Professor Sara Faithfull

Professor of Cancer Nursing Practice, Lead for Clinical Innovation
PhD, MSc, BSc (Hons), RN
+44 (0)1483 682568
25 DK 04
9am to 5pm



Research interests

Research projects

My teaching

My publications


Background: A positive aspect of pain is that it warns us of potential or actual bodily damage but if it persists its benefits are lost and it becomes a chronic condition with disabling and costly consequences. Pain is a common symptom suffered by people with cancer but it is unclear if people with cancer pain require further help from healthcare professionals in order to treat their pain holistically using a biopsychosocial approach.
Purpose: To identified the unmet supportive care needs of people with cancer pain; and to explore the relationship between symptoms such as pain and unmet supportive care needs.
Method: A quantitative approach has been used to explore the unmet supportive care needs of people with cancer pain. One hundred and sixty two people, who required around the clock analgesia, completed a validated needs assessment tool, at two Time Points, in order to investigate whether they had any issues or problems that they required further assistance with over a 2 month period. The data was analysed using descriptive statistics and backwards logistic regression.
Findings: Eighty percent of the participants had at least 1 unmet need. The main areas where people needed more help were in the psychological and physical daily living domains. Psychologically, people had concerns about their loved ones and uncertainly about their future. Physically, people wanted more help with fatigue and not being able to do their usual activities. People with uncontrolled pain and breakthrough pain equally needed as much help in these areas, emphasising that even if people only have intermittent pain it has a huge impact on a person?s psychological and physical wellbeing. The participants? unmet needs improved over time but this was not dependant on a change in the control of pain.
Conclusion: The psychosocial needs of people with cancer pain are not being met if they have uncontrolled or breakthrough pain. Pain assessments should include an assessment of unmet needs. However, due to the subject nature of unmet needs it is difficult to demonstrate that that inventions, that are intended to reduce unmet needs, are effective.
Turner L, Poole K, Faithfull S, Griffin B (2017) Current and future strategies for the nutritional management
of cardiometabolic complications of androgen deprivation therapy
for prostate cancer,
Nutr Res Rev 30 (2) pp. 220-232 Cambridge University Press
Androgen deprivation therapy (ADT) is used widely as part of a combined modality for the treatment of prostate cancer. However, ADT has
also been associated with the development of cardiometabolic complications that can increase mortality from cardiovascular events. There is
emerging evidence to suggest that ADT-related cardiometabolic risk can be mitigated by diet and lifestyle modification. While the clinical
focus for a nutritional approach for achieving this effect is unclear, it may depend upon the timely assessment and targeting of dietary changes
to the specific risk phenotype of the patient. The present review aims to address the metabolic origins of ADT-related cardiometabolic risk,
existing evidence for the effects of dietary intervention in modifying this risk, and the priorities for future dietary strategies.
Faithfull S, Overgaard J, Sharp L (2010) Instructional Session: New developments in radiotherapy, EUR J ONCOL NURS 14 pp. S9-S9 ELSEVIER SCI LTD
Bishop L, Faithfull S, Allan H (2010) An exploration of the influences on clinical decision making and the culture of blood transfusion practise in cancer-related anaemia using an ethnographic methodology, SUPPORTIVE CARE IN CANCER 19 (2) pp. 203-210 SPRINGER
Probst S, Arber A, Faithfull S (2012) Malignant fungating wounds - The meaning of living in an unbounded body., Eur J Oncol Nurs
BACKGROUND: Malignant fungating wounds may have significant physiological, psychological and emotional consequences on patients and their families. This study focuses on understanding the lived experiences of patients with a malignant fungating breast wound and their informal carers. METHOD: The methodological framework of interpretative phenomenological approach according to Heidegger was used. Nine patients were interviewed from January until November 2009. RESULTS: The results demonstrate that most of the patients and their informal carers were on their own while struggling with the erosion of their physical boundaries. The women report a lack of information and advice about how to manage the wound as well as the physical and social limitations imposed on them because of copious wound exudate, odour and bleeding. The women used many different methods and approaches to maintain the boundedness of the body. CONCLUSION: This study contributes to understanding that losing control over the body meant for the women losing control over themselves and their lives. The unboundedness was demonstrated through the symptom experiences. Therefore the care of women needs strategies that are integrated in a palliative, holistic, empathic approach. In particular skills for palliative wound care among medical and nursing staff need to be developed as the women and their carers report a lack of information and advice about how to manage the wound as well as the physical limitations and psychosocial consequences of struggling to maintain the boundedness of the body.
Probst S, Arber A, Faithfull S (2013) Coping with an exulcerated breast carcinoma: an interpretative phenomenological study, JOURNAL OF WOUND CARE 22 (7) pp. 352-360 MA HEALTHCARE LTD
Fenlon D, Faithfull S, Greenfield D, Knowles G, Robb K, Roberts K, Taylor G, Wells M, White I, Wiseman T (2011) Ten Top Tips for Cancer Survivorship: a Prompt for Cancer Patients at the End of Their Primary Treatment, EUROPEAN JOURNAL OF CANCER 47 pp. S238-S238 ELSEVIER SCI LTD
Faithfull S, Cook K, Lucas C (2005) Palliative care of patients with a primary malignant brain tumour: case review of service use and support provided, PALLIATIVE MEDICINE 19 (7) pp. 545-550 HODDER ARNOLD, HODDER HEADLINE PLC
Faithfull S (2005) Education in Europe: are we ready for the future?, EJC SUPPLEMENTS 3 (2) pp. 471-471 PERGAMON-ELSEVIER SCIENCE LTD
Beech N, Arber A, Faithfull S (2012) Restoring a sense of wellness following colorectal cancer: A grounded theory, Journal of Advanced Nursing 68 (5) pp. 1134-1144
Aim: This paper reports a study to develop a grounded theory to explain the experience of recovery following surgery for colorectal cancer. Background. Studies have adopted a biomedical framework to measure quality of life and symptom distress following surgery for colorectal cancer. These studies suggest that symptoms of pain, insomnia and fatigue, may persist for many months following treatment. Fewer studies have considered the individual's experiences and perspective of the emotional, social and cultural aspects of recovery. Methods. A longitudinal study using grounded theory was conducted with 12 individuals, who had received surgery for colorectal cancer. Semi-structured interviews were conducted at four time points over 1year following surgery, between 2007 and 2009. Grounded theory analysis was undertaken using Strauss and Corbin's framework. Findings. Recovery is described in three phases: disrupting the self; repairing the self; restoring the self. The core category is Restoring a sense of wellness; fostered through awareness and enjoyment of the physical, emotional, spiritual and social aspects of life. A sense of wellness exists as a duality with a sense of illness, where both perspectives may co-exist but one usually takes precedence. A sense of illness pervades when the individual is preoccupied with illness and the illness continues to disrupt their daily life. Conclusion. Recovery takes time and energy, particularly when the individual is at home and in relative isolation from health professionals. Opportunities exist for nurses to provide information and support to facilitate the individual in their progress towards achieving a sense of wellness. © 2011 Blackwell Publishing Ltd.
Faithfull S (2004) Commentaries, European Journal of Oncology Nursing 8 (1) pp. 85-86
Faithfull S, Samuel C, Lemanska A, Warnock C, Greenfield D (2015) Self-reported competence in long term care provision for adult cancer survivors: A cross sectional survey of nursing and allied health care professionals, INTERNATIONAL JOURNAL OF NURSING STUDIES 53 pp. 85-94 PERGAMON-ELSEVIER SCIENCE LTD
Chan JM, Newton RU, Culos-Reed SN, Faithfull S, Lambert S, Kenfield SA, Van Blarigan E, Lyons KS, Ramsdill J, Zahavich A, Duncan L, Hart N, Dew M, Moe EL, Dixon C, Winters-Stone KM (2016) An international, population-level initiative to promote healthy lifestyle practices among prostate cancer survivors., JOURNAL OF CLINICAL ONCOLOGY 34 (3) AMER SOC CLINICAL ONCOLOGY
Faithfull S, Cockle-Hearne J, Knibb W, Toms E, Thomas H, Cox A (2007) Meeting the support and follow-up needs of women with ovarian cancer: an evaluation of a nurse-led telephone follow-up service, EJC SUPPLEMENTS 5 (4) pp. 460-461 PERGAMON-ELSEVIER SCIENCE LTD
Faithfull S (2000) Men's experience of radiotherapy for prostate cancer exploring the utility of quality of life data, PSYCHO-ONCOLOGY 9 (4) pp. 358-358 JOHN WILEY & SONS LTD
Faithfull S (2009) What does the future cancer workforce need to look like?, EJC SUPPLEMENTS 7 (2) pp. 80-81 PERGAMON-ELSEVIER SCIENCE LTD
White ID, Faithfull S, Allan H (2013) The re-construction of women's sexual lives after pelvic radiotherapy: A critique of social constructionist and biomedical perspectives on the study of female sexuality after cancer treatment, Social Science and Medicine 76 (1) pp. 188-196
Pelvic radiotherapy creates physical effects and psychological responses that negatively affect the sexual health of women and couples, yet these sexual consequences are not frequently researched or clinically assessed. This focused ethnographic study explored factors that influence the clinical assessment of treatment-induced female sexual difficulties after pelvic radiotherapy within routine medical follow-up. Participant observation of follow-up clinics (n = 69) and in-depth interviews with 24 women, 5 partners and 20 health professionals were undertaken at two cancer centres in the South East of England from 2005 to 2006. Thematic analysis of interview transcripts resulted in five emergent themes, two of which are explored in detail within this paper. A social constructionist approach to human sexuality was used to explore representations of female sexuality in oncology follow-up constructed by clinicians, women and their partners. Yet neither social constructionist nor biomedical (the predominant model in medical follow-up) perspectives on human sexuality provided an adequate interpretation of these study findings. This paper argues that the comprehensive study and practice of sexual rehabilitation in oncology requires a synthesis of both biomedical and social constructionist perspectives in order to capture the complex, subjective and embodied nature of the female sexual response in both health and illness. © 2012 Elsevier Ltd.
Taghipour A, Vydelingum V, Faithfull S (2010) Men's perceptions and experiences of the early detection of prostate cancer: A qualitative study using grounded theory approach, European Journal of Scientific Research 42 (1) pp. 59-70
