Submitted in fulfillment of the requirements for the degree of Doctor of Philosophy: Biotechnology, Durban University of Technology, Durban, South Africa, 2015. / Photodynamic therapy (PDT) is emerging as a viable alternative to invasive anti-cancer treatment regimens such as surgery, chemotherapy or radiotherapy. A series of metal – based phthalocyanine complexes have been discovered that may be used as a drug or photosensitizer in photodynamic therapy for the treatment of cancers. During photodynamic therapy the photosensitizer is administrated intravenously or topically to the patient before laser treatment at an appropriate wavelength is delivered to the cancerous site to activate the photosensitizer. The activated photosensitizer will react with oxygen typically present in the cancerous tissue to produce reactive oxygen species for the eradication of the cancerous tissue. This is the first study where gallium (GaPcCl), indium (InPcCl) and iron (FePcCl) Pc chloride complexes were used for photodynamic research. These metal – based phthalocyanine complexes were investigated using different cancer cell lines (Caco-2, MCF-7, melanoma and A549). Also, the baseline cellular uptake and photodynamic effect of these complexes were established on healthy normal cells (human fibroblast cells). Fluorescent spectrophotometry showed that all three photosensitizers accumulated in a time-dependent manner in Caco-2, MCF-7, melanoma and A549 cancer cells, as well as in healthy normal fibroblast cell in amounts which increased over a period of 24 hours, with emission peaking at 24 hours for all cell lines. Dark toxicity effects and photodynamic therapy efficacy were established with a MTT assay. High concentrations of inactive GaPcCl, InPcCl and FePcCl was toxic to Caco-2, melanoma, A549 and fibroblast cells. However, all three photosensitizers were in its inactive state at low and high photosensitizing concentrations were highly toxic to MCF-7 cancer cells. On the other hand, in vitro photodynamic therapy treatment with both low and high concentrations of GaPcCl, InPcCl and FePcCl were observed to be potently cytotoxic towards all four cancer cell lines upon exposure to laser light for 22 seconds (2.5 J/cm2), 39 seconds (4.5 J/cm2) and 74 seconds (8.5 J/cm2). These results revealed that all three photosensitizers reacts to photodynamic therapy in a concentration-dependent (photosensitizer) and dose-dependent (light dose/time) manner. At 24 hours after photodynamic therapy, the most effective treatment parameters were laser treatment for 74 seconds with FePcCl concentrations from 60 µg/ml - 100 µg/ml which resulted in 0% cell survival of Caco-2 cancer cells. A short laser treatment time of 74 seconds for activation of FePcCl (20 µg/ml) resulted in 0% cell survival of MCF-7 cancer cells. Similarly, FePcCl (40 µg/ml - 100 µg/ml) activated for 22 seconds, 39 seconds and 74 seconds resulted in 100% cell death of A549 cancer cells. Photodynamic therapy treatment with GaPcCl and InPcCl were very effective in reducing the cell viability of melanoma cancer cells. Healthy normal fibroblast cells survived in vitro photodynamic therapy treatment with all three photosensitizers much better than the cancer (Caco-2, MCF-7, melanoma and A549) cells. This confirms the previously reported results that photosensitizers such as phthalocyanines and its metal-based complexes preferentially accumulate in cancer cells than normal healthy cells. All three photosensitizers localized in mitochondria and lysosomes of the Caco-2, MCF-7 and A549 cancer cells. In melanoma cancer cells InPcCl also localized in the mitochondria and lysosome, but GaPcCl and FePcCl localized in mitochondria only. Apoptosis was identified via microscopical and flow cytometric investigations, as the dominant mode of cell death induced by GaPcCl, InPcCl and FePcCl mediated photodynamic therapy in cancer cell lines tested. Therefore, this study concludes that GaPcCl, InPcCl and FePcCl are effective photosensitizers for the in vitro PDT treatment of cancer cells. The effective in vitro PDT treatment for each cell line was dependent on the photosensitizer concentration and illumination period for each of the different photosensitizers. / D

This dissertation presents an ethnographic account of a socially diverse, public breast cancer clinic in Johannesburg. The findings of this qualitative research radically challenge the unproblematised and overdetermined use of the categories of race and gender in existing literature concerning this disease. The growing breast cancer epidemic in South Africa affects all demographic categories of women including young women. Yet, previous research frames this as a racialised and gendered crisis. Black women have been depicted as ignorant “problem patients” who resist biomedical treatment, and all women are described as having a particular relationship to their breasted bodies and a deep fear of mastectomy. Departing from these stereotypes, this ethnography reveals unanticipated data showing, firstly, that race, class, age and level of education did not determine women’s relationship to breast cancer and biomedicine. Secondly, socially diverse women commonly experienced breast cancer as a life-threatening disease that evoked confrontation with existential concerns regarding suffering, death, family, and faith. Due to these commonalities, an intimate and powerful sociality existed amongst women at this clinic. Thirdly, within this sociality, women accepted mastectomy as a necessity in creating a healthy body. Breastlessness was normalised and women generally were reluctant of breast reconstruction, thus destabilising the conceptual relationship between breasts and gender. This dissertation’s deconstruction of the use of hegemonic social categories is a significant intervention in a context where these categories are often viewed as absolute determinants of social and health phenomena, and therefore prompts more nuanced approaches to understanding experiences of illness in post-apartheid South Africa.

