingWicklow, Ireland20 Sep 2013 to 21 Sep 2013Sep 2013Journal of Clinical Urology5337-3456http://uro.sagepub.com/content/6/5.tocDr Frances Drummond, Mr Eamonn O'Leary, Prof Linda SharpAssociations between method of detection, clinical and socio-demographic factors and psychological wellbeing among prostate cancer survivorsIntroduction: Rising incidence and survival mean that more men are living longer with prostate cancer (PCa). This makes it important to understand how PCa impacts on survivors’ wellbeing. Information on long-term psychological wellbeing is lacking.Methods: A postal questionnaire was administered in 2012 to 6,937 PCa (ICD10 C61) survivors 1.5-15 years post-diagnosis, identified through population-based cancer registries in the Republic of Ireland (RoI) and Northern Ireland (NI). Men were “screen-detected” if asymptomatic, diagnosed via PSA testing and “symptomatic” if they reported symptoms at diagnosis. Psychological well-being was assessed using DASS-21. Associations between method of diagnosis, clinical and socio-demographic factors and depression, anxiety and stress were investigated using logistic regression. This preliminary analysis includes 1,402 respondents. Results: Questionnaire response was 58%. 56% of respondents were screen-detected, 44% were symptomatic. Depression, anxiety and stress were present in: 19%, 14%, 25%, respectively. In adjusted analysis, risk of depression was increased in those who were unmarried (1.80 95%CI 1.13, 2.87) and had co-morbidities (1.57 95%CI 1.07, 2.28); and halved in survivors without current incontinence (0.57 95%CI 0.37, 0.87) or fatigue (0.58 95%CI 0.38, 0.90). Similar associations were found for anxiety and stress, however, men treated with radiotherapy had increased risk of stress (OR 1.80 95%CI 1.26, 2.57) than those not treated with radiotherapy.Conclusion: Prevalence of stress and depression were high among PCa survivors. Method of diagnosis was not associated adverse psychological outcomes. However, men with persistent incontinence and fatigue had significantly increased risk of depression, anxiety and stress. If confirmed, these findings provide a rationale for initiatives to improve the psychological wellbeing of PCa survivors.
Cancer data and resources for researchInvited oral presentationAll invasiveSharp LSharp LEconomics of Cancer Research Group SymposiumNUI Galway, Ireland2 Sep 2013Sep 2013Prof Linda Sharp
An all-Ireland population-based study of past and current physical and psychological side-effects following prostate cancer treatmentsOral presentationProstateDrummond FJ, Kinnear H, Sharp L, Gavin AIrish Society of Urology Annual MeetingWicklow, Ireland20 Sep 2013 to 21 Sep 2013Sep 2013Journal of Clinical Urology5337-3456http://uro.sagepub.com/content/6/5.tocDr Frances Drummond, Prof Linda SharpAn all-Ireland population-based study of past and current physical and psychological side-effects following prostate cancer treatmentsIntroduction: In Ireland, prostate cancer (Pca) is the most common male cancer. Recommendations that men should be involved in treatment decisions requires accurate treatment side-effects information. Population-based side-effects data are 1-15 years ago, identified through cancer registries Northern Ireland (NI) and Republic of Ireland (RoI), received a postal questionnaire during 2012.Results: Full results will be presented, results from preliminary analysis of 1,402 respondents: 55% responded (average age was 71-range 20-94 years in RoI, 72-range 39-92 years in NI). Differences in treatment modalities were observed; prostatectomy (RP) was more common in RoI, while hormone (HT) and radiotherapy were more common in NI. Pre-treatment urinary symtpoms were common; 17% reported impotence and 36% reported urinary incontinence. Post-treatment side-effects were also common; 30% of RP patients, 14% of both radiotherapy and HT patients reported ongoing urinary incontinence. Impotence quadrupled post-treatment to 63%, two-thirds reported loss of sexual desire and 20% reported ongoing bowel problems. 24% reported depression post-treatment, increasing from 1-in-20 beforehand. Sweats/hot flashes and changes in breast tissue were more common with HT. Men who reported current incontinence and those treated by RP and/or active surveillance/watchful waiting reported higher levels of regret.Conclusion: This study quantifies, for the first time, a population-based picture of Pca-treatment side-effects which will be valuable for guiding men’s future decision-making, for informing the current screening debate and to identify groups which require additional support post-treatment.
