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Ontario cancer patients’ monthly out-of-pocket costs (OOPC) were assessed to determine whether these costs were problematic. A self-administered questionnaire was administered to breast ( n = 74), colorectal ( n = 70), lung ( n = 68) and prostate ( n = 70) cancer patients between October 2001 and April 2003. It measured categorical OOPC, which were analysed using linear regression modelling, to determine whether any of a variety of independent variables influenced OOPC. Monthly OOPC (mean, range) were: parking/fares ($47, $0–450), devices ($46, $0–2350), prescription drugs ($45, $0–1400), accommodation ($43, $0–1500), complementary and alternative medicine ($29, $0–5000), vitamins ($25, $0–400), homemaking ($14, $0–1000), family care ($12, $0–1200), homecare ($2, $0–330) and other ($8, $0–250), with the total averaging $213 ($0–5230). Imputed travel mileage costs added $372 ($0–6180). Most patients were well served by the current healthcare programmes. In multivariate analysis, variables influencing several OOPC categories were: tumour site, hospitalization, age, and number of clinic trips. Travel costs proved the most problematic, with patients under 65 years and without insurance more likely to have high OOPC. Education and income were not reliable predictors for high OOPC. Many of these costs were for items not traditionally covered by public healthcare financing systems, raising important issues around defining ‘medically necessary’ care and the role of government. [ABSTRACT FROM AUTHOR]

Background: Lung cancer patients who continue to smoke after diagnosis are at increased risk of treatment toxicity, residual/recurrent disease, future malignancies, and all-cause mortality. Guidelines including those from National Comprehensive Cancer Network and Cancer Care Ontario advocate for screening, counseling, and access to smoking cessation services for all cancer patients; however, barriers from both patient and health care professional (HCP) perspectives contribute to lack of implementation., Objective: The objective of this study was to identify the different perspectives among patients and HCPs in how the promotion of person-centred approaches may be used when offering smoking cessation services to patients who are receiving care within a regional cancer centre., Methods: Qualitative data were generated using various methods, including focus groups with HCPs and interviews with patients. In total, 16 HCPs participated in three focus groups: including nine radiation therapists, five registered nurses, one registered dietitian, and one physiotherapist. Of 55 patients accrued, 19 were interviewed. Both focus groups and interviews were audio recorded, and the recordings were transcribed verbatim. Transcripts were then analyzed using narrative thematic analysis to define and identify themes., Results: The identified themes were categorized into three topic areas: knowledge (eg, impact of smoking on illness and why they should not smoke); individual decision to quit (eg, motivators), and the social unacceptability of smoking (eg, the public perception of smoking over the last 40 years). HCP-identified themes included identification of smokers, triggers to start a conversation, approach, gaps and barriers to cessation, rationale for cessation, and judgment. Patient-identified themes included knowledge, individual decision to quit, and the social unacceptability of smoking., Conclusion: Understanding patient and HCP perspectives on smoking cessation will help influence practice to ensure that patients are not judged, assumptions are not made, and individualized and person-centred care is provided. HCP awareness of these themes and the patient perspective may challenge assumptions and values., (Copyright © 2020. Published by Elsevier Inc.)

Objectives: The purpose of this paper is to summarize the use of the knowledge to action framework for adapting guidelines for practice and the evidence for effective implementation interventions to promote a quality response to cancer distress screening data., Methods: We summarize progress in screening implementation in Ontario, Canada and the application of a systematic approach for adapting knowledge to practice and use of evidence-based knowledge translation interventions to ensure the uptake of best practices to manage distress., Results: While significant progress has been made in the uptake of distress screening it is less clear if this has resulted in improvements in patient outcomes, i.e., reduced distress. The use of evidence-based knowledge translation strategies tailored to barriers at many levels of care delivery is critical to facilitate the uptake of distress screening data by the primary oncology team., Significance of Results: There is a wealth of knowledge about the approaches that can be applied to translate knowledge into practice to improve psychosocial care and promote evidence-based distress management by the primary care oncology team. However, further implementation research is needed to advance knowledge about the most effective strategies in the context of cancer care.

