by Mei Chun Cheung. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 34-41). / Abstract and questionare in English and Chinese. / ABSTRACT --- p.ii / ACKNOWLEDGEMENTS --- p.iii / TABLE OF CONTENTS --- p.iv / LIST OF TABLES --- p.v / Chapter CHAPTER I - --- INTRODUCTION --- p.1 / Chapter CHAPTER II - --- METHOD --- p.7 / Chapter CHAPTER III - --- RESULTS --- p.17 / Chapter CHAPTER IV - --- DISCUSSION --- p.29 / REFERENCES --- p.34 / APPENDIX --- p.42

Cheng Kin Fong. / "November 2001." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2001. / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Pain requiring treatment is experienced by many cancer patients at the end of life. When these patients stay at home, family caregivers are often directly implicated in pain management. There are few studies that examine the process that these family caregivers engage in when they take on the responsibility of pain management. This means we need information on whether or not these family caregivers are prepared for management to ensure proper support and optimal pain control. / The purpose of this qualitative study was to study the process used by family caregivers at home to manage the pain of palliative cancer patients using a grounded theory approach. A total of 24 family caregivers with differing relationships to the patient and differing lengths of caregiver experience participated. Family caregivers were recruited using purposeful then theoretical sampling. The data sources were taped, transcribed (semi-structured) interviews, field notes, and memos. Data analysis used Strauss & Corbin's (1998) suggestions for substantive coding: open, axial, and selective coding. / The results lead to the proposition of an explanatory theory titled "the puzzle of pain management," which include: 1) a frame of the process of "drawing on past experiences"; 2) puzzle pieces representing the process "strategizing a game plan" which include the sub-processes of "accepting responsibility," "seeking information," and "establishing a pain management relationship"; 3) puzzle pieces representing the process of "striving to respond to pain" which include the sub-processes of "determining the characteristics of pain," "implementing a strategy for pain relief," and "verifying if pain relief strategies were successful; and 4) "gauging the best fit," a decision-making process that joins the two pieces of the puzzle. / The realization that family caregivers assemble a puzzle of processes indicates that there are factors that nurses must be aware of before creating, teaching, and implementing interventions for pain management. Furthermore, the results provide information to create and subsequently administer interventions based on caregivers' existing knowledge, identified needs for information and support, and current pain management regimens. The puzzle of pain management must be validated by further studies using this theory, in part, to help create interventions that will allow us to know how useful the theory is in practice. / Keywords: family caregivers, carers, pain management, palliative care, cancer pain, home care, grounded theory

Note: / Pain requiring treatment is experienced by many cancer patients at the end of life. When these patients stay at home, family caregivers are often directly implicated in pain management. There are few studies that examine the process that these family caregivers engage in when they take on the responsibility of pain management. This means we need information on whether or not these family caregivers are prepared for management to ensure proper support and optimal pain control. The purpose of this qualitative study was to study the process used by family caregivers at home to manage the pain of palliative cancer patients using a grounded theory approach. A total of 24 family caregivers with differing relationships to the patient and differing lengths of caregiver experience participated. Family caregivers were recruited using purposeful then theoretical sampling. The data sources were taped, transcribed (semi-structured) interviews, field notes, and memos. Data analysis used Strauss & Corbin’s (1998) suggestions for substantive coding: open, axial, and selective coding.[...] / Les patients atteints de cancer en fin de v1e eprouvent souvent des douleurs qui doivent etre traitees. Lorsque ces patients demeurent a la maison, ce sont plus souvent les proches-aidants qui sont impliques directement dans la gestion de cette douleur. Peu d’etudes existent sur le processus que les prochesaidants adoptent lorsqu’ils prennent la responsabilite de gerer la douleur. Il est done opportun d’accroltre nos connaissances afin d’outiller les proches-aidants a gerer de fac;on optimale la douleur et de mieux les soutenir dans leurs roles. Le but de cette etude qualitative est d’etudier le processus que les prochesaidants utilisent lorsqu’ils prennent soin a domicile d’une personne en fin de vie. Cette etude se base sur une approche de theorisation an ere e. L’ echantillon de I’ etude se compose de 24 proches-aidants ayant des types et des durees de relation differentes avec le patient. Les proches-aidants ont ete selectionnes selon une procedure d’echantillonnage a choix raisonne, suivi par une procedure d’echantillonnage theorique. Les donnees recueillies sont basees sur des entrevues (semi-structurees) enregistrees et transcrites, ainsi que sur des notes de terrain et des memos. Les analyses de donnees ont ete basees sur les recommandations de Strauss & Corbin ( 1998) pour le codage; c’ est-a-dire codage ouvert, axial et selectif.[...]

