Orientador: Maria Salete Costa Gurgel / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T14:40:52Z (GMT). No. of bitstreams: 1 Oliveira_MarianaMaiaFreirede_D.pdf: 2898364 bytes, checksum: ef1b9a5f4cfe0e85d9868d03f8604c22 (MD5) Previous issue date: 2012 / Resumo: Introdução: Os avanços no diagnóstico precoce e tratamento do câncer de mama resultam em longa sobrevida, acompanhada, muitas vezes, de significativa morbidade. O linfedema de membro superior (MS) ipsilateral à cirurgia apresenta incidência entre 24% e 49% e promove substancial prejuízo funcional e psicológico. Portanto, mais atenção tem sido dada às complicações físicas e ao aprimoramento das técnicas de prevenção e reabilitação. Objetivo: Avaliar o efeito dos exercícios ativos e da drenagem linfática manual (DLM) nas complicações cicatriciais, na amplitude de movimento (ADM) de ombro, na perimetria e compensações linfáticas do MS no pós-operatório de câncer de mama. Sujeitos e métodos: Ensaio clínico controlado não aleatorizado com 89 mulheres submetidas à cirurgia radical por câncer de mama, pareadas por estadiamento, idade e índice de massa corporal. No pós-operatório, 46 mulheres realizaram exercícios ativos para MS e 43 DLM durante um mês. Avaliações foram realizadas no pré-operatório e 60 dias após a cirurgia e constavam de inspeção, palpação, goniometria, perimetria e realização da linfocintilografia de MS. Neste exame foram analisadas a velocidade de ascensão e intensidade de captação do radiofármaco, além da presença de refluxo dérmico, circulação colateral e absorção hepática. Resultados: Os grupos foram semelhantes quanto às características clínicas e de tratamento. Não houve diferença significativa entre os grupos em relação à incidência de complicações cicatriciais (deiscência, infecção e seroma). A comparação entre os grupos em relação à ADM de ombro (flexão e abdução) e perimetria do MS, no pré e pós-operatórios, não apresentou diferença significativa. Sessenta dias após a cirurgia, 34,8% do grupo exercício e 48,8% do DLM apresentaram piora na velocidade de ascensão do radiofármaco, enquanto que somente 19,6% e 18,6% apresentaram melhora da velocidade, respectivamente. Em relação à intensidade de captação, 43,5% do grupo exercício e 55,8% do DLM apresentaram piora e 13% e 14% apresentaram melhora, respectivamente. A presença de refluxo dérmico e circulação colateral foi semelhante entre os grupos nos dois momentos avaliados. No grupo de exercícios houve aumento significativo da absorção hepática no pós-operatório. Conclusão: A realização de exercícios ativos ou DLM não demonstrou diferença em relação às complicações cicatriciais, à ADM de ombro e à perimetria de MS, sugerindo que exercícios e/ou DLM podem ser empregados de acordo com a experiência do profissional e com as queixas ou sintomas de cada mulher. A avaliação da função linfática pode ser feita em curto prazo, possibilitando a detecção de anomalias antes mesmo da presença de queixa ou do diagnóstico clínico de linfedema. Maior tempo de seguimento é necessário para verificar associação entre os achados da linfocintilografia e o risco de linfedema / Abstract: Introduction: Advances in the early diagnosis and treatment of breast cancer have resulted in long-term survival, which may be accompanied by significant morbidity. The incidence of lymphedema of the upper limb (UL) ipsilateral to surgery ranges from 24 to 49% and promotes substantial functional and psychological disturbance. Therefore, more attention has been devoted to the physical complications and improvement in preventive and rehabilitation techniques. Objective: To evaluate the effect of active exercise and manual lymphatic drainage (MLD) on wound healing complications, shoulder range of motion (ROM), perimetry and lymphatic compensations of the UL following breast cancer surgery. Subjects and methods: A non-randomized controlled clinical trial was conducted, based on 89 women undergoing radical breast cancer surgery, matched for staging, age and body mass index. In the postoperative period, 46 women did active exercises for the UL and 43 received MLD during one month. Assessments were carried out in the preoperative period and 60 days after surgery, including inspection, palpation, goniometry, perimetry and the performance of UL lymphoscintigraphy. This imaging technique evaluated the rate and intensity of radiopharmaceutical uptake, in addition to the presence of dermal backflow, collateral circulation and liver absorption. Results: Groups were similar in terms of clinical characteristics and treatment. There was no significant difference between groups with regards to the incidence of wound healing complications (dehiscence, infection and seroma). In the preoperative and postoperative periods, a comparison between shoulder ROM (flexion and abduction) and UL perimetry in both groups showed no significant difference. Sixty days after surgery, 34.8% of the exercise group and 48.8% of the MLD group showed a worse rate of radiopharmaceutical uptake. In contrast, only 19.6% of the exercise group and 18.6% of the MLD group showed improvement in the rate. Regarding intensity of radiotracer uptake, 43.5% in the exercise group and 55.8% in the MLD group had a worse rate. In contrast, 13% in the exercise group and 14% in the MLD group had improved rate. The presence of dermal backflow and collateral circulation was similar between groups in both time points evaluated. In the exercise group, there was a significant increase in liver absorption in the postoperative period. Conclusion: The practice of active exercise or application of MLD did not demonstrate any difference in terms of wound healing complications, shoulder ROM and UL perimetry, suggesting that exercise and/or MLD may be employed according to professional experience and complaints or symptoms of each woman. Early assessment of lymphatic function may be performed, allowing for the detection of abnormalities even before any patient complaints or clinical diagnosis of lymphedema. A longer follow-up time is required to confirm an association between lymphoscintigraphy findings and the risk of lymphedema / Doutorado / Oncologia Ginecológica e Mamária / Doutora em Ciências da Saúde

