AN INVESTIGATION ON ROUTINE FOLLOW-UP CARE FOR HEAD AND NECK CANCER

BACKGROUND: Follow-up care aims to provide surveillance with early detection of recurring cancers and to address treatment complications and other health issues in survivorship. It is assumed that follow-up care fulfills these aims, however little evidence supports routine surveillance detecting curable disease early enough to improve survival. Cancer survivors are a diverse patient population, suggesting that a single follow-up regimen may not meet all patients’ follow-up needs. Little is known about what effective follow-up care should include for head and neck cancer patients in a Canadian setting. Identification of subgroups of patients with specific needs and current practices would allow for hypotheses to be generated for enhancing follow-up care. OBJECTIVES: 1a) To describe the follow-up needs and preferences of head and neck cancer patients, 1b) to identify which patient characteristics predict needs and preferences, 1c) to evaluate how needs and preferences change over time, 2a) to describe follow-up care practices by physician visits and imaging tests, and 2b) to identify factors associated to the delivered follow-up care. METHODS: 1) 175 patients who completed treatment between 2012 and 2013 in Kingston and London, Ontario were recruited to participate in a prospective survey study on patients’ needs and preferences in follow-up care. Bivariate and multivariate analyses were employed to describe patient survey responses and to identify patient characteristics that predicted needs and preferences. 2) A retrospective cohort study of 3975 patients on routine follow-up from 2007 to 2015 was carried out using data linkages across registry and administrative databases to describe follow-up practices in Ontario by visits and tests. Multivariate regression analyses assessed factors related to follow-up care. RESULTS: 1) Patients’ needs and preferences were wide-ranging with several characteristics predicting needs and preferences (ORECOG=2.69 and ORAnxiety=1.13). Needs and preferences declined as patients transitioned into their second year of follow-up (p<0.05). 2) Wide variation in practices was found, with marked differences compared to existing consensus guidelines. Multiple factors were associated with follow-up practices (RRTumor site=0.73 and RRLHIN=1.47). CONCLUSIONS: Patient characteristics can be used to personalize care and guidelines are not informing practice. Future research should evaluate individualized approaches to follow-up care.

Autonomy-Oriented Social Movements and the Politics of Affect

Abstract This dissertation explores damaging tendencies that exist within autonomy-oriented activism in the West. I examine how affect shapes the way that internal conflict is approached and internal strife is dealt with in radical communities. I adopt Sara Ahmed’s proposition “that our emotions are bound up with the securing of the social hierarchy” (Ahmed, 2004b: 4) and given that autonomy-oriented practices are committed to dismantling existing hierarchies, it follows that the less oppressive social configurations sought by autonomous social movements must have different emotional underpinnings. My thesis involves applying critical theory on affect and emotion in social movements to interview data gathered from activists both currently and historically involved in autonomy-oriented social movement communities in Kingston, Ontario. I ask whether anglophone, western-based, autonomy-oriented social movements reproduced understandings of affect/emotions/feelings that underwrite the social order they are working against? I also ask, “how are our emotions conditioned by capitalism?”. The research that I engage with provides responses to these questions by pointing out how the dominant discourse on emotions in the West encourages and informs certain modes of identity production that affect the diminishing and sad practices of autonomy-oriented communities and the (re)production of oppressive practices found in the dominant order. My work critically places this psychologizing view of emotions, and its damaging effects on resistance, within the context of neoliberal capitalism. I argue that the way we understand the politics of affect is an important dimension of radical struggle, and will inform and impact upon our individual and collective capacities to respond to, and refuse to reproduce relations of control and domination. I look for an understanding of “why” and to “what extent” these determinations exists, and look for hope in a politics of affect which supports an autonomy-oriented ethic.