Trata-se de um estudo caso-controle de câncer de reto como parte do \"Estudo Epidemiológico de Câncer de Esôfago e de Reto no Município de são Paulo\". O estudo compreendeu 92 casos de cancer de reto e 200 controles categorizados em 3 sub-conjuntos (amostra pareada, global e estratificada). Foram objeto de análise as variáveis: local de nascimento do indivíduo e de seus pais, zona de nascimento (rural/urbana) consumo de alimentos (carnes, ovos, verduras, temperos) características do hábito intestinal, tabagismo e consumo de bebidas (cerveja, vinho e pinga). As estimativas dos Riscos Relativos (RR) por ponto e respectivos testes de significância foram calculados para cada tipo de amostra. Utilizou-se análise multivariada, através do procedimento de máxima verossimilhança condicional para a amostra estratificada e os procedimentos clássicos para as amostras pareada e global. A análise estatística dos resultados evidenciou associação positiva apenas entre o consumo de queijo e câncer de reto (RR = 1,41 I--------I 4,30). Não está afastada a possibilidade de que a significância encontrada seja devido a um artefato estatístico, dada a multiplicidade de testes efetuados. A possível associação entre o consumo queijo e câncer de reto, portanto, deve ser interpretada com reserva. / This is a case-control study of rectal cancer and is part of \"The Epidemiological Study of Esophagus and Rectal Cancers in the City of são Paulo, Brazil\". The study included 92 cases of rectal cancer and 200 controls (classified in three types: matched, global and stratified samples). The analised variables were: state of birth classified in great regions of Brazil, place of birth (rural/urban) ,food consumption (meats, eggs, fruits, vegetables, cereals, beans, seasonings, dairy products) caracteristics of the bowel movements, smoking habits and alcohol consumption (beer, wine and hard liquor-\"pinga\"). The point estimates of the Relative Risks and their significance tests were calculated for each type of sample. Multivariate analysis was done, for the stratified sample the conditional maximum likelihood procedure was used and classical procedures (Me Nemar and Cross Ratio estimate) for the other samples. The statistical analysis indicated a positive/association only between cheese consumption and cancer of the rectum (RR = 1,41 I------I 4,30). There is the possibility that the observed statistical significance is a statistical artefact due to the multiplicity of tests that have been perfomed. Because of this, the possible association between cheese consumption and cancer of the rectum must be viewed with caution.

This descriptive, comparative, correlational study explored the relationships among demographic characteristics, health histories, disease characteristics, body image, anxiety and depression, sexual relationship power, female sexual function, and sexual satisfaction; examined sexual self-schema as a moderator or mediator on female sexual function and sexual satisfaction; and compared the differences in female sexual function and sexual satisfaction between women with gynecological or rectal cancer and women without any cancer. Fifty-five females with gynecological or rectal cancer in the study group and 72 females without any cancer in the comparison group completed seven structured questionnaires. For females in the study group, a significant negative relationship existed between time since surgery and anxiety and depression, between the number of cancer treatments and female sexual function, and between performance status and anxiety and depression. In addition, a significant positive relationship existed between performance status and sexual relationship power and between the number of cancer treatments and sexual satisfaction. Further, body image was significantly related to anxiety and depression, sexual relationship power, sexual self-schema, and sexual satisfaction. The anxiety and depression factor was significantly linked with sexual relationship power, female sexual function, and sexual satisfaction. There was a significant negative relationship between sexual satisfaction and sexual relationship power and between sexual satisfaction and female sexual function. Also, females in the study group reported significantly worse sexual function and sexual satisfaction than females in the comparison group. A hierarchical multiple regression model accounted for 40% of the variance in female sexual function, and gynecological/rectal cancer, body image, and the interaction between sexual relationship power and sexual self-schema were three significant predictors. After controlling for gynecological/rectal cancer, body image, sexual relationship power, sexual self-schema, and the interaction term between sexual relationship power and sexual self-schema, female sexual function accounted for 17% of the variance in sexual satisfaction. In unsolicited comments, females in the study group described the changes in their sexual lives after surgery and treatments, emphasizing that sexual information should be provided promptly and effectively by health care providers. The study findings led to implications and recommendations for the conceptual framework, nursing practice, research, and education. / text

No description available.

