Bakgrund: Kolorektal cancer är den tredje vanligaste cancersjukdomen i Sverige, vars symtom och behandling kan ha negativa följder i det dagliga livet och medföra nedsatt livskvalité, vilket ställer stora krav på sjuksköterskan att uppmärksamma nuvarande och potentiella kort- och långsiktiga behov. Genom ökad kunskap och förståelse för personers upplevelse av att leva med kolorektal cancer kan sjuksköterskan främja deras egenvård och därmed deras livskvalité.Syfte: Studien syftar till att beskriva personers upplevelse av att leva med kolorektal cancer.Metod: Studien har genomförts som en litteraturöversikt och baseras på tolv vetenskapliga artiklar med kvalitativ metod. Datasökning har gjorts i databaserna PubMed och Cinahl.Resultat: I resultatet framkom två huvudkategorier som beskriver personers upplevelse av att leva med kolorektal cancer: Upplevelse av att leva ett begränsat liv och Upplevelse av egenvårdsstöd.Slutsats: Att leva med kolorektal cancer medför sociala begränsningar och känslomässiga reaktioner till följd av förändrade avföringsvanor, stomi, fatigue och sexuell dysfunktion, där socialt stöd i vardagen har betydelse för egenvård och hantering av dessa begränsningar. Genom att tillämpa ett salutogent och holistiskt förhållningssätt kan sjuksköterskan få kunskap och uppfattning om personens upplevda begräsningar och egenvårdsbehov för att kunna erbjuda stöd som främjar den enskilda personens egenvårdsförmåga och livskvalité. / Background: Colorectal cancer is the third most common cancer in Sweden, whose symptoms and treatment can have a negative consequence in daily life and lead to reduced quality of life, which places great demands on the nurse to pay attention to current and potential short- and long-term needs. Through increased knowledge and understanding of people's experience of living with colorectal cancer, the nurse can promote their self-care and thus their quality of life.Aim: The study aims to describe people's experience of living with colorectal cancer.Method: The study has been conducted as a literature review and is based on twelve scientific articles with a qualitative method. Data search has been done in the PubMed and Cinahl databases.Results: The results revealed two main categories that describe people's experience of living with colorectal cancer: Experience of living a limited life and Experience of self-care support.Conclusion: Living with colorectal cancer causes social limitations and emotional reactions due to changed bowel habits, stoma, fatigue, and sexual dysfunction, where social support in everyday life is important for self-care and management of these limitations. By applying a salutogenic and holistic approach, the nurse can gain knowledge and perception of the person's perceived limitations and self-care needs to be able to offer support that promotes the individual's self-care ability and quality of life.

Colorectal cancer (CRC) is one of the deadliest cancers in the world. The early stage of the disease is usually asymptomatic and therefore screening methods for colorectal cancer need to improve. There is a need for early detection of CRC as treatment is less effective in the advanced stage of the disease.  The current standard screening methods are endoscopy and fecal immunochemical blood tests. Endoscopy is a commonly used method to diagnose the patient, but it is costly, time consuming, and rather unpopular for the patients. An alternative could be to develop targeted molecular imaging probes that specifically deliver agents for example magnetic resonance imaging to colon adenomas and adenocarcinomas. This alternative would be non-invasive and able to detect the disease before morphological changes become evident. Biomarkers are used as an objective indicator of an altered biological process. Here, a literature study was conducted to identify protein biomarkers that are overexpressed in early stages of CRC. This study has focused on biomarkers that could be used to target imaging agents to cancerous lesions. Thus, the biomarkers need to be membrane-bound and expressed on the luminal side of the gastrointestinal tract. This will help future research to develop orally administered targeted imaging probes. Furthermore, a smaller literature search was conducted to identify cell and mouse models representing early stages of CRC. This was done to facilitate translational research going from in vitro to in vivo. Ideally the same protein is available in cell lines, mouse models and humans to enable translational research. This work has resulted in the selection of 7 different proteins that are upregulated during early stages of CRC. These proteins are potentially apically located and therefore possible targets for monoclonal antibodies. These findings might lead to a novel way for preventive patient screening and hopefully reduce the mortality for colorectal cancer.