The cost of lost productivity due to premature cancer-related mortality: an alternative measure of the cancer burden Oral presentationAll invasiveHanly P, Sharp LSharp LCancer Outcomes Conference 2013Brighton, UK12 Jun 2013 to 14 Jun 2013Jun 2013Prof Linda Sharp, Dr Paul Hanly
Health related quality of life in prostate cancer survivors decreased with time since diagnosis.Oral presentationProstateDrummond FJ, Kinnear K, O'Leary E, O'Brien K, Gavin A, Sharp LDrummond FJNCIN Cancer Outcomes ConferenceBrighton, UK12 Jun 2013 to 14 Jun 2013Jun 2013
Actual and predicted treatment-related side-effects predict low health related quality-of-life in prostate cancer survivors PiCTure studyOral presentationProstateDrummond FJ, Kinnear K, O'Leary E, O'Brien K, Gavin A, Sharp LMASCC/ISOO International Symposium on Supportive Care in CancerBerlin27 Jun 2013 to 29 Jun 2013Jun 2013Support Care CancerSupplement 1S2-30121http://link.springer.com/journal/520/21/1/suppl/page/1Dr Frances Drummond, Mr Eamonn O'Leary, Dr Katie O'Brien, Prof Linda SharpActual and expected treatment-related side-effects predict low health related quality-of-life in prostate cancer survivorsIntroduction: Prostate cancer (PCa) treatments may be associated with side-effects. The impact of these on health-related quality-of-life (HRQoL) longer term is poorly understood.Objectives: To investigate associations between treatment-related side-effects and HRQoL in a population-based sample of long-term PCa survivors. Methods: 6,937 PCa (ICD10 C61) survivors, 1.5-15 years post-diagnosis, identified from the National Cancer Registry Ireland and Northern Ireland Cancer Registry were invited to complete a postal questionnaire. This included questions on: socio-demographic characteristics; treatment(s) received; side-effects expected and experienced (including incontinence, impotence, bowel problems, hot flushes, fatigue); and HRQoL.  An EORTC QLQ30 global health score in the lowest quartile (<38.1) was considered low HRQoL.  Predictors of low HRQoL were investigated using multivariate logistic regression. Results: 3,802 men participated (response rate=55%). In analysis of the first 1,344 respondents, the significant socio-demographic predictors of low HRQoL were age, marital status, educational level and employment status at diagnosis. Risk of low HRQoL was: higher in men with comorbidities; varied by treatment received; and increased with time since diagnosis.  Men who currently experienced treatment-related incontinence had increased risk of low HRQoL (OR=2.90, 95%CI 1.90-4.43). Risk was also increased in men whose side-effects were worse than expected (OR=1.82, 95%CI 1.17-2.84), and reduced in those whose side-effects were not as bad as expected (OR=0.54, 95%CI 0.34-0.86).Conclusions:   Actual and expected side-effects predicted risk of low HRQoL.  If confirmed in the full dataset, these results suggest that men with PCa may benefit from realistic information pre-treatment on risk of side-effects and long-term support in managing side-effects.
Health related quality of life in prostate cancer survivors decreased with time since diagnosis.Oral presentationProstateDrummond FJ, Kinnear H, O'Leary E, O'Brien K, Gavin A, Sharp LDrummond FJNCIN Cancer Outcomes ConferenceBrighton, UK12 Jun 2013 to 14 Jun 2013Jun 2013
An all-Ireland population-based study of immediate and current physical and psychological side-effects of prostate cancer treatmentsPoster presentationProstateDrummond FJ, Kinnear K, O'Leary E, Gavin A, Sharp LMASCC/ISOO International Symposium on Supportive Care in CancerBerlin27 Jun 2013 to 29 Jun 2013Jun 2013Support Care CancerSupplement 1S2-30121http://link.springer.com/journal/520/21/1/suppl/page/1Dr Frances Drummond, Mr Eamonn O'Leary, Prof Linda Sharp
Patterns and predictors of workforce participation in cancer survivors 6 and 12-months post-diagnosis: a longitudinal studyOral presentationBreast, Colorectal, ProstateSharp L, O'Driscoll D, O'Leary E, Higney K, Bradley CSharp LMASCC/ISOO International Symposium on Supportive Care in CancerBerlin27 Jun 2013 to 29 Jun 2013Jun 2013Support Care CancerSuppl 1S1-S30121Prof Linda Sharp, Mr Damian O'Driscoll, Mr Eamonn O'Leary, Ms Kate Higney
Men talk! Our experience of using a freephone number with a postal questionnaire.Poster presentationProstateDrummond FJ, Kinnear H, Craven-Lynn A, Gavin A, Sharp LNCIN Cancer Outcomes ConferenceBrighton, UK12 Jun 2013 to 14 Jun 2013Jun 2013
Factors that influence men’s experiences of prostate cancer care: Preliminary results of a national studyPoster presentationProstateHennessy M, O’ Leary E, Comber H, Drummond FJ, Sharp LDrummond FJCancer Outcomes ConferenceBrighton12 Jun 2013 to 13 Jun 2013Jun 2013Ms Marita Hennessy, Mr Eamonn O'Leary, Dr Harry Comber, Dr Frances Drummond, Prof Linda SharpFactors that influence men’s experiences of prostate cancer care: Results of a national studyBackground: Prostate cancer is the most commonly diagnosed cancer in men in developed countries. Due to widespread PSA testing and a low threshold for referral for prostatic biopsy, the prostate cancer incidence rate in men in Ireland is estimated to be the highest in Europe. In 2006, the publication of a national strategy for cancer control laid the foundations for significant reorganisation and centralisation of cancer services in Ireland. The PiCTure 2 study aims to assess the care experiences of men diagnosed with prostate cancer since this reorganisation. The objectives are to: (1) measure overall patient experience ratings; (2) describe variations in experiences; and (3) investigate associations between experiences and health related quality-of-life and psychological wellbeing.Method: Men diagnosed with invasive prostate cancer (ICD10 C61) 5-20 months prior to study commencement were identified through the National Cancer Registry. The study questionnaire was based on the Prostate Care Questionnaire (Baker et al. 2007), modified for Ireland and pre-tested using cognitive interviewing. Health related quality-of-life and psychological wellbeing were assessed using the EQ5D-5L and DASS. The questionnaire was administered by post to 1,500 men during January-February 2013.Results: More than 800 completed questionnaires have so far been received. Men's experiences will be compared by time since diagnosis, age at diagnosis, treatments received and socio-demographic factors. Factors which contribute to positive/negative experiences will be highlighted and the extent to which these are associated with health related quality-of-life and psychological wellbeing described.Conclusion: This study provides – for the first time in Ireland - important information on men’s experiences of prostate cancer care since the reorganisation of cancer services began. The results will be of value to policy-makers, service providers, health professionals and patient support organisations. 
