Thesis (Ph. D.)--Ohio State University, 2004. / Title from first page of PDF file. Document formatted into pages; contains xi, 170 p.; also includes graphics (some col.) Includes bibliographical references (p. 158-170).

Psycho-social factors of terminal illness were explored with 36 terminally ill hospice patients. These findings were compared with staff accounts to assess whether staff held different perceptions of terminal illness from patients. The dynamic nature terminal illness was explored by re-interviewing thirteen of the original patient-staff dyads 4-6 weeks later. Psychological responses to cancer have been shown to be affected by a variety of psycho-social factors, including age, length of illness and social support. The experience of terminal illness may be different from previous stages of cancer, possibly due to the patient's realisation of the nearness of death (Yalom, 1980). Models of dying highlight the patient's perspective and social environment in the determination of the dying process. Possible communication difficulties between patient and staff and the use of 'proxy data' in clinical and research settings highlights the need to explore patient and staff perspectives more fully. A measure which described positive and negative experiences of terminal illness was developed (POTIS) and administered with the Hospital Anxiety and Depression Scale to terminally ill patients within a hospice. Staff were identified with a patient and their ratings of the patient's experience gathered. Thirteen patients/staff pairs were re-interviewed using the above procedure. Results indicated that staff rated patients as being more anxious than patient's own ratings. There was no difference between staff and patient ratings of depression. Cluster analysis was used to describe natural groups occurring within patient responses to the POTIS and patient demographic data used to describe these groups. Small sample numbers limited conclusions regarding change of perceptions over time. Issues regarding staff and patient perceptions were discussed in terms of the clinical and research use of proxy data. Possible problems with the internal reliability of measures and sample bias which occur with this population were discussed.

Thesis (Ph. D.)--University of Texas at Austin, 2004. / Supervisor: Christopher McCarthy. Vita. Includes bibliographical references. Available also from UMI company.

La presente investigación busca analizar y comparar el nivel de Inteligencia Emocional de los pacientes oncológicos según el sexo. El tipo de muestreo fue no probabilístico por juicio, seleccionando una muestra total de 80 pacientes del Instituto Nacional de Enfermedades Neoplásicas (50% mujeres y 50% hombres), sus edades oscilaban entre los 40 y 65 años. Asimismo, cumpliendo con los criterios de inclusión se evaluó a los pacientes cuyos diagnósticos fueron realizados por médicos especializados en neoplasias; y que se encontraban siguiendo algún tipo de tratamiento.Los instrumentos utilizados fueron la ficha Sociodemográfica y el Inventario de Inteligencia Emocional de Bar-On abreviado y adaptado por Ugarriza. The present research seeks to analyze and compare the level of Emotional Intelligence of oncological patients according to sex. The type of sampling was non-probabilistic   trial, selecting a total sample of 80 patients from the National Institute of Diseases Neoplastic (50% women and 50% men), their ages ranged between 40 and 65 years. Also, complying with The inclusion criteria were evaluated to patients whose diagnoses were made by doctors specialized in neoplasms; and that they were following some kind of treatment. The instruments used were the Sociodemographic tab and the Emotional Intelligence Inventory of Bar-On abbreviated and adapted by Ugarriza

Att drabbas av cancer och genomgå cytostatikabehandling kan inverka på patienters sexualitet. Sjuksköterskor bör se till patienters alla behov för att kunna ge en god omvårdnad. Syftet var att beskriva sjuksköterskors reflektioner kring ämnet sexualitet i omvårdnadsarbetet med cytostatikabehandlade vuxna patienter med cancer. Studiens metod var empirisk med deskriptiv design och kvalitativ ansats. Datainsamlingen skedde via semi-strukturerade intervjuer med sex sjuksköterskor från en onkologisk klinik i Mellansverige. I huvudresultatet presenteras två kategorier, information om sexualitet vid start av cytostatikabehandling och omständigheter som påverkade samtal om sexualitet. Sjuksköterskorna ansåg att det var deras ansvar att informera om sexualitet och att information om ämnet var betydelsefullt. Patienters intresse och behov styrde informationen, men alla patienter fick inte information om sexualitet. Anledning till detta kunde vara att sjuksköterskorna inte ville genera patienter. Sjuksköterskorna hade inte erhållit någon kunskap om sexualitet genom utbildning. Kunskapen hade sjuksköterskorna erhållit genom arbetslivserfarenhet. Slutsats, för att som sjuksköterska regelbundet kunna informera patienter om hur sexualiteten kan påverkas av cytostatikabehandling vid cancersjukdom behövs vidare kunskaper. Detta för att kunna minska den spänning som finns kring ämnet sexualitet. / To suffer from cancer and going through treatment with chemotherapy can affect patients’ sexuality. Nurses should pay regard to all needs of the patients to be able to provide good nursing care. The aim of the study was to describe the nurses’ reflections around sexuality as a part of their nursing practice, related to adult patients with cancer going through chemotherapy. The study is based on qualitative interviews with a descriptive design. The interviews were conducted through semi-structured questions and the study group consisted of six nurses who worked at an oncology clinic in the central part of Sweden. The main result showed two categories, information about sexuality at the start of chemotherapy and circumstances that could affect conversation about sexuality. The nurses considered it to be their responsibility to inform the patient about sexuality and that information was meaningful. The patient’s interest and need directed the information, but all patients’ did not get information about sexuality. A reason to this could be that the nurses did not want to embarrass the patients. The nurses had not gained any knowledge about sexuality through education. The knowledge the nurses had gained came from work experience. Conclusion, to inform patients about how their sexuality can be affected by going trough treatment with chemotherapy regularly, nurses need further knowledge. This could reduce the tension that exists around the topic sexuality.

