O tratamento do câncer de cabeça e pescoço e a dificuldade de comunicação decorrente da laringectomia interferem de maneira significativa na qualidade de vida das pessoas acometidas, principalmente quanto aos aspectos funcionais, psicológicos e sociais. Este estudo teve como o objetivo avaliar a qualidade de vida relacionada à saúde (QVRS) de pessoas com câncer de cabeça e pescoço. Trata-se de um estudo exploratório com metodologia quantitativa, do tipo transversal. A coleta de dados foi realizada no período de maio a setembro de 2015, com 100 pessoas com câncer de cabeça e pescoço, divididas em dois grupos: G1: pessoas laringectomizadas, G2: pessoas não laringectomizadas. Para isto, foi utilizado um aplicativo de comunicação alternativa instalado em tablet e foram aplicados o Critério de Classificação Econômica Brasil (CCEB) e a escala Functional Assessment Cancer Therapy (FACT-H&N). Para a análise dos dados foram utilizados o teste exato de Fisher, teste de Kruskal-Wallis, Ancova e estatística descritiva. Como resultados observou-se a prevalência de pessoas do sexo masculino, com faixa etária entre 59 e 74 anos , casadas, aposentadas não ativas, com baixa escolaridade e baixo nível socioeconômico. Os sujeitos participantes de ambos os grupos avaliaram sua qualidade de vida global, de um modo geral, como satisfatória sendo que as funções mais acometidas foram: bem estar emocional e bem estar funcional. Quanto às comparações dos escores finais da escala, observa-se que os participantes do G1 apresentaram melhor QVRS do que os do G2 no escore FACT-G total score, o G1 apresentou melhor QVRS do que o G2, enquanto no FACT-H&N Total score e TOI o G2 apresentou resultados ligeiramente melhores, porém sem significância estatística. Quanto ao uso do LIVOX, todos os participantes que apresentaram alguma dificuldade no seu uso tinham mais de 58 anos e se declararam aposentados não ativos (p=0,04). Conclui-se que é importante o oferecimento, tanto no pré quanto no pós operatório, de cuidados que possam avaliar e melhorar a qualidade de vida relacionada à saúde das pessoas com câncer de cabeça e pescoço / The treatment of head and neck cancer and the communication difficulties resulting from laryngectomy significantly interfere in the quality of life of the affected people, especially regarding the functional, psychological and social aspects. This study aimed to assess the health-related quality of life (HRQoL) of people with head and neck cancer. This paper is an exploratory cross-sectional study with quantitative methodology. The data collection, which occurred between May and September of 2015, was carried out with 100 people with head and neck cancer, who were divided into two groups: G1: laryngectomized people, G2: non- laryngectomized people. To this end, an alternative communication application (LIVOX), installed on a tablet, was used, and the Brazilian Economic Classification Criteria (CCEB) and the Functional Assessment of Cancer Therapy (FAC-H&N) scale were applied. For the data analysis, the Fisher\'s exact test was used, as well as the Kruskal-Wallis test, the analysis of covariance (ANCOVA) and descriptive statistics. The observed results were the prevalence of people of the male sex, with ages between 59 and 74, married, inactive and retired, and with low education and socioeconomic status. The participant subjects of both groups evaluated their global quality of life as generally satisfactory, with the most affected functions being those of emotional and functional well-being. Regarding the scale\'s final scores comparison, it was observed that the G1 participants presented better HRQoL on the FACT-G total score than those of the G2, whereas the G2 presented slightly better results on the FACT-H&N and TOI, although with no statistical significance. As for the use of the LIVOX app, all participants who presented some sort of difficulty when using it were over 58 years old and declared themselves as inactive (p=0,04). It is therefore concluded that the illness and treatment process interferes in the subject\'s life, and that it is important to offer, at both preoperative and post-operative stages, the means for assessing and improving the health- related quality of life of people with head and neck cancer

Made available in DSpace on 2016-01-26T12:51:29Z (GMT). No. of bitstreams: 1 aneliserusso_dissert.pdf: 4806118 bytes, checksum: 0ae19d04c260950faf6788fde7ad65a0 (MD5) Previous issue date: 2011-05-24 / Some individuals may be present increased risk of developing cancer due to differences in biometabolism. Polymorphisms in xenobiotic metabolizing genes, such as family members of Cytochrome P450 (CYP), of Glutathione-S-Transferases (GSTs) and Microsomal Epoxide Hydrolase (mEH) show association with the carcinogenesis of head and neck. Objective: Identify the frequency of genes polymorphisms CYP1A1 (CYP1A1*2A and CYP1A1*2C), CYP2E1 (CYP2E1*5B and CYP2E*6), GSTT1 (null genotype), GSTM1 (null genotype), GSTP1 (A313G and C341T) and mEH (Tyr113His and His139Arg) in patients with head and neck cancer and in individuals with no cancer history (controls), to identify susceptibility biomarkers of this type of cancer. Methods: included 1,100 individuals, 375 patients with pathological diagnosis of squamous cell carcinoma of head and neck cancer and 725 controls. The variables analyzed were: age, sex, alcohol and tobacco, the occurrence primary site and progression of tumor. Genotyping of