Orientador: Sophie Françoise Mauricette Derchain / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T06:55:09Z (GMT). No. of bitstreams: 1 Jales_RodrigoMenezes_D.pdf: 3030741 bytes, checksum: 80050dd730b2e28cfc892a361c511985 (MD5) Previous issue date: 2012 / Resumo: Objetivo: Avaliar a importância da ultrassonografia na predição de malignidade e sua correlação com os fenótipos Luminal, Her 2 overexpression e Triplo Negativo nos nódulos de mama classificados na categoria BI-RADS 'MARCA REGISTRADA' US 4. Objetivo Artigo 1: avaliar se a medida ultrassonográfica do diâmetro dos cistos pode contribuir com a predição de malignidade em um tipo específico de nódulos complexos classificados na categoria BI-RADS 'MARCA REGISTRADA' -US 4. Objetivo Artigo 2: avaliar as características ultrassonográficas de nódulos mamários classificados na categoria BI-RADS 'MARCA REGISTRADA' -US 4 associadas aos fenótipos Luminal, HER2 overexpression e Triplo Negativo. Sujeitos e métodos: No primeiro artigo foram incluídos em um estudo de corte transversal 48 casos de nódulos com características ultrassonográficas sugestivas de benignidade, entretanto apresentando no seu interior pelo menos um componente cístico. Todos os nódulos foram biopsiados (25 biópsias de fragmento; 23 biópsias de fragmento seguidas de biópsia excisional). O exame anatomopatológico classificou 12/48 (25%) casos como malignos. O maior diâmetro do nódulo, o maior diâmetro do cisto e o padrão de vascularização ao Doppler foram avaliados na predição de malignidade. No segundo artigo, foram selecionados em um estudo de corte transversal 327 nódulos classificados nas categorias BI-RADS 'MARCA REGISTRADA' -US 4a, 4b e 4c. Todos os nódulos foram biopsiados. Os resultados anatomopatológicos foram classificados em benigno 195 (60%) ou maligno 132 (40%). Os nódulos malignos foram então agrupados em três subtipos fenotípicos: Luminal, Her 2 overexpression e Triplo Negativo. As características ultrassonográficas dos nódulos foram comparadas com a categorização fenotípica. Resultados: no primeiro artigo, o padrão da vascularização[presente na lesão (p=1) ou presente imediatamente adjacente à lesão (p=0,46)] não esteve relacionado com a malignidade, enquanto os maiores diâmetros do nódulo e do cisto apresentaram uma relação significativa com a malignidade (p=0,02 e p<0,001, respectivamente). No segundo artigo, as subcategorias BI-RADS 'MARCA REGISTRADA'-US 4a, 4b e 4c não se relacionaram claramente aos fenótipos Luminal, Her2 overexpression ou Triplo Negativo. Entretanto, margens espiculadas, margens indistintas, halo ecogênico e reforço acústico posterior relacionaram-se significativamente com o fenótipo Luminal. Além disso, margens circunscritas e atenuação das ondas de ultrassom relacionaram-se positivamente com o fenótipo Triplo Negativo. Nenhuma característica ecográfica associou-se ao fenótipo Her2 overexpression. Conclusões: O primeiro artigo traz o conceito inédito de que o diâmetro máximo do cisto é um bom preditor de malignidade em nódulos complexos que, exceto pela presença de um ou mais cistos, seriam classificados como provavelmente benignos (BI-RADS 'MARCA REGISTRADA' -US 3). O segundo artigo está em concordância com o conhecimento atual de que existe associação entre variáveis ultrassonográficas como margens, halo ecogênico e características acústicas posteriores e os subtipos fenotípicos Luminal e Triplo Negativo. Entretanto, na amostra avaliada, essa associação não se manifestou claramente na subcategorização BI-RADS 'MARCA REGISTRADA' -US 4a, 4b e 4c / Abstract: Objective: To evaluate the importance of ultrasound in predicting malignancy and its correlation with the phenotypes Luminal, Her 2 overexpression and Triple Negative in breast masses classified as BI-RADS 'TRADE MARK' -US 4. Article 1: To assess whether cyst diameter might contribute to the prediction of malignancy in complex breast masses. Article 2: To assess the sonographic characteristics of BI-RADS 'TRADEMARK'-US 4 breast masses in the Luminal, Triple Negative and HER2 phenotypes. Methods: In the first article, in a cross-sectional study, we identified 48 breast masses that had sonographic features suggestive of benignity, but presenting at least one cystic component. All breast masses were biopsied (25 core-needle; 23 core-needle and excision). Subsequent histologic analysis was performed and 12/48 (25%) malignancies were identified. Different sonographic measurements (largest diameter of the mass and cyst, vascular pattern) were assessed for the detection of malignancy. In the second article, in a cross-sectional study, we selected 327 masses classified in subcategories BI-RADS 'TRADEMARK' -US 4a, 4b and 4c. All masses were biopsied. The pathologic results were classified as benign 195 (60%) or malignant 132 (40%). The malignant masses were further grouped into three phenotypic subtypes: Luminal, Her 2 overexpression and Triple Negative. We then compared the sonographic features of the malignant lesions according to the phenotypic status of the masses. Results: In the first article, among sonographic features, vascular pattern [(present in the lesion (p=1.0) or present immediately adjacent to the lesion (p=0.46)] was not associated with malignancy, whereas the largest mass and cyst dimension had a significantly positive correlation (p=0.02 and p<0.001, respectively) with tumor malignancy. In the second article, the subcategories BI-RADS 'TRADEMARK' -US 4a, 4b and 4c were not clearly