Introduction: Colorectal cancer (CRC) is one of the most frequent malignancies and affects approximately 5% of worldwide population. More than 75% of CRC cases represent sporadic forms. Susceptibility to nonhereditary CRC is significantly influenced by polymorphisms and mutations in low-penetrance genes. Variations in biotransformation and DNA repair genes may result in acumulation of toxins and DNA damage in cells leading to the development of cancer. Furthermore, different gene expression profiles of membrane transporters affecting the accumulation of anticancer drugs in tumour cells, e.g. ABC drug transporters, may largely influence inter-individual variability in drug response and chemotherapy outcome. The aim of this study was to evaluate the role of genetic and lifestyle factors in the risk of onset and progression of colorectal cancer. This study followed selected genetic alterations in xenobiotic-metabolizing enzymes (CYP1B1, GSTM1, GSTT1, GSTP1, NQO1 and EPHX1) and genes involved in response to DNA damage (CHEK2 and NBN), as potential CRC susceptibility factors. Another aim of this study was to investigate expression profile of all human ABC transporter genes to follow their prognostic and predictive potential in colorectal carcinoma. Materials and methods: The polymorphisms and other...

Background: Screening rates for colorectal cancer (CRC) are increasing nationwide including Tennessee (TN); however, their up-to-date status is unknown. The objective of this study is to determine the trends and characteristics of TN adults who are up-to-date status with CRC screening during 2002-2008. Methods: We examined data from the TN Behavioral Risk Factor Surveillance System for 2002, 2004, 2006 and 2008 to estimate the proportion of respondents aged 50 years and above who were up-to-date status with CRC screening, defined as an annual home fecal occult blood test and/or sigmoidoscopy or colonoscopy in the past 5 years. We identified trends in up-to-status in all eligible respondents. Using multivariable logistic regression models, we delineated key characteristics of respondents who were up-to-date status. Results: During 2002-2008, the proportion of respondents with up-to-date status for CRC screening increased from 49% in 2002- 55% in 2006 and then decreased to 46% in 2008. The screening rates were higher among adults aged 65-74 years, those with some college education, those with annual household income ≥$35,000 and those with health-care access. In 2008, the respondents who were not up-to-date status with CRC screening included those with no health-care coverage (adjusted odds ratio [OR] 0.46, 95% confidence interval [CI] 0.33-0.63), those aged 50-54 years (OR 0.62, 95% CI 0.46-0.82) and those with annual household income <$25,000 (OR 0.65, 95% CI 0.52- 0.82). Conclusions: TN adults who are up-to-date status with CRC screening are increasing, but not across all socio-demographic subgroups. The results identified specific subgroups to be targeted by screening programs, along with continued efforts to educate public and providers about the importance of CRC screening.

Objective: Screening for colorectal cancer (CRC) can reduce disease incidence, morbidity, and mortality. However, few studies have investigated the urban-rural differences in social and behavioral factors influencing CRC screening. The objective of the study was to investigate the potential factors across urban-rural groups on the usage of CRC screening. Methods: A total of 38,505 adults (aged ≥40 years) were selected from the 2009 California Health Interview Survey (CHIS) data - the latest CHIS data on CRC screening. The weighted generalized linear mixed-model (WGLIMM) was used to deal with this hierarchical structure data. Weighted simple and multiple mixed logistic regression analyses in SAS ver. 9.4 were used to obtain the odds ratios (ORs) and their 95% confidence intervals (CIs). Results: The overall prevalence of CRC screening was 48.1% while the prevalence in four residence groups - urban, second city, suburban, and town/rural, were 45.8%, 46.9%, 53.7% and 50.1%, respectively. The results of WGLIMM analysis showed that there was residence effect (p < 0.0001) and residence groups had significant interactions with gender, age group, education level, and employment status (p < 0.05). Multiple logistic regression analysis revealed that age, race, marital status, education level, employment stats, binge drinking, and smoking status were associated with CRC screening (p < 0.05). Stratified by residence regions, age and poverty level showed associations with CRC screening in all four residence groups. Education level was positively associated with CRC screening in second city and suburban. Infrequent binge drinking was associated with CRC screening in urban and suburban; while current smoking was a protective factor in urban and town/rural groups. Conclusions: Mixed models are useful to deal with the clustered survey data. Social factors and behavioral factors (binge drinking and smoking) were associated with CRC screening and the associations were affected by living areas such as urban and rural regions.

