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Theses & Dissertations: Cancer Research

Theses/dissertations from 2024 2024.

Novel Spirocyclic Dimer (SpiD3) Displays Potent Preclinical Effects in Hematological Malignancies , Alexandria Eiken

Dying Right: Supporting Anti-Cancer Therapy Through Immunogenic Cell Death , Elizabeth Schmitz

Therapeutic Effects of BET Protein Inhibition in B-cell Malignancies and Beyond , Audrey L. Smith

Identifying the Molecular Determinants of Lung Metastatic Adaptation in Prostate Cancer , Grace M. Waldron

Identification of Mitotic Phosphatases and Cyclin K as Novel Molecular Targets in Pancreatic Cancer , Yi Xiao

Theses/Dissertations from 2023 2023

Development of Combination Therapy Strategies to Treat Cancer Using Dihydroorotate Dehydrogenase Inhibitors , Nicholas Mullen

Overcoming Resistance Mechanisms to CDK4/6 Inhibitor Treatment Using CDK6-Selective PROTAC , Sarah Truong

Theses/Dissertations from 2022 2022

Omics Analysis in Cancer and Development , Emalie J. Clement

Investigating the Role of Splenic Macrophages in Pancreatic Cancer , Daisy V. Gonzalez

Polymeric Chloroquine in Metastatic Pancreatic Cancer Therapy , Rubayat Islam Khan

Evaluating Targets and Therapeutics for the Treatment of Pancreatic Cancer , Shelby M. Knoche

Characterization of 1,1-Diarylethylene FOXM1 Inhibitors Against High-Grade Serous Ovarian Carcinoma Cells , Cassie Liu

Novel Mechanisms of Protein Kinase C α Regulation and Function , Xinyue Li

SOX2 Dosage Governs Tumor Cell Identity and Proliferation , Ethan P. Metz

Post-Transcriptional Control of the Epithelial-to-Mesenchymal Transition (EMT) in Ras-Driven Colorectal Cancers , Chaitra Rao

Use of Machine Learning Algorithms and Highly Multiplexed Immunohistochemistry to Perform In-Depth Characterization of Primary Pancreatic Tumors and Metastatic Sites , Krysten Vance

Characterization of Metastatic Cutaneous Squamous Cell Carcinoma in the Immunosuppressed Patient , Megan E. Wackel

Visceral adipose tissue remodeling in pancreatic ductal adenocarcinoma cachexia: the role of activin A signaling , Pauline Xu

Phos-Tag-Based Screens Identify Novel Therapeutic Targets in Ovarian Cancer and Pancreatic Cancer , Renya Zeng

Theses/Dissertations from 2021 2021

Functional Characterization of Cancer-Associated DNA Polymerase ε Variants , Stephanie R. Barbari

Pancreatic Cancer: Novel Therapy, Research Tools, and Educational Outreach , Ayrianne J. Crawford

Apixaban to Prevent Thrombosis in Adult Patients Treated With Asparaginase , Krishna Gundabolu

Molecular Investigation into the Biologic and Prognostic Elements of Peripheral T-cell Lymphoma with Regulators of Tumor Microenvironment Signaling Explored in Model Systems , Tyler Herek

Utilizing Proteolysis-Targeting Chimeras to Target the Transcriptional Cyclin-Dependent Kinases 9 and 12 , Hannah King

Insights into Cutaneous Squamous Cell Carcinoma Pathogenesis and Metastasis Using a Bedside-to-Bench Approach , Marissa Lobl

Development of a MUC16-Targeted Near-Infrared Antibody Probe for Fluorescence-Guided Surgery of Pancreatic Cancer , Madeline T. Olson

FGFR4 glycosylation and processing in cholangiocarcinoma promote cancer signaling , Andrew J. Phillips

Theses/Dissertations from 2020 2020

Cooperativity of CCNE1 and FOXM1 in High-Grade Serous Ovarian Cancer , Lucy Elge

Characterizing the critical role of metabolic and redox homeostasis in colorectal cancer , Danielle Frodyma

Genomic and Transcriptomic Alterations in Metabolic Regulators and Implications for Anti-tumoral Immune Response , Ryan J. King

Dimers of Isatin Derived Spirocyclic NF-κB Inhibitor Exhibit Potent Anticancer Activity by Inducing UPR Mediated Apoptosis , Smit Kour

From Development to Therapy: A Panoramic Approach to Further Our Understanding of Cancer , Brittany Poelaert

The Cellular Origin and Molecular Drivers of Claudin-Low Mammary Cancer , Patrick D. Raedler

Mitochondrial Metabolism as a Therapeutic Target for Pancreatic Cancer , Simon Shin

Development of Fluorescent Hyaluronic Acid Nanoparticles for Intraoperative Tumor Detection , Nicholas E. Wojtynek

Theses/Dissertations from 2019 2019

The role of E3 ubiquitin ligase FBXO9 in normal and malignant hematopoiesis , R. Willow Hynes-Smith

BRCA1 & CTDP1 BRCT Domainomics in the DNA Damage Response , Kimiko L. Krieger

Targeted Inhibition of Histone Deacetyltransferases for Pancreatic Cancer Therapy , Richard Laschanzky

Human Leukocyte Antigen (HLA) Class I Molecule Components and Amyloid Precursor-Like Protein 2 (APLP2): Roles in Pancreatic Cancer Cell Migration , Bailee Sliker

Theses/Dissertations from 2018 2018

FOXM1 Expression and Contribution to Genomic Instability and Chemoresistance in High-Grade Serous Ovarian Cancer , Carter J. Barger

Overcoming TCF4-Driven BCR Signaling in Diffuse Large B-Cell Lymphoma , Keenan Hartert

Functional Role of Protein Kinase C Alpha in Endometrial Carcinogenesis , Alice Hsu

Functional Signature Ontology-Based Identification and Validation of Novel Therapeutic Targets and Natural Products for the Treatment of Cancer , Beth Neilsen

Elucidating the Roles of Lunatic Fringe in Pancreatic Ductal Adenocarcinoma , Prathamesh Patil

Theses/Dissertations from 2017 2017

Metabolic Reprogramming of Pancreatic Ductal Adenocarcinoma Cells in Response to Chronic Low pH Stress , Jaime Abrego

Understanding the Relationship between TGF-Beta and IGF-1R Signaling in Colorectal Cancer , Katie L. Bailey

The Role of EHD2 in Triple-Negative Breast Cancer Tumorigenesis and Progression , Timothy A. Bielecki

Perturbing anti-apoptotic proteins to develop novel cancer therapies , Jacob Contreras

Role of Ezrin in Colorectal Cancer Cell Survival Regulation , Premila Leiphrakpam

Evaluation of Aminopyrazole Analogs as Cyclin-Dependent Kinase Inhibitors for Colorectal Cancer Therapy , Caroline Robb

Identifying the Role of Janus Kinase 1 in Mammary Gland Development and Breast Cancer , Barbara Swenson

DNMT3A Haploinsufficiency Provokes Hematologic Malignancy of B-Lymphoid, T-Lymphoid, and Myeloid Lineage in Mice , Garland Michael Upchurch

Theses/Dissertations from 2016 2016

EHD1 As a Positive Regulator of Macrophage Colony-Stimulating Factor-1 Receptor , Luke R. Cypher

Inflammation- and Cancer-Associated Neurolymphatic Remodeling and Cachexia in Pancreatic Ductal Adenocarcinoma , Darci M. Fink

Role of CBL-family Ubiquitin Ligases as Critical Negative Regulators of T Cell Activation and Functions , Benjamin Goetz

Exploration into the Functional Impact of MUC1 on the Formation and Regulation of Transcriptional Complexes Containing AP-1 and p53 , Ryan L. Hanson

DNA Polymerase Zeta-Dependent Mutagenesis: Molecular Specificity, Extent of Error-Prone Synthesis, and the Role of dNTP Pools , Olga V. Kochenova

Defining the Role of Phosphorylation and Dephosphorylation in the Regulation of Gap Junction Proteins , Hanjun Li

Molecular Mechanisms Regulating MYC and PGC1β Expression in Colon Cancer , Jamie L. McCall

Pancreatic Cancer Invasion of the Lymphatic Vasculature and Contributions of the Tumor Microenvironment: Roles for E-selectin and CXCR4 , Maria M. Steele

Altered Levels of SOX2, and Its Associated Protein Musashi2, Disrupt Critical Cell Functions in Cancer and Embryonic Stem Cells , Erin L. Wuebben

Theses/Dissertations from 2015 2015

Characterization and target identification of non-toxic IKKβ inhibitors for anticancer therapy , Elizabeth Blowers

Effectors of Ras and KSR1 dependent colon tumorigenesis , Binita Das

Characterization of cancer-associated DNA polymerase delta variants , Tony M. Mertz

A Role for EHD Family Endocytic Regulators in Endothelial Biology , Alexandra E. J. Moffitt

Biochemical pathways regulating mammary epithelial cell homeostasis and differentiation , Chandrani Mukhopadhyay

EPACs: epigenetic regulators that affect cell survival in cancer. , Catherine Murari

Role of the C-terminus of the Catalytic Subunit of Translesion Synthesis Polymerase ζ (Zeta) in UV-induced Mutagensis , Hollie M. Siebler

LGR5 Activates TGFbeta Signaling and Suppresses Metastasis in Colon Cancer , Xiaolin Zhou

LGR5 Activates TGFβ Signaling and Suppresses Metastasis in Colon Cancer , Xiaolin Zhou

Theses/Dissertations from 2014 2014

Genetic dissection of the role of CBL-family ubiquitin ligases and their associated adapters in epidermal growth factor receptor endocytosis , Gulzar Ahmad

Strategies for the identification of chemical probes to study signaling pathways , Jamie Leigh Arnst

Defining the mechanism of signaling through the C-terminus of MUC1 , Roger B. Brown

Targeting telomerase in human pancreatic cancer cells , Katrina Burchett

The identification of KSR1-like molecules in ras-addicted colorectal cancer cells , Drew Gehring

Mechanisms of regulation of AID APOBEC deaminases activity and protection of the genome from promiscuous deamination , Artem Georgievich Lada

Characterization of the DNA-biding properties of human telomeric proteins , Amanda Lakamp-Hawley

Studies on MUC1, p120-catenin, Kaiso: coordinate role of mucins, cell adhesion molecules and cell cycle players in pancreatic cancer , Xiang Liu

Epac interaction with the TGFbeta PKA pathway to regulate cell survival in colon cancer , Meghan Lynn Mendick

Theses/Dissertations from 2013 2013

Deconvolution of the phosphorylation patterns of replication protein A by the DNA damage response to breaks , Kerry D. Brader

Modeling malignant breast cancer occurrence and survival in black and white women , Michael Gleason

The role of dna methyltransferases in myc-induced lymphomagenesis , Ryan A. Hlady

Design and development of inhibitors of CBL (TKB)-protein interactions , Eric A. Kumar

Pancreatic cancer-associated miRNAs : expression, regulation and function , Ashley M. Mohr

Mechanistic studies of mitochondrial outer membrane permeabilization (MOMP) , Xiaming Pang

Novel roles for JAK2/STAT5 signaling in mammary gland development, cancer, and immune dysregulation , Jeffrey Wayne Schmidt

Optimization of therapeutics against lethal pancreatic cancer , Joshua J. Souchek

Theses/Dissertations from 2012 2012

Immune-based novel diagnostic mechanisms for pancreatic cancer , Michael J. Baine

Sox2 associated proteins are essential for cell fate , Jesse Lee Cox

KSR2 regulates cellular proliferation, transformation, and metabolism , Mario R. Fernandez

Discovery of a novel signaling cross-talk between TPX2 and the aurora kinases during mitosis , Jyoti Iyer

Regulation of metabolism by KSR proteins , Paula Jean Klutho

The role of ERK 1/2 signaling in the dna damage-induced G2 , Ryan Kolb

Regulation of the Bcl-2 family network during apoptosis induced by different stimuli , Hernando Lopez

Studies on the role of cullin3 in mitosis , Saili Moghe

Characteristics of amyloid precursor-like protein 2 (APLP2) in pancreatic cancer and Ewing's sarcoma , Haley Louise Capek Peters

Structural and biophysical analysis of a human inosine triphosphate pyrophosphatase polymorphism , Peter David Simone

Functions and regulation of Ron receptor tyrosine kinase in human pancreatic cancer and its therapeutic applications , Yi Zou

Theses/Dissertations from 2011 2011

Coordinate detection of new targets and small molecules for cancer therapy , Kurt Fisher

The role of c-Myc in pancreatic cancer initiation and progression , Wan-Chi Lin

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UKnowledge > College of Medicine > Toxicology and Cancer Biology > Theses & Dissertations

Theses and Dissertations--Toxicology and Cancer Biology

Theses/dissertations from 2024 2024.