related to the phenotypes Luminal, Her2 overexpression or Triple Negative. However, spiculated margins, indistinct margins, echogenic halo, and posterior acoustic shadowing were significantly correlated with the Luminal phenotype. Moreover, circumscribed margins and attenuation were positively related to the Triple Negative phenotype. No sonographic variable was associated with Her2 overexpression phenotype. Conclusions: The first article presents the new concept that cyst diameter is a good predictor of malignancy in complex breast tumors which, except for the presence of the anechoic formation, would otherwise be rendered as probably benign (BI-RADS 'TRADEMARK' 3). The second article is in agreement with current knowledge that there is an association between ultrasound features as margins, posterior acoustic features and lesion boundary and phenotypic subtypes Luminal and Triple Negative. In our sample, this association was not clearly expressed in the subcategorization BI-RADS 'TRADEMARK' -US 4a, 4b and 4c / Doutorado / Oncologia Ginecológica e Mamária / Doutor em Ciências da Saúde

The effect of sera from patients with metastatic breast cancer on the response of normal lymphocytes to phytohaemagglutinin (PHA) was studied. A preliminary experiment indicated that dialysis of sera against tissue culture medium RPMI-1640 revealed differences between patient and control sera which were not apparent using undialysed sera. The ability of a dialysed serum sample to support the PHA response of normal lymphocytes, as measured by 3H-thymidine incorporation, was called the serum support of lymphocyte stimulation (SSLS). Sera having an SSLS value less than 30% of the control mean in the same experiment were called inhibitory sera. Dialysed sera from a proportion of patients with metastatic breast cancer on various treatments were found to inhibit the response of normal lymphocytes to PHA compared with control sera. This effect was not due to cytotoxicity of the inhibitory sera. The SSLS of inhibitory sera remained lower than that of most controls when experimental conditions such as concentration of reagents and duration of incubation were varied. The ability of undialysed sera to support a mixed lymphocyte reaction was significantly correlated with the SSLS of the same sera when dialysed. The presence of inhibitory sera was apparently related mainly to treatment. In the earlier (Phase 1) experiments, treatment with chemotherapy or oestrogens was associated with inhibitory sera, whereas treatment with androgens or corticosteroids was associated with sera which supported PHA stimulation well. In later (Phase 2) experiments, there was a higher proportion of persons with inhibitory sera among patients receiving one or both of the newer hormonal agents, Tamoxifen and Aminoglutethimide, than among controls or untreated patients. In the phase 1 experiment, advanced disease and disease of long duration appeared to be associated with inhibitory sera, but these associations were not confirmed in Phase 2. Higher patient age in both phases and greater tumour differentiation in Phase 1 were associated with inhibitory sera, but in Phase 1, the presence of inhibitory sera was unrelated to prognosis. Prognosis and tumour differentiation were not studied in Phase 2. Lymphocytes from breast, cancer patients responded to PHA significantly less well than did control lymphocytes. However, there was no correlation between the PHA response of patients' lymphocytes and the SSLS of sera from the same patients. A low molecular weight (10,000 dalton) inhibitory substance appeared to be present in a pool of two very inhibitory patients' sera in much greater concentration than in control sera. However, no similar substance could be demonstrated in other less inhibitory sera. Measurement of several serum proteins revealed a borderline significant negative linear relationship between the serum concentration of ai-antitrypsin and the logarithm of the SSLS. Variability in the concentration of ai-antitrypsin could account for less than 10% of the variability in log SSLS. Thus, apparently more than one substance is involved in determining SSLS. / Science, Faculty of / Microbiology and Immunology, Department of / Graduate

Orientadores: Andre Deeke Sasse, Carmen Silvia Passos Lima / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T13:13:47Z (GMT). No. of bitstreams: 1 Duarte_IgorLemos_M.pdf: 729678 bytes, checksum: 3da7b8934fdc3f3c7776ad13bc0dbd2b (MD5) Previous issue date: 2015 / Resumo: Pacientes com câncer de mama localmente avançado são de alto risco para recidiva após ressecção cirúrgica com intuito curativo. Muitos estudos têm sido realizados na tentativa de se descobrir alguma intervenção adjuvante capaz de reduzir este risco. No entanto, há, na literatura atual, controvérsias no que tange a melhor estratégia terapêutica neste cenário. Discordância entre intensidade de dose e densidade de dose ainda permeiam o tema. O objetivo desta revisão sistemática foi avaliar o exato papel da quimioterapia em dose densa nas pacientes portadoras de câncer de mama local. Foram comparados os efeitos da quimioterapia em dose densa com quimioterapia convencional em pacientes com câncer de mama localizado ou loco-regionalmente avançado. Os desfechos clínicos avaliados foram sobrevida global (SG), sobrevida livre de doença (SLD) e toxicidades severas. A análise dos dados extraídos foi realizada no programa estatístico Review Manager 5.0 (RevMan 5; Cochrane Collaboration Software). As diferentes estratégias de tratamento adjuvante foram avaliadas em conjunto e separadamente. Quatro estudos (3418 pacientes) foram incluídos. A metanálise demonstrou que quimioterapia em dose densa pode melhorar a sobrevida livre de doença (3356 pacientes; HR 0,83; 95% IC 0,73-0,95; p 0,0005), independente do status de expressão hormonal. Não