This research project aims to examine the idea of stigma attached to cervical cancer in light of its association with HPV, a sexually transmitted infection (STI). The public recognition of this relationship appears to be increasing due to the current media attention surrounding HPV's causative role in the development of cervical cancer, and the newly-released HPV vaccine. Thus, this study explores the experiences and perceptions of cervical cancer patients and survivors living with this disease at a moment in time when it is becoming a very visible manifestation of a sexually transmitted infection, versus one identified historically as a life-threatening cancer. Disease-related stigma has vast individual, community, and societal repercussions: in the context of both cancer and sexually transmitted infections, it is broadly associated in the literature with decreased levels of screening, reluctance to seek treatment, decreased access to social support, economic discrimination, and major difficulties in implementing large-scale prevention efforts, such as contact tracing or name-based reporting. This study is premised on the belief that including the voices of patients and survivors themselves will provide a more holistic and complete understanding of the dimensions of cervical cancer-related stigma, which in turn will help to inform future educational and prevention messages tailored to reduce its impact. Additionally, it will illuminate the complexities and dynamics of how patients/survivors are able or unable to access social support-a first step in designing more effective and relevant support programs.

While incidence rates are increasing for many cancers in Puerto Rico, mortality rates are declining (Torres-Cintron, et al. 2010), resulting in growing numbers of survivors and creating a situation in which long-term survivorship concerns are beginning to emerge as priorities. The importance of quality-of-life among survivors of cancer is increasingly being recognized among healthcare providers, although there remains a gap in knowledge of how young adult survivors cope with long-term treatment-related physical effects, such as infertility, and of the impact of cancer on survivors' social relationships and future goals. Because understandings of "cancer survivorship," as well as of reproduction, vary according to cultural context, this study examined the physical and social impact of cancer on young adults in Puerto Rico, and specifically the importance of parenthood. A media analysis of women's magazines, key informant interviews with ten cancer researchers, as well as in-depth, semi-structured interviews with 23 young adult cancer survivors, 16 healthcare providers, nine cancer advocates, and two members of the clergy were conducted in order to shed light on the lived experiences, needs, and concerns of young Puerto Rican cancer survivors.

Little is known about the receipt of cancer screening for new primary cancers among Canadian cancer survivors. The objectives of this thesis are to i) synthesize evidence comparing receipt cancer screening between cancer survivors and non-cancer controls; and ii) analyze breast and cervical cancer screening receipt among Nova Scotian colorectal cancer (CRC) survivors. This thesis consists of a systematic review and meta-analysis, and a population-based cohort study of Nova Scotian CRC survivors. We found that while cancer survivors were more likely to receive cancer screening than the general population, a significant proportion of cancer survivors were not screened. We observed significant heterogeneity between studies, most of which remained unexplained after subgroup and sensitivity analyses. 30.1% and 47.9% of Nova Scotian CRC survivors never received a breast and cervical cancer screen after their CRC diagnosis. Receipt of pre-CRC diagnosis screening was strongly predictive of receiving screening post-diagnosis.

Purpose: The purpose of this thesis was to perform a scoping review of the current literature and available clinical practice guidelines to generate an understanding of the primary health care needs of women following treatment for breast cancer. Methods: Based on an extensive scoping review of the literature, research findings regarding the complications of breast cancer treatments and corresponding primary care interventions were synthesized. Additionally, validation of the findings of the scoping review was performed through semi-structured interviews with two primary care physicians and three post-treatment breast cancer patients. Results: Eleven broad categories related to the primary health care needs of women after undergoing treatments for breast cancer were identified. These included concerns related to: surgical complications, lymphedema, gynecologic and menopausal symptoms, psychosocial issues, additional primary cancers, cardiovascular implications, osteoporosis, lifestyle changes, fatigue, cognitive dysfunction, and pregnancy. Additionally, it was determined that the majority of existing clinical practice guidelines for breast cancer were outdated, and related to cancer detection and treatment as opposed to survivorship care. Summary: Findings from the scoping review and interviews demonstrate the vast range of primary care needs of women after undergoing treatment for breast cancer. Additionally, these results highlight the critical need for the development of a comprehensive set of current clinical practice guidelines which target primary care physicians and are specifically focused on the survivorship needs of women following breast cancer treatment. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2011-07-22 16:09:35.682