UNDERSTANDING THE MECHANISM OF FERROPTOSIS SUSCEPTIBILITY VARIATION IN COLORECTAL CANCER , Aziza Alshahrani

Elucidation of Mismatch Repair Regulation by ABL1: Advantages/Disadvantages of Tyrosine Kinase Inhibitor Treatment , Hannah Daniels

ACQUIRED TREATMENT RESISTANCE IN PROSTATE CANCER VIA THE PRODUCTION OF RADIATION DERIVED EXTRACELLULAR VESICLES CONTAINING MITOCHONDRIAL PROTEINS , Caitlin Miller

Theses/Dissertations from 2023 2023

ELUCIDATING THE FUNCTIONAL IMPORTANCE OF PEROXIREDOXIN IV IN PROSTATE CANCER AND ITS SECRETION MECHANISM , Na Ding

Targeting EZH2 to Improve Outcomes of Lung Squamous Cell Carcinoma , Tanner DuCote

UNDERSTANDING AND TARGETING THE TPH1-SEROTONIN-HTR3A AXIS IN SMALL CELL LUNG CANCER , Yanning Hao

CONSERVED NOVEL INTERACTIONS BETWEEN POST-REPLICATIVE REPAIR AND MISMATCH REPAIR PROTEINS HAVE DIFFERENTIAL EFFECTS ON DNA REPAIR PATHWAYS , Anna K. Miller

UNDERSTANDING THE ROLE OF PEROXIREDOXIN IV IN COLORECTAL CANCER DEVELOPMENT , Pratik Thapa

BEYOND MITOSIS, PLK1-MEDIATED PHOSPHORYLATION RE-WIRES CANCER METABOLISM AND PROMOTES CANCER PROGRESSION , Qiongsi Zhang

Theses/Dissertations from 2022 2022

ELUCIDATING THE ROLE OF POLYCOMB REPRESSIVE COMPLEX 2 IN LUNG STEM CELL FATE AND LUNG DISEASE , Aria Byrd

SEX DIMORPHISM IN HEMATOPOIESIS AND BONE MARROW NICHE , xiaojing cui

EXTRACELLULAR VESICLES AND CANCER THERAPY: AN INSIGHT INTO THE ROLE OF OXIDATIVE STRESS , Jenni Ho

OVERCOMING RESISTANCE TO SG-ARIS IN CASTRATION-RESISTANT PROSTATE CANCER , Chaohao Li

Theses/Dissertations from 2021 2021

THE TUMOR SUPPRESSOR PAR-4 REGULATES HYPERTROPHIC OBESITY , Nathalia Araujo

Epigenetic States Regulate Tumor Aggressiveness and Response to Targeted Therapies in Lung Adenocarcinoma , Fan Chen

DELINEATING THE ROLE OF FATTY ACID METABOLISM TO IMPROVE THERAPEUTIC STRATEGIES FOR COLORECTAL CANCER , James Drury

DEVELOPMENT OF TOOLS FOR ATOM-LEVEL INTERPRETATION OF STABLE ISOTOPE-RESOLVED METABOLOMICS DATASETS , Huan Jin

MECHANISMS OF CADMIUM-INDUCED AND EPIDERMAL GROWTH FACTOR RECEPTOR MUTATION-DRIVEN LUNG TUMORIGENESIS , Hsuan-Pei Lin

SCIENCE-BASED REGULATION OF PHARMACOLOGICAL SUBSTANCES IN COMPETITION HORSES , Jacob Machin

A NOVEL ROLE FOR NEUROTENSIN IN REGULATION OF STEM CELL FUNCTION IN THE SMALL INTESTINE , Stephanie Rock

Theses/Dissertations from 2020 2020

NOVEL POST-TRANSLATIONAL MODIFICATION AND FUNCTION OF FUS: THE RELEVANCE TO AMYOTROPHIC LATERAL SCLEROSIS , Alexandra Arenas

Prostate Cancer Resistance to Cabazitaxel Chemotherapy , Diane Begemann

Examining the Role of Metabolic Pathways as Therapeutic Modalities for Triple Negative Breast Cancer , Jeremy Andrew Johnson

THE ROLE OF NEURAL PRECURSOR CELL EXPRESSED DEVELOPMENTALLY DOWN-REGULATED PROTEIN 9 IN ENHANCED AGGRESSIVENESS OF HEXAVALENT CHROMIUM TRANSFORMED BRONCHIAL EPITHELIAL CELLS , Peter Van Wie

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Lung cancer

Affiliations.

• 1 Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC, Australia.
• 2 Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
• 3 Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. Electronic address: [email protected].
• PMID: 34273294
• DOI: 10.1016/S0140-6736(21)00312-3

Lung cancer is one of the most frequently diagnosed cancers and the leading cause of cancer-related deaths worldwide with an estimated 2 million new cases and 1·76 million deaths per year. Substantial improvements in our understanding of disease biology, application of predictive biomarkers, and refinements in treatment have led to remarkable progress in the past two decades and transformed outcomes for many patients. This seminar provides an overview of advances in the screening, diagnosis, and treatment of non-small-cell lung cancer and small-cell lung cancer, with a particular focus on targeted therapies and immune checkpoint inhibitors.

Copyright © 2021 Elsevier Ltd. All rights reserved.

Publication types

• Research Support, Non-U.S. Gov't
• Carcinoma, Non-Small-Cell Lung / diagnosis*
• Carcinoma, Non-Small-Cell Lung / therapy*
• Lung Neoplasms / diagnosis*
• Lung Neoplasms / therapy*
• Small Cell Lung Carcinoma / diagnosis*
• Small Cell Lung Carcinoma / therapy*

• Help & Terms of Use
• Elizabeth Blackwell Institute for Health Research
• Phone 00 44 117 455 6360
• Email [email protected]
• Website http://www.bristol.ac.uk/cancer

United Kingdom

Student theses

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A biologically-inspired artificial lateral line: observations of collective behaviour in fish lead to the development of a novel design of simple and low-cost artificial lateral line sensor.

Supervisor: Hauert, S. (Supervisor), Ioannou, C. (Supervisor) & Genner, M. J. (Supervisor)

Student thesis : Doctoral Thesis › Doctor of Philosophy (PhD)

A characterisation of mononuclear phagocyte dynamics in the healthy and regenerating zebrafish heart

Supervisor: Richardson, B. (Supervisor) & Martin, P. B. (Supervisor)

A Computational Framework for the Optimisation of Antivenom Pharmacokinetics and Pharmacodynamics

Supervisor: Hauert, S. (Supervisor), Blee, J. A. (Supervisor) & Collinson, I. R. (Supervisor)

An Epigenome-Wide Association Study of Eczema

Supervisor: Paternoster, L. (Supervisor), Elliott, H. (Supervisor) & Relton, C. (Supervisor)

Student thesis : Master's Thesis › Master of Science by Research (MScR)

An Investigation into the Link Between Sleep and Alzheimer’s Disease Using a Multi-Method Approach

Supervisor: Coulthard, E. J. (Supervisor) & Ben-Shlomo, Y. (Supervisor)

Applications of HS-AFM Imaging to Marine Microbial Life and its Environment

Supervisor: Day, J. C. C. (Supervisor), Picco, L. M. (Supervisor), Payton, O. D. (Supervisor) & Allen, M. (Supervisor)

Applying ‘omics to understand and predict juvenile idiopathic arthritis

Supervisor: Relton, C. (Supervisor), Ramanan, A. (Supervisor), Sharp, G. (Supervisor) & Zhou, Y. (External person) (Supervisor)

Appraising the causal relationship between DNA methylation and type 2 diabetes

Supervisor: Elliott, H. (Supervisor), Relton, C. (Supervisor) & Sharp, G. (Supervisor)

A qualitative exploration of recruiters' and patients' perspectives and experiences of the recruitment encounter in randomised controlled trials

Supervisor: Young, B. (Supervisor), Rooshenas, L. (Supervisor), Elliott, D. (Supervisor), Jepson, M. (Supervisor) & Donovan , J. L. (Supervisor)

Arole for IGFBP-2 in DNA repair in breast cancer cells

Supervisor: Perks, C. (Supervisor), Holly, J. (Supervisor) & Biernacka, K. M. (Supervisor)

Assessing the feasibility of dietary restriction, including short-term fasting, at the time of chemotherapy

Supervisor: Atkinson, C. (Supervisor), Herbert, G. (Supervisor), Ness, A. (Supervisor) & Perks, C. (Supervisor)

A study of hyperspectral reflectance and fluorescence imaging as alternative Methods for assessing coral health

Supervisor: Day, J. (Supervisor) & Scott, T. (Supervisor)

Biological and lifestyle predictors of survival in head and neck cancer.

Supervisor: Dos Santos Ferreira, D. (Supervisor), Ingle, S. (Supervisor), Ness, A. (Supervisor), Martin, R. (Supervisor) & May, M. T. (Supervisor)

Biosynthetic Studies on Kalimantacin Antibiotics

Supervisor: Willis, C. L. (Supervisor) & Crump, M. P. (Supervisor)

Capturing complexity, comorbidity and frailty in people with parkinsonism and understanding their impact

Supervisor: Ben-Shlomo, Y. (Supervisor) & Henderson, E. (Supervisor)

Causal implications of common infections and platelet function on cardiovascular disease

Supervisor: Paternoster, L. (Supervisor), Richmond, R. (Supervisor), Davey Smith, G. (Supervisor) & Poole, A. (Supervisor)

Causal pathways from cognitive ability to Alzheimer's disease

Supervisor: Davies, N. M. (Supervisor), Anderson, E. L. (Supervisor), Howe, L. D. (Supervisor) & Ben-Shlomo, Y. (Supervisor)

Characterisation of Ataxia Telangiectasia Mutated in RPE-1 cells and its role in cellular sensitivity to hypo-osmotic stress

Supervisor: Mellor, H. H. (Supervisor) & Wood, W. J. (Supervisor)

Characterisation of the cellular compartments containing inhibitory receptors in CD8 + T cells

Supervisor: Wuelfing, C. (Supervisor) & Morgan, D. (Supervisor)

Characterisation of the HELLS and Irc5 subfamily of chromatin remodellers

Supervisor: Dillingham, M. (Supervisor) & Chambers, A. (Supervisor)

Characterising Red Cell-Derived Vesicles in Sickle Cell Disease and Investigating Potential to Induce Tolerance to Human Red Cell Antigens

Supervisor: Blair, A. (Supervisor) & Anstee, D. J. (Supervisor)

Complex trait architecture through the lens of epigenome-wide association studies

Supervisor: Gaunt, T. (Supervisor), Hemani, G. (Supervisor) & Timpson, N. J. (Supervisor)

Decentralised Algorithms for Area Coverage

Supervisor: Ganesh, A. (Supervisor) & Hauert, S. (Supervisor)

Dental care pathways and parent-reported dental outcomes for 5-year-old children born with a cleft in the UK

Supervisor: Fowler, P. V. (Supervisor), Leary, S. D. (Supervisor), Wren, Y. E. (Supervisor) & Williams, J. (Supervisor)

Student thesis : Doctoral Thesis › Doctor of Dental Surgery (DDS)

Diabetes mellitus causes adiposopathy in bone marrow: investigation of the underpinning cellular and molecular mechanisms

Supervisor: Madeddu, P. (Supervisor) & Mellor, H. H. (Supervisor)

Does the association between later eating rhythm and childhood adiposity differ between the UK and China?

Supervisor: Leary, S. D. (Supervisor) & Northstone, K. (Supervisor)

Does the IGF axis influence EMT to play a role in bladder cancer progression?

Supervisor: Perks, C. (Supervisor) & Holly, J. M. P. (Supervisor)

Elucidating mechanisms of tumour resistance to checkpoint blockade

Supervisor: Wooldridge, L. (Supervisor), Morgan, D. (Supervisor) & Wuelfing, C. (Supervisor)

Enhanced numerical techniques for time domain electromagnetic analysis

Evaluation of a primary care epilepsy specialist nurse service.