houve benefício em sobrevida global (3356 pacientes, HR 0,86; IC 95% 0,73-1,01; p 0,006), independente do status de receptor hormonal (SG no subgrupo hormônio positivo HR 0,94; 95% IC 0,74-1,21; SG no subgrupo hormônio negativo HR 0,78; IC 95% 0,62-0,99; p 0,28). Regimes em dose densa causaram pequeno aumento em mucosite, porem sem impacto em eventos cardíacos, leucemia ou mielodisplasia. Em conclusão, a quimioterapia adjuvante em dose densa pode melhora sobrevida livre de doença em pacientes com câncer de mama localizado com pouco impacto na segurança. Entretanto não há claro benefício em sobrevida global. Novas pesquisas podem indicar se há algum impacto em sobrevida global, não verificada atualmente em função do tamanho da amostra, e possivelmente qual grupo de pacientes teria maior benefício / Abstract: Patients with locally advanced breast cancer are at high risk for recurrence after surgical resection with curative intent. Many studies have been conducted in an attempt to discover some adjuvant intervention can reduce this risk. However, there is, in the current literature, controversies regarding the best therapeutic strategy in this scenario. Disagreement between dose intensity and dose density still permeate the theme. The aim of this systematic review was to assess the exact role of dose dense chemotherapy in patients with local breast cancer. The effects of dose dense chemotherapy with conventional chemotherapy in patients with localized breast cancer or loco-regionally advanced were compared. The clinical endpoints were overall survival (OS), disease-free survival (DFS) and severe toxicities. The extracted data was performed in Review Manager 5.0 (RevMan 5, Cochrane Collaboration Software) statistical program. The different strategies of adjuvant treatment were evaluated together and separately. Four studies (3418 patients) were included. The meta-analysis showed that dose dense chemotherapy in improvements can free survival (3356 patients, HR 0,83, 95% CI 0,73 to 0,95, p 0,0005), regardless of the status of hormone expression. There was no benefit in overall survival with chemotherapy dose dense (3356 patients, HR 0,86, 95% CI 0,73 ? 1:01, p 0,006), independent of hormone receptor status d (SG subgroup hormone positive HR 0,94, 95% CI 0,74 ? 1:21, SG in the subgroup negative hormone HR 0,78, 95% CI 0,62 ? 0.99, p 0:28). Regimes in dense dose caused small increase in mucositis, however no impact on cardiac events, leukemia or myelodysplasia. DD adjuvant chemotherapy may improve disease-free survival in patients with early breast cancer with little impact on safety. However there is no clear benefit in overall survival. New research may indicate whether there is any impact on overall survival, not currently seen as a function of sample size, and that group of patients will benefit most / Mestrado / Clinica Medica / Mestre em Clinica Medica

Bakgrund: En av de vanligaste cancerformerna i Sverige är bröstcancer där majoriteten som drabbas är kvinnor. Sjukdomsförloppet debuterar ofta genom någon typ av förändring i bröstet likt en knöl eller apelsinliknande hud. Utifrån sjukdomsbild anpassas behandlingen där de vanligaste alternativen är cytostatika samt strålning som antingen kan ges med kurativt eller palliativt ändamål. Syfte: Syftet med denna beskrivande litteraturstudie var att undersöka kvinnors erfarenheter av att leva med bröstcancer. Metod: Denna litteraturstudie utgick från tio kvalitativa artiklar som söktes fram via databasen Medline via PubMed. Sökorden som användes var erfarenheter, patient, ”brösttumörer”, liv och kvalitativ. Artiklarna analyserades enligt Evans (2002) dataanalysmetod. Huvudresultat: Utmanande biverkningar hörde till kvinnornas vardag där fatigue och smärta upplevdes jobbigast för de flesta av kvinnorna. Självbilden försämrades i samband med sjukdomen och påverkade kvinnorna både psykiskt och socialt. Stödet från anhöriga och vänner var för många kvinnor viktigt för att orka med vardagen. Slutsats: För att hantera de jobbigaste biverkningarna fatigue och smärta visade sig sjuksköterskorna ha en viktig roll för många av kvinnorna. Djupare förståelse kring kvinnornas egen syn på sin sjukdomssituation kan vara viktigt vid relationsskapande mellan sjuksköterskan och patienten vilket även kan inverka positivt på den personcentrerade vården. / Background: One of the most common forms of cancer in Sweden is breast cancer where the majority of those who has it are women. The disease progression often begins with a change in the breast, such as a lump or that the skin feels like an orange. Based on the disease progression the most common treatment alternatives are chemotherapy and radiotherapy that either can be given in curative or palliative purpose. Aim: The aim of this descriptive literature study was to examine women´s experiences of living with breast cancer. Method: This literature study was based on ten qualitative articles that were search through the Medline database PubMed. The keywords that were used was experience, patient,” breast neoplasms” life and qualitative. The articles were analyzed according to Evans (2002) analysis method. Mainresult: The challenging side effects were a part of the women´s everyday life, fatigue and pain were experienced most difficult. The women´s self-esteem got worse when they went through the disease and affected them both mentally and socially. The support from relatives and friends was important for many of the women so they could cope with their everyday life. Conclusion: To deal with the challenging fatigue and pain nurses became an important role for many women. Deeper understanding of the women´s own views on their disease could be an important task to create a deeper relationship between the nurse and the patient which also could have a positive effect on the person-centered care.

