This study utilized ethnographic methodology to describe the communicative interactional patterns in families with a member who has breast cancer. Three breast cancer patients whose families were between the adolescent and launching of children developmental lifestage (McGoldrick & Carter, 1982) were chosen for the study. Data were collected from a series of three interview sessions over a period of four weeks with a two week time lapse between each of the interview sessions. Interview sessions were conducted in the families' homes by the researcher. All interviews were video and audio tape recorded for the purpose of preserving data for transcribing and coding. Research questions examined individual perception of meaning in regard to the disease, the structure and organization of the family in relation to the illness, and the effects of family communicative interaction on the course and management of the disease. Findings indicated that family members' responses to the diagnosis of "breast cancer were influenced by multi-generational "beliefs. All three families formulated a collective belief which supported the mother's belief about the disease. Each of the three families were mother-centered, and each mother seemed to use a metacommunicative approach to mediating family transactions. Each of the three fathers were reported as having been isolated and withdrawn within the family at various times. However, each father appeared to play a protective role in deflecting tension and stress away from the mother. All three couples appeared to have constructed an egalitarian relationship with an implicit agreement as to who was more skilled to hold the power within a particular context. In all three families, the generational boundaries were clearly defined. Conflict and affect were most generally expressed in an indirect manner through wit and sarcasm. However, because each of these three families were structured to allow for personal autonomous functioning of each individual member, patients were supported in seeking a modality outside of the family system to express more ambivalent feelings.

Indiana University-Purdue University Indianapolis (IUPUI) / Long-term psychosocial consequences of breast cancer are increasingly more important to study as survivors are living longer. However, the survivors do not experience cancer alone; their significant others often suffer just as much if not more than the survivors themselves. In this dissertation, we explore some long-term consequences of cancer within the context of the Social Cognitive Processing Theory (SCPT). SCPT proposes that an individual must be able to discuss their feelings in order to cognitively process a traumatic event, such as cancer. If discussions are hindered, in particular by a significant other, then one will be unable to work through his/her concerns, leading to poor psychological outcomes, such as depression and fear of recurrence. The purpose of this dissertation is to use SCPT to identify causal mechanisms of depressive symptoms and fear of recurrence using a large sample of young breast cancer survivors and their partners. For one paper, we also included a large set of older participants for comparison. This dissertation is divided into three distinct articles. Each article tests long-term consequences of breast cancer and its treatment on breast cancer survivors and their partners using SCPT to explain relationships. First we examine the hypothesized predictors of younger breast cancer survivors’ depressive symptoms including the partner variable of depressive symptoms. The second article addresses the partners by predicting their depressive symptoms using SCPT. The third and final article seeks to identify the relationship of predictors and FOR on both survivors and their partners again using SCPT. For survivors, structural equation modeling analyses found significant direct and indirect paths between depressive symptoms and theoretical variables, including social constraints (stb=.266, p<.001) and intrusive thoughts (stb=.453, p<.001). In partners, cognitive processing variables (intrusive thoughts and cognitive avoidance) mediated the relationship between social constraints and depressive symptoms (F(5,498)= 19.385, R2=.163, p<.001). And finally, cognitive processing mediated the relationship between social constraints and fear of recurrence both for survivors [F(3,213)= 47.541, R2=.401, p<.001] and partners [F(3,215)= 27.917, R2=.280, p<.001). The evidence from these studies supports the use of SCPT in predicting depressive symptoms and fear of recurrence in both long-term survivors and partners.

Indiana University-Purdue University Indianapolis (IUPUI) / Triple-negative breast cancers (TNBCs) are negative for the expression of estrogen (ER), progesterone (PR), and HER-2 receptors. TNBC accounts for 15% of all breast cancers and results in disproportionally higher mortality compared to ER & HER2-positive tumours. Moreover, there is a paucity of therapies for this subtype of breast cancer resulting primarily from an inadequate understanding of the transcriptional differences that differentiate TNBC from normal breast. To this end, we embarked on a comprehensive examination of the transcriptomes of TNBCs and normal breast tissues using next-generation whole transcriptome sequencing (RNA-Seq). By comparing RNA-seq data from these tissues, we report the presence of differentially expressed coding and non-coding genes, novel transcribed regions, and mutations not previously reported in breast cancer. From these data we have identified two major themes. First, BRCA1 mutations are well known to be associated with development of TNBC. From these data we have identified many genes that work in concert with BRCA1 that are dysregulated suggesting a role of BRCA1 associated genes with sporadic TNBC. In addition, we observe a mutational profile in genes also associated with BRCA1 and DNA repair that lend more evidence to its role. Second, we demonstrate that using microdissected normal epithelium maybe an optimal comparator when searching for novel therapeutic targets for TNBC. Previous studies have used other controls such as reduction mammoplasties, adjacent normal tissue, or other breast cancer subtypes, which may be sub-optimal and have lead to identifying ineffective therapeutic targets. Our data suggests that the comparison of microdissected ductal epithelium to TNBC can identify potential therapeutic targets that may lead to be better clinical efficacy. In summation, with these data, we provide a detailed transcriptional landscape of TNBC and normal breast that we believe will lead to a better understanding of this complex disease.