Supervisor: Bachmann, M. (Supervisor)

Evaluation of Cardiopulmonary Exercise Testing (CPET) as a Prognostic Tool in Idiopathic Pulmonary Fibrosis (IPF)

Supervisor: Maskell, N. (Supervisor) & Millar, A. (Supervisor)

Evolving Morphological Adaption Methods in Compliant Robots

Supervisor: Hauser, H. (Supervisor) & Hauert, S. (Supervisor)

Examining the Role of Placental-derived MicroRNA Secretions in Response to Gestational Hypoxia on Foetal Neurodevelopment

Supervisor: Case, C. P. (Supervisor), Perks, C. M. (Supervisor), Uney, J. B. (Supervisor) & Fulga, T. A. (External person) (Supervisor)

Expertise during surgical innovation: advancing understanding about non-technical skills and related optimisation factors

Supervisor: Mills, N. (Supervisor), Blencowe, N. (Supervisor) & Blazeby, J. (Supervisor)

Exploring the effect of adiposity on platelet function and related pathways: implications for cardiovascular disease

Supervisor: Timpson, N. (Supervisor) & Hers, I. (Supervisor)

Exploring the in vitro behaviour of endothelial cells in different cell culture models

Supervisor: Mellor, H. (Supervisor) & Gaston, K. (Supervisor)

Exploring the microclot-driven pre-metastatic niche: live imaging studies in zebrafish larvae

Supervisor: Martin, P. B. (Supervisor) & Nobes, C. D. (Supervisor)

Exploring the role of BCL-3 in colorectal cancer cell therapeutic resistance

Supervisor: Martin, P. (Supervisor), Cullen, P. (Supervisor) & Williams, A. (Supervisor)

Extra-pulmonary effects of lung function and lung disease

Supervisor: Davey Smith, G. (Supervisor), Dodd, J. (Supervisor) & Granell, R. (Supervisor)

Fatty acid construction within the biosynthesis of the polyketide antibiotic mupirocin

Supervisor: Crump, M. P. (Supervisor), Willis, C. (External person) (Supervisor) & Race, P. R. (Supervisor)

Feeding and Autoimmunity in Children with Down’s Syndrome Evaluation Study (FADES)

Supervisor: Hamilton-Shield, J. P. (Supervisor), Gillespie, K. M. (Supervisor) & Leary, S. D. (Supervisor)

From peptide oligomers to single-chain proteins

Supervisor: Woolfson, D. (Supervisor) & Crump, M. (Supervisor)

Genetic and Environmental Contributions to Trajectories of Depressive Symptoms

Supervisor: Manley, D. (Supervisor), Timpson, N. J. (Supervisor) & Leckie, G. (Supervisor)

Genetic and epidemiologic approaches to elucidate the role of abnormal hip shape in the development of hip osteoarthritis

Supervisor: Davey Smith, G. (Supervisor) & Tobias, J. (Supervisor)

Genetic and epigenetic data as a tool to augment understanding of oropharyngeal cancer

Supervisor: Relton, C. L. (Supervisor), Thomas, S. J. (Supervisor), Richmond, R. C. (Supervisor) & Elliott, H. R. (Supervisor)

Geographical gene-environment interaction and correlation for mental health in the UK and Sweden

Supervisor: Davis, O. S. (Supervisor) & Davey Smith, G. (Supervisor)

Glial autophagy capability and the control of neuroinflammatory signaling in Parkinson’s disease.

Supervisor: Lane, J. D. (Supervisor) & Carroll, B. M. (Supervisor)

'Hi-Fi Nanoscience' : Exploring the nanoscale with optical pickup units

Supervisor: Payton, O. D. (Supervisor) & Day, J. C. C. (Supervisor)

High-throughput proteomic analysis of the dengue virus secretome and the identification of plasma biomarkers of disease severity

Supervisor: Morgan, D. (Supervisor) & Davidson, A. (Supervisor)

Identification of Protein Disulphide-Isomerase A3 Dependent Proteins from the Secretome of MDA-MB-231 Breast Cancer Cells

Supervisor: Adams, J. (Supervisor)

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• Breast Cancer Research Paper

A GUIDE TO WRITING A BREAST CANCER RESEARCH PAPER

Table of contents, how to write a breast cancer research paper, your breast cancer research paper thesis, breast cancer outline for research paper, introduction for breast cancer research paper, breast cancer research paper body paragraphs, breast cancer research paper conclusion, breast cancer research paper example and other help.

Breast cancer is a serious public health issue that impacts people from every walk of life. There are very few people who will not have their lives impacted in some way by this disease. Because it is so prevalent, there is much research that has been done and much research that is currently in progress. As a result, breast cancer is a popular topic for students in the medical and healthcare fields. In addition to this, breast cancer is also an appropriate topic for courses in political science, education, even business. This guide will provide you with important advice on writing a research paper on this serious disease.

Once you’ve chosen your topic, and conducted the appropriate research, you’ll need to construct a thesis. This is the statement that you will support in your research paper.

Sample Breast Cancer Research Paper

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Now that your topic and thesis are in hand, you can begin the process of creating an outline. Think of this as a foundation for your completed paper. It will help you decide on the structure of your paper, and choose the most important points to support your research paper.

Your introduction paragraph should contain the following elements:

• A hook such as an interesting fact about breast cancer
• A few sentences to introduce the specific topic of your paper
• Your thesis

Best breast cancer research paper topics

• The Impact of Pinkwashing on Breast Cancer Research
• The Prevalence of Breast Cancer in Men
• Are Natural Treatments Ever Appropriate for Breast Cancer?
• What is the Role of CBD in Breast Cancer Treatment?
• How to Tell if a Breast Cancer Charity is Legitimate
• Providing Emotional Support to Loved Ones with Breast Cancer
• Breast Cancer in Film and Literature
• New Research in Breast Cancer Immunotherapy
• New Treatment Options for Metastatic Breast Cancer
• Problems with Current Approaches to Breast Cancer Research
• Treatment Options for Patients Who Cannot Receive Chemotherapy

The body paragraphs are the ‘meat’ of your research paper. This is where you will present facts to your readers. Remember to cite your sources , and to rely on data and academic studies to present your case.

Your concluding paragraph should summarize the points made in your research paper. Show the readers how your research comes together to prove your thesis to be correct.

If you need assistance with a research paper on breast cancer, we recommend looking at an example paper. We are happy to provide such a paper to you, or assistance with writing your own research paper on the subject of breast cancer. We have writers, editors, and customer support reps who are available to help you 7 days per week.

External links

• Breast Cancer Research Papers - Academia.edu . (n.d.). Www.Academia.Edu. Retrieved February 19, 2020, from http://www.academia.edu/Documents/in/Breast_Cancer
• Breast Cancer Research Articles . (2019, May 23). National Cancer Institute; Cancer.gov. https://www.cancer.gov/types/breast/research/articles

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Cancer Theses Samples For Students

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Overconsumption Of Sucrose And Fructose May Contribute To Certain Types Of Cancer Thesis Sample

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Significance of the Study 5 Definition of Terms 7 Review of Literatures 7 IV. Research Methodology 17 V. Limitation/Delimitation 21 VI Data Analysis: 21 VII Data Verification: 24 VIII Summary and Conclusions: 25

Recommendations 26

Appendices 27 Research Questionnaire 27

References 34

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Cancer Research Paper

This sample cancer research paper features: 7800 words (approx. 26 pages), an outline, and a bibliography with 35 sources. Browse other research paper examples for more inspiration. If you need a thorough research paper written according to all the academic standards, you can always turn to our experienced writers for help. This is how your paper can get an A! Feel free to contact our writing service for professional assistance. We offer high-quality assignments for reasonable rates.

This research paper on global burden of cancer, its trends and projections, is split into four themes. The first section provides a basic description of the main sources of routine cancer information. The second section describes the international variation in cancer using the latest available cancer incidence, mortality, and prevalence estimates. Global trends of the most commonly occurring tumors are then presented in the third section, primarily based on high-quality incidence data from established cancer registries worldwide. The final section discusses how the global profile of cancer might look around 2020, on the basis of projections of population aging and growth and some assumptions on future cancer trends.

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Get 10% off with 24start discount code, definitions, uses, and caveats, producing global estimates of cancer burden, global burden of cancer 2002, geographical variations in the eight most common cancers, temporal variations in the five most common cancers, predicting cancer in 2020.

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Routine Measures of Cancer Burden

Cancer incidence is the frequency of occurrence of new cases of cancer in a defined population for a given period of time. It can be expressed as the absolute number of cases, although computation of rates is required for comparative purposes, with the denominator the person-time at risk from which the cases in the numerator arose. The statistic is useful in providing clues to the underlying risk factors and in planning and prioritizing resources for primary prevention, where the aim is to reduce incidence via changes in cultural and personal patterns of behavior.

Population-based cancer registries collect and classify information on all new cases of cancer in a defined population and provide statistics on occurrence for the purposes of assessing and controlling the impact of cancer in the community. Registries may cover entire national populations or selected regions. The comparability, completeness, and accuracy of incidence data are essential in making reliable inferences regarding geographical and temporal variations in incidence rates. The Cancer Incidence In Five Continents (CI5) series, first published in 1962, is now in its eighth volume (Parkin et al., 2002) and covers diagnoses of cancer 1993–97 in 186 registries in 57 countries. Inclusion is a good marker of the quality of an individual registry, given that the editorial process includes numerous assessments of data quality.

Mortality provides a measure of the impact of cancer and is expressed either as number of deaths occurring or as a mortality rate: The number of deaths per 100 000 persons per year. Mortality is a product of the incidence and the case fatality from a given cancer. Death rates estimate the average risk to the population of dying from a specific cancer, while fatality, the inverse of cancer survival (the time that elapsed between the diagnosis of cancer and death from it), represents the probability that an individual with cancer will die from it. Data derive from vital registration systems, where usually a medical practitioner certifies the fact and cause of death. The International Classification of Diseases (ICD) provides a standardized system of nomenclature and coding, and a suggested format for the death certificate.

Mortality data are affected by both the degree of detail and the quality of the information, that is, the accuracy of the recorded cause of death and the completeness of registration. These are known to vary considerably between countries and over time. Mortality data are, however, more comprehensively available than incidence: The WHO mortality databank contains national cancer mortality data on over 70 countries, and for many, over extended periods of time. This availability partly explains its common application as a surrogate for incidence in both geographic and temporal studies of cancer, although its use must be guarded where survival differences are suspected between the groups being compared.

Prevalence is a more complex measure of cancer incidence, fatality, and other influences operating in affected individuals prior to death or cure. Partial prevalence is a useful measure for quantifying the resource requirements needed for treating and supporting cancer patients, as it limits the number of patients to those diagnosed during a fixed time in the past. Prevalence for cases diagnosed within a certain number of years are of relevance to initial treatment (within 1 year), clinical follow-up (2–3 years) and possible cure (4–5 years). There are some exceptions, primarily that of female breast cancer, for which the risk of death remains higher than the general population for many more years.

For several decades, the International Agency for Research on Cancer (IARC) has complied and published estimates of global cancer burden. The first publication in 1984 estimated cancer incidence for 12 common cancers in 1975 in 24 world areas (Parkin et al., 1984); the most recent estimates (for 2002) were compiled as part of IARC’s GLOBOCAN series published in 2004 (Parkin et al., 2005). This database contains regional and country-specific estimates of the cancer incidence, mortality, and prevalence worldwide for 26 cancer sites (Ferlay et al., 2004).

National cancer incidence and mortality data are available for a minority of countries of the world, so estimation procedures are necessary to obtain a comprehensive global picture of cancer. The available sources and methods used to derive the GLOBOCAN 2002 estimates are summarized in Table 1 and Figure 1 (incidence) and Figure 2 (mortality). The baseline data for the compilation are the cancer incidence, mortality, and survival data sets considered the best available within a given country. Incidence rates for a country are obtained wherever possible from cancer registries serving the whole population, or a representative sample of it. The most recent national mortality data from the WHO databank are used to obtain information on cancer deaths. As cancer registries record mortality as well as incidence, a country’s incidence may be estimated by applying a registry-based incidence: mortality ratio to its national mortality data. As mortality data are available for many more countries than incidence (Figures 1 and 2), there are known problems of accuracy and completeness. Adjustments are made where underrecording of mortality is suspected, and deaths recorded as uterus cancer are reallocated back to the specific sites of cervix or corpus uteri. Global prevalence is estimated from combining the estimated incidence data with appropriate estimates of survival (Pisani et al., 2002) (Table 1).

Geographical Variations in Cancer Worldwide

To provide a recent profile of global cancer burden as well as highlight some of the international variations, incidence, mortality, and prevalence estimates are presented from GLOBOCAN 2002. As well as describing the numbers of persons affected, comparisons of risk in different groups are described by the age-standardized rate using the weights from the world standard. Such an adjustment for age allows for the differing population age structures between countries and regions.

The international variability of cancer burden is briefly presented here according to 23 geographical areas for which the United Nations provides population estimates. In the following text, the terms developed and more developed refer to the regions or countries of North America, Europe (including all of the former USSR),

Australia and New Zealand, and Japan, and developing or less developed, the remainder. According to this classification and the corresponding United Nations (UN) population estimates, just over 5.1 billion people of the global population of 6.3 billion were living in less developed regions of the world in 2002, four times the number resident in developed areas (1.2 billion).

Almost 11 million people were diagnosed with cancer in 2002, over 6.5 million died from cancer, and approximately 24.5 million were living with cancer worldwide (Table 2). These total cancer estimates exclude nonmelanoma skin cancers, given difficulties in their accurate measurement and resultant lack of data. In terms of incidence, the leading four cancers, lung (12.4% of global total), female breast (10.6%), colorectum (9.4%), and stomach (8.6%) comprise over 40% of the world cancer burden. A similar percentage emerges for mortality, although lung cancer alone is responsible for one in every six of the deaths from cancer worldwide in 2002 (17.5%). Half of the global cancer mortality burden is explained by five cancers on adding liver cancer (responsible for 8.9% of all cancer deaths) to the above list. The relative magnitude of prevalence reflects both incidence and prognosis, and therefore the most prevalent cancers are female breast (17.9%) followed by colorectum (11.5%) and prostate (9.6%).

