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ObjectivesThe COVID-19 pandemic placed severe strain on cancer carers resulting in an urgent need for information and support.MethodsThe Santin 2019 6-step co-design model was used to rapidly modify an existing online cancer carers resource. Draft content of a COVID-19 module was created via two workshops and six meetings with an expert advisory team (Step 1). This content was then produced into videoed testimonials (Step 2). A module prototype was reviewed by volunteers (Step 3) and modified based on feedback (Step 4). User-testing occurred via two online feedback sessions (Step 5) and modifications were made (Step 6). All steps were audio recorded, transcribed verbatim and analysed thematically.ResultsA COVID-19 support, and information module was rapidly co-designed by n = 45 stakeholders (n = 11 workshop 1 and 2 (3 carers/14 professionals), n = 6 advisory committee (1 carer/5 professionals), n = 4 video content (1 carer/3 professionals) and n = 24 feedback sessions (5 carers/19 professionals). The module contained vaccination information, infection control and how to manage the psychosocial impact of restrictions. Information was delivered in 4 short videos with links to up-to-date guidance and information services. Participants identified that the module included all key information for carers in an accessible and informative way. The use of videos was viewed as an emotive and reassuring.ConclusionsDuring a global pandemic, cancer carers urgently required tailored information. Co-designed online resources allow service providers to rapidly respond to emerging and unprecedented issues and provide urgent information and support.

BackgroundHuman papillomavirus (HPV) vaccination offers protection against the virus responsible for cervical, oropharyngeal, anal, vulval and penile cancers. However, there is considerable variation across, and even within, countries as to how HPV vaccination is offered and accepted. This review aimed to identify what interventions exist to promote uptake and how effective they are.MethodsWe conducted an umbrella review using the JBI (Joanna Briggs Institute) methodology to evaluate routine or catch-up interventions to increase HPV vaccination uptake and/or intention for children aged 9 years and older, adolescents and young adults up to 26. Comprehensive searches for English language quantitative systematic reviews, published between January 2011 and July 2021, were conducted across five databases. After reviewing titles and abstract, relevant papers were independently assessed in detail.Main resultsFrom 1046 records identified, 10 articles were included in the review. They reported on 95 randomised controlled trials, 28 quasi-experimental studies, 14 cohort studies, 6 non-randomised pretest/post-test studies with control groups, 5 single-group pretest/post-test studies, 1 single-group post-test study and 1 randomised longitudinal study. Some interventions promoted change at the individual, community or organisational level, while others used a multicomponent approach. Face-to-face presentations, printed information and supplementing both strategies with additional components appear effective at increasing vaccination intention, while reminders and multicomponent strategies, especially ones that include some intervention aimed at provider level, appear effective at increasing vaccination uptake. Interventions that did not lead to an improvement in HPV vaccination intention or uptake varied in design and impacts were inconsistent across children/adolescents, young adults or parents.ConclusionThe evidence suggests that there is no single solution to increasing vaccination uptake and that different approaches may be better suited to certain populations. However, generalisations are limited by poor reporting and a paucity of studies beyond the USA. Further high-quality studies, therefore, are needed to understand how best to increase HPV vaccination uptake in different target populations.

Background Cancer diagnosis, treatment and survivorship is multifaceted, and the cancer patient experience can serve as a key indicator of healthcare performance and quality. The purpose of this paper was to analyse free-text responses from the second Northern Ireland Cancer Patient Experience Survey (NICPES) in 2018, to understand experiences of care, emerging themes and identify areas for improvement. Methods A 72-item questionnaire (relating to clinical care experience, socio-demographics and 3 free-text questions) was distributed to all Health & Social Care Northern Ireland patients that met the inclusion criteria (≥ 16 years old; confirmed primary diagnosis of cancer and discharged between 1st May and 31st October 2017) in June 2018. Participants could complete the questionnaire online or access a free telephone support line if required. Open-ended free text responses were analysed thematically to identify common themes. Free text responses were divided into positive or negative comments. Results In total, 3,748 people responded to the survey, with 2,416 leaving at least one free text comment (69 %). Women aged 55–74 years were most likely to comment. Overall, 3,644 comments were left across the three comments boxes, which were categorised as either positive (2,462 comments; 68 %) or negative / area for improvement (1,182 comments; 32 %). Analysis of free text responses identified six common themes (staff; speed [diagnosis and treatment]; safety; system; support services and specific concerns), which were all related to the overarching theme of survival. Staff was the largest single theme (1,458 responses) with overwhelmingly positive comments (1,322 responses; 91 %), whilst safety (296 negative comments; 70 %) and system (340 negative comments; 81 %) were predominantly negative. Negative comments relating to primary care, aftercare and the cancer system were reported. Conclusions The high response rate to the free text comments indicates patients were motivated to engage. Analysis indicates most comments provided were positive in nature. Most survey respondents reported a positive experience in relation to staff. However, there were a number of areas for improvement including the aftercare experience, and a perceived disconnect between primary care and cancer services. These results can help inform the effective delivery of cancer services in Northern Ireland.

Following an emergency incident, critically injured patients are often treated by multiple healthcare professionals from Emergency Medical Teams (EMTs) over a short period of time. The process of transportation from the site of an incident to definitive health care therefore depends on coordination and information-sharing which is reliant on the use of Information and Communication Technology (ICT). ICT is essential to ensure the necessary organizational responses to emergency situations by facilitating information-sharing, sustained coordination and collaboration to protect and save the injured. This literature review provides a broad overview which can facilitate an understanding of the experiences between EMTs in emergencies using ICT by systematically finding, reviewing, assessing and synthesizing current evidence. A systematic search guided by PRISMA was performed using relevant electronic databases and manual searches. Studies were limited to original research and only articles published between 2009 and 2021 were included. This review highlights that only a limited number of publications reported ICT use between EMTs in different emergencies in a single study. Fifteen papers were found which reported the experience of coordination and communication using ICT between EMTs in emergency situations in different countries. The findings of these papers indicate that although communication systems during an emergency are crucial, poor quality telecommunications infrastructure affected by difficult weather conditions often led to communication failures between respondents. The majority of these studies highlighted that the use of mobile phones is preferred over other systems due to their multi-functionality. Some of the studies reported issues in coordination between EMTs in which the limited information shared between EMTs affected their preparedness. Furthermore, the review shows that disaster simulation exercises between EMTs are insufficient and require improvement. Future research needs to include the perspectives of emergency operations centre staff along with nurses, physicians and paramedics in a single study to comprehensively explore the EMT response in emergency situations.