Thesis (M.S.W.)--University of Hong Kong, 1984.

La voie de signalisation mTOR (mammalian Target Of Rapamycin) joue un rôle central dans la croissance cellulaire, le métabolisme, et l'homéostasie des lymphocytes T (LT). Lors de la transplantation d'organes, l'administration de rapamycine, un inhibiteur de mTOR (mTORi), bloque l'activation des LT et promeut la polarisation des lymphocytes T CD4 régulateur (Treg). En cancérologie, des mTORi sont utilisés pour leur action inhibitrice sur la prolifération et l'angiogenèse tumorales. Cependant l'immunosuppression via l'induction de Treg nécessaire à la prévention du rejet de greffe pourrait être délétère pour la réponse anti-tumorale. Notre hypothèse est que l'efficacité clinique des mTORi serait également dépendante de la modulation de l'immunité adaptative T induite par ces traitements chez les patients atteints de cancer.Au cours de cette thèse, nous avons abordé cette question immunologique dans une cohorte prospective de patients atteints de cancer rénal métastatique (mRCC) traités par évérolimus. L'analyse du taux de Treg et de la réponse spontanée T CD4 Thl anti-tumorale (anti-télomérase TERT) par Elispot-IFN-y a été effectuée au moment de l'inclusion des patients et tous les deux mois après le début du traitement. Nous avons observé chez la majorité des patients une augmentation du taux de Treg après traitement par évérolimus. Ces Treg expriment Hélios, suggérant un phénotype Treg naturel. La fréquence et la qualité de la réponse Thl anti-TERT sont également augmentées suite au traitement. Nous avons montré que conjointement ces deux paramètres immunologiques corrèlent avec l'efficacité clinique du traitement. Les patients présentant précocement une diminution des Treg associée à une augmentation des Thl anti-TERT ont une meilleure survie par rapport aux patients dont les paramètres immunitaires ne variaient pas, ou variaient dans une même direction (13,2 mois vs 8 et 4 mois). De plus, au moment de la progression la plupart des patients perdaient leur réponse Thl anti-TERT, et cet effet était associé à une augmentation des Treg. Les Treg traités par mTORi in vitro inhibent plus fortement la prolifération de LT allogéniques, par un mécanisme contact dépendant. Par l'utilisation d'anticorps monoclonaux déplétant les LT chez la souris et par l'utilisation de souris DEREG, nous avons montré que la présence de Treg in vivo altère l'efficacité anti-tumorale des mTORi, par un mécanisme impliquant l'inhibition des réponses T CD8 anti-tumorales. En conséquence, l'efficacité des mTORi a pu être augmentée par sa combinaison avec des agents bloquant les Treg. En addition, l'administration de temsirolimus améliore l'efficacité anti-tumorale d'un vaccin thérapeutique, en favorisant la différenciation des LT CD8 anti-tumoraux centraux mémoires (CD62L+CD127+) et précurseurs mémoires (CD127+KLRGl'°) induits par la vaccination.En conclusion, ces études ont montré pour la première fois le rôle de l'immunité T anti-tumorale sur l'efficacité clinique des mTORi et soulignent ainsi l'intérêt potentiel de combiner les mTORi avec des immunothérapies anti-tumorales / The mammalian Target of Rapamycin (mTOR) pathway plays a central role in the regulation of cell growth andmetabolism, and is involved in oncogenesis. Everolimus and temsirolimus are two mTOR inhibitors (mTORi) approvedfor renal and breast carcinoma treatments. However, accumulating evidence highlights a central role for mTOR pathwayin T cell immunity. We showed that 21 out of 23 metastatic renal cell carcinoma patients under everolimus treatmenthad an increase of Tregs atter everolimus treatment. Paradoxically, strong antitumor Th 1 responses were detected andthen greatly decreased at the time of disease progression when high expansion of Tregs occurred. Furthermore, weidentified three immune groups based on the early modulation of both Treg and anti-tumor Thl cells and found thatpatients with {low Tregs plus high anti-tumor Thl cells} showed the best survival. In vitro, mTORi-exposed Tregs highlysuppressed T cell proliferation and Thl-associated cytokines production. We showed in vivo that T cells depletiondifferentially modulated the antitumor efficacy of mTORi. Although anti-mTOR effect was loss in B16-OVA-bearingmice lacking CD8 T cells, CD4 T depletion increased mTORi efficacy. The studies conducted in mice demonstratedthat the presence of Tregs in vivo altered the responses to mTORi via a mechanism involving the inhibition of antitumorCD8 T cell responses. Finally the efficacy of mTORi was improved by combination with Tregs depleting agents andvaccines. Altogether, our results describe for the first time a dual impact of host adaptive antitumor T cell immunity onthe clinical effectiveness of mTQRi and prompt their association with immunotherapies.