Indiana University-Purdue University Indianapolis (IUPUI) / Cognitive changes associated with cancer and its treatment have been well documented. However, the majority of research on cognitive symptoms in cancer has been conducted with early-stage breast cancer patients or survivors in remission. Little is known about cognitive symptoms in patients with late-stage or metastatic cancers. To address this gap in the literature, this study examines cognitive and related symptoms among metastatic breast cancer patients enrolled in a parent study of perceptions of symptom importance and interference. Eighty metastatic breast cancer patients were recruited from the Indiana University Simon Cancer Center to participate in this cross-sectional telephone interview study. The interview consisted of self-report measures, including measures of symptom severity, distress, and the importance of seeing improvement in specific symptoms post-treatment. I hypothesized that cognitive complaints would cluster with fatigue, sleep disturbance, depressive symptoms, anxiety, and pain. This hypothesis was tested using cluster analysis and was partially supported. Cognitive complaints were found to cluster with fatigue, sleep disturbance, depressive symptoms, and anxiety, but not pain. In addition, the extent to which ratings of symptom importance for cognitive symptoms differed from those of other symptoms (i.e., pain, fatigue, sleep problems, depressive symptoms, anxiety, nausea, lymphedema, hot flashes, and neuropathy) was explored using ANOVA and Tukey’s HSD tests. Cognitive complaints were rated as significantly more important than anxiety, depressive symptoms, neuropathy, swelling, nausea, and hot flashes. Importance ratings for cognitive complaints, pain, fatigue, and sleep problems were not significantly different. Developing patient-centered treatment approaches that take into account symptom clustering and patients’ treatment priorities may increase treatment adherence and optimize healthcare quality.

Bakgrund: Bröstcancer är den vanligaste cancersjukdomen bland kvinnor idag och var tionde kvinna drabbas någon gång av sjukdomen. Genetiska faktorer kan öka risken för att drabbas av bröstcancer. Tidig menarche och sen menopaus hör även de till riskfaktorerna. De behandlingsmetoder för bröstcancer som finns tillgängliga är kirurgisk behandling, strålbehandling, cytostatika, hormonpreparat samt annan medicinsk behandling. Indikationen för hormonell behandling är om tumörcellerna har östrogenpositiva receptorer på sin cellyta. Hormonell behandling innefattar i huvudsak Tamoxifen och aromatashämmare. Kvinnor som genomgår en behandling med hormonpreparat kan uppleva typiska biverkningar som liknar de som uppkommer vid menopausen såsom vallningar och svettningar, torra och sköra slemhinnor i underlivet, fatigue, nedsatt sexuell lust samt dysparenui (smärta vid samlag). Sexualiteten berör våra djupaste känslor och bidrar till njutning och lycka. Det sexuella behovet är individuellt men är en essentiell del i människors hälsa. Vårdpersonal måste ha kunskap om sexualitet för att kunna ge denna patientgrupp råd om hur man kan främja den sexuella hälsan under behandlingsperioden. Livskvalitet är ett individuellt fenomen. Samma sjukdom, symtom och behandling kan därför upplevas olika av olika individer. Livskvalitet beror på många faktorer, varav sexualiteten är en av dem.Syfte Syftet var att undersöka hur kvinnor som får hormonell behandling mot bröstcancer upplevde sin sexualitet. Metod: En forskningsöversikt gjordes i enlighet med Forsberg och Wengström (2008). Totalt inkluderades 14 vetenskapliga artiklar i studiens resultat. Inklusionskriterier var att artiklarna skulle vara originalartiklar samt granskade enligt Ulrich. Resultat: Resultatet visade att den hormonella behandlingen påverkade kvinnans sexualitet. Hormonpreparaten gav biverkningar i form av exempelvis dysparenui, nedsatt sexuell lust samt torra slemhinnor i vagina och detta ledde ofta till att kvinnornas sexuella aktivitet minskade. Sjuksköterskan ansåg att diskussionen om sexualitet var en del av sjuksköterskans profession. Trots detta togs ämnet inte upp i den omfattning det borde vilket delvis kan bero på okunskap och osäkerhet inom området. En försämrad sexuell hälsa bidrog även till en sämre livskvalitet hos patienterna. Slutsats: Hormonell behandling för kvinnor med bröstcancer påverkar kvinnans sexualitet i olika grad. Biverkningar av behandlingen kan leda till att kvinnan får en försämrad livskvalitet. Vårdpersonal måste ha kunskap om hur behandling och diagnos kan påverka kvinnans sexulitet. Nyckelord: Breast neoplasms, Endocrine Therapy, Sexuality, Nursing, Quality of Life

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Science in Medicine in Genetic Counselling Johannesburg, 2013 / Five to ten percent of both breast and ovarian cancer cases are attributable to dominantly inherited mutations in genes that predispose to cancer, with a large proportion caused by mutations in the breast and ovarian cancer predisposing genes BRCA1 and BRCA2. Testing for these inherited cancers is indicated for individuals identified as being at high risk, or moderate to high risk, of having a cancer syndrome based on their family history of breast and/or ovarian cancer. Screening for high-risk individuals through services such as genetic counselling, has the potential to improve outcomes for these individuals and lower mortality rates. This study focused on individuals who attended genetic counselling for breast and/or ovarian cancer at the Genetic Counselling Clinics of the Division of Human Genetics, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg from 2001 to 2010. The study was divided into a file review on 218 counsellees and a telephonic interview of 50 counsellees. Focusing on breast and/or ovarian cancer, the study aimed to review who attends genetic counselling and why; who is offered genetic testing; what testing is offered and performed and; who pays for the testing, as well as gain a better understanding of how the service is received by counsellees. The study found that the majority of counsellees are white females, at a high risk of inherited breast and/or ovarian cancer, attend the genetic counselling session alone and are self-referred. There is an under representation of the black and coloured populations and an over representation of the Ashkenazi Jewish population in the cohort. The study‟s findings showed that a main motivator for individuals attending genetic counselling was for BRCA mutation testing, with the majority of testing offered being nationally based testing. The study also demonstrated that the service is generally well received and counsellees reported having a positive experience. Overall, the study pointed to the general lack of understanding and public awareness of genetic counselling, with suggestions to market to both the general population and to other medical professionals in order to reach more high risk individuals. On a practical level, a follow up service was suggested to ensure counsellees adhered to screening measures, informing counsellees on changes to testing protocols and identifying family members who may be at an increased risk of inherited breast and/or ovarian cancer.

