Cancer Charity Research Articles

The semiotics of breast cancer: Signs, symptoms, and sales

Abstract This paper analyses the immunological response of breast cancer patients through the lens of medical semiotics. From this perspective both psychological and physiological symptoms are treated as a set of transitive signs. The symptomatic journey of breast cancer patients was documented through an ethnographic engagement with a breast cancer charity. This journey consists of diagnosis, treatment and remission, where both the physical and psychological trauma maybe irreversible. Equally the genetic disposition of each patient and the variability of the treatment give rise to a plethora of possible immunological responses. The case study organization provided both therapeutic treatment but also sold oncology products to its patients, matching the products’ composition to the specific immunological responses caused by breast cancer treatment, e.g., brittle skins or hair loss, etc. This paper explores how the varied and transient nature of immunological semiosis is identified and commoditized into an economic process. This challenging social context is of interest from a semiotic stand point because it offers a singular paradigm to explain the evolution of signs and symptoms into sales.

RPS Fellow Alastair McMurray runs 30 half-marathons in 30 days to raise money for cancer charities

RPS Fellow Alastair McMurray runs 30 half-marathons in 30 days to raise money for cancer charities

Representations of Young Cancer Survivorship: A Discourse Analysis of Online Presentations of Self.

More young people are surviving treatment for cancer than ever before. Survival can have an adverse impact on their transition to adulthood. Discourses of cancer are applied to cancer survivors of all ages, but they manifest differently for young people. The aim of this study was to describe practices of self-representation in an online Web site that supports young Australian cancer survivors. We conducted a discourse analysis of images and text produced by young cancer survivors (aged 18-35 years) on a public cancer charity Web site. The dominant subject position of participants published on this web site is one of empowered, beautiful cancer survivor. This applies to young people who have learned to embrace their cancer as providing a positive influence on their lives. However, this discourse can marginalize those whose cancer experience remains a source of distress or shame. Web based media can provide a valuable forum for some young people to celebrate their cancer survival and to affirm the constructive influence that their cancer experience has had on their lives. However, we ponder the apparent unsuitability of some forums for young cancer survivors who have not yet found cause for celebration. Nurses have the opportunity to contribute to the development of supportive structures that meet the specific needs of different groups of young cancer survivors. This might mean assisting young cancer survivors who are struggling to find meaning in their cancer experience to negotiate the establishment of a new normal that they can embrace.

Online accounts of gene expression profiling in early-stage breast cancer: Interpreting genomic testing for chemotherapy decision making.

BackgroundGenomic techniques are being developed within oncology and beginning to be experienced within routine cancer care. Little is known about how these tools feature in patients’ experiences of treatment decision making.ObjectiveThis research explores the ways in which women interpret and discuss gene expression profiling for breast cancer treatment decision making, as articulated within online accounts.DesignThis study used a qualitative approach to analyse written exchanges focusing on gene expression profiling in the UK (Oncotype DX test). Accounts are taken from online forums hosted by two UK cancer charity websites, comprising 132 discussion threads from a total of seven forums. Authors qualitatively analysed the data and developed key themes drawing on existing literature from medical sociology.FindingsWomen used online spaces to share and discuss results of gene expression profiling. Women interpreted results in the context of indirect experience of cancer treatment, and sociocultural depictions of cancer and chemotherapy. Users largely represented the test positively, emphasizing its ability to “personalize” treatment pathways, though many also pointed to inherent uncertainties with regards the possibility of cancer recurrence.Discussion and ConclusionsWe highlight the complex contexts in which genomic techniques are experienced, with these shaped by personal biographies, online environments and pervasive cultural narratives of cancer and its treatment. We highlight tensions between the claims of genomic testing to aid treatment decision making and patient reflections on the capability of these techniques to resolve uncertainties surrounding treatment decisions.

