• An audit of primary surgical treatment for women with ovarian cancer referred to a cancer centre.

      Sengupta, P S; Jayson, Gordon C; Slade, Richard J; Eardley, Anne; Radford, John A; Cancer Research Campaign and University of Manchester Department of Medical Oncology, Christie Hospital National Health Trust, Withington, UK. (1999-05)
      Ovarian cancer is the commonest cause of gynaecological cancer death in the UK, and guidelines for initial surgery and staging of this disease are widely available. We report a retrospective audit of the surgical management of patients with newly diagnosed ovarian cancer referred to the Christie Cancer Centre in Manchester in 1996. The aim was to assess compliance with surgical guidelines. The authors found that the majority of patients (92%) presented via an outpatient clinic and for these individuals surgery was therefore elective. This mode of presentation should allow management by a small number of dedicated gynaecologists at each hospital, but up to seven consultants in each hospital performed surgery on a relatively small number of patients. Furthermore, less than half the patients underwent the recommended surgical procedure. Although some patients may have 'inoperable' disease, these data suggest that a greater compliance with national and international guidelines are required to provide an optimal level of care.
    • Breast screening among women aged 65 and over: what do they think of it?

      Eardley, Anne; Elkind, Andrea; Department of Epidemiology and Social Oncology, Christie Hospital and Holt Radium Institute, Withington, Manchester. (1991-08)
    • The concerns of patients under palliative care and a heart failure clinic are not being met.

      Anderson, Heather; Ward, Christopher M; Eardley, Anne; Gomm, S A; Connolly, M; Coppinger, T; Corgie, Delphine; Williams, J L; Makin, Wendy P; Department of Clinical Audit and Quality Assurance, Christie Hospital, Manchester, UK. (2001-07)
      Patients with a terminal illness, identified by palliative care teams working in Manchester, and patients attending a heart failure clinic, were asked to participate in a prospective survey to determine their main concerns. Data were collected from 213 palliative care (PC) patients (mostly with cancer) and 66 patients with heart failure (HF). The median ages of the two patient groups were similar, but the HF patients were more likely to be male and living with a partner; 13% of PC and 7% of HF patients reported that they had no carer. The PC patients had more district nurse, hospice, social work and physiotherapy input. The most frequently reported troublesome problems for PC patients were pain (49%), loss of independence (30%) and difficulty walking (27%). HF patients reported dyspnoea (55%), angina (32%) and tiredness (27%) as the most troublesome problems. From a checklist of symptoms, the frequency of tiredness (PC = 77%, HF = 82%) and difficulty getting about (PC = 71%, HF = 65%) were high in each group. Psychological problems were reported by 61% of PC and 41% of HF patients. Cardiac patients reported more breathlessness and cough than PC patients (83% vs 49% and 44% vs 26%, respectively). Reduced libido was more common in cardiac patients (42% vs 21%). Patient disclosure of troublesome problems to professional carers was high (>87% in both PC and HF patients). Documented action was greater for physical than social or psychological problems. For PC patients, documented action was recorded for 83% physical, 43% social/functional and 52% psychological problems. For HF patients documented action was recorded for 74% cardiac, 60% physical - non-cardiac, 30% social/functional and 28% psychological problems. Clearly many patients' troublesome problems were not being addressed. As a result of this study, specific action by health care professionals was taken in 50% of PC patients and 71% of HF patients. We plan to target specific educational events on the treatment of physical problems, psychological assessment and social service provision.
    • Consumer satisfaction with breast screening: a pilot study.

      Elkind, Andrea; Eardley, Anne; Department of Epidemiology and Social Oncology, Christie Hospital and Holt Radium Institute, Withington, Manchester. (1990-02)
      One hundred and forty-six women registered with a general practice and 84 members of health authority staff, who had attended a breast screening unit by invitation, completed a postal questionnaire about their reactions to screening. The staff of the unit also recorded their observations. The letter of invitation and accompanying health education leaflet were favourably received, and most women were glad of the opportunity offered, although some experienced anxiety. Few practical problems were reported with regard to attending the clinic. In general, the facilities in the clinic were thought to be of a high standard but specific criticisms included problems with access and privacy and feelings of claustrophobia. Some women experienced anxiety or discomfort when the mammogram was being taken, but many favourable comments were made about the helpfulness of staff. Almost all women said that they would return for screening if invited again.
    • Ethical issues in psychosocial research among patients with cancer.

      Eardley, Anne; Cribb, A; Pendleton, L; Department of Epidemiology and Social Oncology, Christie Hospital and Holt Radium Institute, Withington, Manchester, U.K. (1991)
      The ethical implications of psychosocial research among patients with cancer are discussed. Two key issues were identified: obtaining informed consent and the impact of participating in research. Barriers to obtaining genuinely informed consent are described, as well as the costs and benefits of participation in research. Recommendations are made for the conduct of future research, relating to the removal of barriers to informed consent and monitoring the impact of the research process on its subjects.
    • The fate of elderly amputees.