Background and objective: Despite significant progress in prostate cancer research over the last two decades, screening of the disease has remained controversial.From a socio-epidemiological perspective, little is known of patients' beliefs about their illness and why they often delay in seeking diagnosis.The purpose of this qualitative study was to understand the experiences and perceptions of men about the early detection of prostate cancer. Method: This study used a grounded theory approach incorporating the theoretical perspective of social constructionism. A purposive sampling of twelvemen from public and private sector hospitals who had received therapy were interviewed face to face in Persian using a semi-structured interview guide. Interviews were audio taped, then transcribed in full, translated into English by the investigator, and analysed usingMAXqda software. Results: The valuemenaccorded to early detection of prostate cancer was found to be conditional upon their beliefs of prostate illness and their experiences about cure. There was a lack of information about the early detection process. The men felt that medical intervention was focused on the biological aspects, ignoring the needs of the psychosocial concerns. The men were not expecting to have symptoms because of prostate treatment; this influenced their subsequent decision-making. Conclusion: Given men's perceptions and experiences of the illness, screening of prostate cancer seems to have wider implications. The findings suggest that early detection of the disease in Iran may need a screening model that incorporates both biomedical and psychosocial aspects. © EuroJournals Publishing, Inc. 2010.
Faithfull S (1997) Analysis of data over time: A difficult statistical issue, JOURNAL OF ADVANCED NURSING 25 (4) pp. 853-858 BLACKWELL SCIENCE LTD
Faithfull S (2005) The EONS curriculum approach: translation of objectives into competentencies, EJC SUPPLEMENTS 3 (2) pp. 457-457 PERGAMON-ELSEVIER SCIENCE LTD
Fenlon D, Armes J, Doyle N, Faithfull S, Greenfield D, Knowles G, Robb K, Roberts K, Taylor C, Wells M (2011) CCAT: a UK Initiative to Address the Consequences of Cancer Treatment Through Research, Influence and Practice Development, EUROPEAN JOURNAL OF CANCER 47 pp. S224-S225 ELSEVIER SCI LTD
Faithfull S, Knibb W, Riemmer-Hommel P (2007) Choice, equity and access in European health care, EJC SUPPLEMENTS 5 (4) pp. 421-421 PERGAMON-ELSEVIER SCIENCE LTD
Faithfull S, Corner J, Meyer L, Huddart R, Dearnaley D (2001) Evaluation of nurse-led follow up for patients undergoing pelvic radiotherapy, BRITISH JOURNAL OF CANCER 85 (12) pp. 1853-1864 NATURE PUBLISHING GROUP
Faithfull S, Deamaley DP, Huddart RA (1997) Randomised controlled trial of supportive care in radical pelvic radiotherapy: Does it influence radiation morbidity?, EUROPEAN JOURNAL OF CANCER 33 pp. 53-53 PERGAMON-ELSEVIER SCIENCE LTD
Harris R, Probst H, Beardmore C, James S, Dumbleton C, Bolderston A, Faithfull S, Wells M, Southgate E (2012) Radiotherapy skin care: A survey of practice in the UK, Radiography 18 (1) pp. 21-27
Aim: The primary objective of the survey was to evaluate clinical skin care practice in radiotherapy departments across the United Kingdom. Methods and sample: A questionnaire containing sixty-one questions grouped into eight themed sections was developed and a link to an on-line survey, using the Survey Monkey" tool, was e-mailed to all radiotherapy department managers in the United Kingdom (N=67). Each recipient was invited to provide one response per department. Key results: Fifty-four departments responded within the allocated timeframe giving a final response rate of 81%. Products and their use for skin conditions varied and some outdated and unfounded practices were still being used which did not always reflect the current evidence base. The amount of data routinely collected on skin toxicity was limited making it difficult to quantify the extent of skin morbidity following radiotherapy. Conclusion: The survey demonstrated variability in skin care practice in radiotherapy departments across the UK, with limited practice based on evidence or on skin toxicity measurement and monitoring. © 2011 The College of Radiographers.
PURPOSE: The concept of providing personalised care plans for cancer survivors is receiving increasing attention; a recognised element of a care plan is to provide an indication of the risks and consequences of treatment. This paper reports health care professional (HCP) response to providing cancer survivors with information on potential late effects of their cancer treatment. METHODS: Eighteen HCPs from five cancer centres and three general practices in the UK completed semi-structured interviews which were digitally recorded, transcribed and qualitatively analysed using framework analysis. RESULTS: HCPs' view of health care was that it is currently focused on acute care and needs are responded to as they may arise, including those which are late effects of cancer treatments. The concept of pre-empting a discussion of potential late effects during the survivorship phase was felt to be discordant with this approach and could impact on adjustment to life after cancer treatment. CONCLUSION: Providing cancer survivors with information on potential late effects requires further consideration. Evidence for survivor preference for late effect information and the benefit afforded to survivors who receive it could inform the practice of HCPs. If a culture of proactivity is to be encouraged regarding discussions of future potential risk, HCPs may need support in considering ways of presenting survivors with reality whilst being mindful of their need to retain hope during the survivorship phase.
Faithfull S (2002) Re: Management of acute radiotherapy induced skin reactions: a literature review. Eur J Oncol Nurs. 2001 Dec;5(4):221-33., Eur J Oncol Nurs 6 (3)
Mallett J, Faithfull S, Guerrero D, Rhys-Evans F (1997) Nurse prescribing by protocol., Nurs Times 93 (8) pp. 50-52
Taking their lead from patients' needs, innovative practitioners are coming to new prescribing arrangements that are free from past constraints. One such innovation involves nurses making decisions to give a drug according to a predetermined criteria with the support of a medical practitioner. This paper shows how a carefully organised system of administering drugs against protocol can work and how it is proving beneficial to patients.
Deery P, Faithfull S (2003) Developing a patient pathway to deliver a new oral chemotherapy., Prof Nurse 19 (2) pp. 102-106
Introducing service delivery changes is rarely straightforward and requires careful planning. This paper reports on the work involved in preparing for, and implementing, an oral chemotherapy programme to be delivered on an outpatient basis. It outlines the involvement of both hospital and community staff and stresses the importance of providing patients with information.
Probst S, Arber A, Faithfull S (2009) Malignant fungating wounds: A survey of nurses' clinical practice in Switzerland, EUROPEAN JOURNAL OF ONCOLOGY NURSING 13 (4) pp. 295-298 ELSEVIER SCI LTD
Faithfull S (1995) 'Just grin and bear it and hope that it will go away': coping with urinary symptoms from pelvic radiotherapy., Eur J Cancer Care (Engl) 4 (4) pp. 158-165
Fifty per cent of patients with cancer are treated with radiotherapy during the course of their disease. Although side-effects have been described in studies, these are often not representative of the impact that these symptoms have on the individual. This article explores one area of radiotherapy management, that of pelvic radiotherapy in men, and describes how symptoms that patients experience during and following treatment can be a debilitating outcome of cancer therapy. At present, there is limited knowledge on how best to prevent symptoms from occurring, who is most at risk and how to manage these symptoms. Technology has advanced with accelerated regimes, conformal planning and new radiotherapy treatments. Yet still we are no further forward in dealing with toxicity from treatment. The focus of research has been on developing new cures and only now are questions being raised about the quality of life of patients having radiotherapy treatment.
McCabe MS, Faithfull S, Makin W, Wengstrom Y (2013) Survivorship programs and care planning., Cancer 119 Suppl 11 pp. 2179-2186
Formal cancer survivorship care is a growing focus internationally. This article provides a broad overview of the national strategies currently in progress for the development of survivorship programs and care plans within the United States and across Europe. The different approaches taken in their implementation, staffing, and clinical focus are highlighted, with an emphasis on how they are incorporated into various models of care. The considerable variation in making survivorship a formal period of care across countries and health care systems is discussed, including the factors influencing these differences. A review of research focused on the evaluation of definitions and outcomes is provided along with a discussion of important areas requiring future research. Cancer 2013;119(11 suppl):2179-86. © 2013 American Cancer Society.
Ream E, Wilson-Barnett J, Faithfull S, Fincham L, Khoo V, Richardson A (2009) Working patterns and perceived contribution of prostate cancer clinical nurse specialists: A mixed method investigation, INTERNATIONAL JOURNAL OF NURSING STUDIES 46 (10) pp. 1345-1354 PERGAMON-ELSEVIER SCIENCE LTD
Ream E, Quennell A, Fincham L, Faithfull S, Khoo V, Wilson-Barnett J, Richardson A (2008) Supportive care needs of men living with prostate cancer in England: a survey, BRITISH JOURNAL OF CANCER 98 (12) pp. 1903-1909 NATURE PUBLISHING GROUP
Cox A, Faithfull S (2015) Aiding a reassertion of self: a qualitative study of the views and experiences of women with ovarian cancer receiving long-term nurse-led telephone follow-up., Support Care Cancer 23 (8) pp. 2357-2364
PURPOSE: This study explored the views and experiences of women following treatment for ovarian cancer who had received long-term (at least 3 years) nurse-led telephone follow-up. Exploring the long-term experiences of follow-up for women with ovarian cancer provides important information regarding the coping processes of cancer survivors that can inform the development of innovative and patient-centred approaches of cancer follow-up. METHODS: This is a qualitative study approach using interpretative phenomenological analysis (IPA). Eleven women were identified by a clinical nurse specialist as having received nurse-led telephone follow-up for a period of at least 3 years. These women were interviewed in person or over the telephone using a semi-structured interview schedule; interviews were audio-recorded and transcriptions were analysed using IPA. RESULTS: Nurse-led telephone follow-up was felt to support a reassertion of self and a rejection of patient identity. Three core themes emerged regarding the positive impact of nurse-led telephone follow-up: 'Somebody was looking out for me' highlights the perception of increased psychosocial support; 'It's just reassurance' includes both the deep trust in the expertise of the nurse and the reassurance of the continued blood tests; and 'Time was never an issue' presents the perception of relaxed follow-up appointments with time to talk and the perceived practical benefits of this approach. CONCLUSIONS: Nurse-led telephone follow-up was broadly recommended for women following treatment for ovarian cancer, particularly for those later on in the survivorship trajectory when focus may move from biomedical aspects of cure to holistic approaches to well-being. Remote interventions which provide a perception of a consistent and constant source of medical and psychosocial support may support adaption to cancer survivorship by enabling a reassertion of self and a rejection of patient identity.
Faithfull S, Brada M (1998) Somnolence syndrome in adults following cranial irradiation for primary brain tumours., Clin Oncol (R Coll Radiol) 10 (4) pp. 250-254
The purpose of this study was to assess the incidence, pattern and severity of somnolence and fatigue in patients treated with cranial irradiation for primary brain tumours and to identify factors that may influence or mediate symptoms. A detailed prospective study was carried out of 19 patients who received high-dose (45-55 Gy) cranial irradiation as treatment for primary brain tumours. Data were collected for each patient over a 3 month period using a prospective diary utilizing visual analogue scales of common somnolence symptoms and fatigue, and detailed interviews at 2, 6 and 12 weeks following the completion of treatment. Sixteen patients developed somnolence syndrome following treatment. Time series analysis identified a cyclical pattern to the symptoms, with a period of drowsiness and fatigue occurring from day 11 to day 21 and from day 31 to day 35 after radiotherapy. The principal symptoms were those of excessive drowsiness, feeling clumsy, an inability to concentrate, lethargy, being mentally slow and fatigue. Patients treated with accelerated (n = 11) compared with more conventional (n = 8) fractionation experienced more severe drowsiness and fatigue (P