The distribution and frequency of the different cancer types varies by sex and region as well by the measure used to profile disease burden. In women, breast and cervical cancer rank first and second in frequency above colorectal, lung, and stomach cancers worldwide, while liver cancer in men ranks as the fifth most frequent cancer globally and the third most common cause of cancer death (Figure 3 and Table 3). Previous estimates for 1990 showed that the division of cancer burden between less and more developed countries was quite similar (Parkin et al., 1999). The more recent estimates indicate a disproportionate number of cancer cases occur in the developing world (53%), while in terms of mortality, closer to two-thirds of the burden now occurs in less developed regions (Table 4). The shift partly reflects increasing incidence rates of some common cancers in these areas, but the numbers of cases are also profoundly affected by the demographic phenomenon of continuing rapid population growth and aging, particularly in the developing world (see the section titled ‘Predicting cancer in 2020’). According to world area, about one-fourth of the global incidence (2.9 million new cases) and one-fifth of the global mortality (1.4 million deaths) occurs within Eastern Asia, which includes China; in contrast, an estimated 1400 new cases occurred in the Micronesia and Polynesia regions combined. On adjusting for population size and age structure, the comparison reveals a fourfold and threefold variation in age-standardized rates between regions in men and women, respectively (Figure 3). Overall rates are highest in North America, Australia/New Zealand, and Western Europe, and lowest in Northern and Western Africa (Figure 3).

The relative importance of different cancer sites also varies between and within the developing and developed regions (Table 3). Liver and cervical cancer are the fourth and fifth most common new cancers after lung, stomach, and female breast in less developed regions, while the incidence of esophageal cancer (ranking sixth) is more common than colorectal cancer. In developed areas, prostate cancer ranks above stomach cancer as the fourth most frequent cancer in 2002 (after lung, colorectal, and female breast), while cervical and esophageal cancer only rank 16th and 18th in frequency, respectively. The overall risk in different regions evidently reflects the additive contribution of different forms of cancer (Figure 4), so that in Northern Africa, for instance, rates are low for most cancer types other than bladder cancer in men and breast cancer in women. In contrast, in Southern Africa where rates are twice as high, there are elevated rates of a number of neoplasms including prostate, lung, and esophagus in men, and cervix and breast cancer in women.

Lung cancer has ranked as the most common neoplasm globally for several decades. In 2002, over 1.3 million new cases were diagnosed, of which almost one million were in men, making it the most frequent cancer to affect men and the third most common among women (Figure 3). Lung cancer incidence and mortality rates rank first in many developed and developing regions. Age-adjusted incidence rates are highest in Northern America (in both sexes) and in Europe, particularly among Eastern European men (Figure 5). Moderately high rates of lung cancer are seen in Eastern Asia (including China and Japan) and Oceania, with rates lowest in Africa.

Among women, breast cancer dominates in both developing and developed regions, with over 1.1 million new cases per year worldwide (Figure 3). Thus, close to one in four of the five million women diagnosed with a cancer in 2002 were diagnosed with breast cancer (Table 3), making it the second most frequent cancer when both sexes are considered together. In terms of mortality, breast cancer ranks lower (fifth) and given the high incidence and relatively favorable prognosis, it is by far the most prevalent form of cancer, with almost 4.5 million women diagnosed and living with breast cancer within the 5-year period up to 2002 (Table 2). More than half the incident cases occur in the developed world, with the highest incidence seen in Northern America, Oceania, and Northern and Western Europe (Figure 6). The disease tends to be less common in developing countries, although incidence rates are increasing in many (see the section titled ‘Cancer trends worldwide’).

There were just over one million new cases of colorectal cancer in 2002. Similar numbers of men and women are affected, with one in ten cancer patients diagnosed with this cancer. Approximately 50% fewer colorectal deaths (5.3 million) were estimated worldwide in the same year, making it the second most prevalent cancer globally (2.8 million). In more developed countries, two-thirds of a million colorectal cancer cases were estimated for 2002, ranking it second to lung cancer in global frequency (Table 2). It is the most common cause of cancer in Australia and New Zealand, and rates tend to be high in most developed regions (Figure 7 and Table 5). In formerly low-risk Japan, markedly increasing trends in colorectal cancer incidence have been observed in recent decades, to the extent that Japanese populations now have among the highest incidence rates in the world.

Stomach cancer has historically ranked as the second most frequent cancer worldwide, but according to the 2002 estimates, the disease ranked fourth (0.9 million new cases) behind lung, breast, and colorectum. It remains the second most common cause of mortality from cancer, however, with 0.7 million deaths occurring worldwide in the same year (Table 2). Roughly two-thirds of the new cases and deaths in 2002 occurred in men (Table 3), with a similar fraction occurring in developing countries. Rates are highest in Eastern Asia (Figure 8), notably in Japan, where one in five cancers diagnosed were stomach cancer. Rates are also elevated in Eastern Europe and in some South American countries, notably Uruguay and Argentina.

An estimated 0.7 million new cases of prostate cancer occurred worldwide in 2002 (Table 2), making this the fifth most common cancer globally and second in importance in males (Table 3). Mortality is much lower than incidence, with an estimated 0.2 million deaths in the same year (Figure 9). Three-quarters of the prostate cancer incidence worldwide occurred in the developed regions where the disease affects one in five male cancer patients. Incidence rates are notably elevated in North America, with rates considerably higher than next placed Australia/New Zealand, Northern and Western Europe. In contrast, rates in many developed countries are low: There is at least a 75fold variation in the incidence if one compares rates in the United States and China in 2002. The magnitude of such variations reflects more the high prevalence of prostate specific antigen (PSA) testing in some Western countries – as a means to detect latent cancers in asymptomatic individuals – than real differences in risk. In this respect, mortality rates may be a better guide to true geographical differences than incidence.

Liver cancer is the fifth most frequent cancer globally: Over 0.6 million new cases were estimated in 2002 (Table 2). Due to its poor prognosis, it is also the third most common cause of cancer death after lung and stomach cancer, with just under 0.6 million deaths in the same year. Much of the burden is observed among men and populations residing in developing regions: It is the third most common cancer of cancer incidence and the second most common cause of cancer death among males. Rates are highest in Eastern Asia, with China having half of the global liver cancer burden (Figure 10). Rates are also elevated in Central and Eastern Asia.

Esophageal cancer was responsible for approximately 0.45 million of the global cancer incidence and has a rather poor prognosis, almost 0.4 million deaths (Table 2). Over four-fifths of the burden is borne by the less developed world, where it is the fourth most common cause of cancer death after lung, liver, and stomach cancer. The geographic variability in the risk of esophageal cancer worldwide is striking, with the highest risk areas of the world in the so-called esophageal cancer belt, which extends from northern Iran through central Asia to north-central China. Rates are thus elevated in Eastern Asia, but are also high in sub-Saharan Africa (Figure 11).

Cervix cancer is the second most common cancer among women worldwide in 2002, with almost 0.5 million new cases and about 0.25 million deaths (Table 3). Over 80% of the burden occurs in the less developed regions, where cervix cancer accounts for 15% of female cancers. The highest incidence rates are observed in Southern and Eastern Africa, Melanesia, and the Caribbean (Figure 12). Rates in most developed countries are low, and overall, cervix cancer accounts for less than 4% of the total cancer incidence burden.

Kaposi’s sarcoma is a very rare form of cancer in most world regions but is now one of the most common cancers in sub-Saharan Africa as a result of the AIDS epidemic. Approximately 57 000 new cases occurred in Africa in 2002 and, due to poor survival associated with AIDS, approximately 52 000 deaths.

Cancer Trends Worldwide

Investigations of cancer trends have important applications in epidemiological research and in planning and evaluating cancer control strategies. Analyses of how rates of different cancers are changing in different populations over time can provide clues to the underlying determinants and serve as an aid to formulating, implementing, or further developing population-based preventative strategies. Genetic factors have only a minor impact on time trends of cancer in the absence of large migrational influxes and exoduses within the population under study.

Issues concerning data quality and other detectable artifacts in interpreting time trends have been comprehensively addressed (Saxen, 1982; Muir et al., 1994). Truly valid studies would require, for instance, that the definition and content, criteria of malignancy, and likelihood of diagnosis of cancer have not changed with time, that case ascertainment has been equally efficient throughout the study period, that ICD indexing has not changed, and the accuracy and specificity of coding is consistent with time (Muir et al., 1994). Although few data series would meet each of these criteria, cancerspecific artifacts and their likely effects on time trends are reasonably well understood. The efforts of cancer registries in standardizing procedures and data definitions have been important in establishing consistently the high quality and comparability of cancer incidence data over time.

Global trends in the five most common cancers are presented as age-adjusted incidence rates by 5-year calendar period using data from 16 cancer registries representing countries within four regions complied in successive volumes of CI5. While these figures can only provide a broad overview of trends, references are made to trends in cancer mortality (where the trends diverge from incidence), in the age-specific rates by calendar period or birth cohort (where the age-adjusted trends are partially misleading), and according to subsite or histological groups (where they differ from the overall trend).

Lung Cancer

Temporal studies of lung cancer incidence and mortality have played an important role in validating smoking as the primary cause of the disease. The contrasting trends observed in different parts of the world largely reflect the changing profile of tobacco use – the number of cigarettes smoked, the duration of habit, and the composition of the tobacco – within different populations over time. Among males (Figure 13), overall rates in many developed countries – in Northern Europe, Northern America, and Australia – have tended to peak and subsequently decline, although there is a distinct variability in the magnitude of the rates and the year of peak incidence. There have been dramatic increases in rates in many Eastern European countries including Hungary, which presently has the highest rate worldwide. In contrast, there are the beginnings of a decline in some European countries, as observed in Spain and Slovakia (Figure 13). Uniform increases are observed in Japan, with rates of lung cancer doubling within 20 years. In the developing countries displayed in Figure 13, rates tend to be reasonably stable or decreasing; there is, however, a consistent and large variation in lung cancer risk: Rates in Cali are, for instance, five times those of Mumbai.

The global profile of female lung cancer trends is somewhat different. Rates tend to be steadily increasing with time in most countries, an observation that reflects the more recent acquisition of the smoking habit among women (Figure 14). In some Western populations – in the United States and United Kingdom, where the downturn in the prevalence of smoking among women has been established longest – plateaus and recent declines are emerging in the trends. In Spain, as in many (mostly developing) countries, lung cancer rates have been historically low. However, recent increases – as can be can now be detected in the Zaragoza population – illustrate the shift in smoking activity among women during the past two or three decades. A similar pattern can possibly be seen in Mumbai, India.

Recent estimates of the proportion of lung cancer cases due to smoking indicate about 85% of cases in men and 47% in women are due to smoking worldwide, although there is considerable regional variation, and these figures are more representative of countries/regions with a long history of smoking: The current fraction is much lower, for example in Africa and Southern Asia. With transnational tobacco companies using a global tactic to expand their sales, however, a smoking epidemic is emerging in many developing countries and the corresponding attributable fraction is likely to increase. The extent of the projected increases in lung cancer and other tobacco-related diseases have been quantified in China, the pattern of substantially increased burden will likely be repeated in many countries in Asia, Africa, and South America (Peto et al., 1999).

Since the 1950s, its has been established that lung cancer incidence or mortality trends by age are primarily a birth cohort phenomenon, that is, incidence rates in a given birth cohort can be related to the smoking habits of the same generation. The smoking epidemic therefore produces changes in rates first observed within younger age groups that lead to increasingly higher overall rates as these generations reach the older age groups, where lung cancer is most common. Figure 15 depicts lung cancer mortality rates plotted against birth cohort by age for U.S. men and women according to race (Devesa et al., 1989), and provides an illustrative example of the importance of these generational influences. Successive cohort-specific declines in mortality can be observed in men born in the 1930s and in women born 10–15 years later, as they begin to relinquish the smoking habit. The impact of the phenomenon in the overall age-adjusted rates can be seen in Figures 13 and 14.

There are intriguing differences in time trends by histological type of lung cancer. Squamous cell carcinoma incidence rates among men have declined in North America and in some European countries, whereas among women they have generally increased. In contrast, lung cancer adenocarcinoma rates have increased in both sexes in many world areas. Such observations are probably explained by shifts in cigarette composition, towards low-tar, low-nicotine, and filtered cigarettes (Wynder and Muscat, 1995).

Female breast cancer incidence and mortality rates have been increasing in many populations in both developed and developing regions in the last few decades. The temporal patterns are complex, however, in view of the numerous and interactive risk factors involved, as well as the introduction of screening (affecting both incidence and mortality) and improving therapy (affecting mortality) in some Western countries. In several Nordic countries, England and Wales, and The Netherlands, incidence rates had been rising before the introduction of national screening programs in the mid to late 1980s (e.g., Sweden in Figure 16) (Botha et al., 2003). Mean annual incremental increases of 1–3% were observed in a number of European countries in the 1980s and 1990s, including those that had either not introduced programs, had implemented them recently, or had only regional or pilot programs under way (e.g., Slovakia in Figure 16).