The objective of this paper was to discuss the psychological impact of active surveillance (AS) for prostate cancer (PCa) and the resulting implications of psychological wellbeing for treatment decision making and acceptance of AS protocols. Qualitative and quantitative research in the area of anxiety, depression, and distress is discussed drawing from PCa literature as well other health conditions from which parallels can be drawn. Attention is given to the role of the clinician in treatment decision making, including the value of information provision, and perceived trust in the AS as a management approach. Given that research is conflicted regarding the psychological impact of AS for PCa, it is suggested that focus shifts away from debate of the ‘true’ experience of AS rather researchers and clinicians should seek to identify the factors associated with positive and negative psychological response to diagnosis and AS to improve psychological and physical outcomes. Recommendations for clinical practice are discussed.

Background Surgical resection remains the only curative treatment for pancreatic cancer and is associated with significant post-operative morbidity and mortality. Patients eligible for surgery, increasingly receive neo-adjuvant therapy before surgery or adjuvant therapy afterward, inherently exposing them to toxicity. As such, optimizing physical function through exercise during treatment remains imperative to optimize quality of life either before surgery or during rehabilitation. However, current exercise efficacy and prescription in pancreatic cancer is unknown. Therefore, this study aims to summarise the published literature on exercise studies conducted in patients with pancreatic cancer undergoing treatment with a focus on determining the current prescription and progression patterns being used in this population. Methods A systematic review of four databases identified studies evaluating the effects of exercise on aerobic fitness, muscle strength, physical function, body composition, fatigue and quality of life in participants with pancreatic cancer undergoing treatment, published up to 24 July 2020. Two reviewers independently reviewed and appraised the methodological quality of each study. Results Twelve studies with a total of 300 participants were included. Heterogeneity of the literature prevented meta-analysis. Exercise was associated with improvements in outcomes; however, study quality was variable with the majority of studies receiving a weak rating. Conclusions High quality evidence regarding the efficacy and prescription of exercise in pancreatic cancer is lacking. Well-designed trials, which have received feedback and input from key stakeholders prior to implementation, are required to examine the impact of exercise in pancreatic cancer on key cancer related health outcomes.

There is a lack of knowledge regarding communication and information exchange between the emergency medical teams (EMTs) during emergencies, particularly in the Riyadh region of the Kingdom of Saudi Arabia (KSA). The aim of this study is to explore EMTs’ experiences of communication and information exchange during difficult emergency situations in the city of Riyadh.A qualitative exploratory study was undertaken to explore the experiences of 62 respondents from the Saudi Red Crescent Authority (SRCA) and emergency departments (EDs): a total of 18 were SRCA staff (three call takers, four dispatchers, three field supervisors and eight paramedics), and a total of 44 from hospital EDs, comprising 19 ED nurse managers, 12 ED physician consultants and 13 ED paramedics. Semi-structured interviews were held with the participants, who all had the experience of responding to emergencies and had the authority to communicate with one another. The interviews were tape-recorded and transcribed verbatim and the transcripts were analysed using Braun and Clarke’s thematic analysis [1]. NVIVO 11 was used to aid data management.Three themes were identified comprising central factors that influence coordination and communication between the participants. These themes were (1) the emotional impact on SRCA staff performance, (2) the effectiveness of the emergency response, and (3) perceptions of emergencies preparation. The first theme highlighted important factors related to emotional and well-being, which impact the performance of the SRCA operation centre staff and have an impact on the information shared with other relevant staff. In the second theme, issues that emerged that related to the effectiveness of the emergency response, coordination and communication between the EMTs were highlighted to be limited in effectiveness. Although several communication systems were used, some of them were not formally sanctioned and some were technical issues related to the systems used. The third theme explored participants’ perceptions of emergencies preparation, and again the findings demonstrated limited evidence of disaster management training or preparation particularly between EMTs. The training in communication among EMTs staff in preparing for disasters was similarly found to have deficits and could be improved. Finally, the findings from this study demonstrated that the level of debriefing that was put in place following an incident could be substantially improved.Communication between EMTs not only involves the use of advanced technology but also requires improvements in coordinated communication within and between EMTs in relation to an effective response to emergencies and disasters. This could be achieved if the directors, managers and policymakers appreciated more fully the importance of the factors to be considered in relation to the effective use of ICT, the adverse impact of the ineffective use of communications systems, and how the coordination of services could be improved during emergency situations.

Background: Despite evidence indicating the benefits of exercise interventions for women with ovarian cancer both during and following treatment, uptake is poor. There is limited research exploring the implementation of such interventions for this cohort of women. The purpose of this review was to identify implementation theories in relation to exercise interventions for women with stages I−IV ovarian cancer, both during and following treatment; to explain positive and negative contextual factors, which may help or hinder implementation; and to develop a theory on how exercise interventions for women with ovarian cancer may be implemented. Methods: This realist review sourced literature from five electronic databases: CINAHL plus, Medline, Embase, PsycINFO and Google Scholar. Methodological rigour was assessed using the relevant critical appraisal skills programme tools. Results: Nine papers were included. Two intervention stages were identified: first, optimising uptake by providing education to patients on the benefits of exercise, approaching patients when symptoms are adequately managed and offering a personalised exercise programme; second, adherence and retention are influenced by the provision of an “autoregulated” exercise programme with additional supportive infrastructure, individualised goal setting and symptom management support where required. Conclusion: Women with ovarian cancer are reluctant to engage in exercise interventions, despite the supporting evidence in terms of positive clinical outcomes. This realist review elucidates underlying mechanisms and important contextual factors that will support and guide the implementation of exercise interventions for this cohort of women.

ObjectiveTo gather preliminary qualitative data that will assist in the codesign and development of a new informational and supportive website to assist informal cancer carers in Australia.Design and settingUtilising a previously tested codesign process, informal carers’ experiences and perspectives, including those of healthcare professionals’, were examined via focus groups and/or interviews. Data were analysed via thematic analysis.ParticipantsRural (n=9) and urban (n=11) carers’, and healthcare professionals’ (n=8) perspectives were collected. Carers participated in a focus group (n=9) or telephone interview (n=11). Healthcare professionals completed an interview (n=6) or online survey (n=2).ResultsRural and urban carers typically felt ill prepared for their multitudinal caregiving responsibilities. Supporting patient-to-healthcare professional liaisons could especially challenge. Carers’ biopsychosocial and fiscal strains were affected by patients’ hardships and available informal supports. Rural carers described greater social support than urban carers. Both rural and urban carers also described discontentment related to a carer neglecting healthcare system. Both carers and healthcare professionals endorsed the need for a user-friendly, carer-specific website encompassing practical information and resources, peer-driven advice and evidence-based illness information, tailored to the Australian context.ConclusionsCarers and healthcare professionals recognise the pressing need for an Australian, cancer carer-specific online resource. Findings will inform the next phase, where a resource will be designed, developed and tested.