Diss. (sammanfattning) Uppsala : Univ., 2001. / Härtill 5 uppsatser.

Note:

No description available.

Apesar de existir novas técnicas e múltiplas alternativas terapêuticas para o câncer de próstata localmente avançado, esta enfermidade se constitui em um grande problema de saúde pública mundial, resultando em índices significativos de morbidade e mortalidade, gerando desta forma um desafio para urologistas e oncologistas. Existem múltiplas e bem sucedidas estratégias de tratamento da doença localizada, tais como: a prostatectomia radical, a radioterapia externa conformacional, a braquiterapia e a crioablação. Em contraste, o tratamento da doença metastática e localmente avançada, freqüentemente necessita da alguma forma de bloqueio hormonal. Não existe consenso em vários aspectos da terapia hormonal para tumores localmente avançados tais como: o tipo de bloqueio androgênico a ser usado, terapia hormonal precoce ou tardia, associação com outras modalidades terapêuticas e o uso de bloqueio intermitente. Foi realizada uma revisão crítica deste tipo de tratamento, bem como as indicações atuais de bloqueio hormonal nos tumores de próstata localmente avançado. Não existem estudos prospectivos e randomizados que comparem as diversas formas de tratamento cirúrgico versus radioterápico do câncer de próstata localmente avançado. A hormonioterapia adjuvante à prostatectomia radical, na doença localmente avançada, parece reduzir a progressão tumoral bioquímica, porém, não há estudo que evidencie melhora na sobrevida livre de metástase ou na sobrevida global. O bloqueio androgênico neoadjuvante à prostatectomia radical aumenta a proporção dos pacientes com doença órgão-confinada e margens cirúrgicas negativas, porém sem efeito nas taxas de falha bioquímica do tratamento. A terapia hormonal adjuvante à radioterapia em pacientes portadores de câncer de próstata localmente avançado oferece vantagens na sobrevida global. A terapia hormonal neoadjuvante à radioterapia, em estudos multicêntricos e randomizados, resulta em melhor controle local do tumor bem como prolonga a sobrevida doença-específica. Não há, porém evidência de melhora na sobrevida global. O tratamento por tempo prolongado com bloqueadores hormonais adjuvante à radioterapia mostrou-se superior em relação à sobrevida global e sobrevida livre de doença quando comparado a um período curto de bloqueio, principalmente em pacientes com tumores indiferenciados (Gleason 8-10). Os análogos LHRH, orquiectomia ou o dietilestilbestrol se mostraram como opções de monoterapia, igualmente eficazes, para os pacientes que iniciam terapia hormonal de primeira linha, no tratamento da doença localmente avançada. Não existe evidência que justifique o bloqueio androgênico máximo como terapia hormonal de primeira linha ao invés de monoterapia. Existem vantagens potenciais na qualidade de vida e nos custos do tratamento quando realizada a ablação intermitente, mas a sua eficácia a longo prazo necessita ser confirmada / Despite new techniques and multiple therapeutic alternatives, locally advanced prostate cancer is a serious public health problem, resulting in significant morbidity and mortality rates, that remains a great challenge for urologists and oncologists. Several therapeutic strategies to treat localized prostate cancer have been successful such as conformational external beam radiation therapy, brachytherapy and cryoablation. In contrast, treatment of metastatic and locally advanced tumors may often involve androgenic suppression. However, there are no consensus on several aspects of hormonal therapy for locally advanced tumors such as the type of antiandrogenic drug to be used, early versus delayed hormonal therapy, association with other therapeutic modalities and the use of intermittent blockade. We set out to critically review important aspects and current indications of hormonal blockade in the locally advanced prostate tumors. There are no prospective and randomized study that compares current forms of surgical treatment versus radiation therapy of locally advanced prostate cancer. After