No description available.

Background: Mortality from colorectal cancer (CRC) in the Northwest Territories (NWT), a northern region of Canada, is nearly double the national rate. While mortality could be reduced with greater adherence to CRC screening, this requires colonoscopy access which is limited, and difficult to predict in a complex remote health system. Simulation modeling has been used to plan CRC screening but the impact on decision-making and utility in complex remote health system is unclear. Aim: This thesis aims to estimate the colonoscopy requirements and outcomes of CRC screening in the NWT using simulation modeling in a way that will inform feasible patient-centered strategies to enhance screening. Methods: We conducted a systematic review of the validity and utility of simulation modeling in CRC screening delivery (Chapter 1, 2). Next, a retrospective cohort study of CRC screening participation and outcomes between 2014-2019 was conducted (Chapter 3). We used this data and the findings of the systematic review to inform our participatory simulation modeling approach (Chapter 4). With end-users of the simulation model (clinicians, administrators, and patients), we revised an existing simulation model, OncoSim-CRC, to estimate the resource requirements and outcomes of various strategies to deliver a CRC screening program in the NWT. Each scenario model was run for 500 million cases and model validity was assessed. To enhance ongoing collaboration, we shared the concepts of a Communities of Practice (CoP) framework with stakeholders and assisted in generating consensus on priorities for a CoP to address (Chapter 5). Results: The systematic review showed that simulation models have been used to generate evidence critical to informing decision making for a broad range of decisions related to CRC screening delivery. However, the impact of these models on decision making, end-user engagement, and model validity were rarely described. In the retrospective cohort study, we observed that fecal immunohistochemical test(FIT)-based CRC screening did not appear to prevent CRC or provide earlier detection, but did result in more frequent positive pathology results than anticipated for average risk screening. Factors associated with this include long wait times for colonoscopy, over 1 in 3 FIT positive individuals had clinical signs and symptoms of CRC, and higher relative risk of advanced neoplasia among indigenous individuals. These findings and the involvement of end-users, informed the simulation model study. Under the parameters of the model, we estimate that colonoscopy demand with a CRC screening program would surpass capacity within 1-2 years, and continue to increase over the next 10-15 years due to adenoma surveillance. If this colonoscopy demand is met, we estimate screen detected cancers would increase by 110%, and clinically detected cases reduce by 26%. Increasing the phase-in period or revising adenoma follow-up guidelines would reduce demand and still improve cancer detection and prevention. A framework for a CoP, and consensus on priorities among stakeholders were established. Conclusion: Participatory simulation modeling was a useful method of informing CRC screening delivery in a remote northern population. The simulated scenarios provide decision-makers with strategies to enhance programmatic screening while conserving colonoscopy resources. The findings of this thesis helps to characterize the current outcomes of CRC screening in the NWT, and identifies opportunities to improve CRC screening effectiveness for a remote and, largely indigenous population.

No description available.