polymorphisms was performed by Polymerase Chain Reaction - Length Polymorphism, Restriction Fragment (PCR-RFLP), Real-Time PCR (RT-PCR) and multiplex PCR. Datas were evaluated by chi-square, univariate and multiple logistic regression. Results: Advanced age, smoking habits and alcohol consumption were predictors for the development of the head and neck tumors. The polymorphisms CYP2E1*5B (CYP2E1-PstI) and GSTP1 A313G were associated with this disease in univariable analysis. In multirariable analysis the interaction among CYP1A1*2C polymorphism with the female gender (OR= 0.10; 95% CI=0.01-0.72; p< 0.05) and alcohol no-habit (OR= 0.21; 95% CI=0.07-0.67; p< 0.05), mEH His139Arg and alcohol habit (OR= 0.49; 95% CI=0.27-0.90; p< 0.05), CYP2E1* 5B and habits tobacco and alcohol and &#8805;49 age (OR = 4.10; CI 95% 2.44-6.89; p < 0.001; OR = 1.93; CI 95% 1.18-3.16; p=0.0084; OR=9,10; CI 95% 5,86-14,14; p< 0,001, respectively) and GSTP1 A313G and tobacco and alcohol habits, &#8805;48 agea and male gender (OR=4.21; IC 95% 2.71-6.55; p<0.0001; OR=1.65; IC 95% 1.07-2.55; p=0.023; OR=12.37; IC 95% 7.89-19.38; p<0.0001, respectively); decrease the head and neck cancer risk; while CYP1A1*2A and tobacco and alcohol no-habits (OR= 2.84; 95% CI=1.01-7.97; p< 0.05; OR= 2.43; 95% CI=1.00-5.87; p< 0.05, respectively) increase this risk. The CYP2E1*5B polymorphism and tobacco no-habit (OR= 3.75; 95% CI=1.25-11.23; p< 0.05) also increases the risk for this disease. Showed high frequency of the polymorphisms CYP1A1*2C (OR= 2.48; 95% CI=1.00-6.20; p < 0.05) GSTT1 (OR= 3.35; 95% CI=1.67-6.72; p < 0.05) in patients group with primary tumors of larynx; while those who have the pharynx as the primary site GSTT1 (OR=0.29; 95% CI=0.12-0.71; p < 0.05) was less frequent. CYP1A1*2A (CYP1A1-MspI) polymorphism was associated with lymph node involvement and increased risk for cancer (OR =2.45; 95% CI= 1.07-5.64). Conclusion: Our data demonstrate that the interaction between polymorphisms in genes that encode enzymes involved in xenobiotic metabolism and the demographic and risk factors may modulate the development of head and neck cancer. / Alguns indivíduos podem apresentar risco aumentado de desenvolver o câncer devido às diferenças no biometabolismo. Polimorfismos em genes metabolizadores de xenobióticos, tais como os membros da família do Cytocromo P450 (CYP), das Glutatião-S-Transferases (GSTs) e Epóxido Hidrolase Microssomal (mEH) mostram associação com a carcinogênese de cabeça e pescoço. Objetivo: Identificar a frequência de polimorfismos dos genes CYP1A1 (CYP1A1*2A e CYP1A1*2C), CYP2E1 (CYP2E1*5B e CYP2E*6), GSTT1 (genótipo nulo), GSTM1 (genótipo nulo), GSTP1 (A313G e C341T) e mEH (Tyr113His e His139Arg) em pacientes com câncer de cabeça e pescoço e em indivíduos sem história de neoplasia (controles), visando identificar biomarcadores de suscetibilidade para este tipo de câncer. Casuística e Métodos: Foram incluídos no estudo 1.100 indivíduos, 375 pacientes com diagnóstico patológico de carcinoma de células escamosas de cabeça e pescoço e 725 controles. As variáveis analisadas foram: idade, sexo, consumo de álcool e tabaco, sítio primário de ocorrência de tumor e evolução da doença. A genotipagem dos polimorfismos foi realizada por Reação em Cadeia da Polimerase Polimorfismos de Comprimentos de Fragmento de Restrição (PCR-RFLP), PCR em Tempo Real (PCR-RT) e PCR multiplex. Os dados foram avaliados por Qui-quadrado e Regressão logística univariada e múltipla. Resultados: Idade acima de 49 anos, hábitos tabagista e etilista foram preditores para o desenvolvimento de neoplasias de cabeça e pescoço. Os polimorfismos CYP2E1*6 (CYP2E1-DraI) e GSTP1 A313G foram associados com esta doença na análise univariada. Na análise múltipla, a interação entre polimorfismo CYP1A1*2C com o gênero feminino (OR= 0,10; 95% CI=0,01-0,72; p< 0,05) e hábito não etilista (OR= 0,21; 95% CI=0,07-0,67; p< 0,05), mEH His139Arg e hábito etitlista (OR= 0,49; 95% CI=0,27-0,90; p< 0,05), CYP2E1* 5B e hábitos tabagista e etilista e idade &#8805;49 (OR = 4,10; CI 95% 2,44-6,89; p < 0,001; OR = 1,93; CI 95% 1,18-3,16; p = 0,0084; OR = 9,10; CI 95% 5,86-14,14; p < 0,001, respectivamente) e GSTP1 A313G e hábitos tabagista e etilista, idade &#8805;48 anos e gênero masculino (OR=4,21; IC 95% 2,71-6,55; p<0,0001; OR=1,65; IC 95% 1,07-2,55; p=0,023; OR=12,37; IC 95% 7,89-19,38; p<0,0001, respectivamente); diminui o risco de câncer de cabeça e pescoço; enquanto CYP1A1*2A e hábitos não tabagista e não etilista (OR= 2,84; 95% CI=1,01-7,97; p< 0,05; OR= 2,43; 95% CI=1,00-5,87; p< 0,05, respectivamente) aumentam este risco. O polimorfismo CYP2E1*5B e hábito não tabagista (OR= 3,75; 95% CI=1,25-11,23; p< 0,05) também aumenta o risco para esta doença. Foi observada uma alta frequência dos polimorfismos CYP1A1*2C (OR= 2,48; 95% CI=1,00-6,20; p < 0,05) GSTT1 (OR= 3,35; 95% CI=1,67-6,72; p < 0,05) no grupo de pacientes com tumores primários de laringe; enquanto naqueles que tem a faringe como sítio primário o polimorfismo GSTT1 (OR=0,29; 95% CI=0,12-0,71; p < 0,05) foi menos freqüente. O polimorfismo CYP1A1*2A foi associado com o envolvimento de linfonodo e risco aumentado para o câncer (OR=2,45; 95% CI=1,07-5,64). Conclusão: Nossos dados demonstram que a interação entre os polimorfismos em genes que codificam enzimas envolvidas no metabolismo de xenobióticos e os fatores demográficos e de risco podem modular o desenvolvimento do câncer de cabeça e pescoço.

