O trabalho tem como proposta entrar em contato com o câncer infantil e suas conseqüências do ponto de vista da própria criança com câncer, investigando o que significa para ela estar doente e buscando conhecer o sentido de sua vivência neste momento particular de sua vida. O trabalho fundamenta-se no método de pesquisa qualitativa de inspiração fenomenológica em Psicologia. Partindo de uma questão orientadora - Como é para a criança com câncer conviver com sua doença e seu tratamento? - a fonte de investigação utilizada foram as vivências de crianças com câncer no grupo de apoio psicológico, atividade que faz parte da rotina do Serviço de Psicologia do GACC-Grupo de Apoio à Criança com Câncer. O grupo reuniu-se semanalmente durante 01 hora, em local e horário fixos, no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP. Foram utilizados materiais gráfico e lúdicos. As crianças participantes, em média 05 em cada sessão, tinham diferentes diagnósticos de câncer e encontravam-se em diferentes fases de seus tratamentos. Suas idades variaram de 03 a 16 anos. A construção dos resultados compreendeu duas etapas. Na primeira etapa, foram analisadas 30 sessões do grupo de apoio psicológico realizadas no período de abril a dezembro de 1999. Nesta etapa, o objetivo do grupo era propiciar e facilitar a livre expressão de preocupações, dúvidas e sentimentos das crianças participantes, além de proporcionar um momento no qual pudessem compartilhar suas experiências. Desta primeira etapa emergiram três dimensões de análise: os temas das sessões, o próprio grupo enquanto intervenção psicoterapêutica e a gestação da idéia de elaborar o livro das crianças. Na segunda etapa, foram analisadas 15 sessões do grupo de apoio psicológico, realizadas no período de janeiro a junho de 2000. Nesta etapa, o objetivo do grupo era a criação do livro das criança, material informativo sobre o câncer infantil elaborado coletivamente. Desta segunda etapa emergiram os temas das sessões, organizados posteriormente sob a forma do livro das crianças. Após estas duas etapas de análise, foi realizada uma síntese compreensiva da construção dos resultados sob a luz da Psicologia Fenomenológica. Nas considerações finais, foram discutidos os desdobramentos práticos dos aspectos estudados, assim como o papel da Psicologia nestes contextos assistenciais. (FAPESP) / This paper proposes to come into contact with childhood cancer and its consequences from the cancer-stricken child’s own viewpoint, and investigate what it means for the child to be ill, seeking to find out the meaning of its experience at this particular juncture of its life. This paper is based on the qualitative research method of phenomenological inspiration in Psychology. With a leading question as the starting point – What is it like for a child who has cancer to live with this illness and its treatment? – the source used for investigation were the experiences of children suffering from cancer in a psychological support group, a routine activity that is a part of the Psychology Service of the GACC – Support Group for Children with Cancer. This group met weekly for one hour, at a fixed time and place, at the Children’s Hospital of the Ribeirão Preto Medical School of the University of São Paulo (USP). Graphic and playtime materials were used. The participating children, five per session on the average, had different cancer diagnoses, and were at different stages of their treatment. Their ages ranged from 3 to16 years. Construction of results comprised two stages. In the first stage, 30 psychological support group sessions held during the period from April through December 1999 were analyzed. In this stage, the group’s objective was fostering and facilitating the free expression of concerns, doubts and feelings by the participating children, in addition to providing a time for them to share their experiences. In the second stage, 15 psychological support group sessions held during the period from January to June 2000 were analyzed. In this stage, the group’s objective was creating the Children’s Book – collectively prepared informative material on childhood cancer. Subsequently, a synthesis comprising both stages of such construction of results was carried out under the light of Phenomenological Psychology. Practical developments of the aspects studied, as well as the role of Psychology in such care contexts, were discussed in closing remarks.

