This study aimed to investigate the prevalence of and factors associated with nonadherence to medication amongst a sample of breast cancer patients. 131 women with stable disease were interviewed and completed standardised psychological measures. 55% of women reported non-adherence to medication frequently or occasionally, with younger women and those who disliked taking their medication being significantly less adherent (P =0.015, P =0.001). Women who deliberately omitted taking their tablets occasionally or frequently had significantly lower scores, indicative of a weaker influence, on 'internal' and 'powerful others' dimensions of health locus of control (P =0.032, P =0.009). Despite a life-threatening diagnosis, patients may not adhere to medication representing a potential missed opportunity for health gain and waste of resources. Furthermore, interpretation of clinical trial data may be misleading without adherence information. More r esear ch is need ed to iden tify those at risk for non-adherence. If other routes of administration are available these options should be discussed with patients to maximise efficacy of therapy.

Cognitive dysfunction can occur in some patients with amyotrophic lateral sclerosis (ALS) who are not suffering from dementia. The most striking and consistent cognitive deficit has been found using tests of verbal fluency. ALS patients with verbal fluency deficits have shown functional imaging abnormalities predominantly in frontotemporal regions using positron emission tomography (PET). This study used automated volumetric voxel-based analysis of grey and white matter densities of structural magnetic resonance imaging (MRI) scans to explore the underlying pattern of structural cerebral change in nondemented ALS patients with verbal fluency deficits. Two groups of ALS patients, defined by the presence or absence of cognitive impairment on the basis of the Written Verbal Fluency Test (ALSi, cognitively impaired, n=11; ALSu, cognitively unimpaired n=12) were compared with healthy age matched controls (n=12). A comparison of the ALSi group with controls revealed significantly (p<0.002) reduced white matter volume in extensive motor and non-motor regions, including regions corresponding to frontotemporal association fibres. These patients demonstrated a corresponding cognitive profile of executive and memory dysfunction. Less extensive white matter reductions were revealed in the comparison of the ALSu and control groups in regions corresponding to frontal association fibres. White matter volumes were also found to correlate with performance on memory tests. There were no significant reductions in grey matter volume in the comparison of either patient group with controls. The structural white matter abnormalities in frontal and temporal regions revealed here may underlie the cognitive and functional imaging abnormalities previously reported in non-demented ALS patients. The results also suggest that extra-motor structural abnormalities may be present in ALS patients with no evidence of cognitive change. The findings support the hypothesis of a continuum of extra-motor cerebral and cognitive change in this disorder.

Background:During 2001 to 2005, 1-year breast cancer survival was low in ethnically diverse East London. We hypothesised that this was due to low breast cancer awareness and barriers to symptomatic presentation, leading to late stage at diagnosis in women from ethnic minorities. We examined ethnic differences in breast cancer awareness and barriers to symptomatic presentation in East London.Methods:We carried out a population-based survey of 1515 women aged 30+ using the Cancer Research UK Breast Cancer Awareness Measure. We analysed the data using logistic regression adjusting for age group and level of deprivation.Results:South Asian and black women had lower breast cancer awareness than white women. South Asian women, but not black women, reported more emotional barriers to seeking medical help than white women. White women were more likely than non-white women to report worry about wasting the doctor's time as a barrier to symptomatic presentation.Conclusion:Interventions to promote early presentation of breast cancer for South Asian and black women should promote knowledge of symptoms and skills to detect changes, and tackle emotional barriers to symptomatic presentation and for white women tackle the idea that going to the doctor to discuss a breast symptom will waste the doctor's time.

Objective:To identify what patient and carer characteristics influence transition into residential care for people with dementia. Method: Longitudinal study of a cohort of people with dementia and their carers in contact with old age psychiatric services in south London. Results: 100 people with dementia and their main family carer were recruited. At six month follow up 22 were in residential care, 63 in the community, 8 had died, and for 7 there were missing data. Between six and 12 months, 7 of the 63 in the community went into residential care, 4 died, and 12 were lost to follow up. The most striking finding is the 20-fold protective effect of having a co-resident carer (odds ratio 0.05, 95% confidence intervals 0.01 to 0.42, p=0.006). Higher ratings of behavioural problems in the person with dementia were also statistically significantly associated with transition into residential care as was the psychological domain of quality of life of the carer. Conclusion: These findings powerfully illustrate the pivotal role carried out by carers of people with dementia; interventions directly targeted at helping them to maintain this role would be supported by these data. These data also suggest that strategies directed at improving carer quality of life and at the resolution of behavioural disorder in the person with dementia may also have particular value.T he dementias are some of the most common and serious disorders in later life. They cause irreversible decline in global intellectual and physical functioning. There are profound impacts on the person with dementia, their family and carers, and also on health, social and voluntary services, in personal, social, health, and economic terms.1 The challenge of meeting the health and social care needs of people with dementia and their family carers is profound.2 A major element of the economic impact of caring for people with dementia is consequent to their increased risk of requiring admission into residential care.3 Taken with carer and patient choice, these costs have resulted in a focusing of policy on maintaining people with dementia in the community.Patient characteristics such as increasing age, lower cognitive function, poorer self related health, increased limitation in activities of daily living, and not being married have all been reported to be associated with institutionalisation. 4 A recent analysis of the people with Alzheimer's disease receiving Medicare has demonstrated the importance of considering both patient and caregiver characteristics simultaneously when considering nursing home placement in dementia.5 To formulate effective packages of support for carers and people with dementia it is necessary to identify what influences transition into residential care. We therefore carried out a study with that aim and we report data from this here. METHODSPeople diagnosed as having dementia by old age psychiatric services in south east London and living in the community were recruited along with their main family carer. They were assessed at baseline with a...

Background:Low cancer awareness contributes to delay in presentation for cancer symptoms and may lead to delay in cancer diagnosis. The aim of this study was to review the evidence for the effectiveness of interventions to raise cancer awareness and promote early presentation in cancer to inform policy and future research.Methods:We searched bibliographic databases and reference lists for randomised controlled trials of interventions delivered to individuals, and controlled or uncontrolled studies of interventions delivered to communities.Results:We found some evidence that interventions delivered to individuals modestly increase cancer awareness in the short term and insufficient evidence that they promote early presentation. We found limited evidence that public education campaigns reduce stage at presentation of breast cancer, malignant melanoma and retinoblastoma.Conclusions:Interventions delivered to individuals may increase cancer awareness. Interventions delivered to communities may promote cancer awareness and early presentation, although the evidence is limited.

Current findings support recent observations that individuals' ratings of their QoL cannot simply be equated with their physical impairment and functional limitations, and that support systems may be important. Cognitive functioning, known to be impaired in some people with MND, should also be considered when evaluating QoL.

The majority of breast cancer patients preferred hormone therapy via daily tablets rather than monthly injections. Information about side-effects or improved efficacy altered these preferences. Adherence to treatment cannot be assumed; patients' preferences about drug administration may influence this.

Cancer Research UK, London, UK (grant numbers C6280/A3162 and C6280/A6764).