Introdução. Fatores de risco para agravos à saúde se alteram no tempo e no espaço. No que diz respeito ao câncer de cabeça e pescoço (CCP), as associações com tabagismo e consumo de bebidas alcoólicas estão bem estabelecidas. Dados da literatura sugerem que os tipos mais prevalentes de tabaco e álcool numa população estão associados a riscos mais elevados de câncer. No Brasil, poucos estudos epidemiológicos investigaram o efeito de distintos tipos de tabaco e álcool no CCP. Objetivo. Mensurar a razão probabilística de risco para CCP por tipos de tabaco e álcool no consumo não exclusivo (uso de mais de um tipo de tabaco ou bebida alcoólica) e consumo exclusivo (uso de apenas um tipo de tabaco ou bebida alcoólica). Métodos. O presente estudo têm origem em três projetos multicêntricos: Latino-Americano, conduzido de 03/1999 a 12/2001; Genoma Clínico do Câncer realizado de 07/2000 a 08/2011; e o Temático Marcadores de Agressividade em Tumores de Cabeça e Pescoço (GENCAPO), conduzido de 07/2011 a 06/2015. Assim, constituiu-se um estudo caso-controle com dados provenientes de hospitais do Estado de São Paulo. Os casos foram diagnosticados com carcinoma espinocelular de cabeça e pescoço, confirmados histologicamente. Os controles, pacientes com outras doenças que não câncer, foram selecionados em alguns dos hospitais de procedência dos casos. Tanto os casos quanto os controles foram entrevistados por meio de questionários com informações sobre características e hábitos, bem como dados sobre educação e história ocupacional. As associações entre as variáveis tipo de tabaco e tipo de bebidas alcoólicas com CCP, foram estimadas pelo odds ratio (OR) e respectivo intervalo de 95% de confiança (IC 95%) via regressão logística não-condicional, ajustados pelas variáveis de confusão: sexo (feminino, masculino), idade (< 50 anos, 50-59 anos e &#8805; 60 anos), escolaridade (superior, intermediário, analfabeto), ocupação (manual qualificado, manual não qualificado e outros), estudos multicêntricos (Latino-Americano, Genoma Clínico do Câncer e GENCAPO), tabagismo (maços-anos total: Nunca fumaram, <20 maços-ano, &#8805; 20 e < 40 maços-anos e &#8805; 40 maços-anos, para ajuste do efeito do álcool) e consumo de etanol total (Nunca beberam, &#8804; 100 Kg, > 100 e &#8804; 900 e > 900 kg, para ajuste do efeito do tabaco). Resultados. Os riscos decorrentes do tabagismo foram mais expressivos para hipofaringe particularmente, no padrão não-exclusivo e consumo &#8805; 40 maços-ano OR 36,1 (IC95%11,1-117,6); para orofaringe, laringe e cavidade oral, os riscos foram, respectivamente: OR 16,1 (IC95%10,4-24,9); OR 14,2 (IC95% 9,6-21,0); OR 7,4 (IC95% 5,6-10,0). Na condição de consumo exclusivo, para a mesma categoria &#8805; 40 maços-ano para cigarro industrializado, os riscos foram discretamente menos intensos: OR 31,9 (IC95% 9,7-104,3); OR 15,4 (IC95% 9,9-24,0); OR 13,1 (IC95% 8,8-19,5) OR 7,1 (IC95% 5,3-9,6), respectivamente, para hipofaringe, orofaringe, laringe e cavidade oral. No consumo de álcool, foram observadas maiores associações de CCP com as bebidas destiladas. Na condição de consumo exclusivo, para orofaringe o nível de consumo de destilados &#8805; 2000 Kg induziu OR 39,1 (IC 95% 12,7-121,8) em comparação aos que nunca beberam. O uso simultâneo de tabaco e álcool fez aumentar sensivelmente o risco de CCP: OR 10,5 (IC95% 8,5-13,0). Conclusões. Entre os tabagistas com o padrão não-exclusivo de consumo, os maiores riscos foram observados para hipofaringe. Entre os consumidores de bebidas alcoólicas, os destilados conferiram maiores riscos nos dois padrões de consumo. No consumo de cerveja e vinho, as diferenças na intensidade das associações com CCP tornaram-se evidentes apenas nas categorias de maior consumo. / Introduction. Risk factors for health problems change over time and space. With regard to head and neck cancer (HNC), associations with smoking and alcohol consumption are well established. Literature data suggest that the most prevalent types of tobacco and alcohol in a population are associated with higher risks of cancer. In Brazil, few epidemiological studies have investigated the effect of different types of tobacco and alcohol on HNC. Objectives. Measure the probabilistic risks for HNC by tobacco and alcohol types in non-exclusive consumption (use of more than one type of tobacco or alcoholic beverage) and exclusive consumption (use of only one type of tobacco or alcoholic beverage). Methods. The present study has origin from three multicentric projects: Latin American, conducted from 03/1999 to 12/2001; Clinical Genome of Cancer performed from 07/2000 to 08/2011; and the Thematic Markers of Aggression in Head and Neck Tumors (GENCAPO), conducted from 07/2011 to 06/2015. Thus, it is a case-control study with data from hospitals in the State of São Paulo. The cases were diagnosed with squamous cell carcinoma of the head and neck, histologically confirmed. The controls, patients with diseases other than cancer, were selected in some of the hospitals where the cases originated. Both cases and controls were interviewed through questionnaires with information on characteristics and habits, as well as data on education and occupational history. Associations between the variables tobacco type and type of