Psychosocial oncology is well established in Europe and in America. Similar initiatives are, however, rare in Africa. On the African continent, psychosocial services are scarce and often a luxury although the importance of psychosocial variables as mediators in the paediatric cancer outcomes have been widely recognised. The apartheid system in South Africa was instrumental in causing major disparities in health, education and socioeconomic status. In order to provide a more holistic service it becomes imperative to assess not only the psychosocial needs and resources of both children and parents who endure the disease but also the influence of socio-demographic variables such as race, educational level and socioeconomic status. This research was limited to collecting baseline information on how parents and children communicate about the illness, emotional responses and the psychological resources that they utilise to deal with the childhood cancer trajectory. The study group consisted of 100 children between the ages of 5 and 16 years who had been diagnosed with cancer and one or both parents of those children. Data was collected through semi-structured interviews and standardised self-report measures. The results of the study indicate that both parents and children did not suffer disabling psychopathology, but certainly evidenced symptoms of depression and anxiety indicative of adjustment difficulties. Communicating about the illness was generally limited to physiological aspects of the disease and medically related matters, while emotional issues were rarely articulated. Children, parents and their siblings relied heavily on medical staff for their information needs. The age of the child was a significant factor with reference to amount and complexity of information imparted to children: adolescents were given more information about the treatment and prognosis; while younger children were given a limited amount of information. Race, socioeconomic status and educational levels of parents not only influenced the meanings and beliefs families developed around the cancer experience, but also the manner in which they expressed their emotions and the coping strategies that they employed. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2004.

Social support is likely to play an especially important role in coping with a cancer diagnosis as it presents a unique set of stressors to the individual. The purpose of this study was to examine biological sex differences in the perceived availability of three modes of social support (emotional, instrumental, and informational), source of support (friends vs. family), and social support seeking behavior in a population of cancer patients. The sample included 71 men and 71 women who had been diagnosed with cancer within two years of the start of the study. No significant sex differences were found in social support seeking; however, results revealed that women perceived greater availability of emotional support as well as greater support from friends on all modes of social support than did men. Implications of these findings and future directions for research are discussed. / Department of Counseling Psychology and Guidance Services

[Truncated abstract] A diagnosis of breast cancer is a life-changing event for any woman. For young women and their families it can be devastating. Women aged less than 45 years make up 20% of new cases of breast cancer diagnosed annually in Australia. With the trend for women to delay pregnancy, young women diagnosed with breast cancer may want at least the option to become pregnant after diagnosis and treatment but little is known about how pregnancy affects breast cancer or how breast cancer affects pregnancy. The aims of this thesis were to investigate how concurrent and subsequent pregnancy affects the development and outcomes of breast cancer and how breast cancer affects a concurrent or subsequent pregnancy. This study describes two groups of women identified from the entire Western Australian population less than 45 years of age when diagnosed with: 1. Gestational breast cancer, defined as breast cancer diagnosed while a woman is pregnant or in the first twelve months after completion of a pregnancy; and 2. Breast cancer who subsequently conceive. This study focused on three main areas; patterns of care and outcomes for women diagnosed with gestational breast cancer and those women diagnosed with breast cancer who subsequently conceived; the imaging and pathological characteristics of gestational breast cancer; and lastly the psychosocial issues associated with gestational breast cancer. ... This result was statistically significant. In an age and staged matched case control study lymph node negativity did not purvey a survival advantage for women diagnosed with gestational breast cancer as it did for the non- gestational breast cancer controls. Women diagnosed with breast cancer who have good prognosis tumours need not necessarily wait two years to become pregnant. In an age matched case control study women diagnosed with gestational breast cancer were more likely to have extensive insitu carcinoma, higher mitotic rates and tumours with medullary like features than their age matched controls. In a Cox's proportional hazards regression model which included pathological characteristics, there was no significant difference in survival for women diagnosed with gestational breast cancer were compared to women diagnosed with non-gestational breast cancers. The psychosocial issues for women diagnosed with gestational breast cancer are similar to other young women diagnosed with breast cancer but the effect on the 9 lives of women dealing with pregnancy and breast cancer simultaneously was much greater. The issues of breast cancer and pregnancy are complex at both a physical and psychological level. Much more research is needed to understand the mechanisms of how pregnancy affects breast cancer and its spread. Women who are pregnant when diagnosed with breast cancer or who consider pregnancy after their diagnosis need unbiased support from those around them. Survival is important but other survivorship issues may be just as important. To translate these findings into clinical practice and offer directions for future research eleven recommendations are proposed.