Factors driving inequality in prostate cancer survival: a population-based studyPoster presentationProstateBurns RM, Sharp L, Sullivan FJ, Deady S, Drummond FJ, O'Neill CNCIN Cancer Outcomes ConferenceBrighton, UK12 Jun 2013 to 14 Jun 2013Jun 2013
Associations between men’s experiences of prostate cancer care and health related quality-of-life and psychological wellbeing: findings from a national studyPoster presentationProstateHennessy M, O’ Leary E, Comber H, Drummond FJ, Sharp LHennessy MMASCC/ISOO International Symposium on Supportive Care in CancerBerlin27 Jun 2013 to 29 Jun 2013Jun 2013Support Care CancerSuppl 1S121http://link.springer.com/journal/520/21/1/suppl/page/1Ms Marita Hennessy, Mr Eamonn O'Leary, Dr Harry Comber, Dr Frances Drummond, Prof Linda SharpIntroduction: Prostate cancer is the most commonly diagnosed cancer in men in developed countries. The care experience of cancer patients has been investigated in various countries. These studies show significant variations between patients in experiences of care, with prostate cancer patients reporting significant problems and dissatisfaction. The extent to which these experiences impact on health-related quality-of-life and psychological wellbeing is not well understood. Objectives: The PiCTure 2 study aims to assess the care experiences of men recently diagnosed with prostate cancer and investigate associations between experiences and health-related quality-of-life and psychological wellbeing. Methods: Men diagnosed with invasive prostate cancer (ICD10 C61) 5-20 months prior to study commencement were identified through the National Cancer Registry. The study questionnaire was based on the Prostate Care Questionnaire (Baker et al. 2007), modified for Ireland and pre-tested using cognitive interviewing. Health-related quality-of-life and psychological wellbeing were assessed using the EQ5D-5L and DASS. The questionnaire was administered by post to >2,200 men during January-February 2013. Results: More than 950 completed questionnaires have so far been received. Men's experiences will be compared by time since diagnosis, age at diagnosis, treatments received and socio-demographic factors. Factors which contribute to positive/negative experiences will be highlighted and the extent to which these are associated with health related quality-of-life (utility) and psychological wellbeing (depression, anxiety and distress) described. Conclusions: If care experiences are associated with health-related quality-of-life and psychological wellbeing, this provides further rationale for initiatives to improve quality of care.
Men’s experiences of prostate cancer care: qualitative findings from cognitive interviewsPoster presentationProstateHennessy M, Comber H, Drummond FJ, Sharp LHennessy MMASCC/ISOO International Symposium on Supportive Care in CancerBerlin27 Jun 2013 to 29 Jun 2013Jun 2013Support Care CancerSupplement 1S2-30121http://link.springer.com/journal/520/21/1/suppl/page/1Ms Marita Hennessy, Dr Harry Comber, Dr Frances Drummond, Prof Linda SharpIntroduction: Prostate cancer is the most common cancer in men in developed countries. Incidence in Ireland is the highest in Europe. Patients’ experiences of care are an important indicator of quality of care, but remain poorly understood. Objectives: The PiCTure 2 study aims to assess the care experiences of men recently diagnosed with prostate cancer in Ireland. Methods: A questionnaire was developed from the Prostate Care Questionnaire (PCQ; Baker et al., 2007). To modify as appropriate for Ireland, it was pre-tested using cognitive interviewing. Seventeen interviews were conducted with prostate cancer patients (managed by all major treatment modalities) recruited by Urologists and/or Clinical Nurse Specialists at three hospitals during September 2012-January 2013. Men were invited to 'think-aloud' whilst completing the survey; the interviewer used prompts to understand how respondents interpreted survey questions. Interviews lasted 20-90 minutes. Interview recordings were transcribed and analysed thematically. Results: Emergent themes included: breaking the bad news; support (both informational and emotional) from doctors, nurses and spouses/partners; growth in knowledge throughout the diagnosis-treatment trajectory but a reliance on ‘experts’ at the outset and how this impacted on their ability to participate in care and decision-making; and altruism. Key revisions were made to the survey so that it will accurately capture experiences of patients in Ireland. Conclusions: As well as informing survey development, cognitive interviews provided rich qualitative data which will add to the interpretation of the survey findings. The PiCTure 2 results will be of value to policy-makers, service providers, health professionals and patient support organisations.
