published_or_final_version / Medicine / Master / Master of Medical Sciences

In der vorliegenden Arbeit wurde der zelluläre Immunstatus von 17 Patienten mit Erstdiagnose eines soliden gastrointestinalen Tumors vor und nach intravenöser Applikation von drei Zyklen einer konventionellen Polychemotherapie untersucht. Verglichen wurde zu Beginn der Therapie mit einer Kontrollgruppe, bestehend aus 21 nicht onkologisch vorerkrankten Probanden. Zur Messung der individuellen T-Zellvermittelten Immunantwort auf Einzelzellebene wird auf die Methode des IFN-γ-ELISPOT-Assays zurückgegriffen. Die zentrale Frage war, ob die Applikation einer Polychemotherapie einen messbaren Effekt auf die Immunantwort des einzelnen Individuums hat. Zudem sollte untersucht werden, ob generelle Unterschiede zwischen Patienten mit einer unbehandelten Tumorerkrankung und gesunden Probanden bzw. allgemein internistisch erkrankten Patienten zu erkennen sind. In Zusammenschau der Ergebnisse sind trotz überwiegend unveränderter T-Zell-Antwort auf die meisten der eingesetzten Antigene einige statistisch signifikante Unterschiede festzuhalten. So zeigte die Gruppe der Tumorpatienten vor Applikation der Chemotherapie im Vergleich zur Kontrollgruppe eine signifikant erhöhte Spotintensität und einen höheren Stimulationsindex [A] in Bezug auf das Tuberkulose-Antigen CFP-10. Diese Veränderungen waren nach Applikation der Chemotherapie nicht mehr nachzuweisen. Des Weiteren ergaben sich bei den Tumorpatienten vor und nach Chemotherapie signifikante Veränderungen der T-Zell-Antwort bezüglich des Antigens Tetanus-Toxoid. Nach Applikation von 3 Zyklen Chemotherapie kam es zu einer Verminderung des Stimulationsindex [A]. Es wird daher die Vermutung nahe gelegt, dass sich gerade in Bezug auf bakterielle Infektionen die T-Zell-Antwort der Tumorpatienten signifikant ändert. Die klinische Relevanz müsste jedoch anhand gezielter Messung auf spezifische bakterielle Antigene in größer angelegten Studien überprüft werden.

This study addresses the importance of studies of human psychoneuroimmunology in understanding the role of psychological factors in cancer. Research trends in psychosocial aspects of cancer are reviewed, exploring the role of distress and the support group as an intervention which potentially reduces distress through enhancing interpersonal relationships, emotional adjustment and communication with health professionals, in these ways helping the patient to cope with the symptoms of treatment. In South Africa, most hospitals which treat cancer patients medically do not simultaneously have support groups for the newly diagnosed patient to join in order to discuss immediate fears and acquire more knowledge about their particular disease. Following an experimental cancer support group involving patients who had recently undergone a bone marrow transplant (some considerable time after their first cancer diagnosis) in Cape Town's Groote Schuur Hospital, the researcher, as one of the participants in the fortnightly meetings convened to dicuss psychosocial issues related to each patient's experience of the cancer and transplant process, transferred the themes, concepts and questions that arose in that scenario, to a cancer clinic in Pretoria where recently diagnosed patients were asked to volunteer to participate in such a group. It was felt that these patients would derive some benefit early in their treatment programme. Psychosocial concerns are left to the individual patient to seek therapy should it be required. Presently, it is reported in the body of knowledge about cancer, that interventions aimed at alleviating the psychosocial distress of cancer patients highlight hypnosis, guided imagery and relaxation therapy. It is contended that a more appropriate intervention for the majority of people with cancer in South Africa would entail a fellow-patient support group meeting on a regular basis. / Psychology / (M.A. (Psychology)