alcoholic beverages with HNC were estimated by the odds ratio (OR) and respective 95% confidence interval (CI 95%) through non-conditional logistic regression adjusted for confounding variables: sex (female, male), age (<50 years, 50-59 years and &#8805; 60 years), schooling (upper, intermediate and illiterate), occupation (qualified manual, unqualified manual and others), multicenter studies, smoking (Never smoked, <20 pack-years, &#8805; 20 and <40 pack-years and &#8805; 40 pack-years, to adjust the effect of alcohol) and total ethanol (Never drank, &#8804; 100 kg,> 100 and &#8804; 900 and > 900 kg, to adjust the effect of tobacco). Results. The risks due to smoking were more significant for the hypopharynx, particularly, in the non-exclusive pattern and consumption &#8805; 40 packs per year OR 36,1 (95% CI 11,1-117,6); for oropharynx, larynx and oral cavity, the risks were: OR 16,1 (95% CI, 10,4-24,9); OR 14,2 (95% CI 9,6-21,0); OR 7,4 (95% CI 5,6-10,0). In the exclusive consumption condition, for the same category &#8805; 40 packets per year for industrialized cigarettes, the risks were slightly less intense: OR 31,9 (95% CI 9,7-104,3); OR 15,4 (95% CI 9,9-24,0); OR 13,1 (IC95% 8,8-19,5); OR 7,1 (IC95% 5,3-9,6), respectively, for hypopharynx, oropharynx, larynx and oral cavity. In alcohol consumption, higher associations of HNC with distilled beverages were observed. In the exclusive consumption condition, consumption level of distilled &#8805; 2000 kg induced OR 39,1 (95% CI: 12,7-121,8) for oropharynx. Simultaneous use of tobacco and alcohol increased the risk of HNC: OR 10,5 (95% CI 8,5-13,0). Conclusions. Among smokers with the non-exclusive pattern of consumption, the greatest risks were observed for the hypopharynx. Among the consumers of alcoholic beverages, the distilled conferred greater risks in the two patterns of consumption. In beer and wine consumption, differences in intensity of associations with HNC became evident only in the higher consumption categories.

Made available in DSpace on 2016-01-26T12:51:46Z (GMT). No. of bitstreams: 1 lidiamariarbatistadasilva_dissert.pdf: 704096 bytes, checksum: f7be6357fe128cc459a3a697cab13d68 (MD5) Previous issue date: 2010-12-07 / Introduction: Head and neck cancer is a collective term defined by anatomical and topographical basis to describe malignant tumors of the upper aerodigestive tract. This anatomical region includes the oral cavity, pharynx and larynx, having as the main risk factors smoking and alcoholism. The most representative hystologic type from head and neck cancer was squamous cell carcinoma (HNSCC), with more than 500,000 new cases worldwide every year. Folate deficiency is associated with increased risk of several types of cancer and alterations in folate metabolism may contribute to the process of carcinogenesis by influencing DNA methylation and genomic stability. Polymorphisms in genes encoding enzymes involved in this pathway may alter enzyme activity and consequently interfere in concentrations of homocysteine and Sadenosylmethionine that are important for DNA synthesis and cellular methylation reactions. Objectives: Investigate MTHFD1 G1958A, BHMT G742A, TC2 C776G and TC2 A67G polymorphisms involved in folate metabolism on head and neck cancer risk, and the association between these polymorphisms with primary site, tumor extension, lymph node involvement and prognosis of the disease. Patients and Methods: Were included in the study 694 individuals (240 patients with head and neck cancer and 454 controls). Molecular analysis was made by genomic DNA from peripheral blood and genetic alterations were investigated by Polymerase Chain Reaction-restriction Fragment Length Polymorphism (PCR-RFLP) and Real Time-PCR. Socio-demographic data were obtained from patient´s medical records and interview of the controls. Results: Multiple logistic regression showed that tobacco, alcohol and age over 42 years were predictors for the disease (P<0.05). Hardy-Weinberg equilibrium showed that the genotypic distributions were in equilibrium for both groups in all polymorphisms studied. The MTHFD1 1958GA or AA genotypes associated with tobacco (P=0.04) and alcohol (P=0.03) consumption increase the risk for head and neck cancer (HNSCC). These same genotypes were found in higher proportion in patients with advanced stage tumors (P=0.04) and in patients with lower survival (P=0.01). TC2 C776G polymorphism (P=0.03) were less frequent in patients with age over 52 years and TC2 A67G polymorphism (P=0.04) were less frequent in patients with 52-63 years. TC2 C776G polymorphism was not associated to HNC, however was present in higher proportion in patients with pharynx as primary site of tumor (P=0.02). Conclusions: Are predictors for head and neck cancer, regardless of the gene, tobacco and alcohol consumption and age over 42 years. The presence of MTHFD1 G1958A polymorphism associated to tobacco and alcohol consumption may modulate the risk for disease development. / Introdução: Câncer de cabeça e pescoço é um termo coletivo definido por bases anatômicas e topográficas para descrever tumores malignos do trato aerodigestivo superior. Esta região anatômica inclui a cavidade oral, faringe e laringe, tendo como principais fatores de risco o tabagismo e o