Bakgrund: Bröstcancer är den vanligaste cancerformen hos kvinnor och patientgruppen bröstcanceröverlevare blir allt större till följd av moderna forskningsframsteg. Då fler kvinnor får chansen att leva ett långt liv efter sin diagnos har livskvalitet blivit ett centralt begrepp och en bibehållen livskvalitet har blivit ett viktigt mål. Forskning har visat att livskvaliteten kan påverkas av att ha överlevt bröstcancer och sjuksköterskor uttrycker svårigheter att tillgodose patientgruppens behov efter avslutad behandling. Syfte: Syftet med litteraturöversikten var att beskriva kvinnors upplevelser av livskvalitet efter att ha överlevt bröstcancer. Metod: En litteraturöversikt med deskriptiv kvalitativ design som baserats på tio kvalitativa vetenskapliga originalartiklar hämtade från PubMed och CINAHL. Resultat: Fyra kategorier med tillhörande subkategorier identifierades: fysisk påverkan, psykisk påverkan, social påverkan och personlig utveckling. Fysisk påverkan beskrev hur den sexuella hälsan, fysiska symtom samt sömn och fatigue inverkade på livskvaliteten. Psykisk påverkan beskrev hur bröstcanceröverlevares livskvalitet påverkades i förhållande till kroppsbild, känsloliv och kognitiv förmåga. Social påverkan beskrev hur livskvaliteten påverkades genom relationer, arbetsliv och ekonomi. Personlig utveckling beskrev hur bröstcanceröverlevarna till följd av upplevelsen fått nytt perspektiv och hur detta påverkade livskvaliteten.  Slutsats: Kvinnor hade olika upplevelser av livskvalitet efter att ha överlevt bröstcancer. Försämrad livskvalitet visade sig orsakas av biverkningar efter behandling och av den existentiella oron som en livshotande sjukdom kan innebära. Vissa bröstcanceröverlevare fick ett nytt perspektiv där tacksamhet, tillfredsställelse och meningsfullhet präglade upplevelsen vilket påverkade livskvaliteten positivt. Sjuksköterskans roll och hälsofrämjande insatser i förhållande till patientgruppens behov visade sig spela en central roll under rehabilitering. / Background: Breast cancer is the most common form of cancer in women and the group breast cancer survivors is growing as modern research advances. Quality of life has become a central concept and an important goal due to the fact that more women get the chance to live a long life after their diagnosis. Research has shown that quality of life can be affected by having survived breast cancer and nurses express difficulties in meeting the needs of these patients after completed treatment. Aim: The aim of the literature review was to describe women's experience of quality of life after surviving breast cancer.   Method: A literature review with descriptive qualitative design based on ten qualitative scientific original articles from PubMed and CINAHL.  Result: Four categories with associated subcategories were identified: physical impact, psychological impact, social impact and personal development. Physical impact described how sexual health, physical symptoms and fatigue affected the quality of life of breast cancer survivors. Psychological impact described how quality of life was affected by body image, emotional life and cognitive ability. Social impact described how the quality of life was affected by relationships, work life and financial position. Personal development described how breast cancer survivors gained a new perspective as a result of the experience and how this had a positive effect on their quality of life. Conclusion: Women had different experiences of quality of life after surviving breast cancer. Reduced quality of life was found to be caused by side effects after treatment and by the existential anxiety that a life-threatening disease can entail. Some breast cancer survivors obtained a new perspective of life, where gratitude, satisfaction and meaningfulness defined the experience and therefore improved their quality of life. The nurse’s role and health-promoting interventions proved to play a key role during breast cancer rehabilitation.

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Childhood cancer is a life-threatening disease with a profound impact on the family. Treatment side-effects and accompanied dietary difficulties are for example severe stressors, as appropriate nutrition is important for the treatment success and quality of life. In addition, (unhealthy) dietary patterns established in childhood tend to maintain in survivors. Parents are key players in feeding and establishing these pat-terns, though, systematic research on how parents experience these dietary difficulties is limited. This study aimed at exploring parental experiences of children’s dietary changes and difficulties during cancer treatment and after completion: what feelings do parents experience regarding their child’s dietary changes and difficulties, what feeding strategies to they apply to handle these difficulties, and how did they experience professional support and what are parental support needs. A systematic literature review was conducted and resulted in 21 suitable articles. The children were 0-21 years old, had various types of cancer, and received various types of therapy. Findings showed that parents reported many dietary changes (e.g. increase or decrease in food intake) and associated symptoms (e.g. nausea, changed tastes) during and after the cancer treatment course. Parents reported mainly negative feelings towards these dietary difficulties (e.g. distress and anxiety) and applied a wide range of behavioural feeding strategies, both negative (e.g. pressure to eat) and positive (e.g. provide healthy food) strategies. Parents also used complementary and alternative medicine. A high need for informational support regarding eating and feeding was expressed by parents during treatment, a need for emotional and practical support to a lower extent. These results showed how frequent and profound eating and feeding difficulties are in the childhood cancer and survivor population, and their (negative) impact on parents. Parents consequently need more support: they need oral and written information to set realistic expectations and install appropriate feeding strategies. This is important for the child’s nutritional status and general health both during and after cancer.