Objectives To describe communication regarding cancer patient’s end-of-life (EoL) wishes by physicians and family caregivers. Methods An online questionnaire and telephone-based surveys were performed with physicians and family caregivers respectively in three teaching hospitals in Colombia which had been involved in the EoL care of cancer patients. Results For 138 deceased patients we obtained responses from physicians and family caregivers. In 32 % physicians reported they spoke to the caregiver and in 17 % with the patient regarding EoL decisions. In most cases lacking a conversation, physicians indicated the treatment option was “clearly the best for the patient” or that it was “not necessary to discuss treatment with the patient”. Twenty-six percent of the caregivers indicated that someone from the medical team spoke with the patient about treatment, and in 67% who had a conversation, caregivers felt that the provided information was unclear or incomplete. Physicians and family caregivers were aware if the patient had any advance care directive in 6% and 26% of cases, respectively, with low absolute agreement (34%). Conclusions There is a lack of open conversation regarding EoL in patients with advanced cancer with their physicians and family caregivers in Colombia. Communication strategies are urgently needed.

Palliative care is on the global health agenda, as only approximately 14% of people who require palliative care receive it [...]

The human papillomavirus (HPV) can cause a range of cancers as well as genital warts and recurrent respiratory papillomatosis in men and women. Most cases can be prevented by vaccination in adolescence. Many countries vaccinate girls and an increasing number, although still a minority, vaccinate both boys and girls. The case for vaccinating boys is based on arguments of public health, equity, ethics and cost-effectiveness. The selective vaccination of females does not protect males sufficiently and provides no protection at all for men who have sex with men. In the United Kingdom (UK), the government’s vaccination advisory committee (Joint Committee on Vaccination and Immunisation [JCVI]) began to consider whether boys should be vaccinated as well as girls in 2013 and made clear in draft statements that it considered this not to be cost-effective. A campaign group, HPV Action, was established to advocate gender-neutral vaccination. This group became a coalition of over 50 organisations and used evidence-based arguments, political advocacy and media campaigning to make its case. One of its members initiated legal action against the government on the grounds of sex discrimination. In July 2018, the government agreed that boys in the UK should be vaccinated. The lessons for other campaigns in the men’s and public health fields include: be prepared for the long haul, focus on clear and specific goals, build alliances, align the objectives with existing policies, make a financial case for a change of policy, and use all legitimate means to exert pressure.

Statin use is associated with reduced risk of lethal prostate cancer potentially through effects on serum cholesterol. Using data from a prospective study with measured serum cholesterol among men subsequently diagnosed with prostate cancer, we developed a tumour gene expression score to reflect the pre-diagnosis serum cholesterol environment these tumours developed in, and applied this score to a separate study to examine the relationship with prostate cancer-specific outcomes. We identified 127 men with prostate cancer in the prospective Health Professionals Follow-up Study, whose prostate tumors underwent whole genome gene expression profiling. Pre-diagnosis serum cholesterol was measured a median of 3.3 years (IQR 1.5-4.8 years) prior to cancer diagnosis. We excluded men using statins either at time of blood draw for serum cholesterol measurement or at cancer diagnosis. Using tumor biopsy whole genome transcriptomic data from 232 prostate cancer patients treated with radiotherapy in Northern Ireland (NI), we generated the serum cholesterol score by summing z-score-transformed expression for each gene. PTEN status was measured using a published 50-gene transcriptional signature. Both signatures were dichotomized using the median cut-point. Age-adjusted and multivariable Cox regression analysis was used to compute HRs and 95% CI for associations of the cholesterol gene score with biochemical recurrence and metastasis risk. We identified in HPFS a set of 30 genes associated with pre-diagnostic serum cholesterol with a fold change ≥4 which included PTEN. In the NI Cohort, tumors with above median cholesterol scores had higher expression of the PTEN-null signature (p Citation Format: Sarah Jane Winter, Sophia R. Halliday, Travis A. Gerke, Lorelei Ann Mucci, Konrad H. Stopsack, Gillian Prue, Suneil Jain, Emma H. Allott. A gene expression signature of high serum cholesterol and prostate cancer outcomes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3354.

Objectives: To describe communication regarding cancer patient’s end-of-life (EoL) wishes by physicians and caregivers.Methods: An online questionnaire and telephone-based surveys were performed with physicians and caregivers respectively in three teaching hospitals in Colombia who had been involved in the EoL care of cancer patients. Results: For 138 deceased patients we obtained responses from physicians and caregivers. In 32% physicians reported they spoke to the caregiver and in 17% with the patient regarding EoL decisions. In most cases with absence of a conversation, physicians indicated the treatment option was “clearly the best for the patient” or that it was “not necessary to discuss treatment with the patient”.Twenty-six percent of the caregivers indicated that someone from the medical team spoke with the patient about treatment, and in 67% who had a conversation, caregivers felt that the provided information was unclear or incomplete. Physicians and caregivers were unaware if the patient had any advance care directive (ACD) in 65% and 51% of cases, respectively, with a very low absolute agreement (34%).Conclusion: There is a lack of open conversations regarding EoL in patients with advanced cancer with their physicians and caregivers in Colombia. Communication strategies are urgently needed.

Purpose The recent coronavirus pandemic (COVID-19) has affected the delivery of routine cancer care and supportive services. The Macmillan Move More Northern Ireland (MMNI) programme provides access to physical activity and behavioural change support before, during and after cancer treatment. This evaluation details the impact of the pandemic on the MMNI participants and identifies methods to adapt service delivery. Methods A multiple-choice and short answer online survey was sent to 730 MMNI participants, to investigate the impact of the initial, national COVID-19 lockdown. Specifically, the survey examined physical activity patterns, the physical/emotional/social impact of restrictions and attitudes towards digitally supported exercise. Free text responses were analysed thematically with findings verified within the research team. Results 377 participants completed the survey (52% response rate). 50% of respondents had breast cancer, with 36 other diagnoses registered (82% were female). Participants reported physical activity levels decreased during restrictions, citing isolation; declining health/fitness; lack of access and motivation. The dataset trended towards women and those diagnosed with breast cancer. 71% reported the pandemic impacted their physical (n=119) and/or psychosocial (n=231) wellbeing. Many respondents were availing of digitally supported exercise, whilst half of males did not engage (46%). Finally, 80% of respondents were interested in using a MMNI smart application. Conclusion The COVID-19 pandemic has affected participant physical activity levels. Supervised classes were the most popular (pre-pandemic), with enforced leisure centre closures prompting this reduction. The pandemic has negatively affected the psychosocial wellbeing (mental health) of participants, compounded by the restrictions imposed on the traditional delivery of MMNI. This impact is felt equally across cancer types. Participants with breast cancer are the most engaged in using digital technology to access exercise. Although underrepresented, men require greater targeting to ensure equality in access to online services.