1K4Cancer Breaks the Silence: A Crowd-Funding Campaign by Sebeccly Cancer Care

Amount raised: The 1K4Cancer campaign raised a total of $18,099. Background and context: Poverty, chronicity of spending, paying out-of-pocket for health care needs, and the prohibitive cost of cancer drugs are some of the reasons cancer patients don't start or complete treatment. Over 90% of Nigerian cancer patients pay for healthcare expenses out-of-pocket; putting a heavy strain on their finances and those of their caregivers. Sebeccly is a cancer charity that enables cancer care access to indigent cancer patients through several fundraising modalities, one of which is the 1K4Cancer. The campaign is a cancer drug fund and crowd fundraiser that appeals for a minimum donation worth $2.50. Launched in October 2012 (for 3 months), and relaunched in March 2018, 1K4Cancer provides treatment aid to breast cancer patients. Aim: To raise funds and provide access to cancer care to indigent breast cancer patients. Strategy/Tactics: The 1K4Cancer campaign reaches out to individuals/organizations by leveraging on social media, relationship management with donors and several 1K4Cancer ambassadors to engage networks to raise funds to support cancer treatment and screening services. This strategy has an online and offline component, with the offline driving the online component. Program process: The 1K4Cancer runs under 7 broad categories: Community events: Focus on advocacy and education on cancer prevention and early detection. Health talks and the 1K4Cancer appeal are delivered during community outreaches. Online community engagements: partnerships with online blogs and influencers to promote the campaign were secured. The social media community was engaged in heartwarming messages and call-to-action statements to support indigent cancer patients. Media partnership: partnerships with online and traditional media houses were secured. The 1K4Cancer message was published on several eminent blogs. Relationship management with donors: past and prospective donors were engaged to promote the campaign. 1K4Cancer remains transparent and accountable through an online monthly newsletter. Donation collection: donations were made through online bank transfer and Sebeccly's online donation platforms. Volunteers: recruitment of 1K4Cancer volunteers who helped to promote and create more awareness about the campaign offline. Partnerships with hospitals: the beneficiaries of the campaign receive cancer care at Lagos University Teaching Hospital, and Lagos State University Teaching Hospital. Costs and returns: $2715 has been spent on online adverts, branding materials, creatives, publications, administrative charges, and logistics. Total returns so far: $15,384. What was learned: Leveraging on goodwill, accountability, the Internet, and a compelling story are necessary ingredients to a crowd-funding campaign. The 1K4Cancer is an innovative crowd-funding campaign that relieves the financial burden of cancer patients and help achieve access to quality cancer care.

Implementation Learnings From a Cancer-Prevention Multirisk Factor Public Education Campaign

Background and context: The Cancer Council New South Wales (CCNSW) is one of Australia's leading cancer charities and is uniquely 95% community funded. Cancer prevention is one of five strategic priority areas for CCNSW. An estimated to 37,000 cancer cases are preventable each year in Australia; 33% of cancers in men and 31% in women. The CCNSW developed and implemented the 1 in 3 Cancers Campaign in 2016, the first Australian multirisk factor cancer prevention campaign. This was also the organization's first experience in implementing a social marketing mass media campaign. Over two years, the campaign's primary objective was to raise awareness that one in three cancers are preventable, to highlight why preventing cancer is important and practical steps for prevention. Aim: To undertake an organizational review of internal learnings from the development, implementation and evaluation of the 1 in 3 Cancers Campaign and make recommendations for future campaign practice. Strategy/Tactics: Cross-organizational perspectives were provided from 20 Cancer Council staff from the areas of cancer prevention, research, fundraising and community engagement through a one-day workshop. Program/Policy process: Workshop participants: 1) reviewed best practice social marketing processes, 2) reviewed published evidence on mass media public education campaigns, 3) against this framework, determined internal organizational learnings from the 1 in 3 Cancers Campaign and made recommendations for future practice. Outcomes: A summary report of key lessons learnt from the implementation of the 1 in 3 Cancers Campaign and recommendations for future practice. What was learned: Areas of strengths were identified including cross-organizational collaboration, the development of an interactive cancer risk quiz, good community awareness of the campaign and key message take out. Areas for improvement included the need for greater resource investment (namely staff capacity, skills and budget), greater lead times for thorough campaign planning and the need to focus on singular behavioral cancer risk factors in communication messaging rather than multiple risk factors. The workshop concluded that well-planned, well-resourced mass media campaigns were an important evidence-based strategy for future cancer prevention practice.