etilismo. O tipo histológico mais representativo de todos os cânceres de cabeça e pescoço é o carcinoma espinocelular (HNSCC), com mais de 500 mil casos novos no mundo todos os anos. Deficiência de folato no organismo está associada ao aumento do risco de vários tipos de câncer e alterações neste metabolismo podem contribuir para o processo de carcinogênese por influenciar as reações de metilação do DNA e a estabilidade genômica. Polimorfismos em genes que codificam enzimas envolvidas no metabolismo do folato podem alterar a atividade enzimática e interferir nas concentrações de homocisteína, Sadenosilmetionina e outros produtos do metabolismo, importantes para a síntese de DNA e reações de metilação celular. Objetivos: Avaliar a influência dos polimorfismos MTHFD1 G1958A, BHMT G742A, TC2 C776G e TC2 A67G em pacientes com carcinoma espinocelular de cabeça e pescoço e em indivíduos controle sem história da neoplasia, além de verificar a associação entre os polimorfismos e os sítios primários de ocorrência, extensão do tumor, comprometimento de linfonodos, e o prognóstico da doença. Pacientes e Métodos: Foram incluídos no estudo 694 indivíduos (240 pacientes com câncer de cabeça e pescoço e 454 controles). Foi feita análise molecular através de extração de DNA genômico de sangue periférico e as alterações genéticas foram investigadas por meio das técnicas de Reação em Cadeia da Polimerase (PCR) em tempo real e Análise de Polimorfismo de Comprimento de Fragmento de Restrição (PCR-RFLP). Os dados sócio-demográficos foram obtidos através do prontuário dos pacientes e entrevista dos indivíduos controles. Resultados: Regressão logística múltipla mostrou que tabagismo, etilismo e idade superior a 42 anos foram preditores da doença (P<0,05). As distribuições genotípicas estiveram em equilíbrio de Hardy- Weinberg em ambos os grupos em todos os polimorfismos estudados. Os genótipos MTHFD1 1958GA ou AA associados ao tabagismo (P=0,04) e etilismo (P=0,03) aumentaram o risco de carcinoma espinocelular de cabeça e pescoço. Estes mesmos genótipos estiveram presentes em maior proporção em pacientes com tumores em estadios mais avançados T3 e T4 (P=0,04) e em pacientes com menor sobrevida (P=0,01). O polimorfismo TC2 C776G (P=0.03) esteve presente em menor frequência em pacientes com idade superior a 52 anos e o polimorfismo TC2 C776G (P=0.03) em pacientes com idade entre 52-63 anos. O polimorfismo TC2 C776G não foi relacionado ao risco da doença, porém esteve presente em alta proporção em pacientes que tiveram a faringe como sítio primário de ocorrência do tumor. Conclusões: São preditores para o câncer de cabeça e pescoço, independentemente da variável genética o uso de tabaco, álcool e idade superior a 42 anos. A presença do polimorfismo MTHFD1 G1958A associado aos hábitos tabagista e etilista podem modular o risco para o desenvolvimento da doença.

The use of positron emission tomography (PET) for imaging in oncology has grown rapidly in recent years. 2-[18F]-fluorodeoxyglucose (FDG) is the most common tracer of PET, although drawbacks exist. Radiolabeled 1-[11C]-acetate (C-AC) is a simple probe for evaluation of perfusion, anabolism (lipogenesis) and catabolism (oxidative metabolism) in all living tissues. This study explored the potential of AC PET in head and neck cancer, benign and malignant lymph nodes in prostate cancer and normal distribution.  In head and neck cancer, C-AC PET detected more primaries and lymph node metastases than FDG PET. The mean primary tumor volumes delineated by C-AC was 51% larger than that of FDG before radiotherapy (RT). Both FDG and C-AC PET tumor volumes must be carefully validated before used in clinical routine. Baseline tumor clearance rate (kmono) was higher in complete responders (CR) than that in partial responders (PR). kmono tended to correlate inversely with FDG SUV at baseline. Radiosensitive tumors might rely predominantly on oxidative metabolism for their biogenetic needs. kmono increased in PR during RT. The potential reversibility of impaired kmono in radioresistant tumors imply that treatment targeting the intermediary metabolism might improve the outcome. Tumor relative perfusion index (rF) and kmono were coupled in CR throughout the RT, but not in PR. Dynamic C-AC PET provides a new non-invasive method to simultaneously evaluate the tumor oxidative metabolism and perfusion which link the RT response in patients by a single tracer injection. In prostate cancer, elevated C-AC accumulation is common in benign inguinal lymph nodes, probably due to increased lipogenesis rather than lymphatic drainage. CT Hounsfield unit of benign nodes was lower than that of metastases, suggesting that density measurement using CT might improve the specificity of nodal staging of prostate cancer. A novel tracer 2-[18F]-fluoroacetate (F-AC) was synthesized and used for dynamic PET-CT imaging in animals. Compared with C-AC PET-CT, F-AC showed prolonged blood retention, no detectable trapping in myocardium and salivary glands, rapid excretion from liver to bile and urine and de-fluorination resulting in intensive skeletal activity. F-AC does not mimic the normal physiologic path of C-AC and appears to be of little use for assessment of perfusion, intermediary metabolism or lipogenesis.