研究背景: 隨著乳腺癌患者存活率的不斷上升及其存活時間的不斷延長，癌病倖存已成為一個重要的慢性疾病管理問題。之前在該領域的研究主要集中於生活質量的測量。然而，癌病倖存研究應該超出這一範疇而更好地去瞭解乳腺癌倖存者的真實體驗。癌病倖存是一個新興而複雜的概念，它包含了動態的、多維的以及社會文化的觀點。但是，衛生專業人員受限於現有的知識未能為中國大陸乳腺癌患者的長期倖存做好準備。 / 研究目的: 本研究目的是從中國大陸女性的視角詳盡闡述乳腺癌倖存者的親身體驗。具體研究目標包括：1）乳腺癌倖存者的生活質量；2）與乳腺癌倖存者生活質量相關的因素；3）乳腺癌患者的倖存體驗；4）社會人口學及臨床學特徵對於乳腺癌倖存體驗的影響；5）建立一種與文化相關的概念模型用以解釋中國婦女乳腺癌患者的倖存體驗。 / 研究方法: 本研究採用混合研究方法，分兩個階段進行。先是定量法（第一階段），其次是定性法（第二階段）。第一階段是對乳腺癌倖存者其生活質量及相關因素進行橫斷性調查。測量工具包括生活質量-癌症倖存者量表及社會支持問卷簡表。該階段的調查結果將指導第二階段的目的性抽樣並建立半結構式訪談計劃。第二階段是對選定倖存者進行深入訪談以探究她們的癌症倖存體驗。採用內容分析法對訪談數據的潛在及顯性內容進行分析。然後對不同定義組中的定性數據進行比較，探索社會人口學及臨床學特徵對乳腺癌倖存體驗的影響。最後對定量和定性數據進行對比和比較，以確定並探討癌病倖存體驗的組成元素和模型開發。 / 研究結果：在完成第一階段的100位倖存者中，平均年齡為53.75 歲 (SD=7.27)，治療完成後存活時間的中位數為44 個月 (四分位範圍=23-61)。總體生活質量平均值為6.55，範圍3.68 - 8.89。在身體分量表中顯示生活質量最高值，而在靈性分量表找到其最小值。多元回歸分析表明，存活期的長短、對社會支持的滿意度以及家庭年收入與生活質量均顯著相關。 / 29位倖存者完成了第二階段的研究。結果顯示用於描述倖存經驗的七個範疇，包括：體驗令人痛苦的症狀；與不確定性進行抗爭；在女性特質及性行為上的改變；忍受社會壓力；被關照和支持；反思和個人成長；生存並向前發展。定性數據的比較顯示，對於存活時間低於5年，或者家庭年收入較低，亦或感知的生活質量較低的女性，她們傾向於報告負面的倖存經驗。通過提取定量和定性階段上主要的研究結果建立一個概念模型，用以解釋中國女性是如何理解乳腺癌倖存經驗的。它表明，乳腺癌倖存經驗在本質上是多維的。治療完成後，乳腺癌患者在生活變化上會有消極與積極的雙重性，會對生活質量評估產生影響。此外，乳腺癌倖存經驗也不是一成不變的。它是一個動態的應對過程，具有幾種策略以應對癌症導致的生活變化。 / 研究結果：本研究對中國文化背景下乳腺癌倖存經驗提供了證據。本研究全面而深入的瞭解乳腺癌患者倖存經驗，並為進一步發展測量工具以及具備文化敏感性的心理干預提供了基礎，以解決中國女性的倖存經驗的問題。 / Background: With the increasing survival rate and length of survival in breast cancer, cancer survivorship has become an important chronic illness management issue. Previous studies in this area mainly focus on appraisal of quality of life (QOL). However, cancer survivorship studies should go beyond QOL to better understand breast cancer survivor’s experience of living with the disease. Cancer survivorship appears as an emerging but complex concept incorporating dynamic, multidimensional, and socio-cultural perspectives. Little information exists addressing breast cancer survivorship experience in mainland China that impedes health professionals’ ability to deliver quality of cancer care. / Aim: To develop an understanding of breast cancer survivorship experience from the perspective of mainland Chinese women. Specific objectives included exploring 1) women’s perceived QOL; 2) factors associated with women’s QOL; 3) women’s perception of breast cancer survivorship experience; 4) the influence of socio-demographic and clinical characteristics on the women’s perception of their survivorship experience after breast cancer; and 5) to develop a culturally relevant conceptual model to explain Chinese women’s breast cancer survivorship experience. / Methods: A mixed methods study with two phases was conducted, quantitative approach (Phase One) followed by qualitative approach (Phase Two). Phase One was a cross-sectional survey on Chinese breast cancer survivors to investigate their QOL and its associating factors. Instruments included Quality of Life -- Cancer Survivor Scale and six-item Social Support Questionnaire. Findings in this phase contributed to inform the purposive sampling and develop a semi-structured interview schedule for Phase Two. In-depth interviews on selected survivors were conducted to explore their perceptions of cancer survivorship experience. Content analysis was used to analyze both latent and manifest meaning of interview data. Comparisons of qualitative data across defined groups were made to explore the influence of socio-demographic and clinical characteristics on breast cancer survivorship experience. Quantitative and qualitative data were compared and contrasted to identify and explore elements in cancer survivorship experience and model development. / Results: Among 100 survivors who completed Phase One, the mean age was 53.75 years (SD=7.27), and the median length of survivorship since completion of treatment was 44 months (IQR=23-61). The mean overall QOL was 6.55, with a range of 3.68 -8.89. The highest QOL was found in the physical subscale, and the lowest in the spiritual subscale. Multivariate regression analysis identified that length of survivorship, satisfaction with social support, annual household income were significantly associated with QOL. / Twenty-nine survivors completed Phase Two. Seven categories emerged describing the survivorship experience included experiencing distressful symptoms; struggling with uncertainty; alterations in femininity and sexuality; living with social stress; being cared for and supported; reflections and personal growth; and surviving and moving forward. Comparisons of qualitative data revealed that women with less than five years of survivorship, or low annual household income, or low perceived QOL tended to report negative survivorship experience. A conceptual model was developed by drawing the key findings of quantitative and qualitative phases to explain how Chinese women perceive the breast cancer survivorship experience. It reveals that breast