Building a Weight of Evidence to Prevent Cancer in Later Life

Background: Obesity is the largest preventable risk factor for cancer in the UK after smoking. Being overweight as an adult is linked to 13 types of cancer, and overweight children are more likely to become overweight adults. Routine data shows that around one in three children leave primary school in the UK (aged 12) overweight or obese, with the children from the most deprived communities twice as likely to be so. Cancer Research UK is campaigning for restrictions on the marketing of foods high in salt sugar and fat (HFSS foods) to children as part of a comprehensive population level strategy to prevent obesity-related cancers in the future. Aim: To undertake a mixed methods program of research aimed at building a body of evidence to directly inform policy to address childhood obesity. Methods: Individual studies included: a national cross-sectional survey to investigate obesity and cancer awareness in the UK adult population; a modeling study to predict future obesity-related cancer cases; and qualitative and quantitative studies to explore obesity-linked behaviors and exposure to HFSS marketing in children. A narrative synthesis of results from individual studies was conducted to identify key themes and develop recommendations for policy. Results: Cancer was not at the forefront of people's minds when thinking about obesity, with only 26% of UK adults reporting (unprompted) awareness of the link. However, results from modeling identified that the projected impact of obesity on cancer is high: if current trends continue it will lead to a further 670,000 cases in the UK over the next 20 years. Qualitative research identified a high awareness of junk food marketing in children aged 8-19. This influenced their behavior using a variety of persuasive marketing techniques, including catchy slogans and jingles, celebrity endorsements or by referencing youth culture. Logistic regression modeling associated commercial TV screen time with an increased risk of high junk food consumption (OR 1.8, P = 0.002). Furthermore, recalling one extra broadcast advert predicted a significant increase in HFSS consumption, approximately 18,000 extra calories/person/year. Conclusion: These linked studies have informed Cancer Research UK's campaign on obesity, and results have been used to inform work with the media, coalition building and influencing. Findings that HFSS food marketing influenced children's consumption behaviors were published on the charity's lobbying day in parliament where the research was discussed with almost 170 members of parliament. To achieve further HFSS marketing restrictions, research evidence is essential to making the case for policy change and this approach from a large UK cancer charity could inform similar efforts in other countries.

Development of Bespoke and Sustainable 2-Day Cancer, Palliative, End of Life, and Bereavement Care Educational Workshops for Health Care Professionals in Nigeria

In Nigeria there is a consensus that in-country cancer services lack strategy, focus and coordination of care. This is magnified by poverty and by cultural and religious issues, resulting in the majority of patients presenting late and deemed palliative at the time of diagnosis. The Bricon Foundation, a Nigerian nongovernmental organization joined forces with Macmillan Cancer Support, a well-known established UK cancer charity to design an interactive teaching package for Nigerian health care professionals. The aim of the workshops was to share best practice in basic cancer, palliative and end of life care including bereavement support. The project concentrated on facilitating open discussions among Nigerian health care professionals about these topics including communication challenges and how to take care of themselves. The four two-day workshops were designed to identify challenges and obstacles health care professionals faced in delivering cancer and palliative care in Nigeria. They empowered participants to realize their own potential in improving the cancer experience for the patients and themselves. The cancer sessions were adapted from Macmillan cancer awareness materials that have been well evaluated in the UK. Additionally, the team developed a palliative, end of life and bereavement care study day as day two of the workshops to give participants a basic holistic overview. A team of Macmillan Alumni volunteers traveled to Nigeria to work with The Bricon Foundation team in delivering this training, which had sponsorship from NNPC, Total EPNL and partners. After each day participants completed an evaluation form. This enabled the team to adapt subsequent presentations to the Nigerian context using the feedback. The training was delivered to 91 participants from 26 government and private facilities with all 4 workshops evaluating positively. Attendees specifically valued the group work as it facilitated an exchange of ideas ensuring their voice was heard. Most expediently we were able to identify professionals drawn from different areas of healthcare who are interested in delivering future sessions on a regular basis keeping education at the forefront of cancer, palliative care and health care practice development. With further educational sessions anticipated in the near future, evaluation is on-going.