ABSTRACT Background: People with colorectal cancer undergoing rectum amputation get a permanent colostomy, which affects the social life. It may be valuable for health care what these people experience living with colostomy in order to provide the greatest possible support. Objective: The aim of this study is to describe how people who received a colostomy experience their daily lives and the support they have received from the health services.Method: Qualitative interview study with six people, with a descriptive phenomenological approach.Results: The analysis of the interviews about how it's like to live with a colostomy resulted in three themes: 1) Living with a colostomy gives an uncertainty that affect the social life, 2) Physical and psychological impact of getting a colostomy and 3) Support for health care and relatives.Conclusion: Subjects had a positive attitude towards life, which contributed to that they could adjust to living with a colostomy and feel a meaningfulness of life. The study shows that all the interviewed people overall were satisfied with the information provided by the healthcare personnel. It was good with both oral and written information and very appreciated with repeated information. One aspect that could be improved was the information given aboute the closure of anus during surgery and the following complications. This was the most painful experience among the interviewed people. Special nurses in surgery should take more responsibility for that the information reaches the patients and also that a follow-up take place.

Purpose: To describe patient & tumor characteristics among rectal cancer patients in Nova Scotia, to determine factors associated with permanent colostomy and oncologic outcomes and to determine the relationship between surgeon knowledge and oncologic outcomes.Methods:The Provincial cancer registry identified new rectal cancer patients from in Nova Scotia. A comprehensive review of inpatient, outpatient and cancer center medical records was used to assemble the cohort. Surgeon knowledge was assessed using a survey with questions pertaining to rectal cancer care.Results: Patient & tumor characteristics were similar between hospitals providing rectal cancer care. Patients treated by high volume cancer center surgeons are less likely to undergo a permanent colostomy or have a local recurrence compared to patients treated elsewhere. Patients treated by surgeons with a high survey score have improved clinical and oncologic outcomes.Conclusions: There is an opportunity to improve rectal cancer care in Nova Scotia.

No description available.

Trata-se de um estudo caso-controle de câncer de reto como parte do \"Estudo Epidemiológico de Câncer de Esôfago e de Reto no Município de são Paulo\". O estudo compreendeu 92 casos de cancer de reto e 200 controles categorizados em 3 sub-conjuntos (amostra pareada, global e estratificada). Foram objeto de análise as variáveis: local de nascimento do indivíduo e de seus pais, zona de nascimento (rural/urbana) consumo de alimentos (carnes, ovos, verduras, temperos) características do hábito intestinal, tabagismo e consumo de bebidas (cerveja, vinho e pinga). As estimativas dos Riscos Relativos (RR) por ponto e respectivos testes de significância foram calculados para cada tipo de amostra. Utilizou-se análise multivariada, através do procedimento de máxima verossimilhança condicional para a amostra estratificada e os procedimentos clássicos para as amostras pareada e global. A análise estatística dos resultados evidenciou associação positiva apenas entre o consumo de queijo e câncer de reto (RR = 1,41 I--------I 4,30). Não está afastada a possibilidade de que a significância encontrada seja devido a um artefato estatístico, dada a multiplicidade de testes efetuados. A possível associação entre o consumo queijo e câncer de reto, portanto, deve ser interpretada com reserva. / This is a case-control study of rectal cancer and is part of \"The Epidemiological Study of Esophagus and Rectal Cancers in the City of são Paulo, Brazil\". The study included 92 cases of rectal cancer and 200 controls (classified in three types: matched, global and stratified samples). The analised variables were: state of birth classified in great regions of Brazil, place of birth (rural/urban) ,food consumption (meats, eggs, fruits, vegetables, cereals, beans, seasonings, dairy products) caracteristics of the bowel movements, smoking habits and alcohol consumption (beer, wine and hard liquor-\"pinga\"). The point estimates of the Relative Risks and their significance tests were calculated for each type of sample. Multivariate analysis was done, for the stratified sample the conditional maximum likelihood procedure was used and classical procedures (Me Nemar and Cross Ratio estimate) for the other samples. The statistical analysis indicated a positive/association only between cheese consumption and cancer of the rectum (RR = 1,41 I------I 4,30). There is the possibility that the observed statistical significance is a statistical artefact due to the multiplicity of tests that have been perfomed. Because of this, the possible association between cheese consumption and cancer of the rectum must be viewed with caution.