O câncer colorretal é o segundo tipo que mais causa mortes no Brasil. Podem ser utilizados vários tratamentos para esses casos, tais como a quimioterapia, radioterapia e cirurgias, dentre as quais, a colostomia. Apesar de trazer sobrevida, a colostomia pode acarretar mudanças físicas e psicológicas que impactam diretamente os doentes. Pesquisas na área da Psico-oncologia são consideradas importantes nesses casos, pois estudam as dimensões psicológicas do câncer sob diferentes aspectos. Na presente dissertação, foi realizado estudo de caso instrumental com dois sujeitos cada qual se relacionando em regime de união estável com o objetivo de analisar as questões psicodinâmicas envolvidas na vivência da própria sexualidade após a colostomia. Para atingir tal objetivo, foram realizadas entrevistas semiestruturadas e o teste psicológico HTP. Os resultados foram analisados sob enfoque psicanalítico e indicaram: queda na autoestima; autoimagem corporal negativa; isolamento social e dificuldades na aceitação do uso da bolsa coletora; luto pela perda do corpo saudável; vergonha e receio de que os outros percebam sua condição de colostomizado. A dinâmica psíquica de cada entrevistado impactou a maneira de experienciar esse processo. Com personalidades e formas de enfrentamento distintas, foram encontradas diferenças na forma de lidar com seus próprios relacionamentos afetivos. A despeito dessas questões, a colostomia emergiu como a principal culpada pelo distanciamento ocorrido entre as partes, em relação a ambos os casais, embora muitos reveses já estivessem presentes na rotina conjugal antes mesmo da cirurgia. Além disso, a falta de apoio conjugal, indiferença por parte do companheiro e dificuldades na convivência colaboraram para o surgimento de barreiras entre o casal, contribuindo para a derrocada da vida sexual. Os pacientes não foram encaminhados para acompanhamento psicológico, embora considerem a psicoterapia importante. Não encontraram oportunidade em serviços públicos de saúde para dirimir dúvidas e abordar questões de ordem pessoal, conjugal ou sexual / Colorectal is the second type of cancer that causes death in Brazil. There are some kinds of treatment for this disease, including chemotherapy, radiotherapy and surgeries, such as the colostomy. Although this surgery increases survival rates, colostomy might bring physical and psychological changes which impact directly patients on this condition. Researches in the field of psycho-oncology are important on this cases, considering it comprehends psychological dimensions of cancer by differents perspectives. An instrumental study was carried out, with two participants, both living in a common-law marriage. The goal of this research was to analyze psychodynamic aspects involved on their sexual experience after colostomy. In order to accomplish this goal, semi-structured interviews were conducted as well as the application of the psychological test HTP. The results were analyzed by the psychoanalytical approach and indicated self-esteem decrease; negative self-body perception; social isolation and difficulties in accepting the use of the colostomy bag; mourning over the lost healthy body; shame and concerns about others realize they are carrying a colostomy bag. Each personal patients psycho dynamic impacted the way of dealing with this process. Having distinct personalities and coping strategies, differences were found on the way of dealing with their own relationships. Despite these questions, colostomy had emerged as the main reason for the emotional distance in the relationship, even though a lot of setbacks were already part of their daily routine before the surgery. Furthermore, lack of conjugal support, partners indifference and cohabitation adversities cooperated for the emergence of barriers between the couple and all of that contributed to decadence of sexual life. The patients were not referred to psychological support, despite considering psychotherapy important. They have not found any opportunity to dispel doubts about personal, conjugal or sexual subjects on public health care system

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2016-09-01T14:33:08Z No. of bitstreams: 1 Patrícia Danielly de Aguiar Brandão.pdf: 1775158 bytes, checksum: 94c8c0b36d3501f89f8c77d122722241 (MD5) / Made available in DSpace on 2016-09-01T14:33:09Z (GMT). No. of bitstreams: 1 Patrícia Danielly de Aguiar Brandão.pdf: 1775158 bytes, checksum: 94c8c0b36d3501f89f8c77d122722241 (MD5) Previous issue date: 2016-04-04 / The aim of this study was to describe the family caregivers of women with cancer, identifying tasks and difficulties of family caregivers and identify overload and coping strategies. This study is descriptive, exploratory and convenience sample, quantitative and qualitative methods in the analysis of the results were used. Attended by 50 family caregivers of women with cancer admitted on Women's Health Reference Center in São Paulo. For this purpose, the following instruments were used: 1) sociodemographic questionnaire; 2) Inventory Zarit Overload; 3) Scale problems coping strategies. The