Please read the abstract in the section 00front of this document Please cite as follows: Opperman JA, 2002, Die emosionele belewenis van 'n beenmurgoorplanting : 'n Maatskaplike Werk perspektief, MA dissertation, University of Pretoria, Pretoria, viewed yymmdd < http://upetd.up.ac.za/thesis/available/etd- 07252005-110248/ > / Dissertation (MA (Social Work))--University of Pretoria, 2002. / Social Work and Criminology / MA (Social Work) / unrestricted

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.

published_or_final_version / Social Work and Social Administration / Master / Master of Philosophy

Orientador: Laymert Garcia dos Santos / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Filosofia e Ciencias Humanas / Made available in DSpace on 2018-08-04T18:51:14Z (GMT). No. of bitstreams: 1 Monteiro_MarkoSynesioAlves_D.pdf: 14010644 bytes, checksum: 84f93a9c31977e89c8b6246cdca253a9 (MD5) Previous issue date: 2005 / Resumo: A tese tem por objetivo debater as mudanças atualmente em curso nas concepções modernas do corpo, a partir do impacto das novas tecnologias associadas à genética. Tais concepções, calcadas fortemente na dualidade cartesiana, estariam sendo modificadas pela possibilidade, cada vez mais real, de manipulação da natureza em seu nível molecular. As conseqüências teóricas de transformar o corpo, junto com a própria prática científica, em objetos de analise social, são debatidos. Um estudo de caso, a partir de pesquisa de campo feita em laboratórios de bioinformática na Universidade de São Paulo e no Instituto Ludwig de Pesquisa com Câncer/Hospital do Câncer, fundamenta empiricamente a discussão. Os microarrays, utilizados em pesquisas que buscam estabelecer biomarcadores para câncer de próstata, são analisados como objetos que encarnam as novas visões do corpo, num contexto marcado pelo avanço da biotecnologia. A tese debate também alguns aspectos políticos que se mostram relevantes na compreensão desse avanço tecnológico, como os temores de um ressurgimento da eugenia. Ao final, debatem-se alternativas analíticas e políticas para a compreensão do novo esatuto do corpo e da matéria viva, a partir de pistas dadas por artistas, engajados com a expressão artística através do corpo e da tecnologia, e através de teóricos que buscam repensar as bases nas quais assenta-se a biologia e a pesquisa científica contemporâneas / Abstract: This thesis analyzes transformations in contemporary conceptions of the body under the light of changes brought on by new technologies associated with genetics. These conceptions, strongly marked by a cartesian opposition between mind/matter, are being shifted in the context of the growing possibilities of the manipulation nature in its molecular leveI through technology. The theoretical consequences of tuming the body, as well as the scientific practice of manipulating it, as an object for the Social Sciences, are also debated. A case study, originated ITom field research with done in bioinformatics laboratories at the Universidade de São Paulo (USP) and the Ludwig Center for Cancer Research/Cancer Hospital, provides the empirical basis of the argument. Microarrays, used in the research being developed in the laboratories cited above in research towards the development of molecular markers for prostate cancer, are analyzed as objects that embody the new conceptions of the body that arise in a context of rapid advance in biotechnology. The thesis debates also some political aspects that are relevant for a deeper understanding of these technological developments, such as the fears surrounding a retum of eugenic practices. ln the conclusion some analytical and political altematives are discussed, as a means of pursuing a richer criticism of the new statute of the body and of living matter, using the example of artists that use the body and technology as medium of artistic expression; also through a debate of theorists that are busy rethinking the bases of contemporary biology and of current scientific practices / Doutorado / Doutor em Ciências Sociais