Faithfull S (1999) Randomized trial, a method of comparisons: A study of supportive care in radiotherapy nursing, European Journal of Oncology Nursing 3 (3) pp. 176-184
Randomized trials are often considered a poor method for study of cancer nursing issues because of the positivist approach of this method and the size and scale required for experimental studies. However, this method of research is highly valued in health-care evaluations and can provide detailed information on treatment or intervention comparisons. As many cancer nursing interventions are untested it is important that we are able to utilize research methods appropriately to identify care that is of benefit to patients. This article explores some of the advantages and difficulties that can be encountered when undertaking a randomized trial and reflects on the practical implications that such a method can entail. Radiotherapy nursing and interventions for radiotherapy side effects are an area that has been long neglected by researchers. The care of patients and the monitoring for side effects often reflect tradition rather than evidence-based practice. Which health care practitioner should take responsibility for that care or have the necessary skill for managing patient problems is rarely questioned. A randomized trial was used as a method to evaluate the effectiveness of a nursing intervention in comparison to that of conventional medical care. The advantages and disadvantages of this research approach are explored although data are not explored in depth. © 1999 Harcourt Publishers Ltd.
Faithfull S (2002) Letter to the editor, European Journal of Oncology Nursing 6 (3) pp. 179-?
Cox A, Bull E, Cockle-Hearne J, Knibb W, Potter C, Faithfull S (2008) Nurse led telephone follow up in ovarian cancer: A psychosocial perspective, European Journal of Oncology Nursing 12 (5) pp. 412-417 ELSEVIER SCI LTD
Faithfull S (1998) Fatigue in patients receiving radiotherapy., Prof Nurse 13 (7) pp. 459-461
The fatigue that may accompany or follow radiotherapy is often overlooked by health-care staff, yet this side-effect of treatment can cause great distress. More research into the causes and methods of relieving such symptoms is needed.
Watson E, Rose P, Frith E, Hamdy F, Neal D, Kastner C, Russell S, Walter FM, Faithfull S, Wolstenholme J, Perera R, Weller D, Campbell C, Wilkinson C, Neal R, Sooriakumaran P, Butcher H, Matthews M (2014) PROSPECTIV-a pilot trial of a nurse-led psychoeducational intervention delivered in primary care to prostate cancer survivors: study protocol for a randomised controlled trial., BMJ Open 4 (5) pp. e005186-e005186
BACKGROUND: Prostate cancer survivors can experience physical, sexual, psychological and emotional problems, and there is evidence that current follow-up practices fail to meet these men's needs. Studies show that secondary and primary care physicians see a greater role for primary care in delivering follow-up, and that primary care-led follow-up is acceptable to men with prostate cancer. METHODS AND ANALYSIS: A two-phase study with target population being men who are 9-24?months from diagnosis. Phase 1 questionnaire aims to recruit 300 men and measure prostate-related quality of life and unmet needs. Men experiencing problems with urinary, bowel, sexual or hormonal function will be eligible for phase 2, a pilot trial of a primary care nurse-led psychoeducational intervention. Consenting eligible participants will be randomised either to intervention plus usual care, or usual care alone (40 men in each arm). The intervention, based on a self-management approach, underpinned by Bandura's Social Cognitive Theory, will provide advice and support tailored to these men's needs and address any problems they are experiencing. Telephone follow-up will take place at 6?months. Study outcomes will be measured by a questionnaire at 7?months. Phase 1 will allow us to estimate the prevalence of urinary, sexual, bowel and hormone-related problems in prostate cancer survivors and the level of unmet needs. 'Usual care' will also be documented. Phase 2 will provide information on recruitment and retention, acceptability of the intervention/outcome measures, effect sizes of the intervention and cost-effectiveness data, which is required to inform development of a larger, phase 3 randomised controlled trial. The main outcome of interest is change in prostate-cancer-related quality of life. Methodological issues will also be addressed. ETHICS AND DISSEMINATION: Ethics approval has been gained (Oxford REC A 12/SC/0500). Findings will be disseminated in peer-reviewed journals, at conferences, through user networks and relevant clinical groups. TRIAL REGISTRATION NUMBER: ISRCTN 97242511.
Faithfull S (1994) The concept of cure in cancer care., Eur J Cancer Care (Engl) 3 (1) pp. 12-17
The concept of cure is often used in health care practices without thought to the social, cultural and psychological implications of its meaning. Frequently measured in terms of years of disease-free survival, this measure is inadequate in evaluating treatment. Iatrogenic toxicities and illness implications may linger for many months or years after a person experiences cancer. The subcultural perspectives of cure for clinicians may be very different. Historically, the clinician's concept of cure has been the focus and reported outcome of cancer treatment and research. A more dynamic view is encouraged in exploring this concept in relation to the outcomes of nursing practice.
Arber A, Faithfull S, Plaskota M, Lucas C, de Vries K (2010) A study of patients with a primary malignant brain tumour and their carers: symptoms and access to services., Int J Palliat Nurs 16 (1) pp. 24-30 Mark Allen Healthcare
To investigate the symptom experience, access to supportive care services and rehabilitation of patients with a primary malignant brain tumour (PMBT) and their carers.
Faithfull S (1997) The management of radiation morbidity: Can nursing make a difference?, EUROPEAN JOURNAL OF CANCER 33 pp. 1344-1344 PERGAMON-ELSEVIER SCIENCE LTD
Crosby-Nwaobi RR, Faithfull S (2011) High risk of urinary tract infections in post-operative gynaecology patients: A retrospective case analysis, European Journal of Cancer Care 20 (6) pp. 825-831
This study was undertaken to determine the incidence and risk factors related to the occurrence of urinary tract infections (UTIs), post surgery, in women being treated for a gynaecological cancer. A retrospective case analysis of 215 women was conducted using data collected via case review with domains covering known risk factors for the occurrence of urinary infections. Bacteriuria was defined as greater than 10 5 colony-forming units per millilitre. A total of 30.7% of women had a UTI post-operatively. Among these, 75.7% infections were Escherichia coli. Having a catheter in situ for d3 days was found to be slightly significant in the formation of a UTI post-operatively (U= 3878, P
White ID, Faithfull S (2006) Vaginal dilation associated with pelvic radiotherapy: a UK survey of current practice, INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER 16 (3) pp. 1140-1146 BLACKWELL PUBLISHING
Cox A, Illsley M, Knibb W, Lucas C, O'Driscoll M, Potter C, Flowerday A, Faithfull S (2011) The acceptability of e-technology to monitor and assess patient symptoms following palliative radiotherapy for lung cancer., Palliat Med
E-technology is increasingly used in oncology to obtain self-reported symptom assessment information from patients, although its potential to provide a clinical monitoring tool in palliative care is relatively unexplored in the UK. This study aimed to evaluate the support provided to lung cancer patients post palliative radiotherapy using a computerized assessment tool and to determine the clinical acceptability of the tool in a palliative care setting. However, of the 17 clinicians identified as managing patients who met the initial eligibility criteria for the study, only one clinician gave approval for their patient to be contacted regarding participation, therefore the benefits of this novel technology could not be assessed. Thirteen key clinicians from the centres involved in the study were subsequently interviewed. They acknowledged potential benefits of incorporating computerized patient assessment from both a patient and practice perspective, but emphasized the importance of clinical intuition over standardized assessment. Although clinicians were positive about palliative care patients participating in research, they felt that this population of patients were normally too old, with too rapidly deteriorating a condition to participate in a study using e-technology. In order to encourage acceptance of e-technology within palliative care, emphasis is needed on actively promoting the contribution of technologies with the potential to improve patient outcomes and the patient experience.
Faithfull S, Lemanska A, Aslet P, Bhatt N, Coe J, Drudge-Coates L, Feneley M, Glynn-Jones R, Kirby M, Langley S, McNicholas T, Newman J, Smith CC, Sahai A, Trueman E, Payne H (2015) Integrative review on the non-invasive management of lower urinary tract symptoms in men following treatments for pelvic malignancies, INTERNATIONAL JOURNAL OF CLINICAL PRACTICE 69 (10) pp. 1184-1208 WILEY-BLACKWELL
Faithfull S, Hilton M, Booth K (2002) Survey of information leaflets on advice for acute radiation skin reactions in UK radiotherapy centres: a rationale for a systematic review of the literature., Eur J Oncol Nurs 6 (3) pp. 176-178
Faithfull S (1996) How many subjects are needed in a research sample in palliative care?, PALLIATIVE MEDICINE 10 (3) pp. 259-261 EDWARD ARNOLD PUBL LTD
Faithfull S (1993) Palliative care. Age-related problems., Nurs Times 89 (38) pp. 66-68
Cockle-Hearne J, Charnay-Sonnek F, Denis L, Fairbanks HE, Kelly D, Kav S, Leonard K, van Muilekom E, Fernandez-Ortega P, Jensen BT, Faithfull S (2013) The impact of supportive nursing care on the needs of men with prostate cancer: a study across seven European countries., British Journal of Cancer 109 (8) pp. 2121-2130 Cancer Research UK
Background:Prostate cancer is for many men a chronic disease with a long life expectancy after treatment. The impact of prostate cancer therapy on men has been well defined, however, explanation of the consequences of cancer treatment has not been modelled against the wider variables of long-term health-care provision. The aim of this study was to explore the parameters of unmet supportive care needs in men with prostate cancer in relation to the experience of nursing care.Methods:A survey was conducted among a volunteer sample of 1001 men with prostate cancer living in seven European countries.Results:At the time of the survey, 81% of the men had some unmet supportive care needs including psychological, sexual and health system and information needs. Logistic regression indicated that lack of post-treatment nursing care significantly predicted unmet need. Critically, men's contact with nurses and/or receipt of advice and support from nurses, for several different aspects of nursing care significantly had an impact on men's outcomes.Conclusion:Unmet need is related not only to disease and treatment factors but is also associated with the supportive care men received. Imperative to improving men's treatment outcomes is to also consider the access to nursing and the components of supportive care provided, especially after therapy.
Probst, S, Arber A, Trojan A, Faithfull S (2012) Caring for a loved one with a malignant fungating wound, Support Care Cancer 20 pp. 3065-3070 Springer-Verlag