Ce travail de thèse s’est intéressé à la qualité de vie des adolescents avec un passé de cancer via les ressources maternelles. Contrairement au mal-être, désormais bien renseigné dans la littérature, on connait mal encore aujourd’hui ce qui participe à la qualité de vie des adolescents avec un passé de cancer. Dans cette perspective d’analyse, ce travail de thèse a cherché à identifier et à examiner les variables qui influent positivement sur la qualité de vie au sein des dyades mère-adolescent avec un passé de cancer, en ayant recours à une approche comparative. En plus des variables relatives à la détresse émotionnelle (stress, anxiété et dépression), plusieurs autres variables ont ainsi été explorées comme l’ajustement aux buts, le sentiment d’auto-efficacité, l’engagement dans la vie, les stratégies de coping, la perception des mères de la qualité de vie de leur enfant sur la qualité de vie des adolescents ave un passé de cancer mesurée avec le PedsQLTM (Varni, 2001). Au total, 302 participants (51 dyades mère-adolescent avec passé de cancer et 100 dyades mère-adolescent sans passé de cancer) ont répondu à un ensemble de questionnaires évaluant les variables précitées. Les résultats ont mis en évidence que les adolescents avec passé de cancer présentaient une qualité de vie satisfaisante et une détresse émotionnelle plus faible que les adolescents sans passé de cancer. Les modèles exploratoires ont permis de mettre à jour l’influence positive des stratégies de coping, de l’engagement et de l’auto-efficacité sur la qualité de vie des adolescents anciens cancéreux. Enfin, le dernier modèle exploratoire a montré l’importance de prendre en considération la perception que les mères ont de la qualité de vie de leurs enfants, pour son influence à la fois sur les ressources et la qualité de vie des adolescents avec passé de cancer, mais aussi sur la diminution de la détresse émotionnelle. La discussion a souligné une certaine autonomie de fonctionnement de la part des adolescents avec passé de cancer dans le maintien d’une qualité de vie satisfaisante pour laquelle la mère semble avoir largement contribué tout au long de la maladie / The adolescents survivors of cancer are likely to present a strong emotional distress related to their past experience of the disease, which could influence their Quality of Life (QoL). Adolescents’ mothers could also be affected in the long term by the experience of the childhood cancer, remaining constantly worried for their child, even years after the end of the treatment. Therefore, it is important to investigate the presence of resource variables which could preserve or improve adolescents quality of life. Resource variables studied in this thesis are goal adjustment, self-efficacy, life engagement, coping strategies and mothers’ perception of their children’s quality of life. This research includes a comparative analysis with mother-adolescent dyads without prior history of cancer. Participants (n=302 ; including 51 dyads mother-adolescent survivor of cancer ; 100 control dyads mother-adolescent without history of cancer) completed self-report questionnaires. Results revealed that adolescents survivors of childhood cancer presented a correct quality of life, and a lower level of emotional distress when compared to adolescents without history of cancer. The exploratory models showed the positive influence of coping strategies, life engagement and self-efficacy on adolescents survivors of cancer quality of life. Finally, our last exploratory model indicates the importance of taking into consideration mothers’ perceptions regarding their children’s quality of life, because of their influence on the adolescents survivors of cancer resources and quality of life, as well as on the reduction of emotional distress. Discussion highlights the importance to take the mother-adolescent dyad life story into account in order to understand adolescents survivors of cancer adjustment