Due to changes in UK and Scottish policy and NHS directives, there have been many changes and improvements in the way information is provided to patients affected by cancer and their families over the last decade. The information provided should be accurate, detailed and tailored to the individual’s needs across the whole of their cancer trajectory. People affected by laryngeal cancer could be classed as a “Cinderella” group as there is a lack of research with this group of patients and their families, in comparison to other types of cancer, even though the impact of treatment can have a profound and debilitating effect on the individual and their family’s quality of life. How this group of patients and their families use and source information to help them make sense of their experiences across their trajectory is unknown, therefore this study explored the role of information based on the experiences of people affected by laryngeal cancer across their cancer trajectory. The study adopted an interpretive prospective longitudinal approach, using two in-depth qualitative interviews with twenty patients and eighteen carers from across the main treatment pathways associated with this type of cancer. The data were analysed using Framework Analysis and influenced by Dingwall’s Illness Action Model. Four broad thematic headings were developed to explain the role of information: “Search for Normality”, “Illusion of Certainty”, “Reality of Uncertainty” and “Culture of Caring”. Relationships were identified between these headings at four key stages across the cancer trajectory. The ii broad theme “Search for Normality” overarched the whole of the cancer trajectory explaining how information was sourced and used to help this group understand their experience of symptoms. The main findings from the study show that two broad categories of information are used: information from health professionals and experiential information from one’s own and others’ experiential knowledge of health and illness. Both categories of information are sourced and used in different ways at different stages over the course of the trajectory and become inextricably linked over time. The study shows that information is not an entity that can be studied on its own but needs to be studied and explained in the ways it is situated, used and experienced within the context of the complex needs and experiences of this group of patients and their families. This study is the first longitudinal study to provide an explanation of the role of information with people affected by laryngeal cancer across their cancer trajectory. The findings show how the different types of information used from the various sources influence how people affected by laryngeal cancer perceive and understand their diagnosis, treatment and the outcome of treatment. The study findings suggest that health professionals need to situate information in the context of the individual’s understanding and prior knowledge of health and illness to ensure that it does not set unrealistic expectations, with a clear need for continuity and supportive care identified in the post-treatment and follow-up phases.

Syfte: Att skapa förutsättningar för en förbättrad cancervård, genom att fördjupa kunskapen och förståelsen om behov hos huvud- och halscancerpatienter under cancerprocessen. Därutö- ver önskas ett förbättrat omhändertagande genom att implementera och utvärdera kvalitetshö- jande förbättringsinsatser. Satsningen ska resultera i en trygg och smidig resa genom vården med ett minimum av avbrott mellan olika vårdhändelser. Metod: Patientens vårdkedja studerades med en fallstudie, utifrån en aktionsforskningsansats. Behoven identifierades med patientskuggning, reflektion från observationer och semistruktu- rerade fokusgruppsintervjuer med mikrosystemet, före (referensgrupp) och efter intervention (jämförelsegrupp). Analys genomfördes med kvalitativ innehållsanalys och Kano-modell. Resultat: En fast vårdkontakt var en viktig faktor i vårdkedjan. Den fasta vårdkontakten till- mötesgick behov såsom trygghet och tillgänglighet, vilket medförde en smidigare vårdkedja. Under hela vårdförloppet fanns ett stort behov av stöd, praktiskt liksom psykosocialt, från både profession och närstående. Oberoende av position i vårdkedjan önskades individanpas- sad information och ett gott bemötande. Interventionsgruppen rapporterade bättre tillgänglig- het och stöd i förhållande till jämförelsegruppen, som inte hade tillgång till kontaktsjukskö- terska. Involvering av hela mikrosystemet vid analys med Kano-modell medför att behov och förbättringsmöjligheter identifieras och valideras. Slutsatser: En kontaktsjuksköterska kan utgöra en fast vårdkontakt som tillmötesgår och sä- kerställer cancerpatienters behov. Närstående är en viktig del av mikrosystemet och måste beredas utrymme och resurser. En förbättringsinsats genom implementering av kontaktsjuk- sköterska, utformning av nutritions- och kvalitetsregisterrutiner baserat på patientens behov bidrar till god vård och minskar risken för resursslöseri. Studien har även bidragit med fördju- pad kunskap gällande applicering av Kano-modellen i Hälso- och sjukvårdsmiljö. / Purpose: To create opportunities for an improved cancer care, by providing deeper knowledge and understanding of the needs of head and neck cancer patients during the cancer treatment process. Furthermore, to improve care for these patients by implementing and eval- uating QI efforts. This will result in a safe and smooth journey through the care with a mini- mum of disruption. Method: The cancer treatment process was examined in a case study with an action research approach. Patient needs were identified by patient-shadowing, observational reflections and focus groups-interviews with the microsystem, before (non-intervention group) and after in- tervention (intervention group). The data analysis involved qualitative content analysis in- formed by Kano’s quality model. Results: A contact nurse (CN) was an important factor. The CN provided a sense of security and accessibility, giving patients a smoother trajectory of care. Continual support was needed, regarding both, practical and psychosocial matters, from both professionals and relatives. Re- gardless of position in the continuum of care, individual information and good reception was required. Members of the intervention group reported better accessibility and support com- pared to the non-intervention group members, who were not offered a CN. Conclusion: A CN can provide a continual health care contact; meeting and ensuring that the needs of cancer patients are met. Relatives are an important part of the microsystem and should be given space and resources. An improvement effort by implementing routines for a CN, quality registry and nutrition, based on patient needs will facilitate good care and opti- mise resources. The study has also contributed to deeper knowledge of how to use the Kano model in health care.

