This study identifies variables that influence childhood psychosocial adjustment to cancer diagnosis and treatment by examining the illness-related factors of physical functionality, severity of illness, relapse status, and stage in treatment; family context factors of parenting stress and family psychosocial risk; and within-child factors of personal resiliency. These factors were assessed among 37 children with leukemia or lymphoma, one of their caretakers (29 mothers, 7 fathers, 1 grandmother), and one of their medical care providers (14 physicians, 22 nurse practitioners, 1 physician’s assistant) through a one-time completion of questionnaires. Results revealed that several significant associations were found between child adjustment and independent variables. Specifically, the child’s age at the time of diagnosis, the time since his/her diagnosis, his/her gender, the caregiver’s stress related to parenting an ill child, and the child’s personal resiliency were each identified as factors related to child psychosocial adjustment. Directionally, children who are diagnosed at a younger age, or who have been in treatment for a longer period of time may be at risk for psychosocial adjustment difficulties. Female gender and increased frequency and difficulty of parenting stress may also be risk factors associated with maladjustment. Personal child resiliency, as measured by presence of social and emotional strengths, can be protective in terms of preventing adjustment difficulties.

Only one third of older breast cancer survivors (BCS) meet national physical activity (PA) guidelines. Theories of self-regulation and research with older adults suggest that executive function (EF) plays an important role in PA, yet the impact of lower EF on older survivors’ PA is unknown. My project addressed this gap using secondary data from the Thinking and Living with Cancer (TLC) cohort study, which examined cognitive function among older BCS pre-treatment, followed every 12 months, and contemporaneously assessed matched controls. My first aim was to test two hypotheses regarding EF change and PA and determine if these relationships differ between BCS and controls. My hypotheses were: 1) EF decline from baseline to 12 months will predict lower PA at 24 months, and 2) lower PA at 12 months will predict EF decline from 12 to 24 months. My second aim was to explore whether the effects of EF change on PA in BCS differed based on risk factors for accelerated cognitive decline (i.e., older age, more advanced cancer stage, comorbidity, and <i>APOE</i> ε4 genotype). The TLC study measured EF with neuropsychological tests and PA with the International Physical Activity Questionnaire-Short Form. For aims 1 and 2, I used multiple regression with multiple imputation. Primary results showed no significant effect of EF change from baseline to 12 months on PA at 24 months (β=-0.01, p=0.88) and no significant group (BCS vs. controls) by EF interaction (β=-0.05, p=0.33). Separate models in BCS and controls showed similar findings. In the entire sample, PA at 12 months significantly predicted EF change from 12 to 24 months (β=0.17, p=0.01), but there was no significant group by PA interaction (β=-0.06, p=0.54). Separate analyses by group found a significant effect of PA for controls (β=0.07, p=0.02), but not for BCS (β=0.05, p=0.27). Regarding the second aim, there were no significant interactions between EF change and the proposed risk factors on PA. Findings were largely inconsistent with theory and prior research. Continued research in this area will inform future exercise interventions to improve physical and cognitive health for the growing population of older cancer survivors.

Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-04-03T16:11:04Z No. of bitstreams: 2 Djeane%20Barros pt2.pdf: 878414 bytes, checksum: bce97a1481f565376c9b1ada0cf82336 (MD5) Djeane%20Barros pt1.pdf: 126002 bytes, checksum: 281a63929302ed71915b36be955db24e (MD5) / Approved for entry into archive by Rodrigo Meirelles(rodrigomei@ufba.br) on 2013-04-09T16:06:56Z (GMT) No. of bitstreams: 2 Djeane%20Barros pt2.pdf: 878414 bytes, checksum: bce97a1481f565376c9b1ada0cf82336 (MD5) Djeane%20Barros pt1.pdf: 126002 bytes, checksum: 281a63929302ed71915b36be955db24e (MD5) / Made available in DSpace on 2013-04-09T16:06:56Z (GMT). No. of bitstreams: 2 Djeane%20Barros pt2.pdf: 878414 bytes, checksum: bce97a1481f565376c9b1ada0cf82336 (MD5) Djeane%20Barros pt1.pdf: 126002 bytes, checksum: 281a63929302ed71915b36be955db24e (MD5) Previous issue date: 2005 / Trata-se de uma investigação exploratória descritiva de caráter qualitativo que teve como objeto mulheres com câncer invasivo do colo do útero: estratégias de enfrentamento cujo objetivo foi analisar as estratégias de enfrentamento utilizadas pela mulher ao ter como diagnóstico o câncer invasivo do colo do útero. Foram traçados como objetivos específicos: identificar as modificações biopsicossociais decorrentes do câncer; descrever a experiência da mulher frente a esse diagnóstico e descrever as estratégias de enfrentamento por ela utilizada. A investigação foi desenvolvida no Ambulatório de Oncologia do Hospital de referência para o atendimento de pacientes com câncer, localizado na cidade de Itabuna-Bahia. Para a construção desse estudo, tive como suporte o referencial da Psiconcologia com ênfase nas estratégias de enfrentamento. Os sujeitos se constituíram de doze mulheres com diagnóstico de câncer invasivo do colo do útero que se encontravam em tratamento no referido hospital. A coleta de dados foi realizada através da entrevista semi-estruturada, tendo oito questões norteadoras, posteriormente agrupadas e analisadas de acordo com o referencial teórico. Com base na análise temática foram construídas duas categorias: o espaço temporal entre a busca inicial à serviços de saúde e a situação atual de saúde: revendo estratégias de enfrentamentos; as estratégias de enfrentamento da doença são influenciadas pelos contextos em que as mulheres estão inseridas. O estudo permitiu concluir que o câncer do colo do útero é diagnosticado tardiamente devido às dificuldades de acesso aos serviços de saúde como as longas filas, o atendimento rápido e a impessoalidade de alguns profissionais, as poucas consultas e a insatisfação com os serviços prestados. Concluiu-se que muitas enfrentaram o câncer buscando o apoio na família, nos amigos e na religiosidade, encontrando aí o alicerce para definir as suas estratégias. Com isso, a depender do contexto em que a mulher se encontrava inserida, a definição de estratégias de enfrentamento sofrem influências dos familiares, da religião, dos amigos, passando a ser consideradas como resultados positivos ou negativos na forma de lidar com o câncer. / Salvador

Submitted by Noeme Timbo (noeme.timbo@metodista.br) on 2017-04-24T18:37:50Z No. of bitstreams: 1 ANA LUIZA DIAS.pdf: 998026 bytes, checksum: 04c1ef7903cb5ba7c64bf646198de914 (MD5) / Made available in DSpace on 2017-04-24T18:37:50Z (GMT). No. of bitstreams: 1 ANA LUIZA DIAS.pdf: 998026 bytes, checksum: 04c1ef7903cb5ba7c64bf646198de914 (MD5) Previous issue date: 2016-03-18 / Cancer is the main pathology responsible for deaths among children and adolescents in Brazil and the estimate shows that there is a growing incidence of new cases year after year. The treatment for this chronic disease is long, painful and distressing and the possibility of death follows the patient and family all the time in this process. Besides, the health care network in many regions of our country is not prepared to provide the necessary services for this population, therefore, children and caregivers are transferred to cancer centers of reference which are often indeed far from their homes. Therefore, the objectives of this study are aimed at the description of the health beliefs of caregivers of children with cancer welcomed by support houses of São Paulo and to understand the influence that this health beliefs have on the role of caregiver. 