Background: Patients with resectable pancreatic ductal adenocarcinoma (PDAC), undergoing adjuvant chemotherapy can experience an array of complications including fatigue, pain and the loss of physical function. Accumulating evidence from largely early stage breast cancer studies supports exercise as an adjunct therapy to help mitigate treatment complications. However, there is a lack of evidence of its feasibility in pancreatic cancer. The purpose of this study is to explore the initial feasibility of delivering a supervised, individualized, and progressive concurrent exercise intervention to individuals with resectable PDAC who are undergoing adjuvant therapy. Methodology: Ten patients with resectable PDAC undergoing adjuvant chemotherapy will be recruited. Clinical care teams will screen patients against inclusion criteria to determine eligibility. All enrolled participants will complete a 16-week, supervised, tailored, moderate intensity exercise intervention consisting of aerobic and muscle strengthening activities. The primary outcome will be feasibility of delivering a supervised exercise intervention. Secondary outcomes will include measures of physical fitness, fatigue, and quality of life. Outcomes will be measured at baseline (T1), 16 weeks (T2) and 3 months (T3). The feasibility, acceptability and potential utility of the supervised exercise intervention will be explored qualitatively through semi-structured interviews with key stakeholders (e.g. active participants, eligible participants that declined participation and the research staff including exercise physiologists and recruiting clinicians). The use of health and social care services, medications and personal expenses incurred during the trial will also be used to determine cost-effectiveness of this intervention and a potential further RCT in PDAC. Discussion: The overall aim of this study is to determine the utility of a supervised, tailored, moderate intensity exercise intervention in PDAC patients undergoing adjuvant chemotherapy. This feasibility study will help inform the design of future randomised controlled trials to determine the efficacy of the exercise intervention in PDAC.

Background: Due to limited resources in hospitals and social and cultural norms regarding caregiving in Vietnam, carers provide a range of supportive functions for family members diagnosed with cancer. This paper provides empirical evidence on the self-identified unmet needs of carers of inpatients in national oncology hospitals in Vietnam.Methods: An international, multidisciplinary research team conducted focus group and in-depth interviews with informal carers (n=20) and health care providers (n=22) and collaboratively analysed the results using thematic content analysis.Results: Thematic content analysis highlighted four main areas of needs: (i) material requirements such as accessible and comfortable facilities, accommodation and finance; (ii) information needs about cancer, caring, and nutrition; (iii) emotional support; and (iv) training about how to provide care to their family members during (a) treatment and (b) recovery phases.Conclusions: Carers provide invaluable support in supporting people with a cancer diagnosis, particularly given wider systemic challenges in delivering cancer services in Vietnam. Increasing visibility and formal support is likely to have both a positive impact upon the health and wellbeing of carers, as well as for cancer patients under their care.

Methods:Cancer carers and health care professionals' perspectives regarding information and support needs and the content and delivery of web‐based supports, were explored via five focus groups (n = 39) and semistructured interviews (n = 4) in Vietnam in 2018. Focus groups and interviews were transcribed verbatim and analyzed using thematic analysis. Resource components were verified at two joint stakeholder workshops attended by 40 participants.Vietnam, like many low/middle income countries, lacks the infrastructure to provide information and psychosocial support to cancer patients and their carers. We undertook a codesign process to develop a web resource to inform and support carers.Results:The development of a web‐based resource was identified as an urgent need. A web‐based resource was viewed as a suitable interface to provide support across regions in a sustainable way. The structure of the resource should include peer‐led videoed advice, signposting to services and include official endorsement. The potential resource components identified includes (a) cancer causes and consequences; (b) hospital administration, treatment processes, and prices; (c) daily living; (d) emotional and supportive information; (e) skills training; and (f) nutrition and traditional medicine.Conclusion:The development of a web‐based resource to deliver information and psychosocial supports to cancer carers and by‐proxy patients is an urgent requirement in Vietnam. Next steps will include resource development and testing the resources ability to address the unmet needs of cancer carers and patients. A web‐based resource to support cancer carers has the potential for application to other developing countries.

Worldwide cancer incidence is increasing, with viral infections including human papillomavirus (HPV) responsible for a significantly higher number of cancer deaths in low- and middle-income countries (LMICs) when compared to high income countries. Globally, in 2015, there were 72 national HPV vaccination programmes, and 39 demonstration or pilot programmes. Despite HPV’s impact on both sexes, for examples in malignancies such as oropharyngeal cancer (whose incidence is increasing across the world) few countries have a gender-neutral vaccination policy. Herd protection and cost-effectiveness are important considerations in potential extension of vaccination to males and while there is some suggestion that a targeted vaccination programmes for “high risk” groups, such as men-who-have-sex-with-men (MSM) may be preferable, a universal vaccination approach is the best solution to protect both men and women from HPV-related cancer and sexually transmitted disease. Higher incidence of certain HPV-related male cancers, lack of effective treatment, high prevalence of HIV, attitudes to MSM and sexual orientation, all support a universal vaccination strategy for LMICs. Thus, policy-makers and healthcare providers in LMICs need to take timely decisions to “prevent the preventable” by providing vaccination for both girls and boys.