Thesis (MTech. degree in Nursing)--Tshwane University of Technology, 2010. / Cervical cancer, breast cancer and Kaposi's sarcoma are the three most common cancers in women in sub-Saharan Africa. The health care providers in developing countries regularly encounter women with advanced, incurable cervical cancer. Cervical cancer can however, be prevented, even among women at high risk for the disease, through screening using relatively simple technologies. The purpose of the study was to determine whether the supportive-educative role of the oncology nurse can contribute to the prevention of primary and secondary cervical cancer, breast cancer and Kaposi's sarcoma in women living in Soshanguve, South Africa.

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...

MCur / Department of Advanced Nursing Science / See the attached abstract below

Advances in breast cancer detection and oncology treatment modalities have prolonged the survival time for the cancer population, which is officially the largest group of cancer survivors among women in the western world, including South Africa (Brem & Kumar, 2011; Fisher, Dolbeault, Sultan & Bredart, 2014; Herbst, 2011; Reyes-Gibby, et al., 2012). In the light of shocking statistics and ever rising numbers of cancer, especially breast cancer, the time is ripe for further research in the domain of psycho-oncology and has motivated the researcher, due to her interest and involvement in breast cancer, to make this her field of research. Despite the need for a bio-psycho-social approach when treating cancer patients there is little literature available on the psychological interventions in South Africa where the majority of research studies previously conducted in South Africa have generally focused on the bio-medical aspects of cancer (Albrecht, 2009; Venter, 2014). To comprehend the paradigm of psycho-oncology, which is the backbone of this study, a theoretical framework was attained from Engel’s humanistic or psychological model (caring) and Pasteur’s biomedical model (curing) (Borrel-Carrio, Suchman, & Epstein, 2004). The primary aim of this study was to explore the lived experiences of breast cancer patients concerning their diagnosis, treatment and survivorship and unique needs for psycho-oncological interventions through their own “voices”. The research was conducted within a qualitative framework with a case study method of inquiry employing open-ended style interviews and psychotherapeutic sessions with five purposely sampled breast cancer patients. Two qualitative questionnaires were also used for triangulation purposes. Transcripts of all the therapeutic sessions were analysed using interpretive analysis where categories and themes were developed and described in full. Findings indicated that in spite the extensive proof that breast cancer causes numerous sexual and psychological complications during active treatment and afterwards, patients still feel that they have no “platform” to express their emotions and sexual issues within the oncology framework, or that there is enough and sufficient assistance to attend to their needs. e The researcher hopes that this study will make a valuable contribution to research in the field of psycho-oncology in South Africa and to indicate new realities of the chronicity of breast cancer and treatment complications that demand psychotherapeutic interventions in cancer care and that the study will initiate new ways of understanding the role of psychology and the psychologist in the medical world of cancer. The researcher hopes that by offering an understanding of participants’ unique experiences of this process, practitioners will have insight when working therapeutically with this population and empower them to have a quality of life, even within the boundaries of their illness. / Psychology / D. Litt. et Phil. (Psychology)

MCur / Department of Advanced Nursing Science / Historically, cancer is regarded as a disease with very devastating effects on human beings because it leads to many deaths across the world, compared to AIDS, tuberculosis and malaria collectively. Cancer diagnosis has impacted negatively on patients and their immediate families and has caused unbearable consequences. Unlike other chronic diseases, cancer patients undergo different types of treatments which affect their well-being and as a result they tend to have different experiences to those of other chronic diseases sufferers. The study design used was a quantitative cross sectional survey. The purpose was to investigate the impact of cancer diagnosis on cancer patients in Vhembe district. The target population included all patients in the Vhembe District of Limpopo, South Africa who have been diagnosed with cancer in the past six months. Using a probability simple random, a sample of 207 patients diagnosed with cancer, from seven selected hospitals in Vhembe District were selected as respondents and a self -administered questionnaire was used to collect data. Data was analysed using a software package for descriptive statistics (SPSS version 23). Graphs, tables and charts were used to display the results visually and chi-square to compare variables. Ethical principles of privacy, anonymity, informed consent were considered. The findings revealed that cancer diagnosis has negative outcomes as patients experience physical hardship, psychological stress, financial difficulties, as well as interference with family and social life. The study recommended that cancer patients and their families, be supported through the cancer journey. / NRF

A qualitative research design and an ethno-nursing research method were used to identify cultural factors influencing Xhosa women's health seeking behaviours associated with breast lumps. Focus group interviews were conducted to obtain data. The research results revealed that these Xhosa women with breast lumps did not disclose some cultural factors which influenced their health seeking behaviours associated breast lumps. Registered nurses, sharing the same culture and language as the Xhosa women, revealed that Xhosa women with breast lumps sought treatment from traditional healers, prior to seeking medical care from the hospital and/or clinics. When they arrive at the hospital/clinics the breast lumps have often progressed to advanced ulcerated breast cancer, with poor prognoses and poor treatment outcomes. Xhosa women lacked knowledge about the management of breast lumps. Health promotion efforts should address this issue at Primary Health Care services in the Eastern Cape. / Health Studies / M.A. (Health Studies)

A qualitative research design and an ethno-nursing research method were used to identify cultural factors influencing Xhosa women's health seeking behaviours associated with breast lumps. Focus group interviews were conducted to obtain data. The research results revealed that these Xhosa women with breast lumps did not disclose some cultural factors which influenced their health seeking behaviours associated breast lumps. Registered nurses, sharing the same culture and language as the Xhosa women, revealed that Xhosa women with breast lumps sought treatment from traditional healers, prior to seeking medical care from the hospital and/or clinics. When they arrive at the hospital/clinics the breast lumps have often progressed to advanced ulcerated breast cancer, with poor prognoses and poor treatment outcomes. Xhosa women lacked knowledge about the management of breast lumps. Health promotion efforts should address this issue at Primary Health Care services in the Eastern Cape. / Health Studies / M.A. (Health Studies)