Background and aim: In society there is a growing awareness that a vital factor for patientswith chronic diseases, such as head and neck cancer (HNC), is how well they are able to function in their every day lives – a common, but often overlooked, public health issue. The overall aim of this thesis is to reach a deeper understanding of living with HNC and to identify the experiences that patients felt promoted their health and well-being. It also explores the patients' experiences of contact and care from health professionals and whether these encounters could increase their feelings of health and well-being; salutogenic approach. Methods: This thesis engages a qualitative data design. On three occasions, 35 purposivelyselected patients were interviewed (31 from Sweden and one from Denmark, Finland, Island, and Norway). The first study was conducted in the Nordic counties (I), and the remainingstudies were conducted in Sweden (II, III, IV). Interviews were performed on a single basis(I, II, III) and then repeated (IV). The individual, semi-structured qualitative interviews usedopen-ended questions (n=53). Three different forms of analyses were used: critical incident technique (I), thematic content analysis (II), latent content analysis (III), and interpretativedescriptive analysis (paper IV). Findings: Living with head and neck cancer was expressed as living in captivity, in the sensethat patients' sometimes life-threatening symptoms were constant reminders of the disease. The patients experienced a threat against identity and existence. Patients struggled to find power and control over everyday life, and if successful this appeared to offer them better health and well-being along with spiritual growth. The general understanding was that these patients had strong beliefs in the future despite living on a virtual rollercoaster. The patients went through a process of interplay of internal and external enabling that helped them acquire strength and feelings of better health and well-being. Consequently, they found power and control from inner strength and other health resources, e.g. social networks, nature, hobbies, activity, and health professionals. However, the findings also revealed the opposite; that some patients were more vulnerable and felt powerless and faced everyday life with emotional and existential loneliness. They were dependent on next of kin and health professionals. Having good interpersonal relationships and emotional support 24 hours a day from next of kin were crucial, as were health promoting contacts and care from health professionals. This health promoting contact and care built on working relationships with competent health professionals that were available, engaged, respectful, validating, and, above all experienced in the treatment phase. But many patients experienced not health promoting contact and care – and a sense of not being respected, or even believed. Added were the patients' experiences of inadequate coordination between phases of their lengthy illness trajectory. They felt lost and abandoned by health services, especially before and after treatment. Conclusions: Inner strength, good relationships with next of kin, nature, hobbies, andactivities could create strength and a sense of better health and well-being. Patients experienced a mutual working relationship during dialoguing and sensed co-operation and equality in encounters with competent health professionals. This could lead to enhanced power and control i.e. empowerment in a patient's everyday life. The findings highlight psychosocial rehabilitation in a patient-centred organisation when health professionals supportpatients' inner strength and health resources , and also offer long-term support to next of kin.Finally, this research suggests that if health professionals could gain a deeper understanding of the psychosocial, existential, social, and economic questions on patients' minds, they could better sense how patients feel and would be better equipped not only to offer greater support, but to raise their voices to improve health policy and health care for these patients. / Syfte och bakgrund: Avhandlingens övergripande syfte var att få en djupare förståelse för personer med huvud – halscancer vardagsliv samt vad som främjar deras hälsa och välbefinnande d v s ett salutogent synsätt. Kroniska sjukdomstillstånd såsom cancer räknas numera till de stora folksjukdomarna och vid huvud – halscancer är vikten av ett fungerande vardagsliv emellertid ett ofta förbisett folkhälsoproblem. Metod: Avhandlingen omfattar fyra delarbeten baserade på kvalitativa data. Resultaten baseras på semistrukturerade individuella intervjuer (n=53) som riktades till 35 utvalda personer. Den första studien (I) genomfördes i Danmark, Finland, Island, Norge och Sverige och de övriga i Sverige (II, III, IV). Intervjuerna genomfördes vid ett tillfälle (I, II, III) och vid upprepade tillfälle (IV). Tre olika textanalyser användes, kritisk händelse teknik (I), tematisk innehålls analys (II), latent innehållsanalys (III) och tolkande beskrivande analys (IV). Resultat: Att leva med huvud - halscancer beskrevs som ett liv i fångenskap och upplevdes som att åka i berg och dalbana mellan hopp och förtvivlan. De ofta livshotande symtomen påminde ständigt om sjukdomen och upplevdes som hot både mot existensen och mot identiteten. Detta till trots kom ibland en stark optimism och tro på framtiden till uttryck. Några av de intervjuades vardagsliv präglades dock av känslomässig och existentiell ensamhet och upplevelser av sårbarhet och maktlöshet. Att ha makt och kontroll över den egna livssituationen liksom närståendes känslomässiga stöd, ibland dygnet runt, främjade hälsan. Hälsofrämjande kontakter med vårdpersonalen upplevdes främst under sjukhusvistelsen. Avgörande var en god och bekräftande patient vårdar relation samt att personalen hade hög kompetens och visade engagemang och respekt i vårdsituationen. Flera av de intervjuade beskrev dock allvarliga brister i kontakten med sjukvården. Upplevelser av brist på respekt och att inte bli trodd i sin sjukdomsupplevelse beskrevs, vilket vanligast i perioderna före och efter sjukhusvistelsen. Samordningen mellan hälso- och sjukvårdens olika funktioner upplevdes som bristfällig under hela sjukdomsförloppet. Konklusion: Inre styrka, goda relationer med närstående, nära kontakt med naturen, hobbyer och andra aktiviteter skapade upplevelser av hälsa och välbefinnande hos personer med huvud - halscancer. I dialog med kompetent vårdpersonal, där samverkan och jämlikhet var tydlig, upplevdes ömsesidiga, vänliga relationer som en hjälp för dem att få ökad egenmakt och kontroll i vardagslivet. Resultatet visar på patienternas långvariga kamp med ett vardagsliv med ständig känslomässig, psykosocial, existentiell, social och ekonomisk oro. Resultatet pekar också på en brist på patientcentrerad organisation och psykosocial rehabilitering, där vårdpersonal stödjer patienters inre styrka och hälsoresurser. Förhoppningen är att resultatet kan leda till en ökad förståelse hos vårdpersonal för hur vardagslivet kan upplevas då man har en huvud- hals cancer, för att på så vis ge adekvat hjälp till dessa patienter och deras närstående.

No description available.