results of this research on family caregivers are consistent with findings in the literature that describe the caregiver as belonging predominantly to the female population, the majority of caregivers are dedicated full time to the family and are inexperienced when it comes take care of other sick people. The data suggest that there are overload on family caregivers, since assumed the role of caregiver and adopt with greater intensity the coping strategies focused on the problem. The results guide the importance of health professionals to consider sick person and the family caregiver as care unit, as this caregiver is a key player in sickening the way and is conducive to feelings such as fear and anxiety, as well as stress and overload due the care that directs the patient family. Has it that the family caregiver is a unique, sensitive figure, often overlooked and ignored, it needs care and attention to minimize the negative implications and help maximize their capabilities to face care / O objetivo deste estudo foi descrever o familiar cuidador da mulher com câncer, identificando tarefas e dificuldades do familiar cuidador, bem como identificar sobrecarga e as estratégias de enfrentamento. Estudo descritivo, exploratório e com amostra por conveniência, foram utilizados os métodos quantitativos e qualitativos na análise dos resultados. Participaram 50 familiares cuidadores de mulheres com câncer internadas no Centro de Referência da Saúde da Mulher na cidade de São Paulo. Para tal, foram utilizadas os seguintes instrumento: 1) Questionário sociodemográfico; 2) Inventário de Sobrecarga do Zarit; 3) Escala de modos de enfrentamento de problemas. Os resultados da pesquisa sobre o familiar cuidador neste estudo são coerentes com os achados pela literatura que descrevem o cuidador como pertencente, predominantemente, à população feminina, a maior parte dos cuidadores se dedicam em tempo integral ao familiar e é inexperiente ao que se refere cuidar de outras pessoas doentes. Os dados obtidos sugerem que existem sobrecarga nos familiares cuidadores desde que assumiram o papel de cuidador e adotam com maior intensidade as estratégias de enfrentamento focalizados no problema. Os resultados direcionam a importância dos profissionais da saúde em considerar s pessoa doente e o familiar cuidador como unidade de cuidado, pois este cuidador constitui uma peça fundamental no percurso do adoecimento e está propício a sentimentos como medo e angústia, além da tensão e sobrecarga devido aos cuidados que direciona ao familiar doente. Tem-se com isso que o familiar cuidador é uma figura ímpar, sensível, muitas vezes esquecido e ignorado, que necessita de cuidado e atenção para minimizar as implicações negativas e ajudar a maximizar as suas capacidades frente ao cuidar

O câncer corresponde a um grupo de doenças que têm em comum o poder de proliferar células anormais de natureza embrionária primitiva em qualquer parte do organismo. A despeito dos avanços científicos e tecnológicos que permitem um aumento nas possibilidades de cura, o câncer desencadeia repercussões psicológicas em pacientes e familiares. Neste cenário de adoecimento torna-se essencial que esses indivíduos possam ser assistidos por profissionais de saúde que os orientem e os acolham em suas necessidades específicas. Porém, a atuação permeada pelo contato com profissionais de diferentes áreas, por jornadas prolongadas de trabalho e pelo convívio frequente com imprevisibilidade, vulnerabilidade, sofrimento e perda de pacientes, pode gerar sofrimento aos profissionais, dificultando uma assistência de qualidade aos pacientes. Esse estudo teve como objetivo compreender como profissionais de saúde, de diferentes especialidades, atuantes em um serviço especializado em tratamento oncológico pediátrico, vinculado a um hospital-escola do interior do estado de São Paulo, significam suas vivências neste contexto de trabalho. Foram entrevistados oito profissionais e, mediante autorização prévia dos mesmos, as entrevistas foram gravadas e transcritas na íntegra. A compreensão dos relatos foi realizada segundo o referencial fenomenológico, que se justifica pela necessidade de chegar à experiência tal como é vivida e de aproximar dos sentidos atribuídos pelos participantes. As entrevistas foram analisadas qualitativamente conforme o método de análise da estrutura do fenômeno situado, proposto por Martins e Bicudo (1989), Giorgi (1985) e Valle (1997) e, posteriormente, foi realizada uma reflexão sobre os resultados à luz da Psicologia Fenomenológica proposta por Forghieri (2009). Os resultados mostraram que os participantes vivenciam sua atuação de forma ambivalente, marcada por satisfações e dificuldades. A satisfação aparece associada ao vínculo construído e às lições aprendidas com pacientes e familiares, ao reconhecimento recebido pelo trabalho prestado e à oportunidade de servir ao próximo. As dificuldades estão relacionadas ao contato com o sofrimento e com a morte de pacientes, ao convívio com profissionais de diferentes especialidades e à dificuldade de comunicação entre eles, essas últimas