No description available.

Bakgrund: Omkring 8000 kvinnor får diagnosen bröstcancer i Sverige varje år. Dessa kvinnor möter vården vid flertalet tillfällen under den tid de behandlas, och deras behov av stöd och information har i flera studier konstaterats vara viktigt. För att möta och förstå dessa kvinnors behov, behöver vi veta mer om hur de upplever vården. Syfte: Syftet med denna studie var att beskriva hur kvinnor med bröstcancer upplever sin vård. Metod: Studien har gjorts med en innebördsanalys. Den har utförts genom att analysera åtta biografier skrivna av kvinnor med erfarenhet av att själva ha eller ha haft bröstcancer. Resultat: Resultatet visar att kvinnor med bröstcancer vill bli mött som en unik person under tiden som patient. De behöver stöd och bekräftelse från anhöriga och sjukvårdspersonal. De uttrycker också att de vill bli omhändertagna på ett mjukt och varsamt sätt med respekt och utifrån den egna livsvärlden. Konklusioner: Kvinnor med bröstcancer vill bli mött som den unika person de är i mötet med vården. Genom ett större omvårdnadsperspektiv och mer personcentrerad vård kan deras lidande lindras. Nyckelord: bröstcancer, upplevelse, vård / Background: About 8000 women are diagnosed with breast cancer every year in Sweden. These women meet nursing care several times during their treatment and their need of support and information is found important in several studies. To meet and understand these women’s needs, we need to know more about how they experience care. Aim: The aim of this study was to describe how women with breast cancer experience their care.  Method: The study, a meaning analysis, has been performed by analysing eight biographies written by women with experiences of having breast cancer. Result: The results show that women with breast cancer want to be seen as a unique person during their time as patient, they need support and confirmation from relatives and from nursing staff. They also express they want to be taken care of in a soft and gentle way with respect and based on their own life-world. Conclusions: Women with breast cancer want to be met as the unique persons they are in meetings with health care. By having a larger nursing perspective and more person-centred care their suffering can be relieved. Keywords: breast cancer, experience, care,

This ethnographic thesis reports a research project undertaken with a group of breast cancer dragon boaters in the Lake District in the UK. First undertaken as part of a research project to understand the affect of exercise on people affected by breast cancer, the practice has developed and spread around the world. Using participatory and ethnographic sensibilities and methodologies, the thesis works through the experiences of the researcher with the group. Split into three sections, these deal in turn with methodological issues, the collaborative cultures of the group, and the healing rhythms with the group in terms of their collaborations with nature and other paddlers. In section one, it is suggested that any participatory research project can only be approached through an iterative understanding of the group of participants. Through this iterative approach, and although the study was approached with a broad perspective on academic literatures concerning participatory, and autoethnographic approaches, it was only through contact with the group that the particular projects within the research emerged. In section two, the group and its practice are approached in three chapters which seek to highlight the ways in which collaborative groups that concern an illness experience can develop, not through the socially structured pre-group identities of breast cancer survivors, but through the collaborative practice of these individuals. In this case, the implicit collaborative geographies of Paddlers for Life are explored as ‘communities of practice’, as features that emanate from the practice of the group. The following two chapters continue to explore this analysis, examining the practices of the group to explore how paddling is seen as an experience at once separate from but also entwined with the lived experience of cancer. In section three, I develop the experience of the group as it has developed after a cancer experience. By utilising, in particular, Lefebvre’s (2004) understanding of rhythm and Ingold’s (2007) theory of wayfaring, we are able to explore how the experience of breast cancer dragon boating is not seen as a journey with a fixed end, but is explored through the rhythms of lived interactions with the environment. In Chapter 8, these ideas are used to develop the notion of the therapeutic landscape (Gesler 1992), so that it is not particular places or spaces that are emphasised, but the results of rhythmic wayfaring that can be undertaken in the world.