Across Canada, individuals diagnosed with cancer have identified concerns about access to services before, during, and following treatment, highlighting a very real uncertainty that exists about where to turn for information and assistance. Cancer patient navigation programs are emerging as effective interventions, well-equipped to meet these patients' diverse needs. While many provinces have initiated professionally led navigation services, little is known about the potential for volunteer-led navigation. This article highlights pilot programs in British Columbia, Ontario, and Newfoundland, where volunteers are engaged as lay or peer providers of cancer patient navigation services. By describing the recruitment, training, and role of the navigators within each program, the paper underscores the capacity for unique programs to work within current care frameworks across distinct communities. These programs provide an innovative approach to overcoming barriers and augmenting access to supportive care for cancer patients and their family members.

Aim: This article explores how cancer nurses experienced the threat of patients' mortality on malignant haematology units of one institution in Ontario, Canada., Background: Although patients with cancer are living longer with bone marrow transplantations, still they face possibilities of dying due to complications from treatment and their disease., Methods: Interpretive phenomenology guided the process. Nineteen front-line registered nurses were purposively recruited from two inpatient bone marrow transplant units. Focused observations and individual interviews were analysed. Data were collected from April to August 2007., Results: The major findings emphasized nurses' internal conflict related to their simultaneous need to help patients fight their disease and to prepare them for the possibility of letting go. The authors used the terms 'letting go', not to reflect nurses' intents to abandon life but to release patients from perceived norms of the 'curative culture'. Nurses experienced 'bursting the bubble of hope' by circumstances not in their control, and were often not certain whether or not to respond and how to respond to the distress of patients and families about death and dying. When feeling reassured of meeting patients' and families' expectations, nurses enabled patients and families to let go when further treatment was futile, prevented technological intrusions, and helped patients have 'easier' deaths., Conclusion: Results suggest enhancing nurses' capacity to negotiate more effectively the contradictory clinical tasks of fighting disease and preparing patients for the end of life. In this regard, nurses may minimize patients' distress by providing opportunities for them to share their fears and have them validated., (© 2011 Blackwell Publishing Ltd.)

Purpose: Research has drawn attention to the challenges that patients receiving treatment for head and neck cancers experience, including the physical and emotional impact of diagnosis and treatment, the effects of weight loss, challenges related to eating and strategies used by patients to address nutritional problems. There is limited research in head and neck cancer populations about the impact associated with the disruptions and daily experience related to eating problems and the meaning and significance of these changes., Methods: This article describes research that is part of a larger study about patients' experiences of receiving radiation for head and neck cancer. The article reports an in-depth analysis of one of the subthemes from 17 participants, the changed meaning of food that emerged within the overarching theme of disrupted expectations and changes in life routines in the original study. This paper highlights participants' perspectives about their experiences and the disruptions caused by treatment, with a specific focus on the losses associated with the changed meaning of food., Results & Conclusions: There are physical, emotional and social losses associated with a changed meaning of food for Head and Neck cancer patients. Acknowledging the significance of eating problems and the changed meaning of food is required in order to provide patients with the appropriate support, strategies and interventions to manage with the changes and losses., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Purpose: To prospectively evaluate radiation-induced fatigue among patients undergoing curative radiotherapy at the Toronto Sunnybrook Regional Cancer Centre using two different instruments., Materials and Methods: Consecutive consenting English speaking men receiving curative radiotherapy for localised prostate cancer were enrolled in a prospective ethics board approved study. We used an 11 questions fatigue questionnaire (FQ) based on a modified FACT-AN questionnaire and the 2 questions of the fatigue pictogram (FP) to record patients' responses weekly during treatment. The 11 FQ items were summed to calculate a fatigue scale (FS). The proportion and 95% confidence interval for each FQ and FP item and mean FS was calculated at baseline, week 3 and week 6. Chi-squared tests or analysis of variance f-tests were used to compare treatment groups and paired t-tests to compare baseline to week 6. A linear mixed model was used to compare the mean FS for treatment groups across time., Results: From June 2000 to June 2003, we enrolled 130 patients. Fifty-one received conformal radiotherapy to the prostate (CRT), 46 received whole pelvis and prostate boost radiotherapy (WP+PB) and 33 received post prostatectomy radiotherapy to the prostate bed (PBRT). At baseline, 39% (30-47%) reported some fatigue for the FQ and 60% (52-68%) for the FP tiredness item. As treatment progressed, the mean fatigue increased significantly. The FP tiredness item best differentiated between treatment groups (p = 0.04 at week 6) compared to the FQ tiredness item or FS. Those receiving irradiation to smaller volumes (CRT or PBRT) reported lower FS scores than those treated to larger volumes (WP+PB) across time., Conclusions: The pictogram was better than the questionnaire in differentiating between treatment groups. The pictogram could be used to screen and monitor patients with baseline fatigue for interventional studies in a busy clinic.