representando obstáculos a uma atuação integrada. Apesar das dificuldades, eles revelam disponibilidade e desejo de cuidar de seus pacientes, o que faz com que continuem escolhendo esse trabalho. Com intuito de lidar melhor com esse cenário, mobilizam diferentes recursos de enfrentamento, porém, ainda assim, em vários momentos, sentem-se desamparados tanto pelos colegas como pela instituição hospitalar e pela formação acadêmica. Frente aos desafios da prática, esse estudo ressalta a importância de repensar a formação em saúde, bem como a necessidade de oferta de assistência psicológica aos profissionais, como uma estratégia de cuidado ao cuidador. Destinar atenção à saúde mental dos profissionais de saúde é essencial para que eles tenham condições para adotar condutas mais humanizadas, proporcionando uma melhor qualidade da assistência aos pacientes. / Cancer corresponds to a group of diseases that have in commom the power to proliferate abnormal cells of a primitive embrio origin in any part of the organism. Despite the scientific advances which allow a raise in the chances of cure, cancer triggers psychological repercussions in patients and their families. In this scenario of illness it is tantamount that these individuals may be assisted by health professionals who guide them and cater for their specific needs. However, the acting permeated by the contact with professionals from various areas, by long working hours and by the constant idea of unpredictability, vulnerability, suffering and loss of patients might generate anguish to these professionals, making it difficult to have high quality assistance towards these patients. This study aimed at understanding how health professionals, of different areas of expertise, actively working in a job which is specific to the pediatrics oncologic treatment, linked to a university hospital in the inner area of the state of São Paulo, see the experiences they have within the scope of their work. Eight professionals were interviewed and, having the subjects previously authorized, the interviews were recorded and transcribed word by word. The comprehension of the reports was performed according to the phenomenological reference, which is justified by the need to reach the experience exactly the same way it is lived and to get closer to the senses assigned by the participants. The interviews were qualitatively analysed in accordance with the method of situated phenomenon structure analysis, proposed by Martins and Bicudo (1989), Giorgi (1985) and Valle (1997) and, later, a reflexion upon the results was carried out in light of the Phenomenological Psychology proposed by Forghieri (2009). The results showed that the participants live their acting in an ambivalent way, marked by pleasures and difficulties. The pleasures are associated with the bonding built and with the lessons learned with patients and their families, with the recognition awarded by the done service and the opportunity of helping a peer. The difficulties are related to the contact with suffering and to the death of the patients, to the living with professionals of different specialities and to the difficult communication among them, the latest representing obstacles to an integrated acting. In spite of the difficulties, they reveal availability and good will to handle the patients, which makes them keep choosing this line of work. Aiming at dealing better with this scenario, they mobilize different resources of confrontation, yet, still in numerous moments, they feel unassisted both by their co-workers and the hospital institution, as well as by the academic course. Facing the practice challenges, this paper highlights the importance of rethinking the graduation in the area of health, and also the need of offering psychological aid to the professionals as a strategy of care towards the caretaker. Paying attention to the mental health of the health professionals is essential so that they are in good shape to adopt more humanistic approaches, offering assistance of a higher quality towards these patients.

O trabalho tem como tema central o estudo teórico e a pesquisa empírica das variáveis esperança, crenças esperançosas e sentido de vida em pacientes com diagnóstico de câncer. No plano teórico, objetivou estudar a Teoria Antropológica La Espera y la Esperanza, de Laín Entralgo, procurando aplicá-la à experiência profissional em Psico-Oncologia; estabelecer uma relação teórica entre o conceito de esperança, de Laín Entralgo, e o conceito psicológico de crença; buscar um vínculo entre o conceito de esperança de Laín Entralgo e o conceito de sentido da vida de Viktor Frankl; e, desvelar a complementaridade da contribuição de Buber ao conceito de sentido de vida, de Frankl, no sentido de que a análise do encontro seria favorecedora do sentido da vida ou de uma mudança de um sentido já acolhido. No plano empírico, investigou os possíveis efeitos psicológicos e sua repercussão no estado de saúde geral do paciente oncológico, decorrente de uma intervenção psicológica fundamentada por esses princípios teóricos. Foi conduzido um estudo