Management of very low rectal cancer is one of the most challenging issues faced by colorectal surgeons. For tumors in the mid and upper rectum, procedures can be done to resect the cancer while maintaining continence, a major determinant of post-operative quality of life. In the low rectum, however, to optimize oncologic outcomes, many surgeons feel compelled to pursue abdominoperineal (APR) over low anterior resection (LAR), a sphincter-preserving procedure. It was hypothesized that after robust adjustment, procedure choice will not be associated with a difference in disease-free survival in the resection of tumors in the low rectum. To analyze this, the US Rectal Cancer Collaborative Database, a comprehensive, multi-center dataset obtained from six institutions between 2010 and 2016, was queried. Patients undergoing TME resection for Stage I-III very low rectal cancers (involvement) were selected for this study. Patients were categorized by procedure- LAR vs APR. Primary outcome was five-year disease-free survival. Secondary outcomes included overall survival, recurrence, length of stay, and complications. An adjusted analysis was performed to account for all known potential confounders. 431 patients with very low rectal cancer treated by either APR or LAR were identified. 154 (35.7%) underwent APR. The overall recurrence rate was 19.6%. Median follow-up time was 42.5 months. An analysis adjusted for age, gender, BMI, ASA class, and pathologic stage observed no difference in disease free survival between operative types (HR=0.90, 95% CI [0.53-1.52], p=0.70). Similarly, secondary outcomes demonstrated no significant difference between operation types, including length of stay (Beta: 0.04, Std. error = 0.25, p = 0.54), overall survival (HR=1.29, 95% CI [0.71-2.32], p=0.39), or complications (OR = 1.53, 95% CI [0.94 - 2.50], p=0.09). In this analysis, no significant difference in disease-free survival or overall survival was observed between patients undergoing APR or LAR for very low rectal cancer. This comprehensive study supports the treatment of very low rectal cancer, less than 5cm from the anorectal ring with no sphincter involvement, by either abdominal perineal or low anterior resection. Further studies may focus on patient-reported and quality of life outcomes which may influence decision-making.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20800号 / 医博第4300号 / 新制||医||1025(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 武藤 学, 教授 福原 俊一, 教授 福田 和彦 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Background: Rectal cancer 5-year survival has increased from 58% of those diagnosed in 1987-1989 to 68% of those diagnosed in 2003-2009. Rectal cancer patients commonly receive one of two surgical treatments: permanent ostomy (a resection of tumor following by a stoma) or anastomosis (a resection followed by a reconnection with or without a prior temporary ostomy). The multifaceted consequences of both types of surgery potentially can affect both long-term psychological well-being and financial concerns of patients and their families. The overall goal of this dissertation is to increase the understanding of the impact of depression on the quality of life of rectal cancer survivors. Methods: The research data were based on a quality of life survey conducted in 2010-2011 among long-term survivors (≥ 5 years post-diagnosis) of rectal cancer. Participants were identified through the Kaiser Permanente (KP) health systems in Northern California and Southwest Washington/Oregon. Data included both the 2010/2011 survey data and KP electronic medical records (EMRs). Results: 1) The 24.7% prevalence of self-reported current depression among long-term rectal survivors was observed with a higher prevalence of 31% among those with permanent ostomies. Although average perceived financial burden level was low in this population of insured cancer survivors, 20% still reported moderate-to-high burden. Perceived financial burden was especially high among those who recalled having depression immediately after surgery and reported depression at the time of survey.2) All self-reported measures showed low sensitivity varying from 26% to 56% and high specificity from 77% to 82.7% against either diagnostic scheme from EMRs. Using either diagnostic scheme, the MCS-12 measure, a Mental Composite Summary (MCS) score from the 12-item Short-Form Health Survey with a cut-off point of≤45.6 for a self-reported depression, performed better as compared to the other two self-reported measures. 3) Approximately one in six rectal cancer survivors experienced depression after their surgery of sufficient severity to result in a depression diagnosis. Among survivors with recurrent depression diagnoses, those with a permanent ostomy reported significantly lower psychological well-being than those with an anastomosis. Conclusions: Depression burden is elevated after receiving surgery and remains a problem long after cancer diagnosis and treatment. Types of rectal cancer surgery received and gender of survivors may complicate the extent of depression burden. Among long-term rectal cancer survivors, having depression is associated with higher perceived financial burden. Chronic or recurrent course of depression may exist in this group of rectal cancer survivors and has significant impact on long-term psychological well-being. Self-reported measures for depression, such as MCS-12 measure with a cutoff point≤45.6, have the potential to be utilized for epidemiological studies when common screening instruments, electronic medical records, or administrative databases are not available. Implications: These findings underline the significance of depression assessments after surgery for this population of rectal cancer survivors and the importance of symptoms monitoring throughout the cancer survivorship continuum. Depressive symptoms should be monitored and managed as early as after cancer diagnosis and surgery to optimize survivors' long-term emotional well-being. In addition, depression screening and treatment as well as discussion of financial issues may have important roles in long-term survivorship care planning, particularly for those with permanent ostomies.