The pattern observed in North America resembles that of Europe, with similar increases in incidence in both white and black women (Figure 16). Most of the increase in the United States occurred in the early to mid-1980s and is related to the escalation of screening during this time. The overall rate of increase slowed in the late 1980s. Early studies of Connecticut incidence trends prior to widespread mammography emerging documented the importance of birth cohort effects (Stevens et al., 1982).

Increasing mortality rates were observed in many Western countries from the 1950s to 1980s, particularly in eastern and southern Europe. A plateau and subsequent decline in mortality in the 1980s in several northern European countries has also been noted in the United States and Canada. The decrease was seen in both younger and older women (Figure 17). Despite the international consensus that there is sufficient evidence for the efficacy of screening women aged 50–69 by mammography in reducing breast cancer mortality (International Agency for Research on Cancer, 2002), quantification of its contribution to the observed mortality declines has been problematic. While some of the overall reduction in breast cancer mortality has been attributed directly to screening via prediction models, the observed declines – a 25% reduction by 2000 – started in 1986, before screening was introduced. In addition to mammography, a number of improvements have probably contributed to the trend, and include the establishment of treatment protocols, improved chemotherapeutic options, and better therapeutic guidelines. Some recent decreases in mortality are also seen in several countries without national screening programs, although these tend to be confined mainly to younger age groups. Mortality is increasing in several eastern European countries, including the Russian Federation, Estonia, and Hungary.

Some of the largest increases in breast cancer mortality are observed in non-Western countries historically at relatively low risk (Figure 17). Breast cancer remains relatively rare in Japan for instance, although rates of both incidence and mortality have been increasing fairly rapidly (Figures 16 and 17), an observation consistent with the reported increasing risk among successive generations of women (Wakai et al., 1995). In less developed countries, increases in breast cancer incidence and mortality are evident and are often more marked in younger generations of women (Parkin, 1994). There have been reported increases in Bombay, Shanghai, Singapore, and Hong Kong in the last few decades, although in relatively highrisk South American countries such as Uruguay and Chile, the observed mortality rates are reasonably stable among younger women (Parkin, 1994). These increases are often attributed to the westernization of lifestyles, an ill-defined surrogate for changes in factors such as childbearing, dietary habits, and exposure to exogenous estrogen, toward a distribution closer in profile to that of women of the industrialized countries in the West. In Japan, for instance, decreasing age at menarche, increasing age at menopause, decreasing fertility, increasing age at first birth, and increases in both height and weight have been noted (Wakai et al., 1995).

While there are some important differences in the epidemiological characteristics of colon and rectal cancer, Figures 18 and 19 depict the sex-specific trends for colon and rectum combined, thus avoiding the recognized problems of varying subsite allocation of cancers found at the rectosigmoid junction. The most notable features of global trends are the rather rapid increases in male and female rates in countries formerly at low risk. The greatest increases in incidence of colorectal cancer are in Hong Kong, Singapore, Israel, and particularly in the presently high-risk Japan, where there has been a threefold increase in incidence in men in just two decades (Figures 18 and 19). There have also been large rises in several Eastern European countries, including Slovakia, Hungary, and Poland as well as in parts of South America, including Colombia and Puerto Rico. In the high-risk countries, incidence trends are either gradually increasing (South Thames, Sweden), stabilizing (New South Wales), or declining with time (North America). Such moderation has been noted particularly in younger age groups (Coleman et al., 1993). In contrast to the recent attenuation of rates seen in some Western and Northern European countries, relatively large increases have been also observed in Spain (Figures 18 and 19).

Declines in mortality may be a consequence of changes in incidence, a result of progress in therapy or a result from the effects of improved early detection. The pattern in the United States is probably due to more widespread screening, resulting in stage-specific shifts in incidence and a subsequent increase in survival (Troisi et al., 1999).

In high-risk Western countries, there has been a notable shift in the subsite distribution within the colorectum, with increases in incidence of proximal (ascending colon) relative to distal cancer (descending and sigmoid colon) (Thorn et al., 1998; Troisi et al., 1999). In low-risk populations such as Singapore, however, the reverse effect has been reported (Huang et al., 1999), while the trend in proximal and distal rates was similar in Shanghai ( Ji et al., 1998). For rectal cancers, the countries with the most rapid increases tend to be in Eastern Europe and Japan. In the United States, there has been a decline in incidence and mortality for several decades in females of both races and in white men, although a recent increase in rectal cancer is apparent in black males (Troisi et al., 1999).

The risk factors that could explain the geographical and temporal variations in colorectal cancer are likely numerous and interactive. The observed declines in distal cancer incidence in some Western populations may be the result of increasing detection and treatment of premalignant polyps, although some improvements in the quality of the diet in younger generations may explain the observation, notably in the United States and some European populations, and the result of cohort-led declines in incidence rates among younger age groups (Coleman et al., 1993). Where rates are increasing, in Asia and in Eastern Europe, a westernization of lifestyle may in part be responsible, particularly with respect to a Western diet. The rapid increases in some populations in Asia imply the importance of genetic susceptibility.

Uniform declines in rates during the last half century in most populations worldwide remain the central epidemiological feature of stomach cancer; the effect can be seen in both men (Figure 20) and women (Figure 21). While the decreases are more marked in more affluent countries, trends in those developing countries with suitable data also portray downward trends (Figures 20 and 21). The temporal profile is consistent with improved food preservation techniques and better nutrition, particularly the invention of refrigeration for the transport and storage of food, making obsolete salting, smoking, and pickling. There is also evidence that, at least in Western countries, there is a progressive decline in infection rates with Helicobacter pylori between successive birth cohorts, likely a result of continual changes within the childhood environment.

Some studies have reported that the declines in gastric cancer are restricted to intestinal-type adenocarcinoma, with rather stable incidence trends observed for the diffuse-type carcinomas. There has been particular interest in the distinct trends of cancers of the gastric cardia, where rising rates are observed in several populations (Powell et al., 2002). While explanations are not yet established, there have been concomitant increases in the prevalence of Barrett’s esophagus and adenocarcinoma of the lower third of the esophagus. It is possible, therefore, that much of the increase in cardia incidence represents misclassification of cancers at the gastroesophageal junction (Ekstrom et al., 1999).

The large increases in prostate cancer incidence in highrisk countries shown in Figure 22 can be attributed mainly to increasing detection following transurethral resection of the prostate (TURP), and, more recently, due to the use of PSA. In the United States, incidence rates were increasing slowly up to the 1980s (Figure 23), probably due to a genuine increase in risk, coupled with an increasing diagnosis of latent, asymptomatic cancers in prostatectomy specimens, due to the increasing use of TURP (Potosky et al., 1990). Beginning in 1986, and accelerating after 1988, there was a rapid increase in incidence, coinciding with the introduction of testing with PSA, allowing the detection of preclinical (asymptomatic) disease (Potosky et al., 1995).

Prostate cancer mortality rates in the United States had been increasing slowly since the 1970s (Figure 23). With the introduction of PSA screening, and the dramatic surge of incidence induced by it, there was an increase in the rate of increase in mortality, but this was very much less marked than the change in incidence. More recently (since 1992 in white men, 1994 in black men), mortality rates have decreased. The contribution that PSA screening and/or improved treatment has made to the slow, steady decline continues to be the subject of much debate. The increased mortality is probably partly due to miscertification of cause of death among the large number of men who had been diagnosed with latent prostate cancer in the late 1980s and early 1990s. The later decline may be partly attributable to a reversal of this effect; it seems unlikely that screening was entirely responsible. The lead-time (between screen detection and usual clinical presentation) would have to be very short, if screening were to have such a rapid effect on mortality. Similar mortality trends have been reported in Australia, Canada, the UK, France, and the Netherlands, although, in general, they are less pronounced, or occurred later, than in the United States. In some of the countries concerned (Canada, Australia), there has been considerable screening activity, but this is not the case in others where the falls in mortality are just as marked (France, Germany, Italy, UK) (Oliver et al., 2001).

Predictions of future cancer burden have become established tools in planning health policy and allocating future resources, as well as in measuring the success (or failure) of specific interventions. Commonly, predicted rates are obtained by extrapolating recent trends forward into the future via a simple statistical model, with the corresponding population projections applied to this to obtain the predicted number of cases. On a global scale, however, it is not easy, even for the major cancer sites, to predict burden in 2020 by such means. Historical patterns are not always a sound basis for future projections, and past trends of the common cancer forms are often different between and within world regions. Further, it is impossible to achieve in practical terms, given the insufficient availability of data for most of the world.

It is assumed, therefore, that current overall cancer incidence rates will be the same in 2020, with the predicted numbers presented by applying sex and age-specific population forecasts for the same year. Irrespective of changing risk, population growth and aging are extremely important in determining likely future burden, and demographic changes will continue to have major consequences over the next half century, particularly in the developing world. One illustrative scenario that allows for changing risk of several common cancers is also examined.

Table 6 displays the predicted number of new cases of all cancers based on the estimated incidence rates in 2002 applied to population projections in 2020. In the absence of changing risk or intervention, it is projected that by 2020, there will be about 15.8 million new cases of cancer worldwide, an approximately 45% increase from 2002. Three fifths of the total burden will reside in less developed regions as a result of a more rapid aging and population growth. The greatest relative increase in developing countries will occur among the elderly (defined here as aged 65 or over): An 80% increase is projected from the 2 million cases in 2002 to 3.7 million by 2020. Worldwide, roughly half of the predicted 5 million additional incident cases in 2020 will occur in this age group.

To give an indication of the impact of changing risk on future numbers, Table 7 shows the additional burden that would occur if the generally observed (increasing) breast, colorectal, and prostate cancer incidence trends and (decreasing) stomach cancer trends were to continue at a rate of growth/reduction of 1% per annum. While the increases are modest compared to the demographic component, a nearly 0.75 million additional new cases would be expected in 2020 given the combined 1% increases in breast, colorectal, and prostate cancer rates. This would be partially offset by a quarter million drop in incidence were stomach cancer rates to decline with the equivalent rate of change.

In practice, the net effect of time trends on future worldwide burden is difficult to guess. For several sites, trends are in different directions in different world regions and can change direction even on the short term, as has been observed for lung cancer in the last decade. The foreseeable demographic changes are projected to substantially increase the magnitude of global cancer incidence in the next decades. Other than making provisions for an older and disproportionately larger number of persons diagnosed with cancer within the developing regions, effective cancer control activities – including the capacity to reduce and nullify the tobacco epidemic – can limit its impact. This is particularly the case among the vast populations living in Asia, Africa, and South America, where the destructive effects of tobacco to health are beginning to be realized.

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I’m an oncologist. Here’s what I advised my mom after her cancer diagnosis.

Getting a second opinion from a pathologist is just as important as getting one from another cancer doctor.

My mother-in-law was recently diagnosed with cancer. What steps should patients like her take to make sure they get the best care?

When my mom called to tell me about her lung cancer diagnosis in 2017, my brain struggled to keep up with what my ears were hearing. Phrases came in isolated fragments: “shadow on a chest X-ray,” “doctor says I need a biopsy” and “malignant.” Suddenly, I was cast in the cancer drama, playing an unfamiliar role: Rather than oncologist calmly providing information, contextualizing a diagnosis and developing a treatment plan, I was the son of a patient, trying to get answers.

Over the next few days, after the shock had passed, I helped my mom devise a plan. Here’s what we came up with and what I advise my own patients to do, including getting a second opinion from a pathologist, who examines the body’s tissues to distinguish normal from abnormal.

Many patients skip this step, but mistakes happen. In a study my colleagues and I conducted through the National Institutes of Health, which involved more than 900 patients with suspected myelodysplastic syndromes, a bone marrow cancer, pathologists with expertise in this condition disagreed with the diagnosis given by pathologists who weren’t experts in the diagnosis 20 percent of the time.

Even more troubling, 7 percent of patients who received the wrong diagnosis also received the wrong treatment for their cancer.

That is why it is just as important to seek a second opinion from a pathologist, to confirm the diagnosis, as it is from an oncologist to verify the best treatment plan.

Get a formal diagnosis

Most people learn of a possible cancer diagnosis from someone who doesn’t specialize in cancer. Perhaps a primary care physician raised alarm over a breast lump or a blood test showed an elevated prostate-specific antigen, or PSA. In my mom’s case, a chest X-ray to evaluate a cough revealed a mass.

But we can’t say for sure that an abnormality is cancer until a biopsy confirms that cancerous cells are present. Try to stay calm until you get a formal diagnosis through additional testing. It’s possible that lump is not cancer: In one study , patients with swollen lymph nodes and suspected cancer were referred by their primary care providers to surgeons for a biopsy. Only 17 percent were diagnosed with cancer.