Purpose: Caring for a loved one with a malignant fungating wound is very challenging and causes extreme physical and psychological distress. The aim of this study was to explore the experiences of carers who care for a loved one with a fungating breast wound. Method: To explore the lived experiences of carers a methodological framework using Heideggerian hermeneutic phenomenology and semi-structured interviews was used. Seven carers were interviewed from January until November 2009. Results: Having to deal with a situation of a loved one with a visible cancer was hard for all the carers. The visibility of the cancer was one of the most shocking aspects to deal with from the perspective of the patient and the carer. The presence of the visible wound and a cancer at an advanced stage contributed to a change in the relationship and extreme suffering for both the patient and the carer. Despite many problems such as wound odour and copious discharge from the wound, which was difficult to control carers did their best to help their loved one with the wound. Gradually the wound became the centre of the patient and carer?s life and a great deal of time was spent trying to control the wound symptoms. All carers managed the wound on their own without help and advice from health care practitioners. For all of them it was a major burden and they felt isolated. Conclusion: This study contributes to an understanding that the care of women and their carers needs strategies that are integrated in palliative wound care, that takes a holistic and empathic approach that responds to patients and carers psychosocial and emotional needs and a practical need for information to help carers assist in managing the wound related symptoms.
Faithfull S, Wells M (2003) Supportive care in radiotherapy, Elsevier Health Sciences
This book looks at the often debilitating consequences for individuals undergoing radiation therapy and the associated problems for health care professionals ...
Probst S, Arber A, Faithfull S (2011) The Meaning of Living With an Exulcerated Breast Carcinoma, EUROPEAN JOURNAL OF CANCER 47 pp. S296-S297 ELSEVIER SCI LTD
Beech N, Arber A, Faithfull S (2011) Restoring a sense of wellness following colorectal cancer: A grounded theory, Journal of Advanced Nursing
Faithfull S, Hunt G (2005) Exploring nursing values in the development of a nurse-led service, NURSING ETHICS 12 (5) pp. 440-452 ARNOLD, HODDER HEADLINE PLC
Gage H, Storey L, McDowell C, Maguire G, Williams P, Faithfull S, Thomas H, Poole K (2009) Integrated care: Utilisation of complementary and alternative medicine within a conventional cancer treatment centre, COMPLEMENTARY THERAPIES IN MEDICINE 17 (2) pp. 84-91 CHURCHILL LIVINGSTONE
Davidson SE, Faithfull S (2006) Late radiotherapy effects: Is bowel morbidity adequately documented or patients' needs managed appropriately?, CLINICAL ONCOLOGY 18 (5) pp. 419-420 ELSEVIER SCIENCE LONDON
Faithfull S (1995) How to read nursing research, EUROPEAN JOURNAL OF CANCER 31A pp. 1290-1290 PERGAMON-ELSEVIER SCIENCE LTD
Faithfull S, Cockle-Hearne J, Khoo V (2011) Self-management after prostate cancer treatment: evaluating the feasibility of providing a cognitive and behavioural programme for lower urinary tract symptoms, BJU INTERNATIONAL 107 (5) pp. 783-790 WILEY-BLACKWELL
Lemanska A, Cox A, Kirkby N, Chen T, Faithfull S (2014) Predictive Modelling of Patient Reported Radiotherapy-Related Toxicity by the Application of Symptom Clustering and Autoregression, International Journal of Statistics in Medical Research (3) pp. 412-422
Patient reported outcome measures (PROMs) are increasingly being used in research to explore experiences
of cancer survivors. Techniques to predict symptoms, with the aim of providing triage care, rely on the ability to analyse trends in symptoms or quality of life and at present are limited. The secondary analysis in this study uses a statistical method involving the application of autoregression (AR) to PROMs in order to predict symptom intensity following radiotherapy, and to explore its feasibility as an analytical tool. The technique is demonstrated using an existing dataset of 94 prostate cancer patients who completed a validated battery of PROMs over time. In addition the relationship between symptoms was investigated and symptom clusters were identified to determine their value in assisting predictive modeling. Three symptom clusters, namely urinary, gastrointestinal and emotional were identified. The study indicates that incorporating symptom clustering into predictive modeling helps to identify the most informative predictor variables. The analysis also showed that the degree of rise of symptom intensity during radiotherapy has the ability to predict later radiotherapy-related symptoms. The method was most successful for the prediction of urinary and gastrointestinal symptoms. Quantitative or qualitative prediction was possible on different symptoms. The application of this technique to predict radiotherapy outcomes could lead to increased use of PROMs within clinical practice. This in turn would contribute to improvements in both patient care after radiotherapy and also strategies to prevent side effects. In order to further evaluate the predictive ability of the approach, the analysis of a larger dataset with a longer follow up was identified as the next step.
Watson E, Shinkins B, Frith E, Neal D, Hamdy F, Walter F, Weller D, Wilkinson C, Faithfull S, Wolstenholme J, Sooriakumaran P, Kastner C, Campbell C, Neal R, Butcher H, Matthews M, Perera R, Rose P (2015) Symptoms, unmet needs, psychological well-being and health status in survivors of prostate cancer: implications for redesigning follow-up., BJU Int 117 (6B) pp. E10-E19
OBJECTIVE: To explore ongoing symptoms, unmet needs, psychological wellbeing, self-efficacy and overall health status in survivors of prostate cancer. PATIENTS AND METHODS: An invitation to participate in a postal questionnaire survey was sent to 546 men, diagnosed with prostate cancer 9-24 months previously at two UK cancer centres. The study group comprised men who had been subject to a range of treatments: surgery, radiotherapy, hormone therapy and active surveillance. The questionnaire included measures of prostate-related quality of life (Expanded Prostate cancer Index Composite 26-item version, EPIC-26); unmet needs (Supportive Care Needs Survey 34-item version, SCNS-SF34); anxiety and depression (Hospital Anxiety and Depression Scale, HADS), self-efficacy (modified Self-efficacy Scale), health status (EuroQol 5D, EQ-5D) and satisfaction with care (questions developed for this study). A single reminder was sent to non-responders after 3 weeks. Data were analysed by age, co-morbidities, and treatment group. RESULTS: In all, 316 men completed questionnaires (64.1% response rate). Overall satisfaction with follow-up care was high, but was lower for psychosocial than physical aspects of care. Urinary, bowel, and sexual functioning was reported as a moderate/big problem in the last month for 15.2% (n = 48), 5.1% (n = 16), and 36.5% (n = 105) men, respectively. The most commonly reported moderate/high unmet needs related to changes in sexual feelings/relationships, managing fear of recurrence/uncertainty, and concerns about the worries of significant others. It was found that 17% of men (51/307) reported potentially moderate-to-severe levels of anxiety and 10.2% (32/308) reported moderate-to-severe levels of depression. The presence of problematic side-effects was associated with higher psychological morbidity, poorer self-efficacy, greater unmet needs, and poorer overall health status. CONCLUSION: While some men report relatively few problems after prostate cancer treatment, this study highlights important physical and psycho-social issues for a significant minority of survivors of prostate cancer. Strategies for identifying those men with on-going problems, alongside new interventions and models of care, tailored to individual needs, are needed to improve quality of life.
Samuel CA, Faithfull S (2013) Complementary therapy support in cancer survivorship: a survey of complementary and alternative medicine practitioners' provision and perception of skills., Eur J Cancer Care (Engl)
This study reviewed the confidence and perceived skills of complementary and alternative medicine (CAM) practitioners in providing care and symptom management for clients post cancer. An e-survey was mailed to approximately 21 000 CAM practitioners, targeted at those working with clients who were experiencing consequences of cancer and its treatments. Questions were asked about the main symptoms and concerns of clients, the confidence and current skill levels of practitioners and additional training requirements. Six hundred and twelve practitioners responded to the survey, 507 of whom were working with individuals experiencing the consequences of cancer and its treatments. Forty-five per cent (n = 134) had undertaken training in cancer prior to working with cancer patients, 61% (n = 182) had undertaken courses or study days relative to cancer care in the past two years. The most often treated symptoms or concerns of patients were those of a psychosocial nature, pain management and lymphoedema. CAM practitioners with limited knowledge and training are providing support to cancer survivors, particularly in services where the National Health Service has limited provision. CAM practitioners may fulfil a future role in providing long-term support for cancer survivors; however, in order to properly safeguard patients they are in need of further training and development.
Faithfull S, Deery P (2004) Implementation of capecitabine (Xeloda) into a cancer centre: UK experience., Eur J Oncol Nurs 8 Suppl 1 pp. S54-S62
Switching patients from intravenous 5-FU/LV to oral capecitabine (Xeloda) for the treatment of metastatic colorectal cancer is associated with a reduction in the need for hospitalisations to manage 5-FU-associated delivery and complications, with resulting healthcare savings. However, implementing oral therapy with capecitabine within a cancer centre in the UK has required a considerable change in attitude within healthcare services. The resulting need for patients to take an active role in their treatment, and the co-ordination and monitoring of such a service at home has raised issues for chemotherapy services. To enhance patient involvement and compliance with medication a patient guide was developed to educate, and support individuals and enable them to understand the rationale for treatment and when to seek help. In addition, patients are encouraged to monitor and record symptoms in a diary. This change in service focus has required an investment in time educating and informing patients, community health workers and hospital practitioners. This change has been co-ordinated through the chemotherapy outpatient clinic. Effective communication between hospital and home has been important in implementing oral chemotherapy. While the initial challenge of monitoring and educating patients receiving capecitabine has been met, the Primary Care team and cancer centre need to continue to assess side effects and patient compliance in order to improve knowledge of capecitabine among healthcare professionals and ensure safe practice.
Cockle Hearne J, Cooke D, Faithfull S (2015) Developing peer support in film for cancer self-management: what do men want other men to know?, Supportive Care in Cancer Springer
Purpose: This study reports an innovative theory-driven approach for developing filmed peer support for cancer self-management. Peer support conventionally includes empathetic interaction between people with shared experiences. This unique study considers how to authentically communicate peer empathy in a one-way film narrative.
Methods: We co-created a film based on phenomenological interviews with seven men who had volunteered to support other men by sharing their experiences of coping with prostate cancer. The film contributed to successful engagement with self-management. Interpretative Phenomenological Analysis of the interview data was conducted to explore the components of experiential empathy that the men had communicated.
Results: Four themes were identified illustrating what men wanted other men to know about coping with prostate cancer: Going into the unknown, it was difficult but I got through highlighted trauma and the importance of having a determined attitude; Only you can do it illustrated the triumph of their journey and of regaining control; I haven?t changed massively reflected the importance of a constant self; and Stay involved represented the overriding need to remain part of pre-cancer social environments.