exploratório, de natureza qualitativa, baseado na estratégia da pesquisa-ação. Participaram, voluntariamente, quatro homens, com diagnóstico de neoplasia maligna (câncer de próstata = 2; câncer de intestino = 1; câncer de língua = 1), média de idade 62,8 (4,3) e escolaridade 6,8 (3,4). As informações foram coletadas através de entrevistas individuais semi-estruturadas, com frequência semanal e duração de 1h30. Empregou-se o Mini-Exame do Estado Mental (MEEM) para rastreio de déficit cognitivo e o Inventário Beck de Depressão (BDI) para identificação de presença de sintomatologia depressiva. O resultados obtidos no MEEM (28,31,7) revelaram ausência de declínio cognitivo. Os escores do BDI indicaram ausência de sintomas significativos de depressão. Os depoimentos dos participantes foram analisados com base no método de Análise de Conteúdo (Bardin), através da técnica de Análise Temática. Os achados indicam que: crenças esperançosas vinculam o sentido da vida à esperança; a busca de um sentido para a existência é variável importante quando se trata das condutas consequentes da esperança: passividade e atividade; o caráter complementar da contribuição de Buber ao conceito de sentido de vida de Frankl evidencia-se na convivência, em especial na relação dialógica, que se mostra favorecedora da descoberta do sentido da vida ou de uma mudança de um sentido já acolhido; os pacientes esperançosos são mais ativos sob diversos aspectos no sentido físico, psicológico e social, quando o seu estado físico assim o permite, do que aqueles que se mostram desesperançados; as pessoas esperançosas tendem a resignar-se e a encontrar alternativas psicologicamente mais saudáveis em face da doença do que aquelas que se mostram mais desesperançadas. Considerando a natureza da pesquisa, o reduzido número de participantes, usuários do SUS e sob os cuidados do mesmo médico, estes achados devem ser examinados com cautela posto que representam indícios reveladores de que exista uma relação entre crenças esperançosas e a evolução do câncer, favorecida pelo sentido da vida. / The work is focused on the theoretical and empirical research variables hope, believes hopeful and meaning of life in patients with cancer. In theory, it aimed to study the Anthropological Theory of Laín Entralgo, La Espera y la Esperanza, seeking to apply it to professional experience in Psycho-Oncology; to establish a theoretical relationship between the concept of hope, of Laín Entralgo, and the psychological concept of belief; to search for a bond between the concept of hope of Laín Entralgo and the concept meaning of life of Viktor Frankl; and unveiling the complementarity of Buber's contribution to the concept of meaning of life of Frankl, in the sense that the analysis of the encounter would be favoring the meaning of life or a change of a meaning already accepted. On the empirical level investigated the possible psychological effects and its impact on general health status of the oncologic patient, resulting from a psychological intervention based on these theoretical principles. It was conducted an exploratory study, of a qualitative nature, based on the strategy of action research. Participated voluntarily, four men with a diagnosis of malignant neoplasm (prostate cancer = 2; intestine cancer = 1; tongue cancer = 1), mean age of 62.8 (4.3) and educational level 6.8 (3 4). Information was gathered through individual semi-structured, with weekly attendance and duration of 1.5 hours. It was used the Mini Mental State Examination (MMSE) for screening cognitive impairment and the Beck Depression Inventory (BDI) for the identification of the presence of depressive symptoms. The results obtained on the MMSE (28.3 1.7) have revealed no cognitive impairment. The BDI scores indicated no significant symptoms of depression. The testimonials of the participants were examined based on the method of Contents Analysis (Bardin), using the technique of thematic analysis. The findings indicate that: believes hopeful be binding on the meaning of life to hope; the search for meaning existence is an important variable when it comes to behaviors consequential of the hope: passivity and activity; the complementary character of the contribution of Buber to the meaning in life concept of Frankl is evident in the living together, especially in the dialogical relationship, which shows favoring of the discovery of meaning of life or a change of a meaning already accepted; the hopeful patients are most active in diverse aspects in the physical sense, psychological and social, when his physical state allows it, than those who appear hopeless; the hopeful people tend to resign themselves and find alternatives psychologically more healthful in the face of the disease than those that are more hopeless. Considering the nature of the research, the limited number of participants, SUS users and under the care of the same physician, these findings should be examined with caution given that represent evidence which suggested that there is a relationship between believes hopeful and cancer evolution, favored by the meaning of life.