Find out how urgent it is

What if the biopsy does show cancer? It is normal to experience a range of emotions , such as fear, anxiety, sadness, anger or even guilt. I sure did when I learned of my mom’s diagnosis. But before assuming the worst, seek advice from an expert about the seriousness of the cancer. Expect to undergo additional testing, such as radiologic scans or even another biopsy, to determine the cancer’s “stage,” or how much it has spread.

I specialize in caring for people with leukemia and have some patients whom I rush to the hospital to start therapy: A study I conducted with several colleagues showed that the quicker we treat that type of acute leukemia, particularly in younger adults, the longer people live. On the flip side, I have followed other patients with cancer diagnoses, such as some slow-growing, chronic leukemias, for over a decade without any treatment.

In my mom’s case, the biopsy did show lung cancer.

Choose online sources carefully

It is okay to do some online research before meeting with an oncologist, but try not to go down too many rabbit holes. The internet is prone to erroneous health information, with one study finding some sites had very low accuracy for information about pancreatic cancer, and another concluding that only 67 percent of cancer information shared on social media was accurate. Nonprofit (such as established patient advocacy groups), government and academic websites tended to be the most reliable sources.

Take notes at your appointment

When meeting with an oncologist, come with a list of questions to keep the conversation focused on what’s important to you. Bring a family member or friend along to take notes and help you recollect what was said. It can be a lot to remember: When recall for information about treatment and side effects was assessed in 69 older adults with cancer, respondents were correct in only 23 percent of open-ended questions, such as when to contact a doctor or nurse, or recommendations about eating and drinking.

I accompanied my mom, who was 74, to her oncologist appointment and took notes on my computer. Many of my patients and their children use their phones.

Consult another oncologist

Time may be of the essence, and appointments may be difficult to get quickly. So try to be flexible about whom you’re willing to see for a second opinion, where you can see them (some cancer centers like mine have multiple sites), and what time you are willing to see them. For example, my 8 a.m. new patient slot is often more available than my 1 p.m. slot.

In general, larger cancer centers, and particularly academic centers, are more likely to have specialists in your specific cancer and be the most up to date on the latest diagnostic and treatment standards. Some even support telehealth visits, so you can potentially see a world expert from the comfort of your own living room.

Get a second opinion from a pathologist

When scheduling a second opinion with an oncologist, insist that the biopsy of the cancer also be reviewed by the cancer center’s pathology team, who also tend to be specialists. Often, you will have to sign a release for one medical center to send the biopsy specimen to another, or even pick up the specimen and carry it there yourself.

When my mom went for a second opinion, the oncologist she saw at the cancer center where I worked disagreed with her initial diagnosis, which had determined her cancer had spread to nearby lymph nodes and was Stage 3. They found her lung cancer had not spread to her lymph nodes and was only Stage 1. Instead of requiring chemotherapy, radiation therapy and surgery, luckily for her, she just needed the surgery. After the surgery, she was cancer free, and thankfully is alive and well today.

Mikkael A. Sekeres, MD, is the chief of the division of hematology and professor of medicine at the Sylvester Comprehensive Cancer Center, University of Miami. He is author of the books “ When Blood Breaks Down: Life Lessons from Leukemia ” and “ Drugs and the FDA: Safety, Efficacy, and the Public’s Trust .”

A prescription for better living

• Taking care of your skin doesn’t have to be expensive. Here’s a simple, science-backed routine for day and night.
• Our nails are a unique window into our overall health. Here’s what to know about the diseases associated with distinctive nail changes.
• Do you get sleepy in the afternoon after eating lunch? The most likely culprit is your circadian rhythm, but what you eat may also play a role.
• Does acupuncture work for chronic pain? The evidence for using it to treat headaches and back pain is convincing.
• Next time you get a leg cramp, try taking a sip of pickle juice. Athletes have long used it to ward off cramps, and studies show it may actually work.
• Are salads actually good for you ? It depends on what you add to it, especially your choice of dressing.

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“What about diet?” A qualitative study of cancer survivors' views on diet and cancer and their sources of information

R.j. beeken.

1 Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK

K. Williams

Given the abundance of misreporting about diet and cancer in the media and online, cancer survivors are at risk of misinformation. The aim of this study was to explore cancer survivors' beliefs about diet quality and cancer, the impact on their behaviour and sources of information. Semi‐structured interviews were conducted with adult cancer survivors in the United Kingdom who had been diagnosed with any cancer in adulthood and were not currently receiving treatment ( n  = 19). Interviews were analysed using Thematic Analysis. Emergent themes highlighted that participants were aware of diet affecting risk for the development of cancer, but were less clear about its role in recurrence. Nonetheless, their cancer diagnosis appeared to be a prompt for dietary change; predominantly to promote general health. Changes were generally consistent with healthy eating recommendations, although dietary supplements and other non‐evidence‐based actions were mentioned. Participants reported that they had not generally received professional advice about diet and were keen to know more, but were often unsure about information from other sources. The views of our participants suggest cancer survivors would welcome guidance from health professionals. Advice that provides clear recommendations, and which emphasises the benefits of healthy eating for overall well‐being, may be particularly well‐received.

1. Introduction

With increasing numbers of people surviving cancer due to earlier detection and better treatments (Maddams, Utley, & Møller, 2012 ), there is growing interest in the potential of lifestyle factors, such as diet, as a way of reducing the late and long‐term effects of cancer. There is good evidence that a healthy diet (plant‐based with limited intake of high calorie foods, red meat and processed meats) can help prevent cancer (Cancer Research UK, 2015 ; WCRF and AICR, 2007 ). Observational studies have shown that a low‐fat/high‐fibre diet is protective against progression of breast, colorectal and prostate cancers, and there is evidence of an increased risk of breast cancer recurrence from consuming a “Western diet” (Kroenke, Fung, Hu, & Holmes, 2005 ; Patterson, Cadmus, Emond, & Pierce, 2010 ).

The mechanisms linking dietary fat intake with cancer outcomes are not well understood but are thought to be related to sex hormones such as oestrogen. For example, dietary fat intake has been shown to increase levels of oestrogen in the blood, which may promote the development of breast cancer in women (Wu, Pike, & Stram, 1999 ). Fibre is thought to be protective against colorectal cancer because it dilutes faecal contents, increases stool weight and decreases gastrointestinal transit time, potentially reducing exposure to carcinogens (WCRF & AICR, 2007 ). Dietary fibre may also lead to the production of short‐chain fatty acids in the colon, which have been shown to promote apoptosis, potentially reducing the risk of cancer developing (WCRF & AICR, 2011 ). On the other hand, intervention studies suggest that diet may influence outcomes indirectly via its role in energy balance (Chlebowski et al., 2006 ; Pierce et al., 2007 ). However, cancer survivors (defined as “all people who are living with a diagnosis of cancer, and those who have recovered from the disease” [WCRF & AICR, 2007 ]) are also at increased risk of second primary cancers as well as other chronic conditions such as diabetes, osteoporosis and cardiovascular disease (Brown, Brauner, & Minnotte, 1993 ; Travis et al., 2006 ), and diet is an important modifiable factor that could reduce these risks, thereby promoting their long‐term health. Dietary change may also impact quality of life in cancer survivors, particularly for those diagnosed with prostate, breast and colorectal cancer (Kassianos, Raats, Gage, & Peacock, 2015 ).

Previous studies suggest that few cancer survivors attribute the development of their cancer to a poor diet (Willcox, Stewart, & Sitas, 2011 ). However, little is known about whether cancer survivors believe diet to be important for their long‐term health, post‐diagnosis. A recent survey of 3,300 colorectal cancer survivors found that over 20% would like more advice on diet and lifestyle, suggesting that many do not feel sufficiently informed in this area (Department of Health‐Quality Health., 2012 ). Some survivors may want information about diet because of specific nutritional needs or side effects post‐treatment, whereas others may want more information for their general health or to prevent recurrence. Previous studies with breast cancer survivors have found that some are aware that diet may play a role in reducing cancer recurrence (Burris, Jacobsen, Loftus, & Andrykowski, 2012 ; Weiner, Jordan, Thompson, & Fink, 2010 ), but survivors are often unsure what constitutes a healthy diet (Maley, Warren, & Devine, 2013 ). Some studies have shown that cancer survivors report trying to eat a healthy diet following their diagnosis (Lim, Gonzalez, Wang‐Letzkus, Baik, & Ashing‐Giwa, 2013 ; Maskarinec, Murphy, Shumay, & Kakai, 2001 ; Meraviglia & Stuifbergen, 2011 ; Satia, Walsh, & Pruthi, 2009 ; Wang & Chung, 2012 ), however it is unclear what guides these dietary choices.

Many organisations have lifestyle guidelines for cancer prevention (Kushi et al., 2012 ; NHS Choices, 2014 ; WCRF and AICR, 2007 ), but recommendations for cancer survivors are more limited because of insufficient evidence linking diet directly to cancer outcomes. Those that do exist therefore either refer to guidelines for cancer prevention (WCRF and AICR, 2007 ) or focus more on acute health and psychosocial outcomes or nutritional needs as a consequence of treatment, rather than long‐term survival (Schmitz et al., 2010 ). Surveys with health professionals suggest that few discuss lifestyle factors, including diet, with their cancer patients (Daley, Bowden, Rea, Billingham, & Carmicheal, 2008 ; Macmillan Cancer Support/ICM, 2011 ). Insufficient professional advice coupled with a desire for information may lead some cancer survivors to seek out information about diet themselves. This was found in a recent qualitative study of colorectal cancer survivors in the United Kingdom, where several people reported actively try to seek out further information about lifestyle factors such as diet (Anderson, Steele, & Coyle, 2013 ).

Active information‐seeking from media sources has been linked to increased fruit and vegetable consumption among colorectal cancer survivors (Lewis et al., 2012 ), and exposure to health news has been shown to increase knowledge about dietary cancer risks (Stryker, Moriarty, & Jensen, 2008 ). However, when searching in popular media or online, cancer survivors are likely to encounter a wealth of information, not all of which will be reliable and accurate. There is an abundance of media misreporting of the dietary factors that are linked to cancer risk (Goldacre, 2009 ) that could be misleading to patients, particularly if they believe the sources to be trustworthy. Previous studies have demonstrated that survivors do not rate media sources all that highly for general information about their disease and treatment (Chen & Siu, 2001 ), although one study found that those who use the Internet believe this to be a high‐quality source (Mills & Davidson, 2002 ). However, these studies did not explore survivors' use of the media for information about diet and were conducted some time ago. Determining cancer survivors' sources of information about diet and cancer will help understand why they hold particular beliefs about these factors.

Given that little is known about survivors' beliefs about the importance of diet post‐diagnosis and what guides dietary choices post‐diagnosis, a qualitative methodology was chosen to explore this issue. Qualitative research enables us to capture a range of views and to explore why those views are held. Although there are many benefits of quantitative methodologies, a qualitative study enables an in‐depth exploration of cancer survivors' beliefs about the role of diet in their long‐term health and helps us to better understand the sources behind their beliefs and dietary choices.

This study therefore aimed to explore, with a qualitative methodology, cancer survivors' beliefs about the role of diet in their long‐term health and survival, and their sources of information. This could ultimately inform the provision of evidence‐based dietary information to cancer survivors, and the development of effective dietary interventions.

2.1. Participants and recruitment

This was a qualitative interview study with adult cancer survivors (age ≥18 years) living in the United Kingdom, who had been diagnosed with any cancer during adulthood and were not currently receiving treatment for cancer. Because there are few tailored dietary recommendations for survivors, and we were interested in beliefs about the benefits of diet for long‐term health and survival in general, as opposed to nutritional needs specific to certain cancers/treatments, we sought to recruit a range of survivors. This also meant we would be representing a wide range of views, applicable to the wider survivorship population as opposed to focusing on a more specific group. Interviews were chosen over focus groups as we were interested in hearing about patients' individual beliefs and experiences, rather than determining a group consensus. We did not want individuals' unique beliefs and experiences to be influenced by group discussions or concerns that others might view their beliefs to be “incorrect”. Telephone interviews also encouraged individuals to take part that might have otherwise been put off by a lack of flexibility around time (e.g. because of work commitments) and location (e.g. because of distance). A qualitative methodology was chosen because we were not seeking to test a hypothesis, but rather to obtain a rich source of information to better understand the rationale behind dietary beliefs and changes in this population (Holliday, 2010 ).

The study was advertised via an advert on Cancer Research UK's “Cancer Chat” online forum (Cancer Research UK, 2014 ) and by posters and flyers displayed in the University College Hospital Macmillan Cancer Centre. Potential participants were asked to contact the study team by telephone or email to check eligibility, and a follow‐up telephone call was arranged for those making contact by email. During this telephone call, information was given about the study with an opportunity to ask questions. An interview was then arranged for those interested in taking part, either face‐to‐face (at the University) or over the telephone, depending on the participant's preference. A study information sheet, consent form and brief socio‐demographic questionnaire were mailed for completion before the interview took place. We aimed to recruit until it was felt that saturation had been reached. In line with other qualitative studies in similar groups, we anticipated that approximately 15 participants would be required for this to be the case (Meraviglia & Stuifbergen, 2011 ; Thewes, Butow, Girgis, & Pendlebury, 2004 ). Ethics approval was granted by the University College London Research Ethics Committee, reference 0793/004.