Setting the scene: epidemiology of head and neck cancer in IrelandInvited oral presentationHead & neckSharp LSharp LHPV and Head & Neck Cancer SymposiumNUI Galway, Ireland17 May 2013May 2013www.conference.ieProf Linda Sharp
Does the long-term effect of a prostate cancer diagnosis differ in men who were screen-detected or symptomatic at diagnosis: Results from an all-Ireland surveyOral presentationProstateDrummond FJ, Kinnear K, O'Leary E, Gavin A, Sharp LDrummond FJ10th Annual Psychology, Health and Medicine ConferenceDublin, Ireland1 May 2013May 2013
“I don’t care what it’s called, I just want to know if I have cancer.” Women’s emotional responses and information needs after having an HPV testOral presentationCervix uteriM O'Connor, L Costello, W Prendiville, J Murphy, L SharpM O'Connor10th Annual Psychology, Health & Medicine Conference 2013Dublin City University1 May 2013May 2013https://www.ncri.ie/sites/ncri/files/presentations/PHM2013presMOC_FINAL.pptxDr Mairead O'Connor, Prof Linda Sharp, Dr Judith McRaeAims: Testing for human papillomavirus (HPV) has recently being incorporated into several national cervical cancer screening programmes. Understanding the impact of HPV testing on women, and women’s information needs, is important to inform development of information materials. We used qualitative methods to explore emotional responses and factors influencing information needs among women undergoing HPV tests in routine clinical practice.Methods: In-depth semi-structured interviews were conducted with 27 women who attended a colposcopy clinic and had had an HPV test performed. Interviews were transcribed verbatim, coded and analysed using framework analysis.Results: For most women, irrespective of HPV status, having had an HPV test generated little emotional impact. Most women had concerns about their abnormal cytology results (smear test results) and these concerns overrode everything else. Their concerns surrounding their abnormal cytology also influenced their HPV information needs. A few women reported relief and reassurance after testing negative for HPV. Among the few women who did experience adverse emotional outcomes, the most common responses were shame, regret, embarrassment, anxiety, and anger. Amount of HPV-related information previously received sometimes served to increase women’s desire for further information on HPV.Conclusions: Overall, the emotional impact of HPV testing may not be as great as previous studies have suggested. Women’s primary concerns were related to their abnormal cytology results rather than HPV. Organisers of screening programmes need to strike a balance between providing information about abnormal cytology and HPV, while ensuring that individual women receive sufficient information for their (varying) needs at appropriate times.
Strong but not so silent. Experiences of providing a freephone number with a postal survey of prostate cancer survivors.Poster presentationProstateDrummond FJ, Kinnear H, O'Leary E, Gavin A, Sharp L10th Annual Psychology, Health and Medicine ConferenceDublin, Ireland1 May 2013May 2013
Women’s expected adverse emotional reactions to testing HPV positive: results from a national population survey in IrelandPoster presentationCervix uteriO'Connor M, O'Leary E, Murphy J, Martin CM, O'Leary JJ, Sharp LBritish Society for Cervical Cytology and Pathology Conference 2013Glasgow, Scotland24 Apr 2013 to 26 Apr 2013Apr 2013www.bsccp.org.ukDr Mairead O'Connor, Prof Linda SharpBackground: HPV testing is transforming cervical cancer screening. Undergoing a HPV test may provoke adverse emotional reactions for women. In a population survey, we investigated women’s expected responses to testing HPV positive.Methods: A questionnaire was mailed to 5,553 women aged 20-64 years recruited through primary care. Women were asked to imagine that they had tested positive for HPV. Outcome measures were expected worry, stigma, shame, and anxiety1. Mean scores for each outcome were compared by age, awareness of HPV, HPV knowledge score (based on 10 factual questions about HPV infection), and perceived risk of contracting a HPV infection.Results: 3,470 women participated (response rate=62%). 54% had not previously heard of HPV. Of those answering the HPV knowledge questions, 29% answered ≤ 4 correctly, 36% answered 5-6 correctly and 35% answered 7-10 correctly. The mean worry score was significantly higher in younger (<38) than older (>48) women (p<0.001). Younger women also had higher levels of shame (p<0.001), but not stigma or anxiety.Women with no prior awareness of HPV had significant higher levels of worry, stigma, shame and anxiety (all p<0.001). A low HPV knowledge score was associated with higher levels of stigma (p=0.006) and anxiety (p=0.009), but not shame or worry. Women who perceived they had a higher risk of contracting HPV than other women their own age had higher levels of shame (p=0.012), anxiety (p=0.002) and worry (p=0.003). Conclusions: Adverse emotional reactions to testing HPV positive may be more frequent in younger women, those unaware of HPV or with low HPV knowledge, and those with higher perceived infection risk. Improving women’s knowledge about the facts surrounding HPV could help minimise distress in those who test positive.1Waller J, Marlow LA, Wardle J. The association between knowledge of HPV and feelings of stigma, shame and anxiety. Sex Transm Infect. 2007;83:155-9.
Prevalence and predictors of anxiety and worries in women following colposcopy: results from a longitudinal studyOral presentationCervix uteriM O'Connor, J Murphy, C White, C Ruttle, C Martin, G Flannelly, G von Bunau, J O'Leary, L Pilkington, M Anglim, M Turner, N Farah, S Cleary, T Darcy, W Prendiville, L SharpM O'ConnorBritish Society for Cervical Cytology and Pathology Conference 2013Glasgow, Scotland24 Apr 2013 to 26 Apr 2013Apr 2013Dr Mairead O'Connor, Mr Eamonn O'Leary, Prof Linda SharpBackground: Longitudinal data on the psychological after-effects of colposcopy and related procedures is limited. We investigated women’s anxiety and worries at three time-points  following colposcopy.Methods: Questionnaires were mailed to women 4-, 8- and 12-months following an initial colposcopy at two large Dublin hospitals. Anxiety was assessed by the Hospital Anxiety and Depression Scale1 and worries about cervical cancer, future fertility and having sex by the Process Outcome Specific Measure (POSM)2. Prevalence of significant anxiety (HADS anxiety score ≥11) and each worry was estimated at each time-point and multiple logistic regression used to identify factors associated with risk of anxiety or worry.Results: 584 women were recruited (response rate=73%, 59% and 52% at 4, 8 and 12-months respectively). Prevalence of significant anxiety was steady over time (21%, 23% and 20% at 4, 8 and 12-months). The most common worry concerned future fertility; 56% were worried at 4-months, falling to 47% at 8-months and 39% at 12-months. Worries about cervical cancer fell from 36% at 4-months to 23% at 12-months. Worries about having sex were least frequent and also declined over time (from 29% at 4-months to 18% at 12-months). In adjusted models, nulliparity and age were significantly associated with worries about future fertility. Risk of cervical cancer worries was increased in women who had another abnormal smear before the one(s) which resulted in the recruitment colposcopy and who reporting ever having depression, and was reduced in women without children.  Conclusions: Significant proportions of women attending colposcopy report anxiety or worries afterwards. While worries declined over time, the proportions affected remain high at 12-months. Interventions are needed that effectively allay women’s concerns thereby helping minimise the adverse (albeit unintended) effects of cervical screening.  1Snaith RP & Zigmond AS. Acta Psychiatr Scand 1983;67:361-70. 2Gray N et al. Quality of Life Res 2005;14:1553-62.