radical prostatectomy, adjuvant hormonal therapy in the locally advanced disease reduces biochemical failure rates, although no benefit has been shown regarding metastatic free survival or overall suvival. Neoadjuvant androgen blockade enhances the proportion of patients with organ-confined disease and negative surgical margins but no benefit is seen regarding biochemical free recurrence. Neoadjuvant hormonal therapy to the radiotherapy improves local tumor control as well as it prolongs the diseasespecific survival, although there are no survival advantage. Adjuvant hormonal therapy offers overall survival advantage in patients with locally advanced prostate cancer treated with radiotherapy Long term adjuvant hormonal blockade offers survival benefit for patients with high Gleason score (8-10). LHRH analogues, bilateral orquiectomy and dietilestilbestrol were shown are equally effective as adjuvant therapy for patients with locally disease advanced. There are evidences that maximum androgenic blockade are not more efficient than monotherapy. Potential quality of life and costs advantages of intermittent ablation could be considered an alternative treatment for this group of patient

Apesar de existir novas técnicas e múltiplas alternativas terapêuticas para o câncer de próstata localmente avançado, esta enfermidade se constitui em um grande problema de saúde pública mundial, resultando em índices significativos de morbidade e mortalidade, gerando desta forma um desafio para urologistas e oncologistas. Existem múltiplas e bem sucedidas estratégias de tratamento da doença localizada, tais como: a prostatectomia radical, a radioterapia externa conformacional, a braquiterapia e a crioablação. Em contraste, o tratamento da doença metastática e localmente avançada, freqüentemente necessita da alguma forma de bloqueio hormonal. Não existe consenso em vários aspectos da terapia hormonal para tumores localmente avançados tais como: o tipo de bloqueio androgênico a ser usado, terapia hormonal precoce ou tardia, associação com outras modalidades terapêuticas e o uso de bloqueio intermitente. Foi realizada uma revisão crítica deste tipo de tratamento, bem como as indicações atuais de bloqueio hormonal nos tumores de próstata localmente avançado. Não existem estudos prospectivos e randomizados que comparem as diversas formas de tratamento cirúrgico versus radioterápico do câncer de próstata localmente avançado. A hormonioterapia adjuvante à prostatectomia radical, na doença localmente avançada, parece reduzir a progressão tumoral bioquímica, porém, não há estudo que evidencie melhora na sobrevida livre de metástase ou na sobrevida global. O bloqueio androgênico neoadjuvante à prostatectomia radical aumenta a proporção dos pacientes com doença órgão-confinada e margens cirúrgicas negativas, porém sem efeito nas taxas de falha bioquímica do tratamento. A terapia hormonal adjuvante à radioterapia em pacientes portadores de câncer de próstata localmente avançado oferece vantagens na sobrevida global. A terapia hormonal neoadjuvante à radioterapia, em estudos multicêntricos e randomizados, resulta em melhor controle local do tumor bem como prolonga a sobrevida doença-específica. Não há, porém evidência de melhora na sobrevida global. O tratamento por tempo prolongado com bloqueadores hormonais adjuvante à radioterapia mostrou-se superior em relação à sobrevida global e sobrevida livre de doença quando comparado a um período curto de bloqueio, principalmente em pacientes com tumores indiferenciados (Gleason 8-10). Os análogos LHRH, orquiectomia ou o dietilestilbestrol se mostraram como opções de monoterapia, igualmente eficazes, para os pacientes que iniciam terapia hormonal de primeira linha, no tratamento da doença localmente avançada. Não existe evidência que justifique o bloqueio androgênico máximo como terapia hormonal de primeira linha ao invés de monoterapia. Existem vantagens potenciais na qualidade de vida e nos custos do tratamento quando realizada a ablação intermitente, mas a sua eficácia a longo prazo necessita ser confirmada / Despite