Introduction Dysregulated lipid metabolism is a hallmark of prostate cancer. Furthermore, use of the cholesterol lowering statin drugs has been linked to a reduced risk of lethal prostate cancer. To understand the molecular pathways implicated in this relationship, we examined the association between differential expression of genes involved in intratumoral cholesterol metabolism in prostate tumor biopsies and prostate cancer-specific outcomes. Methods Tumor biopsy gene expression data from 242 men diagnosed with localized/locally advanced prostate cancer and treated with radiotherapy and androgen deprivation therapy was analyzed. A total of 71 genes involved in cholesterol transport, biosynthesis and regulation were selected from the Reactome pathway database, with additional genes involved in cholesterol metabolism extracted from literature. For each gene, expression levels were dichotomized by median expression level. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for associations of gene expression with biochemical recurrence and metastasis. Models were adjusted for age at diagnosis and Gleason score. Multiple-testing correction was performed using the Bonferroni correction method. Results During a median follow-up of 10.4 years, 72 (30%) patients experienced biochemical recurrence and 32 (13%) developed metastatic disease. Differential expression of several genes was found to be associated with risk of biochemical recurrence and metastasis, though none remained statistically significant following Bonferroni correction. However, several genes showed similar patterns of association with risk of biochemical recurrence and of metastasis, an association which remained similar following adjustment for age and Gleason score. Low (below median) expression of FDFT1, a gene encoding squalene synthase, a key enzyme in cholesterol biosynthesis, was associated with an increased risk of biochemical recurrence (HR 1.87; 95% CI, 1.15-3.01) and metastasis (HR 3.52; 95% CI, 1.52-8.16). High (above median) expression of SLCO1B3, a gene encoding an organic anion transporting polypeptide transporting a variety of small molecules including statins, was associated with higher risk of biochemical recurrence (HR 2.14; 95% CI, 1.31-3.49) and metastasis (HR 2.70; 95% CI, 1.25-5.90). Conclusion These hypothesis-generating results point to a potential role for altered intratumoral cholesterol metabolism in prostate cancer-specific outcomes. Our findings highlighting differential expression of FDFT1 and SLCO1B3, genes involved in cholesterol biosynthesis and anion transport, respectively, in association with risk of biochemical recurrence and metastasis may provide clues as to the mechanistic pathways of most importance. Validation in other prostate cancer gene expression datasets is required. Citation Format: Sarah J. Winter, Sophia Halliday, Konrad H. Stopsack, Sarah O. Osman, Alan R. Hounsell, Gillian Prue, Suneil Jain, Emma H. Allott. Cholesterol metabolism gene expression and prostate cancer-specific outcomes in radiotherapy-treated patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 162.

In Canada, the human papillomavirus (HPV) vaccine is licensed and recommended for females and males. Although all Canadian jurisdictions fund school-based HPV vaccine programs for girls, only six jurisdictions fund school-based HPV vaccination for boys. The research aimed to analyze the factors that underpin government decisions to fund HPV vaccine for boys using a theoretical policy model, Kingdon's Multiple Streams framework. This approach assesses policy development by examining three concurrent, but independent, streams that guide analysis: Problem Stream, Policy Stream, and Politics Stream. Analysis from the Problem Stream highlights that males are affected by HPV-related diseases and are involved in transmitting HPV infection to their sexual partners. Policy Stream analysis makes clear that while the inclusion of males in HPV vaccine programs is suitable, equitable, and acceptable; there is debate regarding cost-effectiveness. Politics Stream analysis identifies the perspectives of six different stakeholder groups and highlights the contribution of government officials at the provincial and territorial level. Kingdon's Multiple Streams framework helps clarify the opportunities and barriers for HPV vaccine policy change. This analysis identified that the interpretation of cost-effectiveness models and advocacy of stakeholders such as citizen-advocates and HPV-affected politicians have been particularly important in galvanizing policy change.

Aim The aim of this paper is to report the process evaluation of facilitators’ delivery of a psychosocial intervention (called CONNECT), in a randomised controlled trial, to men with prostate cancer and their partners. Background There is a lack of information on the process of implementing psychosocial interventions in controlled trials and, in particular, on the role and performance of facilitators who deliver them. Yet this information is crucial in assessing whether these interventions are effective or not and why. Methods Semi-structured qualitative interviews and diaries were used to collect data (January - October 2012) from four facilitators and a co-facilitator. Data were analysed using the Miles et al. framework. Results Five themes were discernible. These were ‘difficulties to keep to the structure of the intervention’, ‘selective coverage of topics’, ‘partner participation’, ‘overall impression of the group and telephone sessions’ and ‘perceived benefits to participants’. Issues such as not keeping to the aim of the intervention, deviating from the content and/or reluctance in discussing sensitive issues such as sexual health may mean that the psychosocial effects of the intervention may not have been fully realised. Conclusions These findings will be useful for further development and evaluation of the intervention. A tentative conceptual framework of factors, related to facilitators, influencing the fidelity of interventions in the context of controlled trials, is offered. This model, which requires further development and testing, will be useful for researchers worldwide who are involved in developing interventions and training facilitators. This article is protected by copyright. All rights reserved.

Objective Active surveillance (AS) allows men with favorable-risk prostate cancer to avoid or postpone active treatment and hence spares potential adverse effects for a significant proportion of these patients. Active surveillance may create an additional emotional burden for these patients. The aim of the review was to determine the psychological impact of AS to inform future study in this area and to provide recommendations for clinical practice. Methods Studies were identified through database searching from inception to September 2015. Quantitative or qualitative noninterventional studies published in English that assessed the psychological impact of AS were included. The Mixed Methods Appraisal Tool was used to assess methodological quality. Results Twenty-three papers were included (20 quantitative and 3 qualitative). Quantitatively, the majority of patients do not report psychological difficulties; however, when appropriateness of study design is considered, the conclusion that AS has minimal impact on well-being may not be accurate. This is due to small sample sizes, inappropriately timed baseline, and inappropriate/lack of comparison groups. In addition, a mismatch in outcome was noted between the outcome of quantitative and qualitative studies in uncertainty, with qualitative studies indicating a greater psychological impact. Conclusions Because of methodological concerns, many quantitative studies may not provide a true account of the burden of AS. Further mixed-methods studies are necessary to address the limitations highlighted and to provide clarity on the impact of AS. Practitioners should be aware that despite findings of previous reviews, patients may require additional emotional support.