The purpose of this study was to examine role structures and processes and their impact on job satisfaction for oncology advanced practice nurses (APNs) in Ontario. APNs caring for adult, paediatric or palliative patients in integrated regional cancer programs, tertiary care hospitals or community hospitals and agencies were invited to complete a mailed self-report questionnaire. A total of 73 of 77 APNs participated in the study. Most APNs (55%) were acute care nurse practitioners employed by regional cancer programs or tertiary care hospitals. Adult patients with breast or haematological cancers and those receiving initial treatment or palliative care were the primary focus of APN roles. APN education needs related to specialization in oncology, leadership and research were identified. Overall, APNs were minimally satisfied with their roles. Role confidence (beta = .404, p = .001) and the number of overtime hours (beta = -.313, p = .008) were respective positive and negative predictors of APN job satisfaction. Progress in role development is described, and recommendations for improving role development and expanding the delivery of oncology APN services are provided.

Background: The Quality Initiative in Rectal Cancer (QIRC) Strategy randomized 16 hospitals across Ontario to the QIRC strategy versus minimal intervention. The strategy included a workshop, recruitment of a local opinion leader (OL), operative demonstrations, postoperative checklists, audit, and feedback. Surgeons at each intervention hospital used a standardized approach to select a local OL from their ranks. We assessed the experiences of OL and non-OL surgeons in the QIRC strategy., Study Design: Semi-structured qualitative telephone interviews were completed with 8 OLs and 8 non-OL surgeons. Interviews were guided by Grounded Theory. Initial interviews were assessed to ensure that domains of interest were fully explored. Two investigators (FW, MF) independently reviewed all final transcripts and identified themes. Consensus among all investigators was achieved for final themes., Results: All approached surgeons participated in interviews. Seven themes were identified: surgical OLs with subspecialist expertise were supported; surgical OL requires technical expertise; limited role for local OL on changing physician practice in rectal cancer operations; limited effect of identifying local OL on local interactions; operative demonstrations supported; characteristics of operative demonstrator were important; and perceived positive effect of the QIRC strategy on practice., Conclusions: The experience of local OLs in this trial appears to be mixed. Although some of the themes support the concept of a local OL, other themes suggest the local OL had a limited role and effect. The overall QIRC strategy, and in particular the operative demonstration, was viewed positively and was perceived to have a positive longterm effect on participants' practice.

Goals of Work: To determine the financial and family resources burden associated with the treatment of cancer. A questionnaire was developed to determine the direct monthly "out-of-pocket costs" (OOPC), the indirect costs, and the associated perceived family burden., Materials and Methods: A self-administered questionnaire using a quota sample from five cancer clinics in Ontario, Canada was given to 282 cancer patients (74 breast, 70 colorectal, 68 lung, and 70 prostate). Monthly OOPC were obtained for: drugs, home care, homemaking, complementary and alternative medicines, vitamins and supplements, family care, travel, parking, accommodations, devices, and others. The questionnaire asked if OOPC for treatment were a burden, and if others took time from work to provide caregiving., Main Results: The mean monthly OOPC was $213, with an additional $372 related to imputed travel costs. For those patients who responded that the burden was "significant" (16.5%), their OOPC was $452. In the case of patients responding that their burden was "unmanageable" (3.9%), their OOPC was $544. The survey showed that 35.6% of patients required others to take time from work and this was higher in the under-65 category. The mean number of days lost from work in the previous 30 days for these caregivers was 7 days., Conclusions: These results suggest the financial burden is problematic for 20% of this sample. The caregivers' lost time from work influence this burden, and for 36% of this sample, it amounts to one third of their working days in any given month. Policies and programs to address these gaps are needed.