Conclusions: We propose a construct framework of experiential empathy for men with prostate cancer: Resilience, Regaining Control, Continuity-of-Self and Social Connectedness. Filmed peer support that communicates these constructs will offer wide-ranging benefit to meet the needs of this group of men in both e-health and face-to-face self-management contexts. Further research could develop this theory-driven approach to filmed peer support for other cancer groups.
Faithfull S (2000) Neuro-oncology for nurses, INTERNATIONAL JOURNAL OF NURSING STUDIES 37 (1) pp. 92-92 PERGAMON-ELSEVIER SCIENCE LTD
Higham CE, Faithfull S (2015) Bone Health and Pelvic Radiotherapy, CLINICAL ONCOLOGY 27 (11) pp. 668-678 ELSEVIER SCIENCE LONDON
Faithfull S (2010) Where have all the nurses gone: workforce change a necessity?, EUR J ONCOL NURS 14 pp. S1-S1 ELSEVIER SCI LTD
Arber A, Odelius A, Williams P, Lemanska A, Faithfull S (2015) Do patients on oral chemotherapy have sufficient knowledge for optimal adherence? A mixed methods study., European journal of cancer care
A new treatment paradigm has emerged with many patients now receiving oral chemotherapy (OC) as first-line treatment for cancer. Treatment with OC has resulted in reduced hospital costs, more autonomy for patients but with added responsibilities for patient self-management. Little is known about patient's knowledge following patient education to enable optimal adherence with OC. A mixed methods study was carried out using a self-report questionnaire to patients on OC for multiple myeloma (MM) followed by semi-structured interviews with patients at home. Analysis identifies high rates of adherence (92.2%) with OC for MM. However, statistically significant knowledge deficits were identified, which were related to patient ethnicity and to gender. There is the potential for non-intentional non-adherence with OC due to deficits in knowledge of OC. Support at home needs to include primary care practitioners such as GPs, practice nurses and pharmacists so that timely support is easily accessible especially in the early phase of treatment.
Faithfull S (2008) Supportive and palliative care using E technology: The role of workforce attitudes in implementation, PSYCHO-ONCOL 17 pp. S61-S62 JOHN WILEY & SONS LTD
Faithfull S (2004) Assessing fatigue and self-care strategies in patients receiving radiotherapy for non-small-cell lung cancer, by Diana Borthwick, Gillian Knowles Shanne McNamara, Rita O'Dea, Paul Stroner [European Journal of Oncology Nursing 7(4), 231-241]., Eur J Oncol Nurs 8 (1) pp. 85-86 Elsevier
Nevidjon B, Kav S, Gullatte M, Faithfull S (2010) EONS-ONS Leadership Workshop - Part II: Clinical leadership empowerment: utilising your leadership skills, EUR J ONCOL NURS 14 pp. S12-S12 ELSEVIER SCI LTD
Taghipour A, Vydelingum V, Faithfull S (2011) Discovering a sequential social process of prostate cancer detection: A socio-epidemiological study of Iranian men's perspectives, HEALTHMED 5 (1) pp. 41-50 DRUNPP-SARAJEVO
Probst S, Arber A, Faithfull S (2009) Malignant fungating wounds: a survey of nurses' clinical practice in Switzerland, EJC SUPPLEMENTS 7 (2) pp. 232-233 PERGAMON-ELSEVIER SCIENCE LTD
Cockle-Heame J, Faithfull S (2007) State of the art in prostate cancer recovery: Self management what is it, what works and how can it help men with coping?, EJC SUPPLEMENTS 5 (4) pp. 427-427 PERGAMON-ELSEVIER SCIENCE LTD
Foubert J, Faithfull S (2006) Education in Europe: are cancer nurses ready for the future?, J BUON 11 (3) pp. 281-284
Much has been written about the need for continuing professional development for nurses to enhance practice and promote quality-nursing care. However, little has been written about the challenges faced by European nurses in keeping up-to-date with health care developments in relation to specialist areas. Educators providing courses are currently facing many challenges; not only the increasing costs of specialist education provision, distance learning, but also the ever increasing changes in health care requiring modification of specialist nursing skills and knowledge within curriculum. This means that educators need to rethink approaches to teaching and learning and links with practice. One of the challenges for the future is how to shift the skills needed for support of cancer patients out into the community , providing quality care for those requiring outpatient and ambulatory cancer care provision. However, continuing professional development is often encouraged as a mechanism for delivering service training rather perceived as developmental for the individual. The European Oncology Nursing Society (EONS) as a society has grasped the initiative for educational development with educational needs analysis, a curriculum identifying practice as central to learning, practice-related topics such as TITAN and the development of education for cancer in older people. There are enormous possibilities opening up within health care for us to develop cancer nursing in many settings and contexts, not only as a result of improved survival and treatments but because vocational education is being scrutinised as part of the Bologna agreement. Lastly, educationalists need to grasp these opportunities and take the initiative and strengthen education for nurses who don't know they need it. Improvements in specialist cancer care are shared and lessons learnt can translate into other nursing services so that we can provide better care for cancer patients throughout their cancer journey.
Faithfull S (1992) Oncology: chemotherapy for elderly people., Nurs Stand 6 (47) pp. 25-28
Elderly people form a large proportion of cancer patients. This has implications for cancer care, in that age is a substantial risk factor in developing cancer. In spite of efforts to reduce cancer mortality through health education and screening, cancer rates are likely to increase in proportion to the ageing population. It has been suggested that health care professionals generally view elderly people in a negative fashion, which influences the care that these individuals receive. At present, there is a scarcity of information on the nature of cancer in elderly people, their tolerance to cytotoxic treatment, and specific age-related problems. Knowledge in all these areas remains fragmented and the research data conflicting. The nurse plays an important role in assessing and monitoring the impact of cytotoxic chemotherapy treatment. It is, therefore, imperative for cancer nurses to develop specialist knowledge in this area to enable them to understand the effect cytotoxic chemotherapy treatments have on elderly people.
White I, Faithfull S, Allan H (2007) Development of an integrated psychosexual clinical assessment strategy for women receiving pelvic radiotherapy, EJC SUPPLEMENTS 5 (4) pp. 429-429 PERGAMON-ELSEVIER SCIENCE LTD
Faithfull S (2006) E. Milly L. Haagedoorn Lecture EACE 2006. Developing oncology nurse education and training across Europe., J Cancer Educ 21 (4) pp. 212-215
Education is an important tool in the development of specialist nursing within Europe. Awareness of cancer and its treatment and the impact it has on individuals and families helps in reducing negative perceptions and fatalistic attitudes. Education not only improves care, but can enhance outcomes; research studies have identified that appropriate and timely nursing can make a difference. There are several drivers for change within cancer nurse education. First, the increasing complexity of cancer treatment delivery plus the shift of cancer therapy and support into community and ambulatory settings are demanding wider skills. Second, the implementation of the Bologna Process across Europe aiming to make study programs compatible and comparable to facilitate transparency and academic recognition at a European level. As a result of the Bologna declaration, educational systems in most European countries are in the process of reform. These changes are an opportunity for cancer nursing to establish and constitute a starting point for providing a commonality of curricula for cancer nurses across Europe.
Faithfull S, Brada M (1996) Somnolence syndrome: Toxicity of cranial irradiation, BRITISH JOURNAL OF CANCER 74 pp. PO48-PO48 STOCKTON PRESS
Winters-Stone K, Horak F, Jacobs P, Trubowitz P, Dieckmann N, Stoyles S, Faithfull S (2017) Falls, Functioning, and Disability Among Women With
Persistent Symptoms of Chemotherapy-Induced
Peripheral Neuropathy,
Journal of Clinical Oncology 35 (23) pp. 2604-2612 American Society of Clinical Oncology
Chemotherapy-induced peripheral neuropathy (CIPN) may persist after treatment ends and may lead
to functional decline and falls. This study compared objective and self-report measures of physical
function, gait patterns, and falls between women cancer survivors with and without symptoms of
CIPN to identify targets for functional rehabilitation.
A secondary data analysis of 512 women cancer survivors (age, 62 6 6 years; time since diagnosis,
5.8 6 4.1 years) categorized and compared women self-reporting symptoms of CIPN (CIPN+) with
asymptomatic women (CIPN2) on the following: maximal leg strength, timed chair stand, physical
function battery, gait characteristics (speed; step number, rate, and length; base of support), selfreport
physical function and disability, and falls in the past year.
After an average of 6 years after treatment, 47% of women still reported symptoms of CIPN. CIPN+
had significantly worse self-report and objectively measured function than did CIPN2, with the
exception of maximal leg strength and base of support during a usual walk. Gait was slower among
CIPN+, with those women taking significantly more, but slower and shorter, steps than did CIPN2
(all P,.05). CIPN+ reported significantly more disability and 1.8 times the risk of falls compared with
CIPN2 (P , .0001). Increasing symptom severity was linearly associated with worsening function,
increasing disability, and higher fall risk (all P , .05).
This work makes a significant contribution toward understanding the functional impact of CIPN
symptoms on cancer survivors. Remarkably, 47% of women in our sample had CIPN symptoms
many years after treatment, together with worse function, greater disability, and more falls. CIPN
must be assessed earlier in the clinical pathway, and strategies to limit symptom progression and to
improve function must be included in clinical and survivorship care plans.
Desnoo L, Faithfull S (2006) A qualitative study of anterior resection syndrome: the experiences of cancer survivors who have undergone resection surgery, EUROPEAN JOURNAL OF CANCER CARE 15 (3) pp. 244-251 BLACKWELL PUBLISHING
Cockle-Hearne J, Faithfull S (2014) Peer Volunteers in Cancer Self-Management: What Are the Key Characteristics to Look for? Findings From a Phenomenological Study Among Men With Prostate Cancer, PSYCHO-ONCOLOGY 23 pp. 345-346 WILEY-BLACKWELL
Faithfull S (1994) Ageing matters. Negative perceptions., Nurs Times 90 (1) pp. 62-64
Winters-Stone KM, Hilton C, Luoh S-W, Jacobs P, Faithfull S, Horak FB (2016) Comparison of physical function and falls among women with persistent symptoms of chemotherapy-induced peripheral neuropathy, JOURNAL OF CLINICAL ONCOLOGY 34 (3) AMER SOC CLINICAL ONCOLOGY
Faithfull S, Hearne JC, Fairbanks HE, Laing R (2015) Self-management for chronic symptoms in the survivorship phase of illness: A randomised controlled trial of a group intervention for radiotherapy side effects versus usual care for men after treatment for prostate cancer, EUROPEAN JOURNAL OF CANCER 51 pp. S260-S260 ELSEVIER SCI LTD
Faithfull S (2006) Developing oncology nurse education and training across Europe, JOURNAL OF CANCER EDUCATION 21 (4) pp. 212-215 LAWRENCE ERLBAUM ASSOC INC-TAYLOR & FRANCIS
Faithfull S, White I (2008) Delivering sensitive health care information: Challenging the taboo of women's sexual health after pelvic radiotherapy, PATIENT EDUCATION AND COUNSELING 71 (2) pp. 228-233 ELSEVIER IRELAND LTD
Lemanska A, Byford R, Correa A, Cruickshank C, Dearnaley D, Griffin C, Hall E, de Lusignan S, Faithfull S (2017) Linking CHHiP prostate cancer RCT with GP records: A study proposal to investigate the effect of co-morbidities and medications on long-term symptoms and radiotherapy-related toxicity, Technical Innovations & Patient Support in Radiation Oncology 2 pp. 5-12 Elsevier