      Harris, P L; Read, Frances; Eardley, Anne; Charlesworth, D; Wakefield, John; Sellwood, R A; Department of Surgery, University Hospital of South Manchester, Withington Hospital, Manchester M20 8LR (1974-08)
    • Follow up policy after treatment for Hodgkin's disease: too many clinic visits and routine tests? A review of hospital records.

      Radford, John A; Eardley, Anne; Woodman, Ciaran B J; Crowther, Derek; Department of Medical Oncology, Christie Hospital NHS Trust, Manchester. (1997-02-01)
      OBJECTIVE: To examine the effectiveness of routine clinic review in detecting relapse after treatment for Hodgkin's disease. DESIGN: Review of hospital records. SETTING: Regional centre for cancer treatment and research. SUBJECTS: 210 patients with Hodgkin's disease recruited to a chemotherapy trial protocol between 1984 and the end of 1990 who had achieved a complete or partial remission after treatment. MAIN OUTCOME MEASURES: The number of clinic visits made by patients over the period of observation, the number of relapses occurring during that time, and the route by which relapse was detected. RESULTS: The 210 patients generated 2512 outpatient reviews, and 37 relapses were detected. Thirty relapses (81%) were diagnosed in patients who described symptoms, which in 15 cases had resulted in an earlier appointment being arranged. In only four cases (11%; 95% confidence interval 4% to 25%) was relapse detected as a result of routine physical examination on investigation of a patient who did not have symptoms. CONCLUSIONS: Relapse of Hodgkin's disease after treatment is usually detected as a result of the investigation of symptoms rather than by routine screening of asymptomatic patients. It is therefore proposed that the frequency of routine follow up visits should be reduced and greater emphasis placed on patient education. This should underline the importance of symptoms and encourage patients to arrange an earlier appointment if these develop.
    • How district health authorities organise cervical screening.

      Elkind, Andrea; Eardley, Anne; Thompson, Rebecca; Smith, Alwyn; Department of Epidemiology and Social Oncology, Christie Hospital and Holt Radium Institute, Manchester. (1990-10-20)
      OBJECTIVES: To examine how district health authorities organised cervical screening with respect to Department of Health guidelines and to determine their assessment of the problems encountered. DESIGN: Postal questionnaire sent to all 190 district health authorities in England in 1989. PARTICIPANTS: 190 District health authorities in England. MAIN OUTCOME MEASURES: Population coverage of screening, quality of smear testing, and follow up of abdominal test results in comparison with national guidelines for district cervical screening services, and problems encountered by districts. RESULTS: Replies were received from 178 (94%) of districts, in 143 of which the person named as responsible for cervical screening contributed. All districts implemented a computer managed scheme, 150 by the target date of 31 March 1988, but not all of these conformed with the guidelines. At the time of the survey only just over half called women in the target age group of 20-64 and only 70% expected to meet the target date of 13 March 1993 for completing the call. Considerable variation was evident among the schemes with regard to how they dealt with issues related to population coverage, quality of testing, and follow up of abnormal results. The problems most commonly identified by the districts (n = 174) were laboratory workload (107, 61%), computer software (104, 60%), availability of resources (78, 45%), non-attendance (77, 44%), rate of opportunistic screening (62, 36%), and investigation and treatment (60, 34%). CONCLUSIONS: Current practice in running cervical screening schemes needs to be examined to determine the extent to which it contributes to the goal of reducing mortality from cervical cancer.
    • Loosening the bonds of cancer: how feasible?

      Eardley, Anne; Dept. of Epidemiology and Social Oncology, Christie Hospital & Holt Radium Inst., Withington, Manchester, Great Britain. (1988)
      This paper assesses the scope that exists for increasing the personal autonomy of people with cancer. Current organization of cancer services does little to promote autonomy. However, coping theory suggests that autonomy can be enhanced by complementary therapies, by changing perceptions of cancer, and by techniques which minimize the emotional response to the stress of this disease.
    • Made to measure survey.

      Eardley, Anne; Lancaster, Gillian; Elkind, Andrea; Christie Hospital and Holt Radium Institute, Manchester. (1990-11-29)
    • Making cervical screening work.

      Smith, Alwyn; Elkind, Andrea; Eardley, Anne; Department of Epidemiology and Social Oncology, Christie Hospital and Radium Institute, Withington, Manchester. (1989-06-24)
    • Motivation and education in breast cancer screening.

      Hobbs, P; Eardley, Anne; Wakefield, J (1977-09)
    • Patients' needs after radiotherapy, the role of the general practitioner.

      Eardley, Anne; Department of Epidemiology and Social Oncology, Christie Hospital and Holt Radium Institute, Withington, Manchester, England. (1990-03)
      This study assessed the physical and psychosocial sequelae of radical radiotherapy among patients with bladder or prostate cancer and investigated the support received from community health services. When interviewed two months after treatment, over half reported that they had experienced several physical side-effects as well as curtailment of social and everyday activities. Such side-effects were still being experienced by up to half the patients at the time of interview. Seventy-one per cent were unprepared for the duration and type of such effects. Most had seen their general practitioner in connection with their side-effects and 76% felt that this contact had been helpful. Patients appreciated the willingness to spend time listening to their concerns and explaining side-effects, as well as accessibility and flexibility which made it easy to obtain advice and support. Patients who expressed dissatisfaction with their general practitioner all felt that they should have been visited at home. The study suggests that general practitioners can play a valuable role in meeting patients' needs after radiotherapy.
    • Patients' views. Clear views.