2.2. Data collection

Socio‐demographic questions covered gender, age, marital status, education and employment. It also included a check question about their cancer diagnosis (“Have you ever been diagnosed with cancer”), the primary cancer site (“If yes, which type”) and the date of diagnosis (“When were you diagnosed”).

Semi‐structured interviews were carried out by three female researchers (KW, HC and RB) between March and July 2013. Interviews lasted approximately 1 hr, and were recorded and transcribed verbatim. A topic guide (Figure  1 ) was developed by HC, KW and RB to guide the interviews and consisted of a series of open questions covering beliefs about the relationship between diet and cancer, sources of information and changes to diet following cancer diagnosis. This was part of a broader interview that also covered participants' views about other lifestyle factors and cancer. Interviewers were trained to have minimal verbal input and prompt only when appropriate (Oppenheim, 1992 ). The topic guide was piloted with two participants whose data were included because no substantial changes were required.

Topic guide for qualitative interviews

2.3. Analysis

Data were analysed using Thematic Analysis, a qualitative method for identifying, analysing and reporting themes (Braun & Clarke, 2006 ). Thematic analysis was chosen to provide a rich description of the data, and to identify themes at an explicit level using a realist approach (Braun & Clarke, 2006 ). The first three transcripts were reviewed independently by three researchers (KW, HC and RB) who each generated an initial list of codes. These lists were then amended and refined through discussion between the researchers until a single list was agreed. A researcher (KW) entered the list of codes into NVivo version 10 (QSR International Pty Ltd, 2012 ) and coded all the transcripts, with codes added to the list where necessary. A random selection of transcripts ( n  = 5) were coded by a second researcher (HC) to check for reliability. Inter‐rater reliability for the coding was generally high (>.7) with any discrepancies discussed and resolved in discussion. Once the coding had been agreed, KW and RB reviewed the coded transcripts to search for common themes. These themes were reviewed and refined, named and each given a written description.

3.1. Participants

Twenty‐four cancer survivors made contact having seen an advert for the study. Of these, two were not eligible because they lived abroad, two had contacted us about issues unrelated to our study (they were referred to the Cancer Research UK nurse help‐lines) and one did not respond to our attempts to contact them back. Nineteen interviews were conducted with 11 women and 8 men, aged between 24 and 77 years (Table  1 ); 5 face‐to‐face and 14 by telephone. All interviews were conducted with only the participant and interviewer present. Of the 19, 7 were recruited via the online forum and 12 were recruited through flyers. After the target number of 15 interviews was achieved, the authors discussed the themes emerging and whether saturation had been reached (Morse, 2000 ). Although it appeared that saturation was reached at this point, a further four interviews were conducted to confirm this. All participants described their ethnicity as White British, the majority were married (68%) and half were working in some capacity (53%). Educational attainment varied although the majority (58%) had a higher education qualification. Breast cancer was the most common diagnosis (37%) and the majority of participants had been diagnosed in the past 5 years (63%).

Socio‐demographic and health characteristics

3.2. Themes

A number of themes emerged, which were as follows: (1) diet is a potential cause of cancer development, (2) diet is important for long‐term health, (3) a cancer diagnosis prompts dietary change and (4) a desire for more information about diet post‐diagnosis. There were no obvious differences in responses by cancer type, age or gender, so results are presented from the whole sample.

3.2.1. Diet is a potential cause of cancer development

Participants described how they had tried to understand what might have caused their cancer: “for me it was like, well where did this come from, what's caused it?” (101, male, 60 years, non‐Hodgkin lymphoma), “Once I got the cancer it was like, ‘Ok, you have to find a reason for this’” (105, female, 51 years, breast cancer). This had led them to question if diet had played a role: “I've thought of food – is there food I am eating what's causing this?” (110, female, 51 years, breast and bladder cancer), “I think it's absolutely fascinating to know whether it is partly our diet” (103, female, 62 years, breast cancer and non‐Hodgkin lymphoma), “I honestly don't think I could have been doing anything wrong, apart from possibly something to do with my diet” (105, female, 51 years, breast cancer), “It's just that so many people these days, sadly, are getting cancer and I don't know whether it's the water or whether it's the food they eat” (114, female, 74 years, breast cancer).

Participants mentioned specific foods that they thought may contribute to the development of cancer. Occasionally, this related to the development of their own cancer: “It could be the result of eating too many crisps…I'm a bit of a crispaholic” (101, male, 60 years, non‐Hodgkin lymphoma), but more often it was discussed in relation to the onset of other types of cancer, or cancer in other people: “If you eat lots of fatty foods you're going to get, I don't know, some sort of cancer, diabetes, maybe, but, erm, that wasn't the case when it came to mine” (108, male, 24 years, NET), “I think additives are a danger, MSG and all this, I see it as a health danger but whether it can cause cancer or other conditions, I don't know” (116, male, 68 years, lung cancer). When participants did mention specific foods in relation to causing cancer, there were generally accurate beliefs. For example, red meat and burnt food were described as potential causal factors: “I sometimes think that red meat causes possibly bowel cancer” (102, male, 38 years, Hodgkin disease), “When the barbecue's black, that seems to be a big no‐no, is it carcinogenic or something, and I think the cancer develops on it or something” (105, female, 51 years, breast cancer). Others mentioned that fibre may help prevent cancer: “Certain nuts, apparently the high fibre in it's supposed to help stop you getting the cancer” (104, male, 69 years, prostate cancer), “I think if you have the right diet and plenty of roughage, everything is pushed out on a regular basis, but if it sits in there three or four days, this can be a contributing factor to the cancers growing” (109, male, 77 years, colon cancer).

3.2.2. Diet is important for long‐term health

Participants talked about dietary factors that they thought might influence their long‐term health. Generally, they did not have strong beliefs about specific dietary components that could prevent recurrence, although they sometimes mentioned foods in relation to having had cancer: “I read that if you have a carcinoid tumour in your body, still, you need to avoid…spicy food such as curries” (108, male, 24 years, NET), “Like [for] bowel cancer, there are certain foods you are recommended to try and avoid. I think red meat is one” (104, male, 69 years, prostate cancer). More frequently they expressed general beliefs about specific foods that are healthy: “eating tomatoes, apparently, is supposed to be good for you, and nuts, tomatoes, anything, apparently, red‐coloured is supposed to help” (104, male, 69 years, prostate cancer), “Plenty of green veggies, i.e. broccoli and greens and things like that” (114, female, 74 years, breast cancer) or unhealthy: “my understanding is that white flour and sugar are kind of poison to your body” (105, female, 51 years, breast cancer). Methods of cooking that they believed were bad for them were also mentioned: “Just the fact that the way they're manufactured, the stuff's not fresh, it's not getting to you until it's been through all these processes….and it's kept in these polystyrene‐type dishes and stuff which you stick in the microwave or stick in the oven” (105, female, 51 years, breast cancer). Participants emphasised the importance of a balanced diet: “I believe you should have a little bit of everything. I am not one of these who think fruits and vegetables are going to change my life” (110, female, 51 years, breast and bladder cancer), “I think everything in moderation is the way” (116, male, 68 years, lung cancer).

Participants mentioned dietary supplements and views were polarised. Some believed that they were good for their health: “Selenium is very good for you” (114, female, 74 years, breast cancer), “manuka honey…it's meant to have antibacterial” (112, female, 69 years, non‐Hodgkin lymphoma), “magnesium…that's good for the bones” (114, female, 74 years, breast cancer), although they did not specifically mention them in relation to cancer cure or prevention of recurrence. In contrast, others believed dietary supplements could be harmful to health and even cause cancer: “there are some supplements that will give you cancer” (107, male, 50 years, melanoma), “I fundamentally disagree with them [supplements]. I am a pharmacist's daughter and just think it's all rubbish” (113, female, 47 years, thyroid cancer). Those who expressed negative attitudes towards supplements in this sample were from more academic backgrounds or had family members who worked in healthcare.

3.2.3. A cancer diagnosis is a prompt for dietary change

Although participants were often aware of the benefits of a healthy balanced diet, it was not something that they had necessarily paid attention to until they were diagnosed with cancer: “I never really read up on [lifestyle] before…maybe I did and I just ignored it because we were all fine…then once I got the cancer…all the things that you used to do that they're saying are bad for you, you're trying to cut out” (105, female, 51 years, breast cancer). Participants had similar stories about how their cancer diagnosis had prompted them to make changes to their diet: “I have really, really looked at my diet since I was diagnosed with a lymphoma” (103, female, 62 years, breast cancer and non‐Hodgkin lymphoma), “you become acutely sensitised to anything cancer‐related….anything carcinogenic…you become really tuned into in terms of foodstuffs” (101, male, 60 years, non‐Hodgkin lymphoma). Participants did occasionally mention that they had made dietary changes to avoid cancer recurrence: “I read that this has more chance of coming back, then I have to cut out the only things that I can cut out now. I can't stop smoking because I never did, and I can't stop alcohol because I don't. So the only thing I've got to work on is my diet” (105, female, 51 years, breast cancer). However, they seemed to be more concerned about their long‐term health in general and wanted to give themselves the best chance at living a healthy life having survived their cancer diagnosis: “I think I'm probably more worried about [high blood pressure] than I am about getting cancer again” (115, female, 63 years, breast cancer), “I just felt that [dietary changes] would be better for my health” (114, female, 74 years, breast cancer). One participant also mentioned that weight management was a factor in their dietary choices: “If I am being honest, we did it [eat more healthily] more as part of the weight‐loss plan” (106, female, 50 years, breast cancer).

For these participants, eating a healthy balanced diet involved eating more of specific healthy foods, typically more fruit and vegetables: “I eat a lot more fruit than I ever did” (102, male, 38 years, Hodgkin disease). Some mentioned that they try to buy organic foods whenever they could as they believed this was better for them: “I try to go as organic as I can” (105, female, 51 years, breast cancer), “I am also into the organic lentils, sprouts and organic… you know, all better food, much better quality of food” (111, female, 63 years, thyroid cancer). Participants also talked about how they tried to avoid or cut down on particular unhealthy foods. They mentioned a range of foods but these were typically fatty, sugary foods and processed meat: “Cutting down on fatty food, I've reduced my intake of crisps” (101, male, 60 years, non‐Hodgkin lymphoma) and “Red meat, definitely, was reduced” (103, female, 62 years, breast cancer and non‐Hodgkin lymphoma), “I used to eat biscuits and cakes, cakes for breakfast, loved it, always loved cake for breakfast but I haven't had cake for ages, haven't had cake for ages. I might have an occasional biscuit but very rarely. So my diet has changed radically, as has my life” (111, female, 63 years, thyroid cancer). Others emphasised that they just tried to eat healthily and be sensible rather than following a particular diet or eating specific foods: “Just an ordinary, really healthy, sensible diet” (119, female, 67 years, melanoma).

Participants mentioned taking dietary supplements to benefit their health. Again the logic seemed to be about general health rather than a particular anti‐cancer property: “I have been taking supplements for years – magnesium, because that's good for the bones, selenium, as I said, vitamin C, I take that, and also I take a vitamin B which is very good” (114, female, 74 years, breast cancer), “I have a high dose of cod liver oil” (116, male, 68 years, lung cancer), “I take multivitamins and minerals every day” (108, male, 24 years, NET). For the most part, no explicit reasons for taking them were given and participants did not necessarily report any awareness of what they should/should not be doing. One participant said: “Selenium is supposed to be prevention from cancer” (114, female, 74 years, breast cancer) and therefore reported taking it regularly although she was unclear where this information had come from. In contrast, others mentioned that they avoided supplements. For some this was because they had been directed to for treatment reasons: “I've steered clear of all of them [supplements] because of the medication that I'm on” (115, female, 63 years, breast cancer), “I don't take supplements” (117, male, 65 years, testicular cancer). Some participants cited that their reason for avoiding supplements was because they preferred to get their vitamins and minerals from their diet: “It was more focused on…trying to increase my vitamins level naturally as opposed to taking supplements” (103, female, 62 years, breast cancer and non‐Hodgkin lymphoma), “I don't take pills very often. No, nothing. Just an ordinary, really healthy, sensible diet” (119, female, 67 years, melanoma).