Relay for Life UAE: A 24-Hour Community Gathering for the First Time in the Mena Region and North Africa

Amount raised: 793,309.28 USD (2,913,900 AED). Background and context: Relay For Life began in the USA in May 1985 when colorectal surgeon, Dr. Gordy Klatt, wanted to raise awareness around cancer and boost his local cancer charity income. Since then, Relay For Life has become the largest fundraising event for cancer in the world. Friends of Cancer Patients launched the region´s first ever Relay For Life in Sharjah, United Arab Emirates with participation of more than 2500 people. Aim: Relay For Life UAE aims to raise awareness around cancer and spread the importance of leading a healthy life style, raise funds to support the FOCP patients mission against cancer, empower the cancer patients and create a community to support them and their families. Strategy/Tactics: Relay is a team fundraising event where members take turns walking around a track for 24 hours. Each team is asked to have a member on the track at all times to signify that cancer never sleeps. Taking place for the first time in UAE, Relay for Life gives everyone a chance to celebrate cancer survivors and carers; remember loved ones lost to cancer; and fight back by raising awareness and funds to support the work of Friends of Cancer Patients. FOCP has organized number of roadshows to explain to the different communities the concept of Relay for Life and how to be part of it. We reached to schools, universities, public events and parks, private and government organization. We offered a customized package for corporates to encourage their employees to participate as volunteers or as relayers. Furthermore, special packages for families were made to make it easy for them to join, while schools and universities student had a free entry. Program process: Press conference, to announce the date and venue of the event and explain to the media what is Relay For Life. Roadshow, to explain to the public what is Relay for Life and drive registration and donations. Opening ceremony. Survivors lap. Celebrate cancer survivors. Remember loved ones lost to cancer. Fight back by raising awareness and donations. Sponsored WiFi offered to all participants. Teams and families participating have the chance to fundraise during the event by selling items or offering services for a donation. Security all over the venue for 24 hours. ATM machine on site. Sponsored water for all participants. Food providers onsite for 24 hours. What was learned: 24 hours Relay for Life UAE has given the community a chance to create a strong community feeling with the cancer patients and their families. The most important lesson learnt was that people with no affiliation with cancer have seen the cancer survivors and how to be strong and never give up.

The Use of Systems Thinking, Systems Practice, to Elicit the Effectiveness of Cancer Support Services in the Southwest of England

This article summarises the findings of a systemic analysis of Living Well and Active's coordination and delivery of physical activity, health and well-being interventions for those living with cancer in the Southwest of England. The 16-month analysis was informed by cancer charities, consultants, healthcare professionals, local government officers, patients and physical activity health and well-being deliverers. Whilst the findings proved there were pockets of good practice such as interventions delivery, organisations were found to be operating in a fragmented way, were resource starved and struggling to make sense of the top-down imposed healthcare policy changes. This meant the cancer referral process only captured 1:10 cancer survivors who could be assisted on their pathway to normalisation. However, participants' conceptualised a different cancer referral process and a hub of practice similar to Living Well and Active to lead physical activity, health and well-being interventions, to improve the 1:10 cancer referral process.

Measuring research impact: a large cancer research funding programme in Australia

BackgroundMeasuring research impact is of critical interest to philanthropic and government funding agencies interested in ensuring that the research they fund is both scientifically excellent and has meaningful impact into health and other outcomes. The Beat Cancer Project (BCP) is a AUD $34 m cancer research funding scheme that commenced in 2011. It was initiated by an Australian charity (Cancer Council SA), and supported by the South Australian Government and the state’s major universities.MethodsThis study applied Buxton and Hanney’s Payback Framework to assess research impact generated from the BCP after 3 years of funding. Data sources were an audit of peer-reviewed publications from January 2011 to September 2014 from Web of Knowledge and a self-report survey of investigators awarded BCP research funding during its first 3 years of implementation (2011–2013). Of the 104 surveys, 92 (88%) were completed.ResultsThe BCP performed well across all five categories of the Payback Framework. In terms of knowledge production, 1257 peer-reviewed publications were generated and the mean impact factor of publishing journals increased annually. There were many benefits to future research with 21 respondents (23%) reporting career advancement, and 110 higher degrees obtained or expected (including 84 PhDs). Overall, 52% of funded projects generated tools for future research. The funded research attracted substantial further income yielding a very high rate of leverage. For every AUD $1 that the cancer charity invested, the BCP gained an additional AUD $6.06. Five projects (5%) had informed policy and 5 (5%) informed product development, with an additional 31 (34%) and 35 (38%) projects, respectively, anticipating doing so. In terms of health and sector and broader economic benefits, 8 (9%) projects had influenced practice or behaviour of health staff and 32 (34%) would reportedly to do so in the future.ConclusionsResearch impact was a priority of charity and government funders and led to a deliberate funding strategy. Emphasising research impact while maintaining rigorous, competitive processes can achieve the joint objectives of excellence in research, yielding good research impact and a high rate of leverage for philanthropic and public investment, as indicated by these early results.