The word "cancer" has different meanings for different people. In general, it is synonymous with fatality, either imminent or in the forseeable future. How each person perceives and attributes meaning to this personal experience, varies according to idiosyncratic factors. These factors are constituted by each individual's unique internal make up and by external influences and it is the combination of the multiplicity of factors that bring about the personal attributions of meaning for each individual. The thesis examines the attributions of meaning of a sample of 42 women with breast cancer, through administration of a semi-structured interview and questionnaire, with follow up interviews. The theoretical concepts which are explored, examine the shift away from the traditional, Newtonian, linear-causal, neutral observer model (as in the traditional medical model), towards an ecosystemic, a-causal, contextual, holistic stance. Ecosystemic thinking is utilised in this research work, and this way of thinking is applied to the findings. In addition, a qualitative, descriptive approach is adopted, so that an in depth emphasis rather than a quantitative, empirical view of the patients in the sample, is undertaken. The applied questionaire focuses on the patient's experience of cancer diagnosis, with more specific reference to the side effects of the chemotherapy. The emphasis is towards the issue of anticipatory nausea and emesis and the possible use of hypnosis in relation to these effects. Each patient's attribution of meaning to these aspects forms the core of the thesis. The study discloses the wide variety of attributions of meaning held by different women in a similar predicament towards different aspects of that predicament. Concomitantly, the study highlights the limitations of the traditional, medical model which contribute to diminishing the personal understanding of each patient, and the impact of this on both treatment and outcome for each patient. / Psychology / D.Phil. (Psychology)

Please read the abstract in the section 00front of this document / Thesis (DPhil)--University of Pretoria, 2010. / Medical Oncology / unrestricted

No description available.

Det existentiella lidandet återfinns i samband med frågor som rör människans frihet, tillvarons mening, känslor av ensamhet och isolering i livssituationen samt i mötet med döden. Dessa frågor är universellt mänskliga och uppträder därför oavsett människans bekännande till eller avståndstagande från andlighet eller religiositet. Syftet med denna litteraturstudie var dels att beskriva hur det existentiella lidandet tar sig uttryck hos cancerpatienter i kurativ vård men också att beskriva sjuksköterskors bemötanden gentemot dessa patienter och de möten som uppstår mellan patienter och sjuksköterskor. De resultat som framkom av studien visade på att det existentiella lidandet karaktäriseras av förändringar och är en stor del av det totala lidande som cancerpatienter utstår. Samtidigt är emellertid sjuksköterskor, till följd av rädsla och okunskap, i många fall oförmögna att möta de förväntningar och behov som patienterna har. Den teoretiska referensram som använts utgörs av valda delar av Katie Erikssons omvårdnadsteori. / The existential suffering is found in relation to questions about human freedom, meaning of existence, feelings of loneliness and isolation in life and encountering death. These questions are of a universal human character and are therefore to appear irrespective of human confession to or dissociation from spirituality or religiosity. The aim of this review was partly to describe the existential suffering in cancer patients in curative care, partly to describe nurses´ treatments to these patients and the encounters that arise between patients and nurses. The findings emerging in the study revealed that the existential suffering is characterized by changes and is a great part of the total suffering that cancer patients endure. At the same time are nurses, as a result of fear and ignorance, in many cases unable to encounter the patients´ experiences and needs. The theoretical framework used, consist of selected parts of Katie Eriksson´s nursing theory.

Background The word cancer is a term used to describe about 200 different diseases. Cancer patients often receive palliative care, where the purpose is to relive suffering and promote quality of life. Previous research shows that nurses often have a negative approach towards cancer, especially because the lack of knowledge and insecurity in how to communicate with these patients. Aim The aim of this study was to describe nurses' experiences of caring for patients with cancer receiving palliative care in a hospital ward. Method The method used in this study was a literature review based on qualitative studies. Fourteen articles were analysed according to Friberg's (2006) qualitative content analyse in five steps for literature-based studies. Results The result showed that nurses have mixed feelings about meeting patients with cancer in a palliative phase. They had feelings of inadequacy and they felt a great responsibility, many nurses experienced feelings of gratitude towards working with palliative patients with cancer. Nurses also expressed that communication and a trusting relationship with the patients were important. The nurses often felt that they didn't have enough time to give the care that the patients deserved because of a high workload. Conclusion Patients with cancer in a palliative phase are a complex area. Nurses may experience providing care to patients in palliative care as emotionally stressful. To be able to provide high quality care trusting relationships were essential between nurses and patients. Patients with cancer are in need of support from the nurse, but the nurses experienced that time is not enough.