3.2.4. A desire for more information about diet post‐diagnosis

Participants were positive about the idea of getting dietary information, but did not generally recall receiving any from a health professional or had received only basic information or advice about lifestyle: “I didn't really get any advice about that…if anything, it was just try and eat a well‐balanced diet” (110, female, 51 years, breast and bladder cancer), “Well, shamefully, I wasn't given much information” (111, female, 63 years, thyroid cancer), “All I got, as I said, was a one‐off letter with a piece of paper in from the dietitian, saying how I can help to restore, recover and boost my phosphate levels and above, which is a very, very finely focused view of one aspect, one tiny aspect, of recovery from cancer” (101, male, 60 years, non‐Hodgkin lymphoma). It was reported that they had asked for dietary information: “I sort of said to my consultant, ‘What about diet?’” (103, female, 62 years, breast cancer and non‐Hodgkin lymphoma), and “should I be doing anything about my diet or anything while I'm doing this?” (105, female, 51 years, breast cancer). Some had even paid to see a health professional privately because they were not given sufficient information: “the other private appointment was the dietitian because there was nothing at the hospital for me” (105, female, 51 years, breast cancer). When participants had received advice from health professionals, this was not always consistent and sometimes added to their confusion about what they should do: “it was suggested by my breast care nurse that selenium might be a suitable supplement to take and to take it with vitamin A, C and E, as a combo…my current consultant doesn't seem to favour supplements” (103, female, 62 years, breast cancer and non‐Hodgkin lymphoma).

As professional advice seemed to be lacking, participants mentioned that they had researched information about lifestyle themselves. Participants reported seeking advice from cancer charities, and finding this helpful: “the information I got was the very, very good [charity name] booklets” (103, female, 62 years, breast cancer and non‐Hodgkin lymphoma), “there were lots of booklets on all sorts of things – living with cancer, the emotional aspects, the travel insurance, diet, all sorts of things” (112, female, 69 years, non‐Hodgkin lymphoma), “I went to [charity name] for most of my literature” (106, female, 50 years, breast cancer), “I phoned, once, …and they were fairly helpful” (111, female, 63 years, thyroid cancer). One participant also mentioned contacting a local organisation: “I phoned an organisation in [location] to ask about diet because this has been my problem; I don't know what's good and what's bad and whatever” (111, female, 63 years, thyroid cancer).

Survivors had also used the Internet for their research: “I went onto the Internet and found a few things. I just put in ‘anti‐cancer foods’ and got what came up” (105, female, 51 years, breast cancer), “I saw on the Internet, someone suggested a book”, “the Internet for hours and hours and hours, and printing off and printing off…they gave me a website to have a look at and I had a look at it, a thyroid cancer site. I've looked at all of them” (111, female, 63 years, thyroid cancer). Participants mentioned online charity forums as a source of information about lifestyle: “you get a lot of people with lots of ideas and suggestions” (101, male, 60 years, non‐Hodgkin lymphoma). However, participants said that they had difficulty sifting the reliable information from the wealth of nonsense online: “there is so much information and so many claims and counter‐claims, some good‐hearted or good‐willed, some just out to make money and some just plain scams that it's just impossible to tell one from another” (101, male, 60 years, non‐Hodgkin lymphoma), “when I was first diagnosed I went on a heck of a lot of different sites…I found some of them are downright misleading” (104, male, 69 years, prostate cancer), “the worst place of all is online…there are a lot of deliberately misinforming websites…go on any cancer patients' board…people will be promoting the vitamin‐type supplements. And then there's the magic fruit…, the noni and soursop…it's all claptrap” (107, male, 50 years, melanoma). One participant talked about how he had tried to clarify online information by reading research papers: “I read the secondary sources in the cases where there seemed to be something in it. I had a look at the primary sources…it was all groundless” (107, male, 50 years, melanoma).

In addition to doing their own research, participants mentioned obtaining information about lifestyle incidentally from the media: “I keep an eye on reports and media” (116, male, 68 years, lung cancer), “I get it by reading the paper” (117, male, 65 years, testicular cancer), “if there's an article in the newspaper, I'll read that, on cancer prevention” (118, female, 64 years, breast cancer), “you pick things up in the press” (115, female, 63 years, breast cancer). Participants also cited ‘facts’ about diet but could not recall where they had obtained particular information: “It's a well‐known fact [that supplements such as selenium and green vegetables are good for you]” (114, female, 74 years, breast cancer).

4. Discussion

This study aimed to explore cancer survivors' beliefs about the role of diet quality in cancer and to understand their sources of information. The results suggest that survivors are broadly positive about eating healthily, and participants reported making, or at least trying to make, some changes following their cancer diagnosis. Some specific foods and nutrients were mentioned as healthy (e.g. nuts, tomatoes, red foods, green vegetables, selenium, manuka honey) or unhealthy (e.g. red and processed meat, white flour, sugar, spicy food, processed food) but on the whole, participants perceived a healthy balanced diet as more important than specific foods or supplements. Although cancer was often a prompt for addressing lifestyle change, a healthy diet after diagnosis tended to be based on the belief that this was good for general health rather than specifically connected to cancer outcomes. Where diet was discussed specifically in relation to cancer, this was most often in connection with causing cancer as opposed to a role in cancer recurrence. However, in line with previous studies (Wold, Byers, Crane, & Ahnen, 2005 ), participants did not attribute the development of their own cancer to diet. Diet was cited as an important risk factor for cancer in general and in relation to other people rather than themselves. Participants reported not receiving dietary information from a health professional, and obtaining their information from charities, the Internet and the media.

Our participants discussed how their cancer diagnosis had prompted them to think about dietary changes. This may reflect a desire to take control or have some sense of agency post‐diagnosis (Kassianos, Coyle, & Raats, 2015 ), and is also consistent with the idea that a cancer diagnosis may be a “teachable moment”, in which individuals are motivated to adopt health behaviours (McBride & Ostroff, 2003 ). However, this hypothesis is at odds with population studies which have found little evidence of sustained positive health behaviour changes as a result of a cancer diagnosis (Kim et al., 2013 ; Milliron, Vitolins, & Tooze, 2014 ; Williams, Steptoe, & Wardle, 2013 ). This may be because patients are not given the tools (advice, support) to realise the potential of the “teachable moment”, or have other competing interests that take priority over dietary change. However, it also suggests people may be overestimating the extent to which they have made lifestyle changes. This is consistent with findings that people think that their behaviours are already good (Anderson, Steele, & Coyle, 2013 ; Dowswell et al., 2012 ; Satia et al., 2009 ) and on the whole they report continuing these post‐diagnosis (Satia et al., 2009 ).

Our participants reported making changes that included trying to follow a “healthy balanced diet”, reducing specific foods (e.g. high fat foods, red meat) and increasing specific foods (e.g. fruit). Although participants reported that their cancer diagnosis had prompted them to make these positive dietary changes, the motivations for doing this seemed to be driven by beliefs about the importance of diet for improving general health rather than cancer‐related (e.g. to reduce their risk of recurrence). This is consistent with other studies that have shown general health to be an important motivation for healthy eating in adults, and particularly for older adults (Dijkstra, Neter, Brouwer, Huisman, & Visser, 2014 ). It is also not unreasonable that cancer outcomes are not a key driver for dietary change given that there is not yet evidence that diet quality has a direct influence on outcome for all cancers. In addition, although some studies have found evidence for an effect of diet on overall morbidity (Chlebowski et al., 2006 ), the precise mechanisms are not yet understood, and the relationship may well be indirect, for example through the role of diet in overall energy balance.

The fact that cancer was not mentioned in relation to motivations for eating healthily also suggests cancer survivors may not be aware of the added benefits of a healthy diet after a cancer diagnosis—because they are at increased risk of conditions associated with lifestyle (Brown et al., 1993 ; Travis et al., 2006 ). Public awareness of the link between some aspects of lifestyle and cancer is known to be low (Redeker, Wardle, Wilder, Hiom, & Miles, 2009 ) and the same may be true for cancer survivors. On the other hand, it may simply be that post‐diagnosis, individuals are more driven to change their diet by a positive (feel good) approach as opposed to a preventive (don't get sick) approach. Focusing on associations between diet‐ and cancer‐specific outcomes may result in feelings of blame, personal guilt or responsibility at one's cancer diagnosis or recurrence (Bell, 2010 ), which patients may seek to avoid. There is some evidence that interventions seeking to change diet can have a positive impact on quality of life (Kassianos, Coyle, & Raats, 2015 ). Interventions framed in terms of the potential benefits of a healthy diet for overall well‐being and quality of life may be attended to more than those focused on risk reduction.

Recommendations have been produced that suggest cancer survivors should receive lifestyle counselling (Murphy & Girot, 2013 ; Travis, Demark Wahnefried, Allan, Wood, & Ng, 2013 ; WCRF and AICR, 2007 ). However, our participants did not recall receiving professional advice about diet. This may be because such information was provided, but at a time when patients were too burdened or overloaded to take the advice on board, and therefore do not recall it (James‐Martin, Kockwaza, Smith, & Miller, 2013 ). However, surveys also indicate that many health professionals do not discuss lifestyle change with their patients (Anderson, Caswell, Wells, & Steele, 2013 ; Daley et al., 2008 ; Macmillan Cancer Support/ICM, 2011 ), and a recent survey of oncology health professionals found that only half were aware of dietary guidelines for cancer survivors (Williams, Beeken, Fisher, & Wardle, 2015 ). Lack of guidelines, the belief that diet would not affect cancer outcomes and not being the right person to give advice were all identified as barriers to providing dietary advice (Williams et al., 2015 ). In line with previous research (Kassianos, Coyle, et al., 2015 ), our participants placed importance upon receiving health professional advice on diet, but found the advice they did receive insufficient, and at times inconsistent. There is therefore a potential need to support health professionals to locate the current guidelines for cancer survivors, to understand the evidence base with respect to long‐term outcomes and to recognise how their role may be important for the delivery of this advice to patients.

With the lack of health professional advice, our participants reported seeking and obtaining dietary information from the Internet and media. This was also found in a recent qualitative study of prostate cancer survivors' perceived influences on dietary change (Kassianos, Coyle, et al., 2015 ). Use of informal sources may in part explain why some of our participants' beliefs about diet were less well established (e.g. white flour, sugar and food in polystyrene containers being harmful; manuka honey and dietary supplements being beneficial) (WCRF and AICR, 2007 ). Dietary advice is poorly reported in the media (Cooper, Lee, Goldacre, & Sanders, 2011 ; Goldacre, 2009 ); up to two‐thirds of dietary health claims made in UK newspapers have been shown to have insufficient evidence to support them, especially in tabloid newspapers (Cooper et al., 2011 ). Although our participants were able to find some reliable sources of information on charity websites, they reported difficulties in knowing what to believe. Health professionals could provide guidance in this area that would be welcomed.

This study had a number of limitations. Although the evidence for an association between dietary factors and cancer is stronger for certain types of cancers (e.g. red and processed meat and colorectal cancer), views and advice received by participants in our study did not appear to vary based on their cancer type. However, given the small and heterogeneous sample, it is difficult to draw firm conclusions about the absence or presence of any patterns based on participant characteristics, and we were not seeking to do so. Our sample included people with various types of cancers, treatments and time since diagnosis, making it difficult to compare beliefs and experiences, although it gives a good overview of cancer survivors' views. Results from this study must be interpreted within the limitations of the sample. All participants were White British, relatively young, and well educated. Previous research has identified different drivers for healthy eating in older adults and those from lower socio‐economic groups. Although not apparent in our study, gender and the role of partners and other family members, may also be important (Kassianos, Coyle, et al., 2015 ; Mroz & Robertson, 2015 ). Future research should seek to explore this in more depth.

Furthermore, self‐selection bias could explain the generally positive responses to dietary change in the current study. Those interested in our study may be those with a long‐term interest in healthy lifestyles, or those who have become interested since diagnosis. We did not ask about pre‐diagnosis dietary habits except in the context of how things had changed post‐diagnosis. Bias may also have been introduced by the interviewers; 2, health psychologists and a dietitian. Participants' awareness of these roles may have encouraged answers that were positive about healthy eating, although it was emphasised that there were no right or wrong answers. We recruited partly through an Internet forum meaning that some participants may be particularly motivated to find out information about their cancer, and may have higher Internet literacy. However, we balanced this out by putting up posters in a cancer centre where people were attending routine appointments.

5. Conclusions

In conclusion, our findings suggest that cancer survivors are aware of some dietary messages, such as to eat a balanced diet, and report making dietary changes. Although often prompted by a cancer diagnosis, these changes are made primarily because of a desire to feel well and be healthy generally, rather than specifically for disease prevention. The majority of patients' information about diet had been obtained from informal sources (e.g. online, media, others) and there was some confusion over what constitutes a balanced diet. Patients would welcome guidance from health professionals on diet. Interventions that provide clear dietary recommendations for those diagnosed with cancer, and which emphasise the benefits of healthy eating for overall well‐being, may be particularly well‐received. Future research should seek to explore how best to support health professionals to provide this advice.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

HC and JW conceived of the study. All authors contributed to the development of the topic guide. HC, KW, and RB conducted the qualitative interviews. HC, KW, and RB analysed the qualitative interviews in NVivo and generated the list of themes. All authors helped draft the manuscript. All authors read and approved the final manuscript.

Acknowledgments

All authors are supported by funding from Cancer Research UK.

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