The 'link person' - The role of cancer nurse specialists in cancer treatment decisionsOral presentationBreast, Colon, OvaryDrummond FJ, Comber H, Sharp LDrummond FJ32nd Annual International Nursing and Midwifery Research & Education Conference Nursing in Times of AusterityRoyal College of Surgeons in Ireland, Dublin20 Feb 2013 to 21 Feb 2013Feb 2013Dr Frances Drummond, Prof Linda Sharp, Dr Harry ComberTitle: The 'link person' - The role of Cancer Nurse Specialist in cancer treatment decisionsBackground: The Cancer Nurse Specialist (CNS) role is relatively new in Ireland.  The impact of the CNS on cancer treatment decisions has not been been investigated widely.Aim and objectives: The TReat study investigated factors influencing cancer treatment decision making  (TDM) from the perspectives of healthcare professionals (HCP) and patients. This analysis focuses on elucidating the role of the Cancer Nurse Specialist (CNS) in TDM.Methods: In depth qualitative interviews were conducted with 29 CNSs, 15 consultants and 35 cancer patients from 29 hospitals nationwide.  Interviews were transcribed verbatim and content analysis was used to identify main themes.Analysis and results: CNSs attend the treatment discussions between the consultant and patient.  From this point they considered that they play several key roles in TDM; 1) education (providing information about disease, treatment, side effects), 2) emotional support, 3) they empower and guide patients in making decisions, 4) assess fitness (in physical and social terms) for commencement and maintenance of treatment, 5) actively participate in  multidisciplinary teams, 6) facilitate cancer treatment, thus increasing the treatment options available (organise transport, accomodation and funding if necessary) and 7) they are always available to patients and families.  There was good agreement between the roles identified by CNSs themselves and those identified by consultants and patients. However, CNSs identified a number of limitations to fulfilling their role, including time restraints and a lack of emotional support for them. Some patients reported that they did not have sufficent time with the CNS.     Recommendations: The CNS role has improved cancer TDM.  However, the limitations identified should be addressed in order to continue to sustain this improvement.
Insights into the care experiences of men with prostate cancer in IrelandOral presentationProstateHennessy M, Comber H, Drummond FJ, Sharp LHennessy MRCSI Faculty of Nursing and Midwifery 32nd International Nursing Research ConferenceDublin20 Feb 2013 to 21 Feb 2013Feb 2013http://www.rcsi.ie/files/facultyofnursingmidwifery/20130725040938_Book%20of%20Abstracts%202013.pdfMs Marita Hennessy, Dr Harry Comber, Dr Frances Drummond, Prof Linda Sharp
Preliminary insights into men’s experiences of prostate cancer careInvited oral presentationProstateHennessy M, Comber H, Drummond FJ, Sharp LHennessy MUro-oncology Nurse MeetingDublin16 Nov 2012Nov 2012Ms Marita Hennessy, Dr Harry Comber, Dr Frances Drummond, Prof Linda Sharp
Post-treatment support needs of survivors of head & neck cancer - views and experiences of survivors and health professionalsOral presentationHead & neckTimmons A, Gooberman-Hill R, O'Sullivan E, Butow P, Sharp L Timmons A8th International Conference: Quality of Life in Head & Neck CancerLiverpool8 Nov 2012 to 9 Nov 2012Nov 2012Dr Aileen Timmons, Prof Linda Sharp
Patterns and predictors of short- and long-term health-related quality-of-life in men with prostate cancer: preliminary analysis from a population-based studyOral presentationProstateDrummond FJ, Kinnear H, O'Brien K, Gavin A, Sharp LDrummond FJEuropean Quality of Life EORTCBrussels, Belgium17 Oct 2012 to 19 Oct 2012Oct 2012
A profile of ovarian cancer incidence and treatment in Ireland, 1994-2010Poster presentationOvaryDeady S, Comber HDeady S34th International Association of Cancer Registries Conference Cork, Ireland17 Sep 2012 to 19 Sep 2012Sep 2012Dr Sandra Deady, Dr Harry Comber
Estimating completeness of case ascertainment in cancer registration: comparison of different approachesPoster presentationAll invasiveO'Brien K, Comber H, Sharp LO'Brien K34th International Association of Cancer Registries Conference Cork, Ireland17 Sep 2012 to 19 Sep 2012Sep 2012Dr Katie O'Brien, Dr Harry Comber, Prof Linda Sharp
Factors associated with never having had a cervical smear: findings from a national population surveyPoster presentationCervix uteriO'Connor M, O'Leary E, Murphy J, Sharp L34th International Association of Cancer Registries Annual MeetingCork17 Sep 2012Sep 2012https://www.ncri.ie/sites/ncri/files/presentations/IACR-2012-O%27Connor.pdfDr Mairead O'Connor, Mr Eamonn O'Leary, Prof Linda Sharp