PURPOSE:Selective Estrogen Receptor Modulators (SERMs) reduce the risk of breast cancer for women at increased risk by 38%. However, uptake is extremely low and the reasons for this are not completely understood. The aims of this study were to utilize time trade-off methods to determine the degree of risk reduction required to make taking SERMs worthwhile to women, and the factors associated with requiring greater risk reduction to take SERMs.METHODS:Women at increased risk of breast cancer (N=107) were recruited from two familial cancer clinics in Australia. Participants completed a questionnaire either online or in pen and paper format. Hierarchical multiple linear regression analysis was used to analyze the data.RESULTS:Overall, there was considerable heterogeneity in the degree of risk reduction required to make taking SERMs worthwhile. Women with higher perceived breast cancer risk and those with stronger intentions to undergo (or who had undergone) an oophorectomy required a smaller degree of risk reduction to consider taking SERMs worthwhile.CONCLUSION:Women at increased familial risk appear motivated to consider SERMs for prevention. A tailored approach to communicating about medical prevention is essential. Health professionals could usefully highlight the absolute (rather than relative) probability of side effects and take into account an individual's perceived (rather than objective) risk of breast cancer.

Studien handlade om bröstcancerpatienters upplevelser av empati hos läkare i läkar-patientmötet.  Fokus låg på att undersöka i hur stor utsträckning läkarens empatiska förmåga bidrar till upplevelsen av god vård. Metoden var av kvalitativ ansats där semistrukturerade intervjuer utfördes med 12 bröstcancerdrabbade kvinnor. Resultatet gav kategorier tillhörande studiens tre frågeställningar. Frågeställningen om vad som utgör en empatisk läkare belystes av kategorierna (1) sätta sig in i den andres situation, (2) både känsla och handling, (3) kunskap, (4) informativ och (5) god lyssnare. Frågeställningen om icke-empatisk läkare belystes av kategorierna (1) dålig information, (2) opersonlig och (3) dålig förmåga att skapa god behandlingsallians. Frågeställningen om god vård belystes av (1) kontinuitet hos läkare, (2) bli sedd som individ och (3) mer tid hos läkare. I fall av brist på empati upplevde patienterna mindre grad av tillfredställande. God vård och empati är beroende av varandra, den ena kan inte existera utan den andre.

Cancer is a major cause of morbidity and mortality affecting populations in all countries and all regions. Breast cancer (BC) is the second leading cause of cancer death among women in the UK. Although the overall survival of BC has been significantly improved due to systemic therapy in early BC, the treatment of advanced/metastatic BC remains a major challenge. The main limitation of therapeutic failure is the de novo and acquired resistance of BC cells to conventional anticancer drugs. Cancer stem cells (CSCs) have been thought to be responsible for the chemoresistance. My study demonstrated that mammospheres manifested CSC characteristics and are highly resistant to several first line anti-BC drugs. This may be due to the hypoxia in the centre of the spheres. Transfection of BC cells with NFκB p65 induces CSC characters and chemoresistance. Therefore hypoxia-induced activation of NFκB could lead to escape of CSCs from apoptosis and regenerate the tumour after conventional chemotherapy. In clinic, the relapsed cancer is commonly pan-resistant to various drugs. Development of CSCs-targeting drug will be significantly important in clinic for cancer patients. Disulfiram (DS) is a commercially available anti-alcoholism drug with strong cytotoxicity in a wide range of cancer types and has a reversing II effect on chemoresistance. In this study, the anticancer efficacy of DS on cancer cell lines and CSCs was investigated. DS was highly cytotoxic to BC cell lines in vitro in a copper (Cu)-dependent manner. CI-isobologram analysis demonstrated a synergistic effect between DS/Cu and paclitaxel (PAC) in BC cell lines. DS/Cu induces reactive oxygen species (ROS), activates JNK and p38 pathways and simultaneously inhibits NFκB activity in BC cell lines. DS/Cu may trigger intrinsic apoptotic pathway via modulation of the Bcl2 family. The in vitro clonogenicity and sphere-forming ability of BC cell lines were inhibited by DS/Cu. The common stem cell markers such as aldehyde dehydrogenase (ALDH) and CD24-/CD44+ as well as Nanog, Sox2, and Oct4 were also suppressed. In PAC resistant cell line, DS abolished CSC characters and completely reversed PAC resistance. Lipo-DS blocked NFκB activation and specifically targeted CSCs in vitro. Lipo-DS also targeted CSC population in vivo and showed very strong anticancer efficacy. This study elucidated the role of NFB in bridging hypoxia with CSC-related chemoresistance. It also investigated the fundamental anticancer mechanisms of DS. The results derived from this study indicate that further study may be able to translate DS into cancer therapeutics in the future.

No description available.