O tratamento de pacientes com câncer de laringe que realizam a cirurgia de Laringectomia Total (LT), freqüentemente implica a necessidade de procedimentos agressivos que podem causar lesões estéticas e funcionais irrecuperáveis, tais como o uso de sonda nasogástrica, traqueostoma, perda da fala e do sentido olfativo, dificuldade para engolir certos alimentos e a impossibilidade de imersão em líquidos, acarretando uma série de repercussões em uma dimensão psicossocial. Através de uma metodologia qualitativa, baseada na narrativa dos pacientes e seus cuidadores, objetivamos investigar as possíveis repercussões psicossociais na construção subjetiva de pacientes submetidos à LT. Caracterizamos mudanças ocorridas no cotidiano dos pacientes e em suas relações familiares e sociais, com o intuito de compreender como estas mudanças afetam o seu equilíbrio emocional e as suas estratégias de enfrentamento psicológico frente a elas. Todo o percurso em torno da doença é vivido pelo paciente e por sua família como um momento de crise, atravessado por um profundo sentimento de precariedade, que exige uma série de readaptações que afetam expressivamente a rotina e o contexto social em que vivem. Diante das diversas seqüelas físicas decorrentes da LT e do seu tratamento, a perda da fala assume papel prioritário levando o paciente a isolar-se do seu convívio social, afastar-se de suas funções profissionais, o que gera, conseqüentemente, sentimentos de inadequação, baixa auto-estima, vergonha e, até mesmo, culpa pela crença de que seus maus hábitos contribuíram para o adoecer. A família, por seu turno, sofre duplamente: de um lado pela percepção de fragilidade e medo de perda de um ente querido e, de outro, por tentativas, nem sempre bem sucedidas, de dar suporte e oferecer ambiência para as novas necessidades que se apresentam. Percebe-se, ainda, que os aspectos ligados à religiosidade, ao apoio da família e confiabilidade na equipe são encarados como fonte de motivação para o tratamento. A experiência do adoecimento é extremamente rica de sentidos: des-armando, des-pre-ocupando para ocupar-se com o que interessa e realmente está presente no aqui e agora, pedindo espaços de amparo onde o abdicar de si implica em abrir-se para outro. Além de aprofundar temáticas relativas à Psicologia Clínica e Hospitalar, acreditamos que essa pesquisa pôde nos auxiliar na identificação de dispositivos clínicos para a ação do Psicólogo que trabalha nesse contexto. Outros estudos e reflexões são necessários para que possamos melhor compreender essas tantas facetas que envolvem o humano, sem aprisioná-lo, considerando-o em sua singularidade múltipla. No entanto, podemos afirmar que o contato com esses pacientes e a busca de compreensão de seus sofrimentos leva-nos, cada vez mais, a tomar a ética do cuidado como o principal referencial em nossa atividade Clínica / The treatment of patients with larynx cancer who carry through the surgery of Total Laringectomy (TL), frequently implies the necessity of aggressive procedures that they can cause irretrievable esthetic and functional injuries, such as the use of nasogastric feeding, stoma, loss of speaks and the olfactive sense, difficulty to swallow certain foods and the impossibility of immersion in liquids, causing a series of repercussions a psychosocial dimension. Through a qualitative methodology based in the narrative of the patients and its caregivers, we objectify to investigate the possible psychosocial repercussions in the subjective construction of patients submitted to the TL. We search, also, to characterize the occured changes in the daily one of the patients, its familiar and social relations, with intention to understand as these changes affect its emotional balance and to understand its strategies of psychological confrontation. All the passage around the illness is lived by the patient and its family as a moment of crisis, crossed for a deep feeling of precariousness, demanding a series of readjustments that affect its routine expressivelly and of its family ones. Ahead of the diverse physical sequels decurrent of the TL and its treatment, the loss of speaks assumes with priority role taking the patient to isolate itself of its social conviviality, to move away from its professional functions, what it generates, consequently, improper feelings, low auto-esteem, shame and, even though, guilt for the belief of that its bad habits had contributed to become sick. The family, for its turn, suffers doubly: of a side for the perception of fragility and fear of loss and, of another one for attempts, nor always successful, to give support and to offer ambience for the new necessities that if present. One perceives, still, that on aspects to the religiosity, to the support of the family and trustworthiness in the team are faced as source of motivation for the treatment. The experience of become sick is extremely rich of is felt: dis-arming, easying to occupy with what it interests and reallyis present in here and now, asking for support spaces where abdicating of itself it implies in confiding for another one. Beyond going deep thematic relative to Clinical and Hospital Psychology, we believe that this research could assisting in them in the identification of clinical devices for the action of the Psychologist who works in this context. Other studies and reflections are necessary so that let us can more good understand these as much faces that involved the human being, without imprisoning it, considering it in its multiple singularity, however, can affirm that the contact with these patients and the search of understanding of its sufferings take us, each time more, to take the ethics of the care as the main referencial in our Clinical activity

M.A. (Social Work) / Cancer is a common condition and is becoming an important issue in South Africa. During their lifetime people may develop different forms of cancer such as lung -, throat -, skin -, colon -, and breast cancer. Cancer affects people of different age groups from small children up to older people. It cuts across different racial groups and different socio economic levels. The patient with cancer faces one of the greatest stress situations known to man. Cancer is frequently a chronic disease. Acute periods of illness or intensive therapy may interrupt periods of normality for months or years. Treatment may necessitate major alterations in lifestyle or normal body functions. The diagnosis of cancer is seen by many as synonymous with death. (Kellogg & Sullivan : 1978) Kellogg (1978) believes that the fear of loss of self determination, of being dependent and non - productive, can be more stressful than the prospect of death itself. The patient may also fear that the disease, the results of treatment, or the changes he presumes will result, will cause others to isolate or abandon him...

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.

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)

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)