Contexte - Considérées comme un progrès thérapeutique notable en cancérologie, les thérapies ciblées ne sont pas sans effet secondaire, en particulier sur le plan dermatologique. Très peu de données sont actuellement disponibles quant à leurs retentissements sur la qualité de vie des patients. Le service de dermatologie de Gustave Roussy a développé un protocole de recherche prospectif (SKINTARGET) consacré à cette thématique afin de pouvoir proposer des mesures préventives et/ou curatives adaptées. Inscrite dans ces travaux, notre thèse avait pour objectif principal de décrire les changements observés du point de vue de l’état émotionnel, de l’image corporelle et des interactions sociales avec l’apparition des atteintes cutanées, en s’intéressant à la place des représentations associées au traitement dans le processus d’ajustement des patients à ces symptômes.<p>Méthode - Il s’agissait d’une étude comprenant quatre temps d’évaluation (initiation du traitement, un, deux et trois mois après), qui associait de façon concomitante deux modes d’évaluation :quantitatif (questionnaires :IPQ-R, DLQI, POMS, BDI-II, QIC) et qualitatif (entretiens semi-directifs). L’inclusion était proposée par les oncologues aux patients allant débuter un traitement par thérapie ciblée. Les analyses statistiques ont été menées à partir du logiciel SPSS version 14.0 ;les analyses des entretiens ont combiné méthode thématique et méthode par questionnement analytique, en s’appuyant sur le modèle théorique de Pedinielli. <p>Résultats - Quatre-vingt-deux patients ont donné leur accord pour la recherche biomédicale, 62 d’entre eux ont accepté de participer à l’étude psychologique. La partie quantitative a été complétée par 33 patients, pour moitié hommes (âge moyen 56 ans), soignés pour un cancer métastatique cutané, pulmonaire, rénal ou thyroïdien. L’échantillon comptait une majorité de personnes en couple, avec enfants, soit à la retraite soit en arrêt de travail. Quatre-vingt-quatorze pour cent a développé au moins un des principaux symptômes suivants :rash cutané, syndrome main-pied, alopécie ou photosensibilité. Les changements observés ont été un inconfort physique et une gêne à la réalisation des activités du quotidien. Aucun signe de perturbation de la sphère émotionnelle, de l’image du corps et des relations sociales n’a été mis en évidence au cours des trois premiers mois de traitement. Les symptômes dermatologiques ont majoritairement été rattachés par les patients à l’action du traitement, sans être interprétés comme signes de son efficacité. La représentation d’un médicament contrôlant la maladie a émergé comme un des facteurs significativement associés aux variations de l’impact des toxicités cutanées sur la qualité de vie. <p>La partie qualitative a concerné 41 patients, dont les caractéristiques médicales et socio-démographiques étaient très similaires à celles de l’échantillon quantitatif. Pour une majorité les effets secondaires dermatologiques ont été « embêtants », « gênants », quelquefois « impressionnants », voire « perturbants » lorsqu’ils entraînaient douleurs, difficultés à la mobilité ou troubles du sommeil, mais sont restés « gérables, supportables ». Les représentations associées au traitement, très positives, sont apparues comme un élément soutenant dans l’ajustement des patients. Du discours des patients en souffrance psychologique sont ressorties une défiance vis-à-vis du regard d’autrui et une impossibilité d’amorcer le travail de renoncement nécessaire à l’intégration des transformations liées au cancer et à ses traitements. L’origine de cette souffrance serait un débordement des défenses psychiques par une angoisse de mort :la difficulté pour restaurer l’état d’équilibre psychique antérieur provenant de l’activation concurrentielle de deux dynamiques, l’une surnommée « substantielle », l’autre « identitaire ».<p>Discussion - Ces résultats rejoignent les données de la littérature en concluant à un impact d’intensité faible à modérée des toxicités cutanées sur la qualité de vie pour une majorité de patients. Contrairement à ce qui était attendu, il n’a pas été observé de changement sur le plan de l’état émotionnel, de l’image corporelle et des interactions sociales. L’investissement positif du traitement, la réappréciation des valeurs, le très bon état général des patients et l’optimisme ont été évoqués pour expliquer non seulement l’absence de perturbation, mais aussi les très bas niveaux d’anxiété, de tristesse et de fatigue globalement rapportés. L’importance de l’encadrement soignant et médical a également été soulignée parce qu’il sécurise les patients en anticipant les difficultés, en informant et en proposant une prise en charge suivie.<p>Conclusion - Le développement croissant des thérapies ciblées devrait s’accompagner d’un renforcement des mesures de prévention et de prise en charge des effets secondaires dermatologiques, qui requiert formation et sensibilisation des acteurs de soin à cette problématique, en rappelant la dimension singulière du vécu de chaque patient et l’impossibilité de le réduire à l’observable médical.<p>Background - Considered as a significant therapeutic progress in cancer, targeted agents are not without side effects, particularly dermatological ones. Very little information is presently available about their consequences on patients’ quality of life. The dermatological team of Gustave Roussy has developed a prospective research (SKINTARGET) in order to provide preventive and curative adapted care. Integrated into this work, our thesis aimed to describe the psychosocial changes occurring with cutaneous toxicities and to explore the implication of treatment representations in the patient’s adjustment process.<p>Methods - The study included four phases of evaluation (treatment initiation, one, two and three months after) and used simultaneously two methods: a quantitative one (questionnaires: IPQ-R, DLQI, POMS, BDI-II, BIQ) and a qualitative one (semi-structured interviews). The inclusion was proposed by oncologists to patients who were about to start a targeted therapy. Statistical analyzes were conducted with SPSS 14.0 software; analyzes interviews combined thematic approach and analytical questioning methods and referred to the Pedinielli’s theoretical model.<p>Results - Eighty- two patients gave their consent for biomedical research, 62 of them agreed to participate to the psychological study. The quantitative part was completed by 33 patients (50% men, mean age 56 years) treated for metastatic skin, pulmonary, renal or thyroid cancer, who were mostly in a relationship with children, either retired or stopped working. Eighty- four percent developed at least one of the following main symptoms: skin rash, hand-foot syndrome, alopecia or photosensitivity. The observed changes were characterized by a physical discomfort and difficulties in the activities of daily life. No sign of disturbance was noted in emotional domain, body image or social relations during the first three months of treatment. Dermatological symptoms were mainly related by patients to treatment action, without being interpreted as an evidence of its effectiveness. The representation of a drug controlling the disease was significantly associated with a lower impact of skin problems on the quality of life.<p>The qualitative part included 41 patients. Medical and sociodemographic characteristics were very similar to those of the quantitative sample. For most people, dermatological side effects were "boring", "uncomfortable", sometimes "impressive" or "disturbing" when they were associated with pain, mobility difficulties or sleeping troubles, but remained "manageable, bearable". The very positive treatment representations appeared as a supporting element in patients’ adjustment. Psychological distress seemed appear when patients feared being stared by others and failed to engage themselves in the renouncement work which is needed to adjust oneself to the transformations related to cancer and its treatments. In such situation psychological distress was supposed to come from an overflow of the psychic defences by a fear of death; the difficulty to restore mental balance would be explained by the activation of two competitive dynamics, which struggle for the organism and the identity survival.<p>Discussion - These results are consistent with the literature data. The skin toxicities impact on quality of life is mild to moderate for a majority of patients. Contrary to our expectations, there was no evidence of change in the domains of emotions, body image and social interactions. The positive investment of treatment, a reassessment of values, the very good physical state of patients and the influence of optimism in patients state of mind have been cited to explain not only the absence of disturbance, but also the very low levels of anxiety, sadness and fatigue generally reported. The importance of the caregiving provided by health professionals was also highlighted: anticipating difficulties, giving information about side effects and effectively managing problems secure patients.<p>Conclusions - The growing development of targeted therapies implies strengthening prevention and management of dermatological side effects. Moreover, it requires to aware and to train more health professionals to this problem, recalling the singular dimension of each patient which can not being reduced to the medical observable.<p> / Doctorat en Sciences Psychologiques et de l'éducation / info:eu-repo/semantics/nonPublished