Contexte – Les cancers de la prostate, du sein, et colorectaux sont parmi les cancers les plus fréquents dans les pays développés, et, même si plusieurs facteurs de risque sont aujourd’hui bien établis pour ces cancers, leur étiologie reste encore largement à expliquer. L’inflammation chronique est fortement suspectée de jouer un rôle dans la survenue de ces cancers et la présence, dans les tissus tumoraux, d’infiltrats inflammatoires localisés pouvant être considérés comme des lésions précancéreuses, contribue à renforcer l’hypothèse d’un lien possible entre inflammation chronique et cancers. Dans ce contexte, de nombreuses études épidémiologiques se sont intéressées au rôle des Anti-Inflammatoires Non Stéroïdiens (AINS) dans les cancers. En effet, les médicaments ayant des propriétés anti-inflammatoires comme les AINS, dont l’aspirine, et les anti-inflammatoires inhibiteurs sélectifs de la cyclo-oxygénase 2 (COX-2), pourraient diminuer le risque de survenue de ces cancers.Objectifs – L’objectif général de cette thèse a été d’étudier le rôle de la consommation d’AINS, dont l’aspirine, les AINS usuels et les inhibiteurs sélectifs de la COX-2 dans la survenue des cancers de la prostate, du sein et colorectaux.Population et méthodes – Ce travail s’est appuyé sur les données de l’Echantillon Généraliste des Bénéficiaires (EGB) de l’Assurance Maladie pour les trois cancers d’intérêt et sur les données d’une étude cas-témoins réalisée en population générale dans le département de l’Hérault (EPICAP) pour le cancer de la prostate. Pour les données de l’EGB, une cohorte fixe de 426 410 personnes présentes au 1er janvier 2007 a permis d’identifier les cas incidents entre 2008 et 2012 à partir de différents algorithmes. L’exposition aux AINS a été identifiée à partir du 1er janvier 2005 jusqu’à la date de fin d’observation : date de survenue du cancer, date de décès ou date de censure fixée au 31 décembre 2012. Un temps de latence d’au moins un an a été défini entre l’exposition aux AINS et la survenue du cancer d’intérêt. Pour les données d’EPICAP, 819 cas incidents de cancer de la prostate et 879 témoins de population générale, de même âge en moyenne que les cas, ont été interrogés en face-à-face, à l’aide d’un questionnaire standardisé, notamment sur leur consommation d’AINS.Résultats – A partir de la cohorte issue de l’EGB, des résultats préliminaires montraient une augmentation du risque de cancer de la prostate (RR=1,30 [1,17-1,46]) et du sein (RR=1,29 [1,14-1,46]) chez les patients exposés aux AINS et une absence d’association pour les cancers colorectaux (RR=0,92 [0,82-1,05]). En revanche, une association négative était observée pour les cancers de la prostate (RR=0,85 [0,74-0,96]) et colorectaux (RR=0,77 [0,66-0,90]) lorsque le temps de latence considéré était de six ans. L’étude EPICAP a montré que la consommation d’AINS était associée négativement au cancer de la prostate (OR=0,77 [0,61-0,98]). Cette association était plus prononcée pour une fréquence de consommation quotidienne (OR=0,75 [0,33-0,92]) ou d’une consommation pluriquotidienne (OR=0,38 [0,18-0,79]), et pour une durée entre 5 à 10 ans (OR=0,55 [0,33-0,92]). L’association était renforcée pour une molécule ayant une activité anti-COX-2 préférentielle (OR=0,48 [0,28-0,79]). Enfin, une association négative était également observée pour les cancers de la prostate de haut grade (Gleason score =7 (4+3) ou GS>7) avec un OR de 0,62 [0,41-0,95].Conclusion – L’ensemble de ce travail de thèse a montré que la consommation d’AINS semblait être associée négativement à la survenue du cancer de la prostate et aux cancers colorectaux. Pour le cancer de la prostate cette thèse s’est appuyée sur deux bases de données et deux méthodologies différentes, permettant d’appréhender les limites et les forces de chacune. / Background – Prostate, breast, and colorectal cancers are among the most common cancers in developed countries. Many risk factors have been identified over the years but could explain only a part of the new cases. Chronic inflammation is highly suspected to play a role in the carcinogenesis of those cancers and the presence of inflammatory infiltrate in tumoral tissue, considered as precancerous lesions, reinforced this hypothesis. In this context, several epidemiological studies have investigated the potential role of Non-steroidal anti-inflammatory drugs (NSAIDs) in cancer occurrence. Indeed, NSAIDs such as aspirin and non-aspirin NSAIDS including selective inhibitors of cyclo-oxygenase 2 (COX-2) may decrease the incidence of those cancers.Objectives – The main objective of the thesis was to investigate the role of NSAIDs use including aspirin, non-aspirin NSAIDs and selective inhibitors of COX-2 in the occurrence of prostate, breast and colorectal cancers.Population and methods – This work was based on the General Sample of health insurance Beneficiaries (EGB) for the three localizations of cancer and on the data of a population-based case-control study carried out in the département of Herault (EPICAP) for prostate cancer. In the EGB study, a cohort of 426 410 persons present in the database in January 1st, 2007 allowed to identify incident cases between 2008 and 2012 based on different algorithms. Exposure to NSAIDs was determined from January 1st, 2005 until the end of the follow up defined as either cancer incident date, date of death, or censure date fixed as December 31st, 2012. A latency of at least one year between the beginning of exposure to NSAIDs and the cancer occurrence was taken into account. For the EPICAP study, 819 incident prostate cancer cases and 879 population-based controls, frequently matched by age to the cases, were face-to-face interviewed using a standardized questionnaire, specifically on their NSAIDs use.Results – From the EGB cohort, preliminary results showed a positive association between all NSAIDs use and prostate or breast cancer occurrence (RR=1,30 [1,17-1,46], RR=1,29 [1,14-1,46], respectively), while no association was found with colorectal cancer occurrence (RR=0,92 [0,82-1,05]). These associations became negative associations when a latency of six years was taken into account in prostate and colorectal cancer (RR=0,85[0,74-0,96], RR=0,77 [0,66-0,90], respectively). In the EPICAP study, NSAIDs use was negatively associated with prostate cancer (OR=0,77 [0,61-0,98]). This association was more pronounced with daily intake (OR=0,75 [0,33-0,92]) or more than once a day (OR=0,38 [0,18-0,79]), and for a duration of five to ten years (OR=0,55 [0,33-0,92]). The negative association was reinforced for preferential anti-COX-2 NSAIDs (OR=0,48 [0,28-0,79]), and for patient with high grade prostate cancer (Gleason score, GS=7 (4+3) or GS>7 : OR=0,62 [0,41-0,95]).Conclusion – This work showed that NSAIDs use was negatively to prostate and colorectal cancer occurrence. For prostate cancer, this thesis was based on two different databases (a medical and administrative database and a case-control study) and used two different methodologies, allowing comparison about strengths and limits of both.