cancer survivorship experience is multidimensional in nature, with a duality for the negative and positive aspects of life changes after completion of treatment, contributing to influence appraisal of QOL. Furthermore, breast cancer survivorship experience is not static but a dynamic coping process with several strategies for dealing with life changes that result from cancer. / Conclusions: The study provides evidence of several components of breast cancer survivorship within Chinese cultural context. This offers a comprehensive and insightful understanding of the experience after surviving breast cancer, and a basis for further inquiry for developing an instrument and culturally sensitive psychosocial intervention to address Chinese women’s survivorship experience. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Cheng, Huilin. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 252-283). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendixes inchludes Chinese. / Chapter CHAPTER ONE --- INTRODUCTION --- p.1 / Background of the study --- p.2 / Breast cancer incidence --- p.2 / Breast cancer diagnosis and treatments --- p.3 / Breast cancer survival --- p.5 / Cancer survivorship --- p.7 / Overview of cancer survivorship --- p.7 / Breast cancer survivorship research --- p.10 / Rationale for the study --- p.12 / Purpose of the study --- p.13 / Organization of the thesis --- p.13 / Chapter CHAPTER TWO --- LITERATURE REVIEW --- p.15 / Literature search --- p.15 / Search strategy --- p.15 / Selection criteria --- p.16 / Definition of cancer survivor --- p.17 / Concept of cancer survivorship --- p.18 / Concept of quality of life (QOL) --- p.22 / Definitions --- p.22 / Measurements --- p.25 / Generic instrument --- p.26 / Cancer-specific instrument --- p.26 / Cancer survivor-specific instrument --- p.27 / Distinctions between cancer survivorship and QOL --- p.29 / Quantitative studies on breast cancer survivorship --- p.30 / Overall QOL and QOL across different domains of breast cancer survivors --- p.30 / Overall QOL --- p.30 / Physical effect --- p.31 / Psychological effect --- p.34 / Social effect --- p.36 / Spiritual effect --- p.37 / Factors affecting the QOL of breast cancer survivors --- p.40 / Socio-demographic factors --- p.41 / Clinical factors --- p.42 / Social support --- p.47 / Ethnicity --- p.49 / Methodological critique of quantitative studies --- p.52 / Qualitative studies on breast cancer survivorship --- p.54 / Multidimensional nature of breast cancer survivorship --- p.54 / Dynamic nature of breast cancer survivorship --- p.57 / Influence of ethnicity on breast cancer survivorship --- p.60 / Methodological critique of qualitative studies --- p.62 / Mixed methods study on breast cancer survivorship --- p.63 / Summary --- p.65 / Chapter CHAPTER THREE --- METHODOLOGY --- p.67 / Study aim and objectives --- p.67 / Definitions of terms --- p.68 / An overview of mixed methods research --- p.69 / Philosophical foundation of mixed methods research --- p.71 / Research design: Sequential explanatory mixed methods --- p.72 / Overview of the selected design --- p.72 / Justification for the selected design --- p.74 / Integration of data from Phases One and Two --- p.76 / Study setting --- p.78 / Description of the Phase One study method --- p.79 / Sampling --- p.80 / Sample size --- p.80 / Sampling criteria --- p.80 / Instruments --- p.81 / Socio-demographic and clinical characteristics --- p.81 / Perceived social support --- p.81 / QOL --- p.82 / Sexual QOL --- p.85 / Willingness to participate in Phase Two --- p.86 / Data collection procedures --- p.86 / Quantitative data analysis --- p.87 / Descriptive analysis --- p.87 / Regression analysis --- p.88 / Description of the Phase Two study method --- p.88 / Sample and sampling --- p.89 / Sampling and selection criteria --- p.89 / Sample size --- p.90 / Data collection method --- p.91 / Semi-structured face-to-face interview --- p.91 / Interview schedule --- p.92 / Data collection procedure --- p.93 / Qualitative data analysis --- p.94 / Content analysis --- p.94 / Comparative analysis in qualitative research --- p.97 / Ensuring rigor of qualitative inquiry --- p.99 / Justification for using validity and reliability --- p.99 / Strategies for achieving validity --- p.100 / Strategies for achieving reliability --- p.101 / Ethical considerations --- p.101 / Pilot study --- p.102 / Pilot study of Phase One --- p.102 / Pilot study of Phase Two --- p.104 / Chapter CHAPTER FOUR --- FINDINGS FOR PHASE ONE --- p.106 / Characteristics of participants --- p.106 / Socio-demographic characteristics --- p.106 / Clinical characteristics --- p.108 / Perceived social support --- p.110 / QOL --- p.111 / Physical domain --- p.112 / Psychological domain --- p.113 / Social domain --- p.114 / Spiritual