Text in Afrikaans / The problem that motivated the study was that siblings of children with cancer may experience the relationships within the family differently after cancer treatment. The purpose was to investigate and describe how family dynamics are experienced by the siblings of a cancer patient after his/her treatment for cancer. The research methodology includes qualitative research of an explorative and descriptive nature. Data were collected through unstructured interviews with siblings of children who had received treatment for cancer. From this data eight categories were identified accordingly. Although the data do not indicate that siblings experienced family dynamics after treatment as problematic, as expected, the information contributes by making parents of cancer patients more aware of the siblings' emotions and needs. / Social Work / M.Diac (Spelterapie)

Text in Afrikaans / The problem that motivated the study was that siblings of children with cancer may experience the relationships within the family differently after cancer treatment. The purpose was to investigate and describe how family dynamics are experienced by the siblings of a cancer patient after his/her treatment for cancer. The research methodology includes qualitative research of an explorative and descriptive nature. Data were collected through unstructured interviews with siblings of children who had received treatment for cancer. From this data eight categories were identified accordingly. Although the data do not indicate that siblings experienced family dynamics after treatment as problematic, as expected, the information contributes by making parents of cancer patients more aware of the siblings' emotions and needs. / Social Work / M.Diac (Spelterapie)

This research was aimed at listening to the care stories of people living with cancer in remission. The participants spoke about relationships with their families, medical professionals and their spirituality, thereby giving a voice to personal experiences of cancer as part of family life. Postmodern social construction discourse guided the explaining of how cancer invades and affects people's Jives and relationships. This participatory action research was situated in a contextual practical theology. Narrative conversations with the participants spoke about experiences of both care and communication by medical professionals, their struggles in communicating with their partners and families, their spiritual search and longing for pastoral care to sustain and guide them. / Practical Theology / M.Th. (Pastoral Therapy)

This research was aimed at listening to the care stories of people living with cancer in remission. The participants spoke about relationships with their families, medical professionals and their spirituality, thereby giving a voice to personal experiences of cancer as part of family life. Postmodern social construction discourse guided the explaining of how cancer invades and affects people's Jives and relationships. This participatory action research was situated in a contextual practical theology. Narrative conversations with the participants spoke about experiences of both care and communication by medical professionals, their struggles in communicating with their partners and families, their spiritual search and longing for pastoral care to sustain and guide them. / Philosophy, Practical and Systematic Theology / M.Th. (Pastoral Therapy)