The Western diet is commonly consumed by industrialized societies and characterized by an increased consumption of vegetable oils rich in omega-6 (n-6) fatty acids. This results in a higher ratio of omega-6 to omega-3 (n-3) fatty acids in the diet. Omega-6 polyunsaturated fatty acids (PUFA) are believed to induce a pro-inflammatory response in the body. Therefore, this change in PUFA concentration and/or ratio of n-6:n-3 in the Western diet may contribute to colorectal cancer (CRC) risk. Five identical diets, varying only in PUFA concentration and n-6:n-3 ratio, were fed to mice dosed with a carcinogen and an inflammatory accent (AOM+DSS). The diets included: 1.) AIN-93G, control diet, containing 7% (kcal) dietary PUFA, 7:1 n-6:n-3 ratio, 2.) 2.5% dietary PUFA 1:1 n-6:n-3 ratio, 3.) 2.5% PUFA 20:1 n-6:n-3, 4.) 10% PUFA 1:1 n-6:n-3, and 5.) 10% PUFA 20:1 n-6:n-3. PUFA ratio had a significant effect on tumor size. Diets having an n-6:n-3 ratio of 1:1 resulted in significantly larger tumors than diets with an n-6:n-3ratio of 20:1. Mice fed either the AIN-93G or 2.5% 1:1 diet had the highest number of tumors compared to the other experimental diets. From these results, it appears that the dietary PUFA profile influences the etiology of CRC. Studies investigating CRC commonly use rodent models to investigate human diseases. Typically rodents are fed diets formulated to promote growth and heath, however these diets are considerably different than the Western diet in terms of macro- and micronutrients. Diet is known to influence CRC incidence, which led to the development of the Total Western Diet (TWD) by Hinze and colleagues. The TWD is a rodent diet that uses purified ingredients to match the macro- and micronutrient composition of the average American diet. However, the complex nature of whole-foods is also known to impact colon health, so the TWD was redesigned. The TWD-2 is the only whole-foods-based rodent diet that emulates the macro- and micronutrient consumption of the average American. Initiating studies using the TWD-2, in place of the AIN diets, will hopefully make the rodent a better model for human disease research.