AimTo determine HPV and HPV vaccine awareness, knowledge and acceptance in male adolescents worldwide.MethodsA mixed methods systematic review was conducted. In accordance with PRISMA guidelines, relevant literature was identified through an electronic database search using specified keywords from inception to September 2015. Non-interventional studies presented in English that assessed HPV knowledge and provided data on male adolescents were included. If available, data on HPV and HPV vaccine perceptions, attitudes and/or HPV vaccine acceptance were also extracted. All studies were critically appraised to provide an indication of methodological quality. Results were compiled using a convergent synthesis.Results22 papers were included. The majority of studies were cross-sectional and conducted in the US and Europe. Across continents, regardless of a country’s HPV vaccination programme status, boys’ knowledge of HPV and/or HPV vaccination was generally low to moderate and significantly lower than female knowledge or awareness. There was a disagreement in the association of knowledge and vaccine acceptance, with higher knowledge not always being predictive of acceptance.ConclusionsComparison and synthesis of research concerning HPV knowledge and attitudes was made difficult due to the lack of universal definition of vaccine acceptance, and no universally accepted tool for its measurement or for the measurement of HPV knowledge. It is imperative that future research utilises consistent measures of HPV knowledge and attitudes to facilitate interpretation and comparison across studies internationally. Prospective longitudinal studies would be more informative providing data on factors that influenced the move from vaccine intention to uptake.

Objective This study aimed to explore the psychological impact of favorable-risk prostate cancer (PCa) and associated treatment (active surveillance [AS] or active treatment [AT]), comparing prevalence and temporal variability of generalized anxiety, PCa-specific anxiety, and depression symptoms. Methods PCa patients were recruited at diagnosis prior to treatment decision-making and completed questionnaires assessing anxiety (State-Trait Anxiety Inventory short form [STAI-6] and Memorial Anxiety Scale for Prostate Cancer [MAX-PC]) and depression symptoms (Centre for Epidemiologic Studies Depression Scale [CES-D]) at four timepoints for 9 months. Non-cancer controls were recruited via university staff lists and community groups. Results were analyzed using analysis of variance. Results Fifty-four PCa (AS n = 11, AT n = 43) and 53 non-cancer participants were recruited. The main effect of time or treatment group were not statistically significant for CES-D scores (P > .05). The main effect of treatment on STAI-6 scores was significant (F2,73 = 4.678, .012) with AS patients reporting highest STAI-6 scores (T1 M = 36.56; T2 M = 36.89, T3 M = 38.46; T4 M = 38.89). There was a significant main effect for time since diagnosis on MAX-PC (F3,123 = 3.68, .01); AS patient scored higher than AT at all timepoints (T1 M = 10.33 vs 10.78; T2 M = 11.11 vs 11.30; T3 M = 13.44 vs 10.55; T4 M = 11.33 vs 8.88); however, both groups declined overall with time. Conclusions Men undergoing AS had significantly higher anxiety symptoms than AT and non-cancer participants, contradicting previous literature. This may be due to perceived inactivity of AS relative to traditional narratives of cancer treatment. Participant experiences appear to be less favorable relative to other international centers. Recommendations for future research and clinical practice include the need to improve diagnosis and treatment information provision particularly for lower risk patients.

BackgroundIncreasingly, cancer is recognised as a chronic condition with a growing population of informal caregivers providing care for cancer patients. Informal caregiving can negatively affect the health and well‐being of caregivers. We need a synthesised account of best evidence to aid decision‐making about effective ways to support caregivers for individuals 'living with cancer'.ObjectivesTo assess the effectiveness of psychosocial interventions designed to improve the quality of life (QoL), physical health and well‐being of informal caregivers of people living with cancer compared with usual care.Search methodsWe searched CENTRAL, MEDLINE, Embase, PsycINFO, ProQuest, Open SIGLE, Web of Science from inception up to January 2018, trial registries and citation lists of included studies.Selection criteriaWe included randomised and quasi‐randomised controlled trials comparing psychosocial interventions delivered to adult informal caregivers of adults affected by cancer on a group or individual basis with usual care. Psychosocial interventions included non‐pharmacological interventions that involved an interpersonal relationship between caregivers and healthcare professionals. We included interventions delivered also to caregiver‐patient dyads. Interventions delivered to caregivers of individuals receiving palliative or inpatient care were excluded. Our primary outcome was caregiver QoL. Secondary outcomes included patient QoL, caregiver and patient depression, anxiety, psychological distress, physical health status and intervention satisfaction and adverse effects.Data collection and analysisPairs of review authors independently screened studies for eligibility, extracted data and conducted 'Risk of bias' assessments. We synthesised findings using meta‐analysis, where possible, and reported remaining results in a narrative synthesis.Main resultsNineteen trials (n = 3, 725) were included in the review. All trials were reported in English and were undertaken in high‐income countries. Trials targeted caregivers of patients affected by a number of cancers spanning newly diagnosed patients, patients awaiting treatment, patients who were being treated currently and individuals post‐treatment. Most trials delivered interventions to caregiver‐patient dyads (predominantly spousal dyads) and there was variation in intervention delivery to groups or individual participants. There was much heterogeneity across interventions though the majority were defined as psycho‐educational. All trials were rated as being at 'high risk of bias'.Compared to usual care, psychosocial interventions may improve slightly caregiver QoL immediately post intervention (standardised mean difference (SMD) 0.29, 95% confidence interval (CI) 0.04 to 0.53; studies = 2, 265 participants) and may have little to no effect on caregiver QoL at 12 months (SMD 0.14, 95% CI ‐ 0.11 to 0.40; studies = 2, 239 participants) post‐intervention (both low‐quality evidence).Psychosocial interventions probably have little to no effect on caregiver depression immediately to one‐month post‐intervention (SMD 0.01, 95% CI ‐0.14 to 0.15; studies = 9, 702 participants) (moderate‐quality evidence). Psychosocial interventions may have little to no effect on caregiver anxiety immediately post‐intervention (SMD ‐0.12, 95 % CI ‐0.33 to 0.10; studies = 5, 329 participants), depression three‐to‐six months (SMD 0.03, 95% CI ‐0.33 to 0.38; studies = 5. 379 participants) post‐intervention and patient QoL six to 12 months (SMD ‐0.05, 95% CI ‐0.37 to 0.26; studies = 3, 294 participants) post‐intervention (all low‐quality evidence). There was uncertainty whether psychosocial interventions improve patient QoL immediately (SMD ‐0.03, 95 %CI ‐0.50 to 0.44; studies = 2, 292 participants) or caregiver anxiety three‐to‐six months (SMD‐0.25, 95% CI ‐0.64 to 0.13; studies = 4, 272 participants) post‐intervention (both very low‐quality evidence). Two studies which could not be pooled in a meta‐analysis for caregiver physical health status found little to no effect immediately post‐intervention and a small intervention effect 12 months post‐intervention. Caregiver or patient satisfaction or cost‐effectiveness of interventions were not assessed in any studies. Interventions demonstrated good feasibility and acceptability.Psychosocial interventions probably have little to no effect on patient physical health status immediately post‐intervention (SMD 0.17, 95 % CI ‐0.07 to 0.41; studies = 4, 461 participants) and patient depression three to six months post‐intervention (SMD‐0.11, 95% CI ‐0.33 to 0.12; studies = 6, 534 participants) (both moderate‐quality evidence).Psychosocial interventions may have little to no effect on caregiver psychological distress immediately to one‐month (SMD ‐0.08, 95% CI ‐0.42 to 0.26; studies = 3, 134 participants), and seven to 12 months (SMD 0.08, 95% CI ‐0.42 to 0.58; studies = 2, 62 participants) post‐intervention; patient depression immediately (SMD ‐0.12, 95% CI ‐0.31 to 0.07; studies = 9, 852 participants); anxiety immediately (SMD ‐0.13, 95% CI ‐0.41 to 0.15;studies = 4, 422 participants), and three to six months (SMD ‐0.22, 95% CI ‐0.45 to 0.02; studies = 4, 370 participants); psychological distress immediately (SMD ‐0.02, 95% CI ‐0.47 to 0.44; studies = 2, 74 participants) and seven to 12 months (SMD ‐0.27, 95% CI ‐0.78 to 0.24; studies = 2, 61 participants); and physical health status six to 12 months (SMD 0.06, 95% CI ‐0.18 to 0.30; studies = 2, 275 participants) post‐intervention (all low‐quality evidence).Three trials reported adverse effects associated with the interventions, compared with usual care, including higher distress, sexual function‐related distress and lower relationship satisfaction levels for caregivers, higher distress levels for patients, and that some content was perceived as insensitive to some participants.Trials not able to be pooled in a meta‐analysis did not tend to report effect size and it was difficult to discern intervention effectiveness. Variable intervention effects were reported for patient and caregiver outcomes.Authors' conclusionsHeterogeneity across studies makes it difficult to draw firm conclusions regarding the effectiveness of psychosocial interventions for this population. There is an immediate need for rigorous trials with process evaluations and clearer, detailed intervention descriptions. Cost‐effectiveness studies should be conducted alongside future trials.