Post-treatment supportive care needs of head and neck cancer survivors: unmet needs, gaps in services and barriers to accessPoster presentationHead & neckTimmons A, Gooberman-Hill R, O'Sullivan E, Butow P, Sharp L Timmons A34th International Association of Cancer Registries Conference Cork, Ireland17 Sep 2012 to 19 Sep 2012Sep 2012Dr Aileen Timmons, Prof Linda Sharp
Is cancer survival affected by smoking status at diagnosis? A population-based studyPoster presentationAll invasiveMcDevitt J, Carsin AE, Sharp LMcDevitt J34th International Association of Cancer Registries Conference Cork, Ireland17 Sep 2012 to 19 Sep 2012Sep 2012Dr Joe McDevitt, Prof Linda Sharp, Ms Anne-Elie CarsinIS CANCER SURVIVAL AFFECTED BY SMOKING STATUS AT DIAGNOSIS?A POPULATION-BASED STUDYBackground: A few small studies suggest that smoking may be associated with poorer outcomes in cancer patients.  In a large, population-based study, we investigated whether smoking status at diagnosis affected survival in people diagnosed with: cancers of the breast, prostate, colorectum, lung, stomach, bladder, ovary, and head and neck (H&N), non-Hodgkin lymphoma (NHL) and melanoma.Methods: We abstracted cancers diagnosed 1994-2008 from the National Cancer Registry Ireland. Follow-up was until 31/12/2009. Cox proportional hazards models were used to compare risk of cancer-specific death in current or ex-smokers versus non-smokers, adjusting for other prognostic factors (including age, stage, and deprivation category).Results: 81,102 cases were included in the analysis. Current smokers were at increased risk of dying from cancer, for all sites, with the exception of stomach and bladder: (adjusted HR[95%CI] prostate=1.32[1.21,1.43]; colorectal=1.14[1.08,1.20]; breast=1.13[1.05,1.21]; lung=1.11[1.04,1.17]; H&N=1.24[1.08,1.42]; NHL=1.22[1.08,1.37], and melanoma=1.31[1.06,1.61].Conclusions: Smoking at diagnosis increased the risk of dying from several cancers. Smoking status misclassification was likely, with some smokers probably recorded as non-smokers; thus the true effects of smoking may have been underestimated. These results could be explained by the effects of smoking on immune competence, inflammatory response, genetic damage, or metabolism of chemotherapy drugs.
Associations between population density and cancer risk Oral presentationAll invasiveSharp L, Donnelly D, Hegarty A, Carsin AE, Deady S, McCluskey N, Gavin A, Comber HSharp L34th International Association of Cancer Registries Conference Cork, Ireland17 Sep 2012 to 19 Sep 2012Sep 2012Prof Linda Sharp, Dr Sandra Deady, Dr Harry Comber
Who dies from melanoma? A population-based study of Irish patientsPoster presentationMelanoma of skinWalsh PM, Deady S, Bennett M, Murphy MWalsh PM34th International Association of Cancer Registries Conference Cork, Ireland17 Sep 2012 to 19 Sep 2012Sep 2012Dr Paul Walsh, Dr Sandra DeadyWho dies from melanoma? A population-based study of Irish patients.Background: Incidence of melanoma of the skin tends to be higher among patients from more affluent backgrounds, but survival from melanoma also tends to be higher in that group (and among women). Other demographic or geographic differences might also be expected.Objectives: To assess disparities in cause-specific survival for melanoma patients diagnosed in Ireland during 1994-2008.Methods: Descriptive statistics on incidence, stage and survival are presented, and survival variations are assessed by Cox modelling.Results: Invasive melanoma incidence was c40% lower in the most deprived compared with the least deprived population stratum. In situ melanomas were less frequent proportionately in the most deprived compared to the least deprived group (29% v 32%), likewise stage I melanomas (42% v 47% of invasive cases). Five-year survival from invasive melanoma averaged 81% for the most deprived compared with 86% for the least deprived group overall (age-/sex-adjusted hazard ratio 1.33, 95% CI 1.11-1.58); in men, 71% v 79% (HR 1.47, CI 1.16-1.84); in women, 88% v 90% (HR 1.17, CI 0.89-1.52). Deprivation-related disparities in survival appeared to improve over the study period, and appeared less marked for women. Significant disparities remained for the most deprived group after adjustment for stage, overall (HR 1.22, CI 1.01-1.45) and in men (HR 1.35, 1.06-1.72).Conclusions: Unexplained disparities seen in this analysis suggest the possible involvement of other prognostic, lifestyle or treatment-related factors, not all of which may be available in routine cancer registry data.