"The empathy impulse: A multinomial model of intentional and unintentional empathy for pain": Correction.

Reports an error in "The empathy impulse: A multinomial model of intentional and unintentional empathy for pain" by C. Daryl Cameron, Victoria L. Spring and Andrew R. Todd (Emotion, 2017[Apr], Vol 17[3], 395-411). In this article, there was an error in the calculation of some of the effect sizes. The w effect size was manually computed incorrectly. The incorrect number of total observations was used, which affected the final effect size estimates. This computing error does not change any of the results or interpretations about model fit based on the G² statistic, or about significant differences across conditions in process parameters. Therefore, it does not change any of the hypothesis tests or conclusions. The w statistics for overall model fit should be .02 instead of .04 in Study 1, .01 instead of .02 in Study 2, .01 instead of .03 for the OIT in Study 3 (model fit for the PIT remains the same: .00), and .02 instead of .03 in Study 4. The corrected tables can be seen here: http://osf.io/qebku at the Open Science Framework site for the article. (The following abstract of the original article appeared in record 2017-01641-001.) Empathy for pain is often described as automatic. Here, we used implicit measurement and multinomial modeling to formally quantify unintentional empathy for pain: empathy that occurs despite intentions to the contrary. We developed the pain identification task (PIT), a sequential priming task wherein participants judge the painfulness of target experiences while trying to avoid the influence of prime experiences. Using multinomial modeling, we distinguished 3 component processes underlying PIT performance: empathy toward target stimuli (Intentional Empathy), empathy toward prime stimuli (Unintentional Empathy), and bias to judge target stimuli as painful (Response Bias). In Experiment 1, imposing a fast (vs. slow) response deadline uniquely reduced Intentional Empathy. In Experiment 2, inducing imagine-self (vs. imagine-other) perspective-taking uniquely increased Unintentional Empathy. In Experiment 3, Intentional and Unintentional Empathy were stronger toward targets with typical (vs. atypical) pain outcomes, suggesting that outcome information matters and that effects on the PIT are not reducible to affective priming. Typicality of pain outcomes more weakly affected task performance when target stimuli were merely categorized rather than judged for painfulness, suggesting that effects on the latter are not reducible to semantic priming. In Experiment 4, Unintentional Empathy was stronger for participants who engaged in costly donation to cancer charities, but this parameter was also high for those who donated to an objectively worse but socially more popular charity, suggesting that overly high empathy may facilitate maladaptive altruism. Theoretical and practical applications of our modeling approach for understanding variation in empathy are discussed. (PsycINFO Database Record

The acceptability and feasibility of lay‐health led interventions for the prevention and early detection of cancer

US-based evidence suggests that lay-health worker (LHW) interventions can increase awareness around cancer risk-related lifestyles, symptom recognition, and screening programme uptake. The suitability of LHW interventions in the UK and the potential barriers and facilitators for implementation is currently unknown. This study explored the acceptability and feasibility of developing LHW interventions for cancer prevention, screening, and early diagnosis. Purposive sampling recruited 5 separate lay groups: (1) completed cancer treatment; (2) friends/family of cancer patients; (3) cancer hospital volunteers; (4) cancer charity volunteers; and (5) members of the public. Audio-recorded focus groups and semi-structured interviews were transcribed for thematic analysis using framework matrices. Forty-one people (66% female, aged 23-84years) participated. Three main themes are reported: (1) scope of LHW roles, with a clear remit embedded within communities or primary care practices; (2) defining LHW tasks, with a focus on supporting people overcome barriers including lack of cancer symptom knowledge and non-attendance at screening; and (3) clear boundaries, with LHW training and on-going support from healthcare staff seen as key for intervention success. All groups were uncomfortable about having lifestyle-related risk conversations and potentially inflicting guilt. The post-treatment group expressed less concern about the possible emotional impact of discussing cancer symptoms, compared with the other groups. LHW interventions to promote early diagnosis or screening were generally considered acceptable in a UK context. LHW interventions focussing on reducing cancer risk may be less feasible.

Protocol for the trismus trial—therabite versus wooden spatula in the amelioration of trismus in patients with head and neck cancer: randomised pilot study

IntroductionPatients can develop trismus from their head and neck cancer or as a result of treatment. Trismus affects the jaw muscles and makes mouth opening difficult. To potentially combat trismus,...