10 women were interviewed, mostly mothers of infants aged from 04 to 13 years who were under treatment for cancer or in remission and control period. The collected data were analyzed according to the research model in "health beliefs" which assesses the impact of the diagnosis, susceptibility, severity, benefits, barriers, self-efficacy and expectations for the future according to the perception of each caregiver. The results show that from diagnosis until the last visit of the control period anguish, anxiety, insecurity and fear are present in the routine of these women and the distance of their homes, the extended family and their everyday activities is a factor that significantly aggravates the intense suffering that this experience cause. From these results it is recommended that more psychosocial care from multidisciplinary teams of support houses and health care network in order to lessen the emotional burden and reduce the psychological damage caused by cancer and their processing. It is expected that changes in this area allow families a better living with the disease and the inevitable transfer to oncology centers, as well as re-establish basic aspects of quality of life of children cancer patients caregivers. / O câncer é a principal patologia responsável por óbitos entre crianças e adolescentes do Brasil e a estimativa mostra que haverá uma crescente incidência de novos casos ano após ano. O tratamento para esta doença crônica é longo, doloroso e angustiante e a possibilidade de morte segue o paciente e a família o tempo todo neste processo. Além disso, a rede de assistência à saúde de muitas regiões do nosso país não está preparada para prestar os serviços necessários para esta população, sendo assim, crianças e acompanhantes são transferidos para centros oncológicos de referência que muitas vezes ficam deveras distantes de seus lares. Portanto, os objetivos deste estudo visam à descrição das convicções de saúde das cuidadoras de crianças com câncer acolhidas por casas de apoio da cidade de São Paulo, bem como à compreensão da influência que estas convicções de saúde exercem no papel de cuidador. Foram entrevistadas 10 mulheres, em sua grande maioria mães, de infantes com idade entre 04 e 13 anos que estavam sob o tratamento contra o câncer ou em período de remissão e controle. Os dados levantados foram analisados de acordo com o modelo de pesquisa em “convicções de saúde” que avalia o impacto do diagnóstico, a suscetibilidade, a severidade, os benefícios, as barreiras, a eficácia própria e as expectativas para futuro segundo a percepção de cada cuidador. Os resultados apontam que desde o diagnóstico até a última consulta do período de controle a angústia, a ansiedade, a insegurança e o medo estão presentes na rotina destas mulheres. Também, o distanciamento de seus lares, dos familiares e de suas atividades corriqueiras é um fator que agrava significantemente o sofrimento intenso que esta experiência causa. Diante destes resultados recomenda-se mais atenção psicossocial das equipes multidisciplinares das casas de apoio e da rede de assistência à saúde com o propósito de diminuir a carga emocional e reduzir os danos psíquicos causados pelo câncer e seu respectivo tratamento. Espera-se que mudanças neste âmbito possibilitem às famílias um melhor convívio com a doença e a inevitável transferência para outros centros de atendimento, bem como restabeleça aspectos fundamentais da qualidade de vida de cuidadores de pacientes oncológicos infantis.

Hintergrund Es existieren keine Studien zur Inanspruchnahme psychoonkologischer Angebote durch Weichteilsarkompatienten in Deutschland. Ziel war es deshalb, die Häufigkeit der Inanspruchnahme psychoonkologischer Angebote im Krankenhaus in dieser Gruppe zu ermitteln und damit assoziierte Faktoren zu untersuchen. Methode Die Kohortenstudie PROSa (Krankheitslast und Versorgungssituation bei Sarkomen) wurde zwischen 2017 und 2020 in 39 deutschen Studienzentren durchgeführt. Für die vorliegende Analyse wurden Querschnittsdaten von erwachsenen Weichteilsarkompatienten ausgewertet. Faktoren auf Patienten- wie auf Einrichtungsebene wurden als mögliche Prädiktoren der Inanspruchnahme psychoonkologischer Beratung mittels logistischer Regression in einem verallgemeinerten linearen gemischten Modell exploriert. Resultate Bei 910 teilnehmenden Patienten lagen von 576 (63,3 %) Angaben zur Inanspruchnahme vor. 212 Patienten (unter Einbeziehung der fehlenden Angaben 23,3 %, ohne diese 36,7 %) nahmen psychoonkologische Angebote in Anspruch. Negativ mit der Inanspruchnahme assoziiert waren männliches (vs. weibliches) Geschlecht (Odds Ratio [OR] 0,62) und höheres Alter (18–< 40 Jahre vs. 65–< 75 Jahre: OR 0,32; 18–< 40 Jahre vs. ≥ 75 Jahre: OR 0,19). Positiv assoziiert waren Bildungsgrad (Abitur vs. Haupt‑/Volksschulabschluss [OR 2,01]) und Grading (High-grade-Tumoren vs. „low-grade“ [OR 4,41]). Wenn Psychoonkologen am Tumorboard beteiligt waren, war die Inanspruchnahme deutlich höher (OR 6,69). Konklusion Frauen, jüngere Personen, Patienten mit höherer Bildung und fortgeschrittenem Krankheitsstadium nehmen häufiger psychoonkologische Versorgung in Anspruch. Ein struktureller Faktor für eine erhöhte Inanspruchnahme ist die Beteiligung der Psychoonkologie am Tumorboard.