      Eardley, Anne; Mahjoob, Sue; Fry, Mike; Knupfer, D; Christie Hospital, Manchester. (1998-06-11)
    • A pilot study of attendance for breast cancer screening.

      Eardley, Anne; Elkind, Andrea; Department of Epidemiology and Social Oncology, Christie Hospital and Holt Radium Institute, Withington, Manchester, England. (1990)
      Previous research has identified some characteristics related to attendance for breast cancer screening, but few research findings carry practical implications for the optimum organisation of the service. The present study describes the reactions of women attending one of the first breast screening units to be established in the U.K. following government directives. Responses to the invitation to be screened and reasons for attendance suggest ways in which the idea of screening can be conveyed in health education. Practical problems were few, but some negative features of the design of the screening unit and of the experience of being screened were identified. Recommendations for the organisation of breast cancer screening are presented using the typology of factors influencing health behaviour developed by Green et al.
    • Randomized controlled trial to assess the effectiveness of a videotape about radiotherapy.

      Harrison, Roger; Dey, Paola; Slevin, Nicholas J; Eardley, Anne; Gibbs, A; Cowan, Richard A; Logue, John P; Leidecker, Vicki; Hopwood, Penelope; Centre for Cancer Epidemiology, Kinnaird Road, Manchester, M20 9QL. (2001-01-05)
      In a randomized controlled trial, the additional provision of information on videotape was no more effective than written information alone in reducing pre-treatment worry about radiotherapy. Images of surviving cancer patients, however, may provide further reassurance to patients once therapy is completed.
    • Reasons for non-attendance for computer-managed cervical screening: pilot interviews.

      Elkind, Andrea; Haran, D; Eardley, Anne; Spencer, B; Department of Epidemiology and Social Oncology, Christie Hospital and Holt Radium Institute, Withington, Manchester, England. (1988)
      A pilot interview study looked at reasons why women did not attend a clinic following an invitation for a cervical smear test offered via a computer-managed scheme. Three broad issues were identified. First, the inaccuracy of the computer database (the FPC register) meant some women were inaccessible because they no longer lived at the address recorded. Other women were ineligible or unsuitable within the criteria of the scheme but had been sent invitations inappropriately because their screening records were incomplete or out of date. Second, aspects of service organisation and provision led to misclassification of some attenders as non-attenders and to various failures of communication such as non-receipt of the invitation or health education leaflet or unsuccessful attempts to rearrange appointments. In addition, the appointment or venue offered could be unsatisfactory. The third issue concerned the characteristics of the women which sometimes interacted with practical problems connected with service provision. Other women believed the test to be inappropriate for themselves while some were deterred by the prospect of the test itself. In general, embarrassment was pervasive and reflected in preferences for different types of service provision. Women who had neither attended nor been otherwise tested were particularly likely to express feelings of fear and fatalism. General attitudes to the test were favourable but this was not always applied personally. A typology of reasons for non-attendance for computer-managed cervical screening is presented.
    • The relationship between oncologists and peripheral hospital radiologists in the North-West of England.

      Bungay, Peter M; Carrington, Bernadette M; Corgie, Delphine; Eardley, Anne; Department of Diagnostic Radiology, Christie Hospital NHS Trust, Manchester, UK. (2002-04)
      AIM: To audit the relationship between Cancer Centre oncologists visiting peripheral hospitals and peripheral hospital radiologists by assessing (i) oncologists' knowledge of local radiological services; (ii) oncologists' perceptions of peripheral radiological services; (iii) peripheral radiologist's perceptions of oncologists; (iv) barriers to communication. MATERIALS AND METHODS: A postal questionnaire was sent to all radiology departments visited by an oncologist, and to all medical and clinical oncologists from two regional oncology centres. RESULTS: The response rate was 100% (21 peripheral hospital radiology departments and all 35 oncologists). (i) Oncologists' knowledge of peripheral hospital imaging modalities was limited (especially MRI and intervention). (ii) 72% of oncologists rated the peripheral hospital radiology service as excellent or good, 46% rated the radiology report quality excellent to good. Deficiencies in oncological reports were identified. (iii) 44% of radiologists thought the oncologist did not relate well with the local radiology department. 50% of radiologists did not know the visiting oncologist's specialist interest. (iv) 69% of oncologists did not regularly attend peripheral hospital clinico-radiological meetings. Lack of written and oral information was hampering both specialties. CONCLUSION: Communication between oncologists and the local radiology department should include: (1) information about local radiology services for visiting oncologists (including trainees) and on the oncology team for radiologists; (2) standardized report content; (3) improved clinical information for radiologists; (4) regular clinico-radiological meetings.
    • Smear campaign.

      Eardley, Anne; Elkind, Andrea; Christie Hospital Trust, Manchester. (1992-08-20)