Objective: To assess attitudes and acceptability of Ontario consumers and doctors towards colorectal screening with faecal occult blood testing (FOBT) and colonoscopy., Design, Setting and Participants: Focus groups with gender-specific samples of the population, high-risk gastroenterology patients and family doctors., Method: Semi-structured interview guides used by facilitator to lead groups through knowledge of risk factors and prevention of colorectal cancer, the screening modalities, requirements for implementing screening programmes, barriers to screening and preferences towards screening., Main Findings: There were low levels of knowledge about colorectal cancer and its prevention in the general population. FOBT was an acceptable screening modality, but considerable education about its use and benefits would be necessary to implement a screening programme. Colonoscopy was not perceived to be a good choice for a primary screen in the general population. The high-risk group supported use of FOBT in the general population and emphasized the need for education. The doctors were more reluctant about screening, requesting clear guidelines. They also identified the time and resources that would be required if a screening programme were initiated., Conclusion: While colorectal screening is acceptable in this sample, information and decision aids are required to enable consumers and providers to make effective decisions. Implementation of colorectal screening programmes requires substantial educational efforts for both consumers and doctors.

Purpose/objectives: To examine the knowledge, attitudes, beliefs, and practices regarding breast and cervical cancer screening in selected ethnocultural groups (i.e., Italian, Ukranian, Finnish, and the native population) in Northwestern Ontario, Canada., Design: Descriptive, exploratory., Setting: Rural and urban settings in Northwestern Ontario., Sample: 105 women aged 40 and older who were residents of Northwestern Ontario and members of selected ethnic groups, including Italian, Ukranian, Finnish, Ojibwa, and Oji-Cree., Methods: An interview guide was designed specifically for this study to gather information regarding knowledge, attitudes, beliefs, and practices about breast self-examination (BSE), clinical breast examination (CBE), mammography, and cervical cancer screening procedures. Data were obtained through face-to-face interviews (two or three hours) in English or the language spoken. Interviews in other languages were transcribed into English., Findings: Ojibwa and Oji-Cree women were more likely than any other group to not have practiced BSE, to have refused CBE or mammogram, to not have been told how to perform BSE, to not have received written information about breast examination, and to be uncomfortable and fearful about cervical cancer screening procedures (33% refused internal examination as compared to 0-8% in the other ethnic groups). Four issues emerged from the findings: (a) using multimedia sources to inform women about screening programs, (b) educating women regarding breast and cervical cancer screening, (c) reminding women when they are due for screening, and (d) identifying that Pap tests are uncomfortable and frightening., Conclusions: Cultural beliefs, attitudes, and practices of marginal populations (e.g., native women) are important to consider when developing strategies to address barriers to effective breast and cervical screening., Implications for Nursing: Educational programs that are culturally sensitive to participants are imperative.

Social science researchers have fruitfully used a range of conceptualizations of "performance": as a metaphor for social life, a way of vivifying research findings, and a form of scholarly representation. In this article, the researchers consider performance in its hermeneutic sense, as a way of generating meaning. The drama Handle With Care? Living With Metastatic Breast Cancer was created by a research team, a theater troupe, and women with breast cancer. The researchers employ an interpretive phenomenologicalframework to explore interviews with women with breast cancer involved in creating Handle With Care? The performative context in which the drama developed allowed certain illness meanings to emerge, intensify, and shift. The article also considers ethical dilemmas surfaced by this project.