domain --- p.115 / Sexual domain --- p.116 / Factors associated with QOL --- p.117 / Differences in overall QOL and QOL domains by socio-demographic and clinical characteristics, as well as perceived social support --- p.118 / Factors associated with overall QOL and different QOL domains --- p.126 / Participants’ willingness to participate in Phase Two of the study --- p.129 / Contribution of Phase One findings to the development of Phase Two --- p.132 / Selection criteria for purposive sampling --- p.132 / Development of interview schedule --- p.134 / Summary --- p.135 / Chapter CHAPTER FIVE --- FINDINGS FOR PHASE TWO --- p.137 / Characteristics of participants --- p.137 / Categories identified from content analysis --- p.140 / Experiencing distressful symptoms --- p.142 / Memory and concentration problems --- p.142 / Lymphedema --- p.142 / Fatigue --- p.143 / Struggling with uncertainty --- p.144 / Fear of recurrence --- p.144 / Fatalism --- p.145 / Unpredictability of illness --- p.146 / Alterations in femininity and sexuality --- p.147 / Poor body image --- p.147 / Changes in sexual activity --- p.149 / Living with social stress --- p.150 / Being stigmatized --- p.150 / Financial burden --- p.151 / Being cared for and supported --- p.152 / Family members and close friends --- p.153 / Cancer self-help group --- p.154 / Workplace --- p.155 / Health professionals --- p.155 / Reflections and personal growth --- p.156 / Re-prioritizing life perspectives --- p.156 / Change in personal character --- p.157 / Gaining inner strength --- p.158 / Surviving and moving forward --- p.159 / Performing self-care --- p.159 / Attitude towards having cancer --- p.160 / Hope for the future --- p.162 / Sense of normalcy --- p.163 / Comparison of categories and subcategories by selected characteristics --- p.164 / Comparison of categories between participants with high- and low-perceived QOL --- p.164 / Comparison of categories between participants with high- and low-annual household income --- p.167 / Comparison of categories between participants with short- and long- term survivorship --- p.169 / Summary --- p.170 / Chapter CHAPTER SIX --- DISCUSSION --- p.171 / Purpose of integration --- p.171 / Convergent findings --- p.172 / Complementary findings --- p.173 / Socio-demographic background of the participants --- p.174 / Clinical characteristics of the participants --- p.176 / Women's perception of QOL --- p.178 / Women's perceived levels of overall QOL and specific domains --- p.178 / Overall QOL --- p.178 / QOL in the physical domain --- p.179 / QOL in the psychological domain --- p.180 / QOL in the social domain --- p.181 / QOL in the spiritual domain --- p.182 / QOL in the sexual domain --- p.183 / Factors associated with women’s perceived levels of QOL --- p.184 / Socio-demographic factors influencing women’s perceived QOL --- p.184 / Clinical characteristics influencing women’s perceived QOL --- p.185 / Women's perception of social support and QOL --- p.186 / Social network and support --- p.186 / Social network and QOL --- p.188 / Satisfaction with social support and QOL --- p.189 / Women's perception of the breast cancer survivorship experience --- p.190 / Symptom distress --- p.191 / Uncertainty --- p.192 / Body image --- p.194 / Sexuality --- p.196 / Cancer-related stigma --- p.197 / Financial burden --- p.198 / Meaning in life --- p.200 / Self-identity --- p.202 / Fatalism --- p.203 / Attitude towards having cancer --- p.205 / Self-care/self-management --- p.206 / Hope --- p.207 / Summary --- p.208 / Chapter CHAPTER SEVEN --- A CONCEPTUAL MODEL TO EXPLAIN CHINESE WOMEN’S BREAST CANCER SURVIVORSHP EXPEREINCE --- p.210 / Overview of the proposed conceptual model --- p.210 / Content of the conceptual model --- p.211 / Function of the conceptual model --- p.212 / Perceived negative life change --- p.218 / Symptom distress --- p.218 / Uncertainty --- p.219 / Concern about body image --- p.220 / Cancer-related stigma --- p.222 / Financial burden --- p.223 / Perceived positive life change --- p.224 / Meaning in life --- p.224 / Positive self-identity --- p.225 / Social support --- p.226 / Co-existence of perceived negative and positive life changes --- p.228 / Perceived quality of life --- p.228 / Coping --- p.229 / Fatalistic voluntarism --- p.230 / Maintaining hope --- p.231 / Positive attitude --- p.232 / Performing self-care/self-management --- p.233 / Comparison between previous theory and the present model --- p.234 / Summary --- p.238 / Chapter CHAPTER EIGHT --- CONCLUSION --- p.239 / Limitations --- p.239 / Implications for nursing practice --- p.243 / Recommendations for future research --- p.248 / Conclusion --- p.251 / REFERENCE --- p.252 / APPENDIX --- p.284

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2002. / Härtill 4 uppsatser.