Men with metastatic castrate-resistant prostate cancer can experience an array of treatment-related side effects. Accumulating evidence suggests exercise may alleviate some of these adversities and assist in disease management. However, empirical evidence in advanced prostate cancer patients remains limited. The purpose of this study is to determine whether men with metastatic prostate cancer, who are ineligible for high-intensity exercise, can partake in a home-based, moderate-intensity exercise program and the impact of doing so on quality of life and physical fitness parameters. Thirty men with adenocarcinoma of the prostate and progressive systemic, metastatic disease will be recruited. Clinicians will screen patients against inclusion criteria to determine eligibility. All men enrolled will be prescribed a tailored, home-based, moderate-intensity exercise intervention consisting of aerobic and strengthening components for 12 weeks. Patients will receive supplementary education materials and weekly behavioural change consultations throughout the intervention. The primary outcome will be the feasibility of delivering such an intervention in men with metastatic disease. Secondary endpoints including skeletal events will be monitored for safety, as will the feasibility of patient-reported outcome measures and the sampling time points, generating data pertaining to completion rates and potential effect in future trials. General physical fitness will be assessed during these visits, using timed sit-to-stand testing and a 6-min walking test. Prior to each visit, objective physical activity levels will be captured for 7 days using an accelerometer, to determine the feasibility of this technology and the quality of data obtained. In parallel with the feasibility aspects of the trial, changes compared to baseline will be reported. Direct regular contact will also serve as a feedback loop, should any issues arise. This study has received ethical approval from the Office for Research Ethics Committees Northern Ireland. This study aims to determine the potential utility of a home-based exercise intervention in managing side effects associated with advanced prostate cancer and its treatment. This feasibility trial will inform the design and implementation of a larger randomised control trial to determine the efficacy of moderate aerobic and strengthening exercise as an adjuvant therapy in men with metastatic prostate cancer. Collecting such evidence provides further support for exercise in this paradigm and potential for its inclusion as a low-toxicity therapy in standard cancer care, in the longer term. ClinicalTrials.gov, NCT03658486 Trial sponsor: Queen’s University Belfast (Reference: B18/15). Contact: Dr. Paula Tighe, Research and Enterprise, Queen’s University Belfast. Telephone: 02890 973,296. Email: p.tighe@qub.ac.uk . The sponsor reviewed the protocol and ethical application prior to submission. Protocol issue: Version 1 (18th May 2018). Authors: MB, MM, SJ and GP.

www.trendsinmenshealth.com TRENDS IN UROLOGY & MEN’S HEALTH JANUARY/FEBRUARY 2016 Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide, so predominant and so easily acquired that nearly all sexually active men and women will be exposed to the virus at some point in their lives. The rate of genital HPV infection is similar in males and females; however, males have a lower immune response to natural HPV infection than their female counterparts,1 meaning that there is not the same association between age and HPV prevalence in men as there is in women. In women, HPV prevalence peaks between 18–24 years and subsequently declines.2 In contrast, in men, there is a consistently higher prevalence of HPV.3

The American Academy of Paediatrics (AAP) divides adolescence into early (12-14 years), middle (15-17 years), and late (18-21 years) stages. School-based HPV educational interventions are largely directed at parents of early adolescents at the time of vaccination. As the average age of first sexual intercourse in high income countries is 15-17 years old, a second educational intervention for middle adolescents could have a strong impact on HPV prevention, providing an opportunity for self consenting to HPV vaccination in many countries. This paper appraises literature exploring the impact of school-based educational interventions in 15-17 year olds, on HPV vaccination uptake and/or perceptions/knowledge of HPV and its associated cancers. Randomised controlled trials (RCTs) and quasi-experimental designs (QEDs) (2007-2019) were included if they delivered a school-based educational intervention for 15-17 year olds, and the outcome measures included HPV vaccination uptake, knowledge of HPV and associated cancers or perception/attitude regarding self-protection against HPV. Fifteen studies met the inclusion criteria and were assessed for quality using the Quality Assessment Tool for Quantitative Studies. All studies demonstrated a statistically significant improvement in at least one major outcome measure postintervention, despite the wide range in design of interventions, though only three studies actually measured changes to HPV vaccination uptake. Stakeholder engagement was absent in most intervention designs and many were not rounded in evidenced theory. Content was largely focused on female cervical cancer, rarely discussing oropharyngeal cancer, the most pre-dominant HPV-associated cancer in men. An optimal mixed gender intervention remains to be established for middle adolescents.