A Qualitative Exploration of the Experiences and Perceptions of Women Living With a Diagnosis of Breast Cancer in Barbados: Financial Loss

Abstract 45 Background Cancer is one of the leading causes of morbidity and mortality in Latin America and the Caribbean. It is the second leading cause of death in Barbados and has an age standardized mortality rate of 117.7 and 179.3 per 100,000 in females and males, respectively. Breast cancer has the highest incidence and mortality rates for cancers among women in Barbados. Little research has been done on the factors influencing cancer survivorship in Barbados. Aims This study sought to examine the lived experiences of patients diagnosed and treated for breast cancer in Barbados with a view to identifying health system, societal and individual characteristics that facilitate or inhibit survivorship. Methods Individual, face-to-face semi-structured interviews were conducted until the point of saturation (12th interview). Participants were purposively selected with the assistance of a cancer charity on the island. All participants were female aged 27-69 years. All interviews were audio-taped and transcribed verbatim. Data was analyzed using thematic analysis with constant comparison. ATLAS.ti (8) data management software used. Results Patient survivorship was affected by a complex interaction between: a) health system characteristics b) patient characteristics (inner resilience), and c) societal acceptance (namely perceptions and experiences of stigma and social support). The results presented in this paper highlight the health system characteristics related to the financing of cancer care. Patients experienced financial hardship although primary health care is free to citizens at the point of access. Public cancer care was not always timely; with care via the private sector requiring out-of-pocket spending, this often led to catastrophic financial hardship and dependence on social networks that facilitated care access. The experience of financial loss due to personal financing of care was further exacerbated by diminished employability and job-related discrimination due to cancer diagnosis. Significance These results highlighted the need for financial support structures for cancer patients in small island developing states such as Barbados as part of universal access to health care. AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

The 'lost tribe' reconsidered: Teenagers and young adults treated for cancer in adult settings in the UK.

Although the UK has pioneered the development of specialist adolescent cancer units, the majority of teenagers and young adults (TYAs) continue to be treated at their local hospital or at a cancer centre alongside adults of all ages. This study aimed to elicit young people's views on this experience of having cancer treatment in an adult setting. Seventeen participants who had been treated for cancer in an adult hospital between the ages of 15 and 24 were recruited via cancer charities and social media. Telephone interviews were conducted with the participants and the resulting data were analysed using thematic analysis. Already feeling out of sync as a TYA with cancer, participants felt out of place in the adult setting. Four factors contributed to this negative experience: a lack of affinity with older patients; the challenging issues in the adult setting; the absence of empathy towards TYAs by staff; and the unsuitability of the environment for adolescents. Staff working with TYAs with cancer in the adult setting should be aware of the potentially detrimental impact of this environment on this cohort of patients, and consider ways of adapting and modifying their approach.

Charities’ use of Twitter: exploring social support for women living with and beyond breast cancer

ABSTRACTTwitter is one social media platform that enables those experiencing breast cancer to access support from others. This study explores how cancer charities provide support to women living with and beyond breast cancer (LWBBC) through their Twitter feeds. Seven hundred and seventy-two tweets from seven purposively sampled cancer charities were used to explore Twitter posts made relating to social support. Two questions were posed: (1) what type of support is positioned by cancer charities on Twitter for women LWBBC and (2) what themes emerge from tweet content pertaining to support for women LWBBC? Using a peer-reviewed typology of ‘social support’ [Rui, J., Chen, Y., & Damiano, A. (2013). Health organizations providing and seeking social support: A twitter-based content analysis. Cyberpsychology, Behavior, And Social Networking, 16(9), 669–673. doi:10.1089/cyber.2012.0350], a deductive content analysis was utilised to identify informational, instrumental or emotional social support tweets (n = 199). Over half (56%) of tweets offered informational support; 27% provided or sought instrumental support and 18% related to emotional support. Interestingly, 74.3% (n = 573) of tweets were not related to providing or seeking social support. An inductive qualitative thematic analysis of the 199 tweets identified the focus (i.e., themes) of support. Three themes were identified: (1) raising awareness, (2) focusing on the future and (3) sharing stories. Cancer charities predominantly use Twitter to signpost women to informational resources and to seek instrumental support to meet charitable objectives. As the number of women LWBBC continues to increase, this study provides valuable insight into how charities represent themselves on Twitter in relation to the social support needs of women LWBBC.