A gold standard measurement does not exist to assess fatigue symptoms across patient populations. Current tools only consist of self-report measures that may not assess fatigue objectively. The National Institutes of Health-Brief Fatigue Inventory (NIH-BFI) is a clinician-administered instrument developed as a more objective assessment of fatigue symptoms. This study assessed the NIH-BFI's validity in diverse clinical populations, which included patients diagnosed with a mood disorder, Parkinson's disease, cancer, and healthy controls. Results suggest good criterion-related and convergent validity for the NIH-BFI. Results also indicate significant differences in fatigue severity between cohorts. Moreover, the data also suggest significant differences among groups in depression, anxiety, pain catastrophizing, sleep quality, global mental and physical health, and cognitive functioning. This study proposes that the NIH-BFI is a valid clinician-administered measure of fatigue that can be administered in multiple clinical populations.

Thesis (M.Med. (Radiation Oncology)) -- University of Limpopo, 2022 / Background Hypothyroidism in head and neck cancer patients after radiotherapy is known to occur, yet thyroid function tests are not routinely monitored in all patients post radiation therapy. Routine post radiation therapy thyroid function testing is currently not part of the follow-up protocol in these patients at Pietersburg Hospital. The aim of this study is to evaluate post radiation therapy hypothyroidism among head and neck cancer patients treated with radiotherapy at Pietersburg Hospital Methods A prospective (cohort) observational study was carried out among head and neck cancer patients receiving radiotherapy at the radiation oncology department in Pietersburg Hospital. Sample size of n=37 was calculated using Statistica V13.0. Thyroid function tests were performed at the start of radiation therapy and repeated on the first day of follow up, 6 weeks after completing radiation therapy. During follow up, participants were also interviewed for the presence of symptoms of hypothyroidism such as dry skin, dry hair, fatigue, cold intolerance, or weight gain. Data analysis was done with STATA version 16. Descriptive statistics were used to characterise variables, and summarised in tables, graphs and charts. Changes in thyroid function tests and other variables were analysed. A p-value of 0.05 was deemed statistically significant. Results Thirty-seven patients were enrolled in the study, 26 males and 11 females. The mean age of the patients was 53.1 ±12.3 standard deviation [SD]) with a range of 40.8 to 65.4 years. The most common diagnoses were cancer of the larynx and hypopharynx, forming 29.7% and oral cavity cancer, 29.7%. Only three patients (8%) had an early stage cancer (Stages 1 and 2), 11 patients (29.7%) moderately advanced cancer (Stage 3) while the majority (62%; n =23) had locally advanced cancer (Stage 4). Majority of the patients received 70Gy in 35 daily fractions, five fractions per week via 3-D conformal radiotherapy. Only 29 patients who had complete pre- and post radiotherapy thyroid function tests were included in the final analysis. Of these, none had clinical hypothyroidism at 3 months. Two patients (6.8%) had sub-clinical hypothyroidism, with post radiation therapy TSH values greater than 3.5mIU/ml. The mean post radiation therapy TSH values increased by 8.3% and the mean fT4 values decreased by 2.05% compared to the pre-radiation therapy values. Both changes were not statistically significant (p=0.99 and p=0.82 respectively). There was no statistically significant correlation between changes in TSH and fT4 versus age (p=0.88 and p=0.92 respectively), sex (p=0.55 and p=0.15 respectively), cancer stage (p=0.21 and p=0.78 respectively), and cancer site (p=0.17 and p=0.74 respectively). The most common post radiotherapy symptom was fatigue (62%) followed by cold intolerance (54%), weight gain (43%) and dry skin or dry hair (43% each). Conclusion The results of the study suggest that sub-clinical hypothyroidism is detectable early post radiation therapy presenting as clinical symptoms.