Hannah Dale, Gozde Ozakinci, Pauline Adair & Gerry Humphris PhD Student, School of Medicine, University of St. Andrews Health Psychologist NHS Fife

Men’s cancer inequalities Cancer incidence and mortality rates are worse for men than women in most countries (Micheli et al., 2009; Jemal et al, 2011) Single men have even worse outcomes than partnered men or single/partnered women (e.g. Konski et al, 2006) May be affected by (All party parliamentary group on cancer, 2009): poorer symptom awareness poorer help seeking lower uptake of screening programmes Influence of psychosocial issues and health behaviours on mortality generally lack evidence or are disputed

Psychosocial and behaviour factors Largely accepted that psychosocial factors and health behaviours affect men’s experience of cancer Systematic review of psychosocial and behaviour change interventions for men with cancer Very little evidence for effective interventions No interventions focussing on single men Relationships between these factors in men not well understood Strongest evidence for social support influencing psychosocial issues Men also disadvantaged around help seeking and uptake to services (Nekolaichuk et al, 2011)

Objectives To examine relationships between social support, distress, lifestyle behaviours and desire for help, in men with cancer

Methods Cross-sectional questionnaire study targeting all adult men with a diagnosis of cancer Assessed: Demographic factors (Relationship status, age, type of cancer(s), time since diagnosis, and postcode) Distress (DT) Depression and anxiety (HADS) Social support (Social Provisions Scale) Health behaviours (5 point likert scale) Desire for more support Recruited through the NHS in the East of Scotland Data from the Scottish Longitudinal study enables comparable demographic details to be examined

Results; representativeness 127 men with cancer participated Mean age 62 (range 23-86) 76% married Compared to the Scottish Longitudinal Study data, the sample was comparable for most demographics. Slight under-representation from those living in urban areas and those with skin cancer Slight over representation of those with cancers of the male genital organs, respiratory and haematological cancers

Results; sample overview Many participants reported good levels of support % scored within the clinical range for distress. The majority of people were meeting government guidelines for not smoking, and drinking a maximum of 21 units of alcohol per week. Only 24% met guidelines for 5 or more pieces of fruit or vegetables per day 67% met guidelines for 2.5 hours of exercise per week

Results 3; relationships Lower levels of social support were linked to worse psychological health, along with smoking. Psychological issues were linked to greater smoking, less fruit and vegetable consumption and lower exercise levels. Having poor scores for social support and psychological issues all predicted wanting help for that issue. There were also links between psychological issues and wanting help to improve lifestyle issues

Results; modelling Desire for help.54 Support to reduce distress Support to improve feelings Support to improve diet Support to increase exercise.83 Distress HADS Depression HADS AnxietyDistress Thermometer Support Total Social Support Support Distress

Discussion Psychosocial issues may interact to affect help seeking behaviour. When examined together, help seeking for both psychological issues and health behaviours is affected by social support mediated by distress. Since help seeking is facilitated though psychological health, psychological difficulties may act to legitimise help seeking. Further research: qualitative interviews with men with cancer to explore reasons for help seeking along with barriers and facilitators to doing so.

Limitations & future research Limitations Small sample size Broad range of cancers HADS 2 factor structure Path analysis for meditational model Future research Longitudinal data would build on this Larger sample sizes needed Different measures?

Conclusions Experiencing distress may be pivotal in men with cancer desiring more help. Distress appears to mediate the relationship between social support and desire for more help for psychological issues and lifestyle behaviours. Self-reported lifestyle behaviour would appear not to be implicated in these relationships. Interventions and services aimed at men with cancer may need to tailor material to gain men’s acceptability to access help.

Thank you Any Questions?