new techniques and multiple therapeutic alternatives, locally advanced prostate cancer is a serious public health problem, resulting in significant morbidity and mortality rates, that remains a great challenge for urologists and oncologists. Several therapeutic strategies to treat localized prostate cancer have been successful such as conformational external beam radiation therapy, brachytherapy and cryoablation. In contrast, treatment of metastatic and locally advanced tumors may often involve androgenic suppression. However, there are no consensus on several aspects of hormonal therapy for locally advanced tumors such as the type of antiandrogenic drug to be used, early versus delayed hormonal therapy, association with other therapeutic modalities and the use of intermittent blockade. We set out to critically review important aspects and current indications of hormonal blockade in the locally advanced prostate tumors. There are no prospective and randomized study that compares current forms of surgical treatment versus radiation therapy of locally advanced prostate cancer. After radical prostatectomy, adjuvant hormonal therapy in the locally advanced disease reduces biochemical failure rates, although no benefit has been shown regarding metastatic free survival or overall suvival. Neoadjuvant androgen blockade enhances the proportion of patients with organ-confined disease and negative surgical margins but no benefit is seen regarding biochemical free recurrence. Neoadjuvant hormonal therapy to the radiotherapy improves local tumor control as well as it prolongs the diseasespecific survival, although there are no survival advantage. Adjuvant hormonal therapy offers overall survival advantage in patients with locally advanced prostate cancer treated with radiotherapy Long term adjuvant hormonal blockade offers survival benefit for patients with high Gleason score (8-10). LHRH analogues, bilateral orquiectomy and dietilestilbestrol were shown are equally effective as adjuvant therapy for patients with locally disease advanced. There are evidences that maximum androgenic blockade are not more efficient than monotherapy. Potential quality of life and costs advantages of intermittent ablation could be considered an alternative treatment for this group of patient

Carcinomas de glândulas salivares são raros e seu tratamento de escolha é cirúrgico, seguido ou não de radioterapia. Até 50% dos casos apresentam recorrências neoplásicas e a maioria delas é local. O único tratamento de resgate com potencial curativo é o cirúrgico. No entanto, poucos estudos abordam o tema. O objetivo deste estudo é avaliar a ocorrência de complicações cirúrgicas e os fatores prognósticos clínicos e anatomopatológicos em pacientes portadores de carcinoma de glândulas salivares recidivado, submetidos à cirurgia de resgate. Foram avaliados 59 pacientes que preenchiam os critérios de elegibilidade do estudo: diagnóstico comprovado da recidiva de carcinoma de glândulas salivares e cirurgia de resgate realizada com intenção curativa. Trinta e 5 pacientes desta série (59,3%) foram tratados previamente em outra instituição. A cirurgia de resgate de todos os pacientes foi realizada no Hospital A. C. Camargo, em São Paulo, entre os anos de 1957 a 2000. O local do tumor primário foi parótida em 34 casos (57,6%); cavidade oral, em 13 (22,1%) e glândula submandibular, em 12 (20,3%). O tipo histológico mais freqüente foi o carcinoma adenocístico em 23 casos (39%), seguido pelo carcinoma mucoepidermóide, em 14 (23,7%). O tratamento prévio foi somente cirurgia em 47 casos, cirurgia e radioterapia adjuvante em 11 casos e cirurgia e quimioterapia em apenas um caso. A maioria dos pacientes apresentou recorrência local (39; 66%), em sete casos a recorrência foi regional (11,9%) e em treze foi locorregional (22,1%). O estádio clínico da recorrência foi inicial (rEC I e II) em 15 casos (25,5%) e avançado (rEC III e IV), em 44 (74,5%). O tratamento cirúrgico da recorrência foi ressecção local em 39 casos (66,1%), esvaziamento cervical isolado em 7 (11,9%) e cirurgias em monobloco (ressecção local associada a esvaziamento cervical) em 13 casos (22%). Em 5 pacientes foi realizada parotidectomia ampliada com temporalectomia. A taxa global de complicações cirúrgicas foi de 32,2%. A complicação mais comum foi a infecção da ferida operatória. Não houve mortalidade pós-operatória. Houve nova recorrência em 36 pacientes (61%). A recorrência mais freqüente foi a distância, em 16 casos (27%), sendo o pulmão o sítio mais acometido. Em 10 casos (17%) houve falha no controle local; em 5 (8,5%), falha locorregional e em 5, falha regional (8,5%). A sobrevida atuarial global, após a cirurgia de resgate, foi de 61,3% em 5 anos e 42% em 10 anos. O sexo, o tipo histológico, a topografia, o estadiamento clínico e a conservação do nervo facial (tumores parotídeos) não apresentaram associação com a sobrevida global. Em análise univariada a idade maior que 60 anos foi associada a pior prognóstico. Este estudo demonstra que o prognóstico de pacientes com carcinomas de glândulas salivares recidivados, selecionados para serem submetidos à cirurgia de resgate é aceitável. As taxas de complicações cirúrgicas foram geralmente locais e não houve mortalidade pós-operatória nesta série. / Salivary gland carcinomas are rare and the main treatment option is surgery with or without postoperative radiotherapy. Almost half of the cases present recurrences of tumors and the majority are local. The only potentially curative treatment for recurrent tumors is salvage surgery. However, few papers were published on this subject. The aim of this study is evaluate the surgical complications and clinical and pathologic prognostic factors in patients with recurrent salivary gland carcinoma submitted to salvage surgery. We reviewed the medical charts of 59 patients that fulfilled the eligibility critera of the study: proven diagnosis of locorregionally recurrent salivary gland carcinoma and surgery with curative intention. Thirty five patients (59,3%) had been previously treated at another institution. The salvage surgery in all the patients was performed at the A. C. Camargo Hospital in São Paulo, Brazil from 1957 to 2000. The site of the primary tumor was the parotid in 34 cases, the oral cavity in 13 and submandibular gland in 12 cases. The most frequent histopathologic type was adenoid cystic carcinoma (23 cases; 39%) and mucoepidermoid carcinoma (14 cases ;23.7%). The prior treatment was surgery alone in 47 cases, surgery with adjuvant radiotherapy in 11 cases and surgery and adjuvant chemotherapy in only one case. The majority of the patients presented local recurrence (39; 66%), in seven cases the recurrence was regional (11.9%) and in thirteen cases it was locorregional (22.1%). The clinical stage of the recurrences were initial (rCS I/II) in 15 patients (25.5%) and advanced (rCS III/IV) in 44 patients (74.5%). The surgical treatment of the recurrence was local ressection in 39 cases (66.1%), en bloc surgeries (local ressection and neck dissection) in thirteen cases (22%) and neck dissection alone in seven cases (11.9%). Wide parotidectomy with temporal bone ressection was performed in five cases. The overall rate of surgical complications was 32.2%. The most frequent complication was wound infection. There was no post-operative deaths. There was a new recurrence in 61% of the patients, and the majority were distant metastases (16 cases; 27%). The lung was the most frequent involved site. In ten cases (17%) the recurrence was local, in five cases it was locorregional (8.5%). The actuarial overall survival were 61.3% in 5 years and 42% in ten years and in five cases it was regional (8.5%). Gender, histopathology, site of the primary tumor, facial nerve preservation (parotid tumors), were not associated with overall survival. In the univariate analysis, only age older than 60 years was associate with a poor prognosis. This study shows that the prognosis of patients with recurrent salivary gland carcinoma treated to salvage surgery is acceptable. The rates of surgical complications are local and there was no post-operative mortality in this series.