Essa pesquisa resultou das inquietaÃÃes provocadas por nossa prÃtica clÃnico-hospitalar com homens portadores de cÃncer peniano submetidos à amputaÃÃo cirÃrgica do pÃnis. Percebemos, quanto a isso, a existÃncia de uma dissimetria entre o discurso desses homens e aquele sustentado pela medicina e pela psico-oncologia, o qual à centrado, sobretudo, no funcionamento sexual amparado na anatomia e fisiologia. Essa nÃo-coincidÃncia nos despertou o desejo de problematizar essa questÃo em uma pesquisa de mestrado, tendo em vista as possibilidades de favorecer em nosso trabalho, junto a essa equipe, uma maior coerÃncia entre o acompanhamento desses pacientes e suas experiÃncias para com esse dano real sofrido. Nosso objetivo geral foi investigar o impacto da penectomia na sexualidade masculina; e os especÃficos, identificar possÃveis saÃdas encontradas pelo sujeito para a satisfaÃÃo pulsional na ausÃncia do pÃnis e verificar os destinos desse impacto em relaÃÃo aos pontos de ancoragem da virilidade e seus respectivos deslocamentos. Para tanto, procuramos, na medida do possÃvel, escutar esses homens a partir da tÃcnica analÃtica, abstendo-nos de dirigirmos suas falas, embora nÃo se tratasse estritamente de uma psicanÃlise. Destarte, procuramos estabelecer uma maior coerÃncia entre a nossa pesquisa e a clÃnica psicanalÃtica, espaÃo privilegiado da pesquisa psicanalÃtica no sentido que lhe à dado por Freud e Lacan. Escutamos seis sujeitos, por ocasiÃo de suas revisÃes pÃs-cirÃrgicas, oriundos do ServiÃo de Urologia do Hospital do CÃncer do Cearà â ICC, local onde se deu a nossa prÃtica para com eles. O tempo decorrido desde a cirurgia atà o encontro conosco variou de dez meses a trÃs anos, e a mÃdia de idade das pessoas atendidas foi de 60,5 anos. ApÃs cada encontro, as falas dos sujeitos foram anotadas e, posteriormente, relatadas sob a forma de vinheta clinica. Assim, mantivemo-nos fiÃis aos significantes por eles produzidos, inerentes Ãs suas subjetividades e nÃo a um saber prÃvio a elas. Quanto aos resultados obtidos, destacamos: a dissociaÃÃo entre amor e desejo presente na vida amorosa dos sujeitos pesquisados; o confronto com a tarefa de reconstruir a imagem viril, perante a mulher e os outros homens, sem o sustentÃculo imaginÃrio fornecido pela anatomia; a tendÃncia de elaborar o sem sentido da doenÃa e da cirurgia atribuindo-as ao exercÃcio da virilidade junto a outras mulheres, que nÃo a esposa; e a ausÃncia de âvida sexualâ para os que ainda possuem o coto peniano, contrariando o que preconiza o saber mÃdico quanto à capacidade de gozo sexual dos pacientes parcialmente penectomizados. ConcluÃmos que atravÃs de uma escuta psicanalÃtica foi possÃvel perceber que, no discurso desses sujeitos, a sexualidade se mostra, de certo modo, refratÃria aos modelos reabilitadores restritos à dimensÃo funcional da sexualidade e, portanto, redutÃveis ao comportamento dos mesmos quando do ato sexual. Isso evidenciou a relevÃncia de um trabalho mais abrangente para com eles, nÃo restrito a intervenÃÃes pedagÃgicas, com o intuito de fazer com que eles elaborem a perda sofrida e possam lidar de forma simbÃlica com a sua nova realidade, inclusive corporal. / This research arises from our restlessness concerning clinical and hospital-related practice involving men suffering from penile cancer who underwent surgical removal of the penis. We perceived that there was dissonance between these men‟s discourse and that one advanced by medical community and psycho-oncologists, centered mainly on sexual functioning as supported by anatomy and physiology. That discrepancy aroused our desire to tackle the issue by means of a master‟s research considering the possibilities of improving with this work a more coherent design for the follow-up of the patients and their experiences related to a serious damage sustained. Our general objective was to evaluate the impact of penectomy on male sexuality; and, as specific objectives to identify possible alternatives found by patients to fulfill the satisfaction drive in face of penile absence, and ascertain where the reflecting impact would end considering virility anchorage points. Leaning on analytical techniques, we tried to listen to these men, avoiding directing their speeches, considering that this was not psychoanalytical sessions. We tried to establish a more coherent design between our research and psychoanalytical practice, a privileged tool adopted by psychoanalytical research if one considers the meaning of this tool as developed by Freud and Lacan. We heard six subjects during their post-surgical evaluation visits, all of them referred by the Urological Service from the Cancer Hospital of the State of CearÃ, where we developed our research. The time between surgical procedure and our encounter with subjects ranged from 10 to 36 months, mean age of them being 60.5 years. After each encounter, we took notes of the subjects‟ speeches, and later presented them as a clinical sketch. Thus, we kept ourselves tuned to major issues inherent to patients‟ subjectivities and not to previous knowledge that we could have about those values. As upshots of our investigative work, we can highlight the dissociation between love and desire in the amorous lives of subjects; the struggle of them to rebuild their virile image in face of female counterpart and other men, lacking as they were the strong imaginary force provided by anatomy; the trend to elaborate on life‟s meaninglessness as a result from disease and surgery preventing them from exerting their virility in relation to other women but the wife; the absence of âsexual lifeâ for those who maintain a penile stump, thus disputing the medical knowledge that propounds existence of a capability for sexual pleasure by patients who underwent partial penectomy. We concluded that by means of a psychoanalytical hearing technique it was possible to assess from the subjects‟ discourse that sexuality presents itself to a certain extent resistant to rehabilitating models based solely on its functional dimension, and, therefore, restricted to patient behavior in relation to the sexual act. This disclosed the importance of a more extensive work with those patients without restricting itself to pedagogical interventions, but aiming at making patients elaborate on their loss and help them tackle in a symbolic way their new reality, including bodily configuration.