Patients receiving cancer treatment often have one or more co-morbid conditions that are treated pharmacologically. Co-morbidities are recorded in clinical trials usually only at baseline. However, co-morbidities evolve and new ones emerge during cancer treatment. The interaction between multi-morbidity and cancer recovery is significant but poorly understood.


To investigate the effect of co-morbidities (e.g. cardiovascular and diabetes) and medications (e.g. statins, antihypertensives, metformin) on radiotherapy-related toxicity and long-term symptoms in order to identify potential risk factors. The possible protective effect of medications such as statins or antihypertensives in reducing radiotherapy-related toxicity will also be explored.


Two datasets will be linked. 1) CHHiP (Conventional or Hypofractionated High Dose Intensity Modulated Radiotherapy for Prostate Cancer) randomised control trial. CHHiP contains pelvic symptoms and radiation-related toxicity reported by patients and clinicians. 2) GP (General Practice) data from RCGP RSC (Royal College of General Practitioners Research and Surveillance Centre). The GP records of CHHiP patients will be extracted, including cardiovascular co-morbidities, diabetes and prescription medications. Statistical analysis of the combined dataset will be performed in order to investigate the effect.


Linking two sources of healthcare data is an exciting area of big healthcare data research. With limited data in clinical trials (not all clinical trials collect information on co-morbidities or medications) and limited lengths of follow-up, linking different sources of information is increasingly needed to investigate long-term outcomes. With increasing pressures to collect detailed information in clinical trials (e.g. co-morbidities, medications), linkage to routinely collected data offers the potential to support efficient conduct of clinical trials.