Purpose/objectives: To explore and document the lived experience of receiving low-dose rate brachytherapy for gynecologic cancer., Design: Qualitative method based on phenomenology., Setting: Radiation treatment facility in a cancer-care setting in Toronto, Ontario, Canada., Sample: Ten women between the ages of 36 and 75 (x = 59.2) receiving low-dose rate brachytherapy for cancer of the cervix or endometrium., Methods: Verbatim data were analyzed manually using Giorgi's method of analyzing qualitative data., Findings: Three themes emerged from the data: (a) women's experiences with brachytherapy were embedded within the complete context in which treatment was given, shaped by personal, environmental, and treatment-related factors, (b) the discomfort that women experienced during brachytherapy was perceived as a totality of symptoms including but not limited to pain, and (c) the brachytherapy experience was characterized by an intense focus on time and tensions embedded in issues related to time., Conclusions: When dealing with the brachytherapy treatment, women are concerned with the context in which the treatment is provided and the care that is associated with the treatment. Different and unique strategies assist women to get through treatment. Supportive nursing interventions can be implemented easily in the nursing care plan for women undergoing brachytherapy., Implications for Nursing Practice: The aspects of nursing care that women perceive as positive, such as competence level of the nurse, symptom management, and providing information in sensory terms, should be strengthened. Alternatively, aspects of nursing care that are perceived negatively by women should be changed. Nurses have to avoid situations that will prolong the time of brachytherapy treatment. Nurses should support women in using coping strategies that assist them in getting through the brachytherapy treatment.

This paper describes the application of art therapy in assisting cancer patients to visually express their cancer experience on several levels--physically, psychosocially, and spiritually. The art therapy/museum education program was developed in 1996 at the McMichael Canadian Art Collection in partnership with Toronto-Sunnybrook Regional Cancer Centre-Bayview Support Network. To date, the program has run for three rounds with 16 sessions in each round. The facilitator for all three rounds was a trained art therapist. The program provided an unique opportunity for an arts institution to serve the community at large by offering an artistic outlet in a peaceful, rural setting in contrast to a sterile hospital environment. The specific goals of the program and the general therapeutic benefits of art therapy are described. In addition, the effectiveness of an existential/phenomenological approach in not only serving the cancer population, but also bridging the two diverse disciplines--art therapy and museum education--is explored. It is suggested that an existential therapeutic approach promotes the confrontation and acceptance of death that is necessary in order to lead a more meaningful life. Moreover, a phenomenological approach promotes the act of "seeing" as an essential ingredient in gaining objectivity and bringing unconscious thoughts into consciousness. The importance of social and emotional support in the way of art therapy in addition to medical care is emphasized. Through art therapy, cancer patients are encouraged to discover ways to face pain and misfortune and be creative in their "art of living."

Art therapy is a healing art intended to integrate physical, emotional, and spiritual care by facilitating creative ways for patients to respond to their cancer experience. A new art therapy program was designed to provide cancer patients with opportunities to learn about the McMichael Canadian Art Collection and to explore personal feelings about their cancer experience through combined gallery and studio components. The role of the facilitator was to assist in the interpretation of a participant's drawing in order to reveal meaning in the art. This paper presents patients' perspectives about the new art therapy program. Content analysis of participant feedback provided information about the structure, process, and outcomes of the program. Evaluation of the art therapy/museum education program demonstrated many benefits for cancer patients including support, psychological strength, and new insights about their cancer experience.

Purpose: The authors describe the experience of men with prostate cancer and their spouses in the early recovery period after surgery., Description of Study: As part of a longitudinal qualitative study, semistructured interviews were held with 34 patients who had prostate cancer and their spouses 8 to 10 weeks after surgery., Results: Five components of experience emerged from the interviews: 1) hearing news about the extent of their cancer after surgery influenced how patients viewed their cancer experience and, in many cases, their recovery; 2) men placed great emphasis on recovering their physical capacity quickly; 3) couples connected with each other through working out care routines and managing periods of irritability; 4) couples described a range of responses to surgery side effects and complications; and 5) the meaning of cancer varied for couples, with most seeing the experience as a temporary disruption., Clinical Implications: Physicians, nurses, social workers, and other health professionals working with patients before and after prostatectomies may assist couples to prepare better for the early recovery period by being both sensitive to the men's need to recover physical capacity quickly while helping them to understand that recovery takes time. Accurate information about expected periods of irritability, side effects, and possible complications would diminish the likelihood of distress during this period.