AIM: Little is known about how patient groups provide information for patients. We invited 838 patient groups from Europe and North America to participate in an online survey.METHODS: The survey covered: (i) availability, accessibility and quality of information provided; (ii) methods by which patient groups communicate; (iii) ways in which patient groups acquire information and confirm its veracity/accuracy; (iv) how people access information online.RESULTS: European patient groups were significantly less effective in providing medical-related information than their North American counterparts in: clinical trials, potential causes of cancer, medical research, diagnosis/screening, symptoms, treatments (all p < 0.0001); Recommendations of best practice/care (p < 0.03), healthcare services(p = 0.029) and complimentary medicine (p = 0.01). Clinical trials (p = 0.0006), medical research (p = 0.006) and diagnosis/screening (p = 0.0024) were also areas where North American patients were more likely to require medical-related information. Similar patterns emerged for non-medical information with nutrition (CONCLUSION: These results emphasise the more mature nature of cancer patient engagement/information provision in North America, providing valuable insights and guidance to inform development of more robust and effective cancer patient information communication platforms in Europe.

Literature has shown that participation in physical activity is associated with a reduction in the incidence of certain cancers. Physical activity levels across the life course are low. Since cellular damage from an inactive lifestyle accumulates over time, promoting physical activity from childhood is fundamental for cancer prevention. To date, interventions to promote physical activity in children have been unsuccessful over the long term. Physical activity can be accrued through several domains including sport and active play. Research suggests that sport participation and not active play tracks from childhood to adulthood. Active play may be easier to promote because it does not necessitate a certain level of skill or competency, and is enjoyable. The purpose of the present paper is to encourage more research into all areas of active play to increase population physical activity levels across the life course and thus aid in the prevention of specific cancers.

Objective Cancer may impact negatively on an informal caregiver's health long after treatment has ended. This review identifies the self-report measures currently in use to measure caregivers need for support and determines their scientific soundness and clinical utility. Method A systematic electronic database search of Medline, CINAHL, PsychINFO, BNI ProQuest was conducted. The psychometric properties and clinical utility of needs assessment tools for caregivers of cancer survivors (excluding advanced disease) were extracted and summarised. Results Seven cancer survivor caregiver needs assessment tools were identified. Data on instrument development was well reported, although variability was noted in their structure and content. The majority demonstrated some degree of reliability and validity; only two were evaluated for test–retest reliability (CaSPUN and SPUNS) with only the SPUNS showing a high degree of reliability over time. The Health Care Needs Survey (HCNS), Needs Assessment of Family Caregivers-Cancer (NAFC-C) and Cancer Caregiving Tasks Consequences and Needs Questionnaire (CaTCoN) have been validated at various stages of the cancer continuum. Minimal data was available on responsiveness. Conclusion All assessment tools identified require further psychometric analysis. For research purposes, the use of the SPUNS (with its acceptable test–retest reliability) appears most appropriate; although its length may be of concern for clinical use; therefore, the shorter SCNS-PC however, it requires further psychometric testing before it can be fully recommended. Further analysis is necessary on ideal response formats and the meaning of a total needs score. Copyright © 2014 John Wiley & Sons, Ltd.

Human papillomavirus (HPV) vaccination programmes in the UK were established in 2008, and targeted females aged 12–13 years. This decision was based on recommendations from the Joint Committee for Vaccination and Immunisation (JCVI), after assessing the available evidence for the impact and cost effectiveness of HPV vaccination programmes. The theory was that reducing HPV rates in females would result in lower infection rates in males of a similar age. This herd immunity did not extend to men-who-have-sex-with-men (MSM) or heterosexual men having sex abroad. Public Health England (PHE) undertook a trial of a targeted HPV vaccination programme for MSM in 2016–2017. The 12-month pilot involved MSM up to 45 years of age being offered Gardasil® 4, a quadrivalent HPV vaccine, through genitourinary medicine (GUM) and HIV clinics across England. GPs were not included in the pilot as there was insufficient evidence of acceptability and effective delivery. The pilot was reported as a success, and PHE has recommended rolling out this programme across England.1 The JCVI issued an interim statement regarding extending HPV immunisation to adolescent males in July 2017, again concluding that there was insufficient evidence for benefit in males.2 However, after strong responses through stakeholder consultations, continued pressure from lobby groups such as HPV Action (www.hpvaction.org), and further analysis of the latest research, the JCVI recently (18 July 2018) recommended extending the HPV vaccination programme to adolescent males.3 HPV is a major cause of infection-related cancers. It is associated with cervical, anal, oropharyngeal, penile, vulval and vaginal …

ObjectivesMen who have sex with men (MSM) are at greater risk for human papillomavirus (HPV)-associated cancers. Since 2016, MSM have been offered the HPV vaccination, which is most effective when received prior to sexual debut, at genitourinary medicine clinics in the UK. In September 2019, the national HPV vaccination programme will be extended to boys. This study aimed to understand young MSM’s (YMSM) knowledge and attitudes towards HPV vaccination.DesignQuestionnaires assessed YMSM demographics, sexual behaviour, culture, knowledge and attitudes towards HPV vaccination and stage of vaccine decision-making using the precaution adoption process model. Focus groups explored sexual health information sources, attitudes, barriers and facilitators to vaccination and strategies to support vaccination uptake. Questionnaire data were analysed using descriptive statistics and focus group data were analysed thematically.SettingQuestionnaires were completed online or on paper. Focus groups were conducted within Lesbian Gay Bisexual Transgender Queer organisational settings and a university student’s union in England and Northern Ireland.ParticipantsSeventeen YMSM (M=20.5 years) participated in four focus groups and 51 (M=21.1 years) completed questionnaires.ResultsOver half of YMSM were aware of HPV (54.9%), yet few (21.6%) had previously discussed vaccination with a healthcare professional (HCP). Thematic analyses found YMSM were willing to receive the HPV vaccine. Vaccination programmes requiring YMSM to request the vaccine, particularly prior to sexual orientation disclosure to family and friends, were viewed as unfeasible. Educational campaigns explaining vaccine benefits were indicated as a way to encourage uptake.ConclusionsThis study suggests that to effectively implement HPV vaccination for YMSM, this population requires clearer information and greater discussion with their HCP. In support of the decision made by the Joint Committee on Vaccination and Immunisation, universal vaccination is the most feasible and equitable option. However, the absence of a catch-up programme will leave a significant number of YMSM at risk of HPV infection.