Cockle Hearne J, Cooke DD, Faithfull S (2015) Developing peer support in film for cancer self-management: what do men want other men to know?, Support Care Cancer Springer-Verlag
Purpose: This study reports an innovative theory-driven approach for developing filmed peer support for cancer self-management. Peer support conventionally includes empathetic interaction between people with shared experiences. This unique study considers how to authentically communicate peer empathy in a one-way film narrative. Methods: We co-created a film based on phenomenological interviews with seven men who had volunteered to support other men by sharing their experiences of coping with prostate cancer. The film contributed to successful engagement with self-management. Interpretative Phenomenological Analysis of the interview data was conducted to explore the components of experiential empathy that the men had communicated. Results: Four themes were identified illustrating what men wanted other men to know about coping with prostate cancer: Going into the unknown, it was difficult but I got through highlighted trauma and the importance of having a determined attitude; Only you can do it illustrated the triumph of their journey and of regaining control; I haven?t changed massively reflected the importance of a constant self; and Stay involved represented the overriding need to remain part of pre-cancer social environments. Conclusions: We propose a construct framework of experiential empathy for men with prostate cancer: Resilience, Regaining Control, Continuity-of-Self and Social Connectedness. Filmed peer support that communicates these constructs will offer wide-ranging benefit to meet the needs of this group of men in both e-health and face-to-face self-management contexts. Further research could develop this theory-driven approach to filmed peer support for other cancer groups.
Laverty D, Arber AM, Faithfull S (2016) Respite for patients and carers in neurodegenerative disease: a grounded theory study, European Journal of Palliative Care 23 (4) pp. 175-179 Hayward Medical Communications
Neurodegenerative diseases (NDDs) are incurable and debilitating, and result in progressive deterioration of cognitive (dementias) and physical (ataxias) functioning. People with these conditions have constantly changing needs due to steady deterioration, with episodes of rapid decline,1,2 which places a heavy burden both on patients and their carers. Greater emphasis is now placed on keeping patients in their own homes in order to meet their personal wishes and reduce hospital/institutional costs.3,4 Respite can offer several avenues of support including rehabilitation, maximisation of functionality and improved quality of life for the patient. It can also be crucial in enabling carers to continue in their caring roles.
Laverty D, Faithfull S, Arber AM (2013) Developing respite care at an inner London hospice, European Journal of Palliative Care 20 (2) pp. 72-76 Hayward Medical Communications
In the UK, palliative care plays an important role in supporting patients and their carers during the course of a progressive and life-threatening illness. There has been much research into people?s preferred place of care and death, the future care needs of an aging society and the lack of resources and services in the community to support people?s wishes.1,2 There have also been numerous national drivers to emphasise and promote community-based care...
Faithfull S, Burton C, Clarke S, Kirby M, Lyon A, Levitt G, Poole K, Walter F (2017) Mitigating risk of cardiovascular disease in people living with and beyond cancer, Cancer Nursing Practice 16 (1) pp. 18-23 RCN Publishing
Rates of cancer survival have increased in recent decades due to earlier diagnosis and improved therapies, but a longer life span does not necessarily equate to a healthier life. Chronic illness as a consequence of cancer and its treatment is reported in a significant proportion of survivors. An increased risk of cardiovascular diseases, such as myocardial infarction, stroke and heart failure. Is one of the side effects of some cancer therapies. Nurses in oncology and primary care can minimise cardiovascular risks by improving people?s awareness of symptoms, conducting health assessment and appropriate referrals. Secondary prevention through lifestyle advice, smoking cessation and obesity reduction is also essential. This should be in combination with more detailed cardiac assessment for those high-risk groups at all stages of the patient pathway. Appropriate risk management and early detection of heart problems can prevent long term illness and reduce multimorbidity for people living with and beyond cancer.
Purpose: To investigate the role of symptom clusters in the analysis and utilisation of Patient-Reported Outcome Measures (PROMs) for data modelling and clinical practice. To compare symptom clusters with scales, and explore their value in PROMs interpretation and symptom management. Methods: A dataset called RT01 (ISCRTN47772397) of 843 prostate cancer patients was used. PROMs were reported with the University of California, Los Angeles Prostate Cancer Index (UCLA-PCI). Symptom clusters were explored with hierarchical cluster analysis (HCA) and average linkage method (correlation >0.6). The reliability of the Urinary Function Scale was evaluated with Cronbach's Alpha. The strength of the relationship between the items was investigated with Spearman's correlation. Predictive accuracy of the clusters was compared to the scales by receiver operating characteristic (ROC) analysis. Presence of urinary symptoms at 3 years measured with the Late Effects on Normal Tissue: Subjective, Objective, Management tool (LENT/SOM) was an endpoint. Results: Two symptom clusters were identified (Urinary Cluster and Sexual Cluster). The grouping of symptom clusters was different than UCLA-PCI Scales. Two items of the Urinary Function Scales (?Number of pads? and ?Urinary leak interfering with sex?) were excluded from the Urinary Cluster. The correlation with the other items in the scale ranged from 0.20-0.21 and 0.31-0.39 respectively. Cronbach's Alpha showed low correlation of those items with the Urinary Function Scale (0.14-0.36 and 0.33-0.44 respectively). All Urinary Function Scale items were subject to a ceiling effect. Clusters had better predictive accuracy, AUC = 0.70-0.65, while scales AUC = 0.67-0.61. Conclusion: This study adds to the knowledge on how cluster analysis can be applied for the interpretation and utilisation of PROMs. We conclude that multiple-item scales should be evaluated and that symptom clusters provide an adaptive and study specific approach for modelling and interpretation of PROMs.
Purpose: To examine the findings of existing studies in relation to men's cultural beliefs about changes to
their bodies relevant to prostate cancer and how these affect interpretation of bodily changes and helpseeking
Method: We undertook a narrative review of studies conducted from 2004 to 2017 in 6 databases that
highlighted men's beliefs and help-seeking actions for bodily changes suggestive of prostate cancer.
Results: Eighteen (18) studies reflecting men from various ethnicities and nationalities were included.
The belief that blood and painful urination were warning signs to seek medical help delayed helpseeking
among men compared to men that did not experience these symptoms. The belief that urinary
symptoms such as dribbling, cystitis and urinary hesitancy were transient and related to ageing,
normality and infection significantly delayed symptom appraisal and help-seeking. Men also held the
belief that sexual changes, such as impotence and ejaculation dysfunction were private, embarrassing
and a taboo. These beliefs impeded timely help-seeking. Cultural beliefs, spirituality and the role of
wives/partners were significant for men to help appraise symptoms as requiring medical attention thus
sanctioning the need for help-seeking.
Conclusions: This review underscores a critical need for further empirical research into men's beliefs
about bodily changes relevant to prostate health and how these beliefs affect their interpretation of
symptoms and subsequent help-seeking actions.
Jones Jacky, Jones Gareth D., Thacker Michael, Faithfull Sara (2017) Physical activity interventions are delivered consistently across hospitalized older adults but multimorbidity is associated with poorer rehabilitation outcomes: A population-based cohort study, Journal of Evaluation in Clinical Practice 23 (6) pp. 1469-1477 Wiley
Older adults live with multimorbidity including frailty and cognitive impairment often requiring hospitalization. While physical activity interventions (PAIs) are a normal rehabilitative treatment, their clinical effect in hospitalized older adults is uncertain.

To observe PAI dosing characteristics and determine their impact on clinical performance parameters.

A single-site prospective observational cohort study in an older persons' unit.

Seventy-five older persons' unit patients e65 years.

PAI; therapeutic contact between physiotherapy clinician and patient.

Parameters included changes in activities-of-daily-living (Barthel Index), handgrip strength, balance confidence, and gait velocity, measured between admission and discharge (episode). Dosing characteristics were PAI temporal initiation, frequency, and duration. Frailty/cognition status was dichotomized independently per participant yielding 4 subgroups: frail/nonfrail and cognitively-impaired/cognitively-unimpaired.

Median (interquartile range) PAI initiation occurred after 2 days (1-4), frequency was 0.4 PAIs per day (0.3-0.5), and PAI duration per episode was 3.75 hours (1.8-7.2). All clinical parameters improved significantly across episodes: grip strength median (interquartile range) change, 2.0 kg (0.0-2.3) (P

PAI dosing is consistent. However, while clinical changes during hospital episodes are positive, more favourable responses to PAIs occur if patients are nonfrail/cognitively-unimpaired. Therefore, to deliver a personalized rehabilitation approach, adaptation of PAI dose based on patient presentation is desirable.

Watson E, Shinkins B, Matheson L, Burns R, Frith E, Neal D, Hamdy F, Walter F, Weller D, Wilkinson C, Faithfull S, Sooriakumaran P, Kastner C, Campbell C, Neal R, Butcher H, Matthews M, Perera R, Wolstenholme J, Rose P (2017) Supporting prostate cancer survivors in primary care: Findings from a pilot
trial of a nurse-led psycho-educational intervention (PROSPECTIV),
European Journal of Oncology Nursing 32 pp. 73-81 Elsevier

This study sought to test the acceptability and feasibility of a nurse-led psycho-educational intervention
(NLPI) delivered in primary care to prostate cancer survivors, and to provide preliminary estimates of the effectiveness
of the intervention.


Men who reported an ongoing problem with urinary, bowel, sexual or hormone-related functioning/
vitality on a self-completion questionnaire were invited to participate. Participants were randomly assigned to
the NLPI plus usual care, or to usual care alone. Recruitment and retention rates were assessed. Prostate-related
quality of life, self-efficacy, unmet needs, and psychological morbidity were measured at baseline and 9 months.
Health-care resource use data was also collected. An integrated qualitative study assessed experiences of the


61% eligible men (83/136) participated in the trial, with an 87% (72/83) completion rate. Interviews
indicated that the intervention filled an important gap in care following treatment completion, helping men to
self-manage, and improving their sense of well-being. However, only a small reduction in unmet needs and small
improvement in self-efficacy was observed, and no difference in prostate-related quality of life or psychological
morbidity. Patients receiving the NLPI recorded more primary care visits, while the usual care group recorded
more secondary care visits. Most men (70%; (21/30)) felt the optimal time for the intervention was around the
time of diagnosis/before the end of treatment.


Findings suggest a nurse-led psycho-educational intervention in primary care is feasible, acceptable
and potentially useful to prostate cancer survivors.

Lemanska Agnieszka, Dearnaley David, Sydes Matthew R, Faithfull Sara (2018) Older age, early symptoms and physical function are associated with the severity of late symptom clusters for men undergoing radiotherapy for prostate cancer, Clinical Oncology 30 (6) pp. 334-345 Elsevier
To identify symptom clusters and predisposing factors associated with long-term symptoms and health-related quality of life (HRQOL) following radiotherapy in men with prostate cancer.