Background and aim: In society there is a growing awareness that a vital factor for patientswith chronic diseases, such as head and neck cancer (HNC), is how well they are able tofunction in their everyday lives – a common, but often overlooked, public health issue. Theoverall aim of this thesis is to reach a deeper understanding of living with HNC and toidentify the experiences that patients felt promoted their health and well-being. It alsoexplores the patients’ experiences of contact and care from health professionals and whetherthese encounters could increase their feelings of health and well-being; salutogenic approach. Methods: This thesis engages a qualitative data design. On three occasions, 35 purposivelyselected patients were interviewed (31 from Sweden and one from Denmark, Finland, Island,and Norway). The first study was conducted in the Nordic counties (I), and the remainingstudies were conducted in Sweden (II, III, IV). Interviews were performed on a single basis(I, II, III) and then repeated (IV). The individual, semi-structured qualitative interviews usedopen-ended questions (n=53). Three different forms of analyses were used: critical incidenttechnique (I), thematic content analysis (II), latent content analysis (III), and interpretativedescriptive analysis (paper IV). Findings: Living with head and neck cancer was expressed as living in captivity, in the sensethat patients’ sometimes life-threatening symptoms were constant reminders of the disease.The patients experienced a threat against identity and existence. Patients struggled to findpower and control over everyday life, and if successful this appeared to offer them better health and well-being along with spiritual growth. The general understanding was that these patients had strong beliefs in the future despite living on a virtual rollercoaster. The patients went through a process of interplay of internal and external enabling that helped them acquire strength and feelings of better health and well-being. Consequently, they found power and control from inner strength and other health resources, e.g. social networks, nature, hobbies,activity, and health professionals. However, the findings also revealed the opposite; that somepatients were more vulnerable and felt powerless and faced everyday life with emotional andexistential loneliness. They were dependent on next of kin and health professionals. Having good interpersonal relationships and emotional support 24 hours a day from next of kin were crucial, as were health promoting contacts and care from health professionals. This healthpromoting contact and care built on working relationships with competent healthprofessionals that were available, engaged, respectful, validating, and, above all experiencedin the treatment phase. But many patients experienced not health promoting contact and care –and a sense of not being respected, or even believed. Added were the patients’ experiences ofinadequate coordination between phases of their lengthy illness trajectory. They felt lost andabandoned by health services, especially before and after treatment. Conclusions: Inner strength, good relationships with next of kin, nature, hobbies, andactivities could create strength and a sense of better health and well-being. Patientsexperienced a mutual working relationship during dialoguing and sensed co-operation andequality in encounters with competent health professionals. This could lead to enhancedpower and control i.e. empowerment in a patient’s everyday life. The findings highlightpsychosocial rehabilitation in a patient-centred organisation when health professionals supportpatients’ inner strength and health resources, and also offer long-term support to next of kin.Finally, this research suggests that if health professionals could gain a deeper understandingof the psychosocial, existential, social, and economic questions on patients’ minds, they couldbetter sense how patients feel and would be better equipped not only to offer greater support,but to raise their voices to improve health policy and health care for these patients. / Syfte och bakgrund: Avhandlingens övergripande syfte var att få en djupare förståelse förpersoner med huvud – halscancer vardagsliv samt vad som främjar deras hälsa ochvälbefinnande d v s ett salutogent synsätt. Kroniska sjukdomstillstånd såsom cancer räknasnumera till de stora folksjukdomarna och vid huvud – halscancer är vikten av ett fungerandevardagsliv emellertid ett ofta förbisett folkhälsoproblem. Metod: Avhandlingen omfattar fyra delarbeten baserade på kvalitativa data. Resultatenbaseras på semistrukturerade individuella intervjuer (n=53) som riktades till 35 utvaldapersoner. Den första studien (I) genomfördes i Danmark, Finland, Island, Norge och Sverigeoch de övriga i Sverige (II, III, IV). Intervjuerna genomfördes vid ett tillfälle (I, II, III) ochvid upprepade tillfälle (IV). Tre olika textanalyser användes, kritisk händelse teknik (I),tematisk innehålls analys (II), latent innehållsanalys (III) och tolkande beskrivande analys(IV). Resultat: Att leva med huvud - halscancer beskrevs som ett liv i fångenskap och upplevdessom att åka i berg och dalbana mellan hopp och förtvivlan. De ofta livshotande symtomenpåminde ständigt om sjukdomen och upplevdes som hot både mot existensen och motidentiteten. Detta till trots kom ibland en stark optimism och tro på framtiden till uttryck.Några av de intervjuades vardagsliv präglades dock av känslomässig och existentiellensamhet och upplevelser av sårbarhet och maktlöshet. Att ha makt och kontroll över denegna livssituationen liksom närståendes känslomässiga stöd, ibland dygnet runt, främjadehälsan. Hälsofrämjande kontakter med vårdpersonalen upplevdes främst under sjukhusvistelsen. Avgörande var en god och bekräftande patient vårdar relation samt att personalenhade hög kompetens och visade engagemang och respekt i vårdsituationen. Flera av deintervjuade beskrev dock allvarliga brister i kontakten med sjukvården. Upplevelser av bristpå respekt och att inte bli trodd i sin sjukdomsupplevelse beskrevs, vilket vanligast iperioderna före och efter sjukhusvistelsen. Samordningen mellan hälso- och sjukvårdens olikafunktioner upplevdes som bristfällig under hela sjukdomsförloppet. Konklusion Inre styrka, goda relationer med närstående, nära kontakt med naturen, hobbyeroch andra aktiviteter skapade upplevelser av hälsa och välbefinnande hos personer med huvud- halscancer. I dialog med kompetent vårdpersonal, där samverkan och jämlikhet var tydlig,upplevdes ömsesidiga, vänliga relationer som en hjälp för dem att få ökad egenmakt ochkontroll i vardagslivet. Resultatet visar på patienternas långvariga kamp med ett vardagslivmed ständig känslomässig, psykosocial, existentiell, social och ekonomisk oro. Resultatetpekar också på en brist på patientcentrerad organisation och psykosocial rehabilitering, därvårdpersonal stödjer patienters inre styrka och hälsoresurser. Förhoppningen är att resultatetkan leda till en ökad förståelse hos vårdpersonal för hur vardagslivet kan upplevas då man haren huvud- hals cancer, för att på så vis ge adekvat hjälp till dessa patienter och derasnärstående.