Background: Members of self-help groups (SHGs) for support of cancer patients are concerned that physicians are skeptical about these groups and see them as potentially harmful. The purpose of this study was to assess family physicians' attitudes towards self-help groups and see whether these could be changed through an educational intervention., Methods: A questionnaire assessing attitudes toward SHGs was mailed to 1,422 eligible Ontario family physicians, to which 911 responded (64% response rate). Responders were sent an educational package consisting of an article about self-help groups, a list of local cancer self-help groups, and a follow-up questionnaire., Results: The study was completed by 584/911 family physicians (64%). After being exposed to educational material, the physicians were more positive about the helpfulness of SHGs (p = 0.021), and less concerned about SHGs' being harmful (p = 0.003). They were more positive about the potential for SHGs to provide participants with opportunities for: sharing information (p = 0.004), bonding with other patients (p < 0.001), feeling understood (p = 0.004), sharing common experiences (p = 0.004), providing hope (p < 0.001), sharing laughter (p = 0.001), becoming more assertive (p < 0.001), communicating with health professionals (p = 0.04), dealing with issues related to death and dying (p = 0.005), advocacy (p = 0.01), and overcoming isolation (p = 0.002). They were less concerned with the potential for SHGs to provide misinformation (p = 0.003), the negative effects of associating with the very ill (p = 0.002), dwelling on illness (p = 0.002), or cultivating false hope (p = 0.001)., Conclusion: Having family physicians complete a questionnaire, followed by educational material specific to their concerns, changed their attitudes toward self-help groups. Further study is needed to see whether behavioral changes resulted.

Purpose: Despite the phenomenal growth during the past decade of cancer self-help groups for adult patients with cancer, little research has been conducted to document the interface between these groups and healthcare professionals, especially physicians. This study was initiated to provide information about family physician practices, awareness, and attitudes about self-help groups., Description: A survey questionnaire was mailed to a random sample of Ontario family physicians drawn from the College of Family Physicians of Canada's membership database., Results: A total of 911 completed questionnaires were returned, for a response rate of 64%. A majority (56.8%) of respondents were aware of at least one cancer self-help group in their region; 26.8% of these spoke frequently with their cancer patients about such groups. Most family physicians indicated that they were positively inclined toward cancer self-help groups, giving especially high ratings of helpfulness to sharing common experiences, overcoming isolation, feeling understood, and sharing information. Ratings of potential harm were low, with the most concern expressed about the possible provision of misinformation and the promotion of unconventional therapies. Responses to an open-ended question showed that many family physicians qualify their support for cancer self-help groups, depending on patient need, group composition, and leadership., Clinical Implications: Family physicians and other members of the cancer care team should give increased attention to informing cancer patients about the potential benefits of self-help groups. Efforts need to be made to assist cancer self-help groups in developing informational brochures and to ensure that groups are listed in cancer resource directories. Educational initiatives about self-help groups would be useful for family physicians and other health professionals engaged in the care of cancer patients.

Objective: To assess Ontario family physicians' attitudes toward, awareness of, and practices related to self-help groups in general and cancer self-help groups specifically., Design: Mailed survey using a modified Dillman method., Setting: Ontario family practices., Participants: A random sample of 1500 Ontario members of the College of Family Physicians of Canada, of whom 949 responded. A total of 911 completed questionnaires were received, for an eligible response rate of 64%., Main Outcome Measures: Physician demographics, practice characteristics; extent of awareness of self-help groups and their perceived value; attitudes toward self-help groups; practices related to interactions with patients about self-help groups., Results: Only 40.2% of respondents were aware of six or more self-help groups in their region; 56.8% were aware of at least one cancer self-help group. Discussions with patients about groups were reported as occurring "frequently" by 12% of respondents, who indicated they made referrals to an array of groups. Ratings of group helpfulness were relatively high (83.8% scoring 3, 4, or 5 on a 5-point scale, where 5 is "very helpful"). There were low ratings of potential harm (1% scoring 4 or 5 on a 5-point scale, where 5 is "very harmful"). Confidence intervals for proportions reported on in this paper were all within 4%., Conclusions: Family physicians have predominantly positive attitudes about the potential benefits of self-help groups, and many are recommending groups to their patients.

