HOPE Protocol [PDF, 420KB] - National Cancer Survivorship Initiative

Footnotes
1 A rapid review aimed at updating that of ‘Evidence to inform the Cancer Reform Strategy:
The clinical effectiveness and cost-effectiveness of follow-up services after treatment for
cancer, ‘as conducted by the Centre for Reviews and Dissemination (2007) is currently
underway.
2 Davies, NJ (2009a,b) Self-Management Programmes for Cancer Survivors: A Structured
Review of Outcome Measures, commissioned by Macmillan Cancer Support for the NCSI.
3 A report by the Picker Institute, commissioned by NHS Improvement and Macmillan Cancer
Support, demonstrated an implicit assumption among survivors and carers that ‘follow-up’
care occurs when treatment has ended (Sheldon, Davis, and Parsons, 2008). Therefore, the
baseline measurement period of 6-weeks post-treatment encompasses this shared definition
whilst also providing time between final treatment and the intervention for survivors to
become socially reintegrated.
4 Health status evaluations have been demonstrated to change according to age and illness
(Kaplan and Orna Baron-Epel, 2002); Demographic variables such as age and educational
status might be important predictors of quality of life and thus need to be controlled when
analysing data (Wenzel et al, 1999).
5 Evidence exists in the way of social support being a potential buffer against disease
progression (Smith et al., 1994), as well as being positively associated with better
psychological well-being (Stanton and Snider, 1993; Rodrigue, Behen, and Tumlin, 1994)
and better psychosocial adjustment (Heim et al., 1997).
6 It is important to control for socio-economic status (SES) as it is related to health
behaviours, such as breast screening (Yarbrough and Braden, 2001). However, the most
effective method of measuring SES has been under debate, with potential indicators being
income, occupation, postcode, educational status, to name a few (Deonandan et al., 2000;
Shavers, 2007). Educational attainment is perhaps the most widely used indicator of SES
due to the ability to characterise the educational achievement level of most individuals.
Furthermore, education can be seen as the most basic component of SES because of its
influence on other SES indicators such as occupation and income (Adler and Newman,
2002). There are several possible mechanisms through which education might influence
health status. For example, people with higher education may have developed better
information-processing and critical thinking skills, skills in navigating health services, and
abilities required to interact effectively with healthcare providers. Individuals with higher
education may also be more likely to be socialised to health-promoting behaviour and
lifestyles, and have better work, economic conditions, and psychological resources (Ross
and Mirowsky, 1995; Yen and Moss, 1999). An advantage of using education as a measure
of SES for adults is that the likelihood of reverse causation (e.g., which came first, poor
health or low SES)—which can be a problem with other standard SES measures—is
reduced, as education is usually complete before detrimental health effects occur (Stewart,
2001).
7 Co-morbidities have been found to correlate with various dimensions of quality of life in
women with breast cancer (Davies et al., 2008).
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