Integrative Whole-Person Oncology Care in the UK.

The term "whole-person cancer care"-an approach that addresses the needs of the person as well as treating the disease-is more widely understood in the United Kingdom than its synonym "integrative oncology." The National Health Service (NHS) provides free access to care for all, which makes it harder to prioritize NHS funding of whole-person medicine, where interventions may be multimodal and lacking in cost-effectiveness data. Despite this, around 30% of cancer patients are known to use some form of complementary or alternative medicine (CAM). This is virtually never medically led, and usually without the support or even the knowledge of their oncology teams, with the exception of one or two large cancer centers. UK oncology services are, however, starting to be influenced from three sides; first, by well-developed and more holistic palliative care services; second, by directives from central government via the sustainable health care agenda; and third, by increasing pressure from patient-led groups and cancer charities. CAM remains unlikely to be provided through the NHS, but nutrition, physical activity, mindfulness, and stress management are already becoming a core part of the NHS "Living With and Beyond Cancer" agenda. This supports cancer survivors into stratified pathways of care, based on individual, self-reported holistic needs and risk assessments, which are shared between health care professionals and patients. Health and well-being events are being built into cancer care pathways, designed to activate patients into self-management and support positive lifestyle change. Those with greater needs can be directed toward appropriate external providers, where many examples of innovative practice exist. These changes in policy and vision for the NHS present an opportunity for integrative oncology to develop further and to reach populations who would, in many other countries, remain underserved or hard to reach by whole-person approaches.

Individual Trade-Offs Between Possible Benefits and Risks of Cancer Treatments: Results from a Stated Preference Study with Patients with Multiple Myeloma.

The objectives of this study were to elicit the preferences of patients with multiple myeloma regarding the possible benefits and risks of cancer treatments and to illustrate how such data may be used to estimate patients' acceptance of new treatments. Patients with multiple myeloma from the cancer charity Myeloma UK were invited to participate in an online survey based on multicriteria decision analysis and swing weighting to elicit individual stated preferences for the following attributes: (a) 1-year progression-free survival (PFS, ranging from 50% to 90%), (b) mild or moderate toxicity for 2 months or longer (ranging from 85% to 45%), and (c) severe or life-threatening toxicity (ranging from 80% to 20%). A total of 560 participants completed the survey. The average weight given to PFS was 0.54, followed by 0.32 for severe or life-threatening toxicity and 0.14 for mild or moderate chronic toxicity. Participants who ranked severe or life-threatening toxicity above mild or moderate chronic toxicity (56%) were more frequently younger, working, and looking after dependent family members and had more frequently experienced severe or life-threatening side effects. The amount of weight given to PFS did not depend on any of the collected covariates. The feasibility of using the collected preference data to estimate the patients' acceptance of specific multiple myeloma treatments was demonstrated in a subsequent decision analysis example. Stated preference studies provide a systematic approach to gain knowledge about the distribution of preferences in the population and about what this implies for patients' acceptance of specific treatments. This study demonstrated how quantitative preference statements from a large group of participants can be collected through an online survey and how such information may be used to explore the acceptability of specific treatments based on the attributes studied. Results from such studies have the potential to become an important new tool for gathering patient views and studying heterogeneity in preferences in a systematic way, along with other methods, such as focus groups and expert opinions.

Transformative (h)activism: Breast cancer awareness and the "World of Warcraft" Running of the Gnomes

Players of the massively multiplayer online role-playing game World of Warcraft (WoW) are accustomed to a transformative culture that appropriates off-line events and personas into virtual-world representations inside of the game. Following this culture, players have transformed an off-line event—the Race for the Cure, to benefit breast cancer charities—into an online event called the Running of the Gnomes with parameters and participation properties appropriate for the virtual world. This transformative event is a disruptive form of civil disobedience including elements of hacktivism. Though the event conforms to the game's culture and rules, the mass collective action of the Running of the Gnomes disrupts the player experience by flooding the game's chat boxes with messages about an off-line concern (breast cancer) and also disrupts the game itself by crashing the server through the sheer volume of player participation. This disruption is embraced as an integral part of the event and is one of the primary causes for the event's success as a fundraising activity.