Long term physical and psychological side effects of prostate cancer treatments: a population-based studyPoster presentationProstateKinnear H, Drummond FJ, Sharp L, Gavin AInternational Agency for Research on Cancer (IARC)Cork, Ireland16 Sep 2012 to 19 Sep 2012Sep 2012
Association between screening status and tumour subtypes in breast cancers diagnosed in women in the screening age-rangeOral presentationBreastO'Brien K, Sharp L, Kelleher T, Comber HO'Brien K34th International Association of Cancer Registries Conference Cork, Ireland17 Sep 2012 to 19 Sep 2012Sep 2012Dr Katie O'Brien, Prof Linda Sharp, Dr Harry Comber
Long term health related quality of life in men with prostate cancer: a population-based studyPoster presentationProstateDrummond FJ, Kinnear H, O'Brien K, Gavin A, O'Neill, Sharp LInternational Agency for Research on Cancer (IARC)Cork, Ireland16 Sep 2012 to 19 Sep 2012Sep 2012
PiCTure 2: Men’s experiences of prostate cancer care in IrelandInvited oral presentationProstateHennessy M, Comber H, Drummond FJ, Sharp LHennessy MNational Cancer Control Programme Prostate Leads MeetingDublin6 Sep 2012Sep 2012Ms Marita Hennessy, Dr Harry Comber, Dr Frances Drummond, Prof Linda Sharp
Patterns and predictors of long-term health-related quality-of--life in men with prostate cancer: preliminary results from the PiCTure studyOral presentationProstateDrummond FJ, Kinnear H, O'Brien K, Gavin A, O'Neill, Sharp LDrummond FJIrish Society of Urology Annual MeetingBelfast, Northern Ireland20 Sep 2012 to 21 Sep 2012Sep 2012
"HPV is the nicer name for genital warts": beliefs, misconceptions, unanswered questions and factors influencing information needs among women who have a HPV test within routine follow-upOral presentationCervix uteriSharp L, O'Connor M, Costello L, Murphy J, Prendiville WSharp LUICC World Congress on Cancer, 2012Montreal, Canada28 Aug 2012Aug 2012Prof Linda Sharp, Dr Mairead O'Connor, Ms Lisa CostelloBackground: The causal relationship between certain strains of human papillomavirus (HPV) and cervical cancer is transforming prevention. Several screening programmes are implementing HPV testing as part of routine follow-up of women with abnormal cytology tests or who have been treated for cervical intra-epithelial neoplasia (CIN). Although it is important to understand women’s views of HPV testing, and their information needs, most previous research has included women asked to hypothetically think about having an HPV test or women tested within clinical research studies. Objectives: In women who had undergone testing for HPV infection in routine clinical practice, we: (1) explored beliefs and misconceptions about HPV; (2) identified common unanswered questions; and (3) identified factors influencing information needs.Methods: In-depth interviews were conducted with 27 women who had HPV tests performed in a colposcopy clinic for triage following low-grade cytology tests or post-treatment surveillance. Interviews were transcribed verbatim, coded and analysed using a framework approach to identify main themes.Results: Three main themes emerged relating to HPV beliefs and misconceptions. Some women believed the HPV test had been for genital warts; some believed that HPV infection is related to skin conditions such as warts or blisters; and for some the virus name triggered associations with sexually transmitted diseases. Women had more misconceptions if: they were unaware of links between HPV, cell changes and cervical cancer; or the information they had received had focused primarily on their cell changes. Women had many unanswered questions about HPV. These fell into five groups: symptoms; transmission & nature of the infection; prevention & treatment; consequences of infection; and the HPV test itself. Women who had more knowledge about HPV had more unanswered questions. Factors that impacted on women’s HPV information needs included: concerns surrounding abnormal cytology or diagnosis of CIN (which, for most, took precedence over HPV); awareness that HPV is sexually transmitted (which, for most, increased information needs); and amount of information already received about HPV, cell changes and/or treatment. For some women, having received more information about HPV increased their desire for further information.Conclusion: This study reveals significant misconceptions, unanswered questions and unmet needs for information among women who have had a HPV test as part of routine follow-up. The results suggest that a “one size fits all” approach to HPV information provision is unlikely to be acceptable or effective. The challenge for screening programmes is to find a balance between providing women with clear, understandable, and sufficient information for their (varying) needs at appropriate stages during follow-up while avoiding information overload.
Factors predicting hospital length-of-stay after radical prostatectomy in Ireland: a population-based studyOral presentationProstateKelly M, Sharp L, Dwane F, Kelleher T, Comber HKelly MCancer Outcomes Conference 2012Birmingham, UK14 Jun 2012 to 15 Jun 2012Jun 2012Ms Maria Kelly, Prof Linda Sharp, Ms Fiona Dwane, Ms Tracy Kelleher, Dr Harry ComberFactors predicting hospital length-of-stay after radical prostatectomy in Ireland: a population-based study.Background: Radical prostatectomy (RP) is a leading treatment option for localised prostate cancer. Although hospital in-patient stays accounts for much of the costs of treatment, little is known about population-level trends in length-of-stay (LOS). We investigated factors predicting hospital LOS and readmissions in men who had RP following prostate cancer.Methods: Incident prostate cancers (ICD-O3: C61), diagnosed January 2002-December 2008 in men < 70 years, were identified from the Irish Cancer Registry, and linked to public hospital episodes. For those who had RP (ICD-9 CM procedure codes 60.3, 60.4, 60.5, 60.62) the associated hospital episode was identified. LOS was calculated as the number of days from date of admission to date of discharge. Patient-, tumour-, and health service-related factors predicting longer LOS (upper quartile, >9 days) were investigated using logistic regression. Patterns in day-case and in-patient readmissions within 28 days of discharge following RP were explored.Results: Over the study period 9096 prostate cancers were diagnosed in men under 70, 26.5% of whom had RP by end of follow-up 31/12/2009. Two of eight public hospitals and eight of forty surgeons carried out 50% of all public-service RPs. Median LOS was 8 days (10th-90th percentile = 6-13 days) and fell significantly over time (2002, 9 days; 2008, 7 days; p < 0.001). In adjusted analyses men who were not married (OR = 1.71, 95% CI 1.25-2.34), had co-morbidities (OR = 1.64, 95% CI 1.25-2.16) or stage III-IV cancer (OR = 2.19, 95% CI 1.44-3.34) were significantly more likely to have prolonged LOS. Those treated in higher volume hospitals (annual median >49 RPs) or by higher volume surgeons (annual median >17 RPs) were significantly less likely to have prolonged LOS (OR = 0.34, 95% CI 0.26-0.45; OR = 0.55, 95% CI 0.42-0.71 respectively). 55% of patients were readmitted within 28 days of discharge mainly for catheter removal. 6% of readmissions were emergencies.Conclusion: Median LOS after RP decreased between 2002 and 2008 in Ireland but it remains higher than in both England and the US. Although volumes of RPs conducted in Ireland are low, there is considerable variation between hospitals and surgeons. Hospital and surgeon volume were strong predictors of shorter LOS, after adjusting for other variables. These factors point to a need for a comprehensive review of prostate cancer service provision.