Patient-reported outcomes (PROs) data from the Medical Research Council RT01 radiotherapy with neoadjuvant androgen deprivation therapy (ADT) trial of 843 patients were used. PROs were collected over 5 years with the University of California, Los Angeles Prostate Cancer Index (UCLA-PCI) and the 36-Item Short-Form Health Survey (SF-36). Symptom clusters were explored using hierarchical cluster analysis (HCA). The association of treatment dose, baseline patient characteristics and early symptom clusters with the change in severity of PROs over three years was investigated with multivariate linear mixed effects models.

Seven symptom clusters of three or more symptoms were identified. The clusters were stable over time. The longitudinal profiles of symptom clusters showed the onset of acute symptoms during treatment for all symptom clusters and significant recovery by six months. Some clusters such as Physical Health and Sexual Function were adversely affected more than others by ADT, and were less likely to return to pre-treatment levels over time. Older age was significantly associated with decreased long-term Physical Function, Physical Health and Sexual Function (p

Men with poorer physical function and health prior to or during treatment were more likely to report poorer PROs at year three. Early assessment using PROs and lifestyle interventions should be employed to identify those with higher needs and provide targeted rehabilitation and symptom management.

Cockle Hearne Jane, Barnett D, Hicks J, Simpson M, White I, Faithfull Sara (2018) A Web-Based Intervention to Reduce Distress After Prostate
Cancer Treatment: Development and Feasibility of the Getting
Down to Coping Program in Two Different Clinical Settings,
JMIR Cancer 4 (1) e8 JMIR Publications
Background: Distress after prostate cancer treatment is a substantial burden for up to one-third of men diagnosed. Physical and emotional symptoms and health service use can intensify, yet men are reticent to accept support. To provide accessible support that can be cost effectively integrated into care pathways, we developed a unique, Web-based, self-guided, cognitive-behavior program incorporating filmed and interactive peer support.

Objective: To assess feasibility of the intervention among men experiencing distress after prostate cancer treatment. Demand, acceptability, change in distress and self-efficacy, and challenges for implementation in clinical practice were measured.
Methods: A pre-post, within-participant comparison, mixed-methods research design was followed. Phase I and II were conducted in primary care psychological service and secondary care cancer service, respectively. Men received clinician-generated postal invitations: phase I, 432 men diagnosed Results: A total of 135 men consented (phase I, 61/432, 14.1%; phase II, 74/606, 12.2%); from 96 eligible men screened for distress, 32% (30/96) entered the intervention (phase I, n=10; phase II, n=20). Twenty-four completed the Web-based program and assessments (phase I, n=8; phase II, n=16). Adherence for phase I and II was module completion rate 63% (mean 2.5, SD 1.9) versus 92% (mean 3.7, SD 1.0); rate of completing cognitive behavior therapy exercises 77% (mean 16.1, SD 6.2) versus 88% (mean 18.6, SD 3.9). Chat room activity occurred among 63% (5/8) and 75% (12/16) of men, respectively. In phase I, 75% (6/8) of men viewed all the films; in phase II, the total number of unique views weekly was 16, 11, 11, and 10, respectively. The phase II mood diary was completed by 100% (16/16) of men. Satisfaction was high for the program and films. Limited efficacy testing indicated improvement in distress baseline to post intervention: phase I, P=.03, r=?.55; phase II, P=.001, r=?.59. Self-efficacy improved for coping P=.02, r=?.41. Service assessment confirmed ease of assimilation into clinical practice and clarified health care practitioner roles.

Conclusions: The Web-based program is acceptable and innovative in clinical practice. It was endorsed by patients and has potential to positively impact the experience of men with distress after prostate cancer treatment. It can potentially be delivered in a stepped model of psychological support in primary or secondary care. Feasibility evidence is compelling, supporting further evaluative research to determine clinical and cost effectiveness.

Poole K, Anning J, Campbell M, Gasson S, Heyworth J, Langley S, Saxton J, Faithfull S (2106) Stimulating?, ? reassuring? or ?just interesting?: men?s perceptions of a fitness assessment after treatment for prostate cancer,
There has been an increasing recognition over the last ten years of the importance of integrating palliative care alongside other aspects of care for people with life-limiting illness including kidney disease. Over the same time period, policy initiatives have aimed to address and improve the end of life care for all adults with kidney disease. However, little is known about the transitions experienced by people with end-stage kidney disease (ESKD) as they approach the end of life.
This qualitative study explored the transitions experienced by people with ESKD as they approached the end of their lives. A constructivist grounded theory methodology was used, and unstructured interviews were conducted with twelve people living with ESKD who were deemed to be approaching the end of their lives. The interview data were analysed and interpreted using the constant comparative method.
The core category of ?restructuring reality? emerged from the data analysis alongside three dynamic, interrelated conceptual categories and the subcategories within these. These conceptual categories were: ?striving to maintain autonomy and control in decision making?, ?managing uncertainty: knowing without clarity or confirmation?, and ?the importance of personal virtues in transitioning through the illness?. The substantive theory which emerged from the data analysis and which conceptualised the process and experience of transition for people with ESKD in this study was defined as 'the restructuring of reality during transition for people with ESKD approaching the end of life?.
The study findings provided valuable insight into the experience of people with ESKD as they approach the end of their lives. The tentative theory presented in this study added to the knowledge of the transitions experienced by people with ESKD as they approached the end of their life. The theory captured how participants made sense of and adjusted to the changes they experienced as their health deteriorated; it emphasised that being able to continue to contribute and be involved in decision-making about care was an important aspect of the transition process as people approached the end of their lives. The study findings also highlighted the importance of healthcare professionals undertaking end of life discussions with patients throughout their illness trajectory to ensure people with ESKD are afforded the opportunity to be involved in timely decision making and provided with good quality end of life care.
Aim: This study aimed to develop a grounded theory to explain the experience of patients with neurodegenerative diseases and their carers, following an episode of residential respite care.
Background: Neurodegenerative diseases are incurable, debilitating and result in progressive deterioration of the patient which present as problems with cognitive functioning (dementias) and/or physical functioning (ataxias). To allow quality of life and purpose for the patient and caregiver, as well as providing value for money, respite is an area of care which could offer the patient rehabilitation, maximisation of functionality and quality of life; relief from caregiving duties for the carer and signposting for additional assistance and support.
Methods: This was a qualitative, grounded theory study conducted across south east England. An initial audit, attendance at support groups and specialist clinics provided scoping of the scale of the problems encountered by this patient population. Data collection included 17 semi structured interviews conducted with patients and carers who had recently received residential respite, non-participant observation at a hospice offering dedicated respite care and 4 hospice staff interviews.
Findings: A successful respite depended on the patient and carer identifying the need for respite and the information required to determine where, what, when and how respite could be accessed. The logistics of the referral process, preparation for respite and the handover of care needs to professionals were key factors for a therapeutic admission.
Conclusion: The outcomes from the respite admission should be mutually acceptable to both the patient and carer and be able to demonstrate acceptance and adaptation to a new normalcy, influenced by disease progression and reflecting on time present and time past. The onward journey sees a transitioning which involves restoration and building up a level of resilience for the carer, which all contribute to sustainability and being able to continue in the caring role.
Aim: To evaluate the reliability and reproducibility of the Spectromatch-Pro digital colour system (Spectromatch Ltd. UK) in the reproduction of simulated skin-silicone colour samples; and to determine threshold Delta E (?E) (CIE L*a*b*) of perceptible and acceptable colour differences for maxillofacial prosthetics.

Method: A two phase quantitative research design.
Phase 1: tested; (i) the reproducibility of the spectrophotometer for eight subjects (n=48) scans; from four ethnic groups White, Chinese, Asian and Black. (ii) minimum silicone-skin sample thickness for colour scanning; and (iii) reproducibility of simulated silicone-skin samples formulae recipe.
Phase 2: Determine the perceptible and acceptable colour match difference between colour silicone-skin samples and human skin for 8 subjects'; from baseline colour scan, an in-built colour L*a*b* gradient scales 0-8 at 0.5 ?E increments were formulated. Silicones samples (n=776) were processed; perceptible and acceptable colour difference (?E) assessed by (n=12) colour assessors.

Results: The spectrophotometer skin colour scans for White, Chinese Indian and Black ethnic groups demonstrated positive correlation (r=0.99). Scanner reproducibility for the eight subjects, Mean ± SD, ?E maximum (1.43 ± 0.63), to minimum (0.47 ± 0.21); colour formulae silicone sample achieved an acceptable colour match of 0.43 ?E to 1.36 ?E. The minimum silicone sample thickness (mm); for light to dark skin tones was 8 mm (White 6 mm; Black 8 mm). Pigment formula-sample reproducibility (Mean ?E and SD) maximum (1.36 ± 0.29), minimum (0.43 ± 0.16).

The acceptable colour difference threshold for skin simulated medical elastomers for four ethnic groups 1.54 ?E, White 1.61 ?E; Chinese 1.87 ?E; Indian was not detectable; and Black 2.33 ?E. Perceptible and acceptable colour difference (L*a*b*) CIE for L* (Light/dark) for all subjects 1.68 to 3.18 ?E; for a* (red/green), the scores were below 2 cut off point (not acceptable); and for b* (blue/yellow) 1.58 to 0.51 ?E.

Conclusion: This study has established the reproducibility of the Spectromatch digital colour system; and objectively defined the perceptible and acceptable (?E) thresholds (1) for facial prosthetics (Mean ?E 1.54), (2) the relationship to human eye sensitivity and the perceptibility / acceptability for silicone-skin colour match for maxillofacial prosthetics.