Despite the relatively large number of parents with cancer, relatively little is known about the extent to which having cancer affects the parenting experience. Qualitative studies have identified issues and concerns that create distress among parents with cancer, but quantitative studies have yet to be conducted. Studies demonstrate that parents with cancer experience psychological distress, and that parenting self-efficacy is related to psychological distress among parents without cancer. However, no study to date has examined the relationships between parenting self-efficacy and psychological distress among parents with cancer. This study sought to address these gaps in the literature by comparing parents with cancer to parents without cancer on measures of parenting self-efficacy and psychological distress. It was hypothesized that cancer patients would report lower parenting self-efficacy and higher levels of psychological distress than parents without cancer. This study also sought to explore whether parenting or general self-efficacy mediated the relationship between cancer status and psychological distress. A sample of 57 patients who had been diagnosed with cancer and undergone hematopoietic stem cell transplantation (HSCT), and a control group of 57 parents with no history of cancer were recruited for participation in the study. Patients were recruited during routine outpatient visits or by mail, and controls were recruited using community outreach. Medical record reviews were conducted to assess clinical variables, and participants filled out a standard demographic questionnaire as well as self-report measures of parenting self-efficacy, general self-efficacy, and psychological distress. As hypothesized, results demonstrated that parents with cancer reported less parenting self-efficacy, and more psychological distress than controls (all p-values < .05). Furthermore, findings indicated that both parenting self-efficacy and general self-efficacy mediated the relationship between cancer status and psychological distress. This study fills several gaps in the quantitative literature on parenting with cancer, and suggests that both parenting and general self-efficacy are possible targets for interventions seeking to lessen distress among parents with cancer. Future research should use matched case-control designs to examine longitudinal relationships between parenting self-efficacy and psychological distress, and empirically evaluate interventions aimed at improving parenting and general self-efficacy.

The purpose of this study was to assess fear of cancer recurrence (FCR) in breast cancer survivors returning for regularly scheduled follow-up mammograms. FCR was hypothesized to increase prior to the mammogram, decrease from immediately pre- to immediately post-mammogram, and then increase following the mammogram. Based on the cognitive-behavioral model (CBM) of health anxiety, greater perceived risk of recurrence, worse perceived consequences of a recurrence, lower coping self-efficacy, and more engagement in reassurance-seeking behaviors were hypothesized to be associated with greater FCR in each time segment. Finally, exploratory analyses evaluated the various trajectories in FCR over time using growth mixture modeling and the CBM to predict class membership. The sample comprised 161 women who completed treatment for stage 0-IIIA breast cancer between 6 and 36 months previously. Participants completed the following measures at least 31 days prior to the scheduled mammogram: perceived risk and perceived consequences of breast cancer recurrence, treatment efficacy beliefs, coping self-efficacy, and reassurance seeking behaviors. Participants reported FCR at one month, one week, and immediately prior to the mammogram as well as one month, one week, and immediately after the mammogram using visual analogue scales (VAS) to rate anxiety and worry about cancer recurrence, the Cancer Worry Scale (CWS), and the Fear of Cancer Recurrence Inventory (FCRI). State anxiety and reassurance post-mammogram were also assessed. FCR significantly changed over time with increases in CWS scores prior to the mammogram, a significant decline on the VAS observed immediately following receipt of results, and a significant increase on the VAS, and decrease in reassurance during the month following the mammogram. The CBM did not significantly predict change in FCR over time, but certain variables did predict fluctuations including coping-self efficacy and perceived risk in the expected directions. Finally, growth mixture models revealed two classes, high-FCR and low-FCR, which were predicted by the CBM. These study findings support the use of the CBM in predicting which cancer survivors experience greater FCR and indicates that CBM-driven interventions may prove beneficial for reducing distressing FCR.