The purpose of this study was to identify the information needs of nurses regarding benign breast conditions and breast cancer. One hundred and five Ontario nurses who are directly involved in providing information to women were interviewed. The majority of nurses indicated feeling either somewhat or very comfortable during their discussions with women and perceived their knowledge was sufficient for answering women's questions. Nurses rated existing information concerning discovery of breast abnormalities and the diagnostic phases the highest in terms of quality, quantity and accessibility. Overall, a large proportion of nurses did not perceive gaps in information for nurses about breast disease. This work raises interesting practice questions for nursing in light of the reports by patients that they experience difficulties obtaining information.

Nine focus groups for well, longer-term survivors of breast cancer were held in Ontario, Canada. Prevalent themes identified through analysis of focus group transcripts fell into two broad categories, one reflecting the context within which women seek information and the other reflecting the content of information desired and sought. Themes related to context included: the ongoing impact on women of their initial disease experience and continued uncertainty about possible recurrence; womens' lack of information and understanding about processes involved in developing medical knowledge; prevailing mistrust about the impact of cost curtailment policies; and, concerns related to how professional communication can aid or hinder the goal of obtaining information. Themes related to content issues included: follow-up protocols, tamoxifen, detecting signs of possible recurrence, prevention for daughters, neglected side effects of treatment, insurance, lifestyle, and unconventional therapies.

The greatest risk factor for developing cancer is age, yet little is known about the cancer-related knowledge, attitudes and beliefs of the older adult (age > 55 years). A community-based needs assessment was conducted to understand these dimensions in a large metropolitan community. Ten focus groups (n = 158 older adults) and 9 individuals were interviewed. Content analysis for the audiotaped sessions was completed. The study participants focused on "being active" and living a healthy lifestyle. Many worried about illness interfering with their ability to do what they wanted to do. Many had had exposure to cancer through family members or friends, but still had many unanswered questions about cancer. Age was not seen as a risk factor for cancer, and a range of attitudes existed regarding cancer prevention and early detection. Overall, despite fearing cancer, participants thought older adults needed to know about cancer and suggested a wide range of approaches to disseminate information effectively to older adults.

Purpose/objectives: To identify the knowledge level concerning cancer in older Canadian adults., Design: Descriptive., Setting: Urban community in Canada., Sample: Convenience sample of 513 adults over the age of 55 (72% female; 68% born in countries other than Canada)., Methods: A self-report questionnaire, the Cancer Knowledge Survey for Elders, was administered to participants in their native language (eight different language groups). Distribution was through community workers and public healthy nurses who worked with older adults., Main Research Variables: Knowledge about cancer, language group, length of time living in the country., Findings: The highest number of correct responses (87%) was for the item "Can some cancers be cured if they are discovered early?" The highest number of wrong answers (67%) was for the item "Can a bump or bruise to the body cause cancer?" Sixty-six percent did not consider age as a risk factor. For all but three items, the proportion of English language to non-English language individuals with correct answers was significantly different individuals whose native language was not English were less knowledgeable about cancer., Implications for Nursing Practice: This study offers a basis for a large multicultural survey. Should the observations be confirmed in a larger sample, implications exist for public education about the risk factors and signs and symptoms of cancer, especially with individuals for whom English is not a native language., Conclusions: In this sample, specific areas were identified in which knowledge about cancer was lacking. In particular, the increased risk of cancer with advancing age was not recognized by a significant portion of study participants.

The popularity of unconventional therapies has grown dramatically in recent years. This paper reports on the results of a pilot study investigating the perspectives of physicians involved with cancer care regarding their reactions to this trend and their ways of trying to meet associated challenges. Nine oncologists, nine general practitioners, and one surgeon were interviewed over the telephone, employing open-ended questions. The physicians were unanimously interested in having information available about unconventional therapies. They also expressed a desire to be supportive of patient choices in this area, provided conventional therapy was not compromised. However, there was little interest in initiating communication about unconventional therapies, with most seeing such discussions as a poor use of their time. Suggestions for future research, as well as educational and policy strategies, are addressed.