What do women who have never had a smear test think? Women's attitudes and beliefs and other factors associated with never having had a smearOral presentationCervix uteriO'Connor M, O'Leary E, Murphy J, Sharp LSharp LBritish Society for Cervical Cytology and Pathology Conference 2012Gateshead, UK18 Apr 2012 to 20 Apr 2012Apr 2012www.bsccp.org.ukDr Mairead O'Connor, Prof Linda Sharp, Mr Eamonn O'Leary
Post-treatment supportive care needs in head & neck cancer - what about the caregivers?Oral presentationHead & neckTimmons A, Gooberman-Hill R, O'Sullivan E, Butow P, Sharp L Timmons A8th International Conference: Quality of Life in Head & Neck CancerLiverpool8 Feb 2012 to 9 Feb 2012Feb 2012Dr Aileen Timmons, Prof Linda Sharp
The psychological cost of screening women in Ireland for cervical cancerInvited oral presentationCervix uteriO'Connor M, Murphy J, Sharp LO'Connor MUCC Seminar, Department of Epidemiology and Publc health, UCC, Cork24 Nov 2011Nov 2011Dr Mairead O'Connor, Dr Judith McRae, Prof Linda Sharp
Does age effect cancer treatment decisions? A qualitative study among healthcare professionalsOral presentationBreast, Colorectal, OvaryDrummond FJ, Costello L, Comber H, Sharp LDrummond FJ3rd Population Cancer ConferenceDublin, Ireland17 Nov 2011Nov 2011
Age as a factor in cancer treatment decisions - a qualitative study among healthcare professionalsOral presentationBreast, Colorectal, OvaryDrummond FJ, Costello L, Comber H, Sharp LDrummond FJAgeing globally - ageing locallyCroke Park, Dublin, Ireland2 Nov 2011 to 3 Nov 2011Nov 2011
Women’s experience and views of HPV testing: a qualitative study of the impact of HPV testing on women Invited oral presentationCervix uteriO’Connor M, Costello L, Murphy J, Prendiville W, Sharp LO'Connor MNurses in Colposcopy Clinics Ireland Association Annual Conference 2011Wexford General Hospital21 Oct 2011Oct 2011Dr Mairead O'Connor, Ms Lisa Costello, Dr Judith McRae, Prof Linda Sharp
Psychological after-effects of colposcopy: prevalence of worries, anxiety and depression at 4 monthsOral presentationCervix uteriM O'Connor, J Murphy, C White, C Ruttle, C Martin, G Flannelly, G von Bunau, J O'Leary, L Pilkington, M Anglim, M Turner, N Farah, S Cleary, T Darcy, W Prendiville, L SharpM O'ConnorJoint BSCC-NAC ASMKeele, UK13 Jul 2011 to 16 Jul 2011Aug 2011Cytopathology4i-xvi22https://www.ncri.ie/sites/ncri/files/presentations/BSCCpresentation%20MOC_FINAL.pptxDr Mairead O'Connor, Mr Eamonn O'Leary, Prof Linda SharpIntroduction: It is widely known that colposcopy can be a distressing experience for women. Various studies have reported raised anxiety levels both prior to and during the examination. Considerably less is known about the psychological after-effects of colposcopy and associated procedures. We assessed worries, anxiety and depression in women following colposcopy.Methods: Questionnaires were mailed to women, who had completed their initial colpscopic management at two large Dublin hospitals; they were dispatched 4 months post-colposcopy. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS; significantly anxiety, HADS subscale score ≥11; significant depression, HADS subscale score =>8). Questions on worries about general health, cervical cancer, ability to have children in the future and having sex were also incorporated from the Process Outcome Specific Measure (POSM). Recruitment for the study is ongoing and these results relate to the first 149 respondents.       Results: Just under one-third of respondents had completed third level education. 36% were aged 22-30. Almost 40% reported that they currently smoked. 25% had previously had another colposcopy. Over half (54%) had concerns about their general health, 54% were worried about their future fertility and 43% had fears about having cervical cancer. 25% said that they were worried about having sex. The prevalence of significant anxiety and depression was 24% and 12%, respectively. Prevalence of worries, anxiety and depression did not vary by women’s socio-demographic characteristics or by whether they had previously had another colposcopy. Women with anxiety were more likely to be concerned about their general health, having sex and worry that they had cervical cancer.Conclusions: High proportions of women report significant anxiety and depression following colposcopy. These results also reveal some of the specific issues which concern women. . Interventations that focus on women’s concerns over having sex, their general health and future fertility and address fears about cancer may help reduce the adverse psychological impact of.colposcopy.Take home message(s): Better understanding of the after-effects of colposcopy is needed to underpin the development of interventions to help minimize the adverse psychological impact of cervical screening on women.
Factors affecting ovarian cancer treatment decisions - a qualitative study among cancer nurse specialistsOral presentationOvaryDrummond FJ, Costello L, Comber H, Sharp LDrummond FJ11th Annual Interdisciplinary Research Conference "Transforming healthcare through research & education"TCD, Dublin, Ireland4 Nov 2010 to 5 Nov 2010Nov 2010