Background: With advances in medical treatments, the numbers of cancer survivors have grown considerably over recent years. Following completion of cancer treatment, patients can experience a range of physical and psychological difficulties, particularly around critical transition phases such as adjustment to survivorship. One of the most common difficulties cited by cancer survivors is that of fear of cancer recurrence (FOR). Existing treatments for improving psychological wellbeing in this population appear to offer limited efficacy, and there are very few interventions directly targeting FOR. Acceptance-based approaches, with an underlying aim of improving psychological flexibility, offer one novel alternative approach to addressing these difficulties. Methods: This thesis presents a systematic review and meta-analysis of the literature in relation to the effectiveness of acceptance-based interventions for post treatment cancer survivors, with a particular focus on Mindfulness-Based Interventions (MBI). A cross sectional questionnaire study is then reported which explores the potential role of psychological flexibility in mediating the relationship between FOR and distress and quality of life (QoL)outcomes. Results: The findings of the review offer tentative support for the effectiveness of MBI in reducing stress and depressive symptoms, while less convincing results emerged for anxiety. Results from the empirical study suggest that while psychological flexibility does not appear to significantly mediate the impact of FOR on distress and QoL, value based living and cognitive fusion did emerge as significant mediating variables within these relationships. Conclusions: Findings suggest that acceptance-based approaches, may be of benefit in reducing the burden of distress and improving the lives of cancer survivors. Supporting cancer survivors to become less entangled with their thoughts and live in accordance with their values may be particularly beneficial. Further studies using larger samples and longitudinal designs are warranted.

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<b><u>Introduction:</b></u> Some cancer survivors are known to have an elevated risk of morbidity and mortality from cardiovascular disease. An important cause of this elevated risk is recognised to be irradiation of normal tissues during radiotherapy received as part of cancer therapy. There are substantial difficulties in studying radiation-related cardiovascular disease (RRCD). The reasons for this include the complexities of measuring radiation normal tissue doses retrospectively and the prolonged latencies of many of the cardiovascular endpoints. A variety of complimentary research methodologies can help provide additional knowledge to guide the appropriate management of patients treated in the past and of new patients in the future. <b><u>Methods:</b></u> 1) A cohort study of mortality from circulatory disease in the nationwide British Childhood Cancer Survivor Study (BCCSS). 2) A case-control study of valvular heart disease (VHD) in Dutch Hodgkin lymphoma (HL) survivors, including retrospective radiation dosimetry to estimate the radiation dose to heart valves. 3) A dosimetric study of cardiovascular radiation doses in patients entered into the UK NCRI Lymphoma Study Group RAPID trial, including predictions of 15-year cardiac mortality using innovative methods. 4) A modelling study to predict mean whole heart dose (MWHD) from involved field radiotherapy (IFRT) for HL using anatomical measures. 5) A prospective study using cardiovascular magnetic resonance (CMR) imaging to characterise the heart in women receiving radiotherapy for breast cancer. <b><u>Results:</b></u> 1) The risks of all types of circulatory mortality are elevated in survivors of childhood cancer. The absolute excess risks continue to increase 40+ years following diagnosis. The risk of death from cardiomyopathy and heart failure increased substantially with the introduction of anthracycline chemotherapy. There is no evidence of a reduction in risk of circulatory mortality in more recent eras of diagnosis. 2) There is a strong relationship between estimated radiation dose to the affected heart valve and the risk of subsequent VHD (p<0.001). This effect was modelled to allow prediction of the risk of VHD. 3) A proportion of patients treated with IFRT received a substantial cardiac radiation dose (MWHD = 8.8 Gy, SD = 5.6) but, on average, the predicted 15-year cardiac mortality following treatment is low (absolute risk 0.2%, range 0.0 to 2.7%). 4) It is possible to estimate the mean whole heart dose from IFRT prior to detailed radiotherapy planning based on pre-treatment diagnostic imaging to an accuracy of 5-6% of the prescribed dose. 5) Although women received low cardiac doses (MWHD = 1.5 Gy, SD = 0.8) and have a low predicted risk of cardiac radiation-related morbidity and mortality, there is some evidence of subclinical effects on strain and strain rate imaging of the anterior portions of the left ventricle that receive the highest radiation dose. <b><u>Conclusions:</b></u> Using a variety of methods these studies have all succeeded in adding to knowledge about the nature, magnitude and timing of RRCD. This knowledge can be used to help the future management of cancer patients. In addition, each of the studies has natural and planned extensions and will continue to contribute further knowledge into the future.