Most cases of lung cancer have a commonly-understood behavioral etiology. Thus, individuals with lung cancer are often blamed for their illness by others and may therefore seek to avoid this blame by concealing their diagnosis from others. This study sought to determine the prevalence of diagnosis concealment, examine potential predictors of concealment, and test parts of a cognitive-affective-behavioral model of the effects of concealing a concealable stigma among individuals receiving treatment for lung cancer. With regard to predictors of concealment, it was hypothesized that concealment would be positively associated with male gender, introversion, and trait social anxiety and would be negatively associated with social support and the use of seeking guidance and support as a coping strategy. Hypothesized correlates of concealment included poorer self-esteem as well as greater anxiety, cancer-specific distress, and social avoidance. A sample of 117 participants receiving chemotherapy or radiation for stage I-IV non-small cell lung cancer and limited to extensive stage small cell lung cancer was recruited during routine outpatient visits. A medical chart review was conducted to assess clinical factors and participants completed a standard demographic questionnaire as well as measures of coping strategies, introversion, trait social anxiety, social avoidance, social support, anxiety, depression, cancer-specific distress, self-esteem, perceived stigma, public self-consciousness, and private self-consciousness. Results indicated that 31% of participants concealed their diagnosis from others since their diagnosis and 26% concealed their diagnosis in the month preceding their participation in the study. Hypotheses regarding predictors and correlates of concealment were not supported. However, exploratory analyses identified use of alcohol, recency of a recurrence of lung cancer, use of positive reappraisal as a coping strategy, and social support as predictors of concealment as well as internalized shame as a correlate of concealment. These findings serve to extend existing literature on concealing a concealable stigma and support parts of an existing model on the effects of concealment. Future research should aim to test the impacts of concealment in the context of certain social situations to examine longitudinal relationships between predictors and consequences of concealment.

Anxiety is a common problem for cancer patients, especially those who must receive chemotherapy. Anxiety may have a negative effect on quality of life, interrupting sleep, causing uncomfortable physical symptoms, and inhibiting sound decision-making. This study examined the relationship between spiritual well-being and anxiety in patients on chemotherapy for cancer. The convenience sample consisted of 30 patients, 15 male and 15 female, receiving chemotherapy in a two physician private medical oncology practice in Southwest Florida. Patients completed the State-Trait Anxiety Inventory and the functional Assessment of Chronic Illness Therapy-Spiritual Well- Being Scale. Participants ranged in age from 31 to 88, with a mean age of 59.7 years. Almost 60% were getting chemotherapy with the goal of slowing down the growth of Cancer (n=15) or relief of symptoms (n=2) and did not consider their cancer to be curable. Participants had been given an average of 15 chemotherapy treatments. Ninety percent were Catholic or non-Catholic Christian. Sixty percent were not heavily involved in organized religion. The results of this study show strong negative relationships between spiritual well-being and both state anxiety (r= -0.463, p=0.010) and trait anxiety (r= -0.524, p=0.003). A strong positive relationship was found between level of involvement inorganized religion and level of spiritual well-being (r= 0.545, p=0.002). Trait anxiety was also significantly negatively associated with involvement in organized religion (r= -0.38, p=0.037). Although the sample size was small and homogenous, the results support findings of previous studies. This study is important for nursing because it examines key aspects of psychological distress in cancer patients undergoing chemotherapy. Findings suggest the need for evidence-based studies focusing on designing appropriate assessment and pertinent interventions.