Eudaimonic psychological well-being (PWB) refers to a lifelong process of purposeful engagement in goal-driven tasks or activities resulting in positive psychological functioning. These activities reflect autonomy, purpose in life, self-acceptance, personal growth, positive relations with others, and environmental mastery. While more women are surviving breast cancer, they face a multitude of late and long term physiopsychosocial challenges that result from being diagnosed and treated. Protective health effects associated with the experience of PWB can potentially mitigate ill-being and benefit overall health of breast cancer survivors (BCS). Adequate preparation by healthcare teams to transition them from primary treatment to early survivorship is critical for the immediate and long term PWB of BCS. The purpose of this dissertation was to: 1) summarize current literature addressing PWB among BCS; 2) describe the helpfulness of information BCS satisfied and dissatisfied receive from their healthcare team to prepare to transition into life immediately after treatment; and 3) examine relationships between PWB and factors that negatively influence BCS’ ability to successfully transition to early survivorship Three manuscripts describe results of data analysis. From a literature review, factors that correlate with PWB among BCS were identified: coping, social support, self-esteem, post-traumatic growth, religious struggles and the impact of physical symptoms. Based on qualitative responses, BCS who are satisfied and dissatisfied with information received to prepare for transition into early survivorship emphasized the importance of receiving comprehensive information on: (1) what to expect physically and emotionally post-treatment, and (2) how their lives moving forward will be unlike their lives prior to being diagnosed. Among a convenience sample of 56 BCS, significant negative relationships between PWB and a) cancer problems frequently experienced by early survivors of breast cancer, b) psychological distress, and c) satisfaction with information received to transition from primary treatment into early survivorship was noted from a prospective, cross-sectional research design study. PWB is becoming increasingly important given that BCS live longer. Information learned from this dissertation can be used by healthcare teams to promote or maintain positive psychological functioning among these survivors, focusing initially on preparing them for life immediately after treatment.

Cancer is the second leading cause of death in America. It’s been suggested that regular physical activity (PA) can improve health outcomes in cancer survivors. An estimate from BRFSS data (2009) suggested that 47% of all cancer survivors met recommended guidelines and that this estimate was not different from the population at large (48%). Several factors were examined from these BRFSS data to determine whether subgroups of survivors existed who might benefit from interventions aimed at improving their PA status. The purpose of this investigation was to obtain more recent estimates of adherence to established PA guidelines for cancer survivors. Data from 2015 NHIS were obtained from the CDC website. Of the survivors, 40% met PA guidelines. Additionally, 79% were 54 years or older, more likely to be female (60%), predominantly white (80%), with more than 2 comorbidities (41%), and with some form of functional limitation (66%). Compared to a study based on 2009 BRFSS data, an even smaller proportion of survivors met PA guidelines in this study. This might be due to differences in age distributions and no limitation of the analysis according to time since diagnosis. Targeted interventions to increase activity in cancer survivors continue to be warranted.

Bakgrund: Ungdomar och unga vuxna i åldrarna 15 till 39 år är en särskilt sårbar ålder där flertalet stora förändringar sker i livet. Att samtidigt genomgå en cancerbehandling innebär en stor påfrestning som kan ge stora följder för både den fysiska och psykiska hälsan. Ungdomar och unga vuxna som insjuknar i cancer är en växande population och som efter avslutad behandling har livet framför sig där både den fysiska och psykiska hälsan kan påverkas. Syfte: Syftet var att beskriva ungdomar och unga vuxnas psykiska hälsa efter avslutad cancerbehandling.  Metod: Metoden som valdes för denna studie var en litteraturöversikt. Totalt analyserades och sammanställdes 15 vetenskapliga artiklar. Databaserna som användes för sökningarna av vetenskapliga artiklar var Public Medline [PubMed] och Cumulate Index to Nursing and Allied Health Literature [CINAHL]. Data analyserades med hjälp av integrerad analys. Resultat: Resultatet visade att ungdomar och unga vuxna upplevde olika grader av psykisk hälsa efter avslutad cancerbehandling och att den psykiska hälsan påverkades av olika faktorer. Personlig utveckling och nya värderingar av livet var de vanligaste beskrivningarna av psykisk hälsa medan depression, ångest, posttraumatiskt stressyndrom, rädsla för återfall och komplikationer samt osäkerhet inför framtiden var vanliga tillstånd av nedsatt psykisk hälsa. Otillräcklig uppföljning, information och rehabilitering innebar en risk för nedsatt psykisk hälsa hos ungdomar och unga vuxna efter avslutad cancerbehandling.  Slutsats: Ungdomar och unga vuxna som avslutat sin cancerbehandling visade sig ha hög risk för nedsatt psykisk hälsa. Främst var det rädslan för återfall och framtida hälsoproblem som bidrog till depression och nedsatt psykisk hälsa. Ytterligare forskning krävs för att utforma rehabilitering och uppföljning som tillgodoser ungdomar och unga vuxnas specifika behov efter avslutad cancerbehandling. / Background: Adolescents and young adults, ages 15 to 39 years, is a particularly vulnerable age where multiple big changes in life happens. To undergo a cancer treatment at the same time indicates a big challenge for their health and can have big consequences on both their physical and mental health. Adolescent and young adults with a cancer diagnosis are a growing population with their life ahead of them after completion of cancer treatment but may still experience varied outcomes in physical and mental health. Aim: The aim was to describe adolescents’ and young adults’ mental health after completion of cancer treatment. Method: The design chosen for this study was a literature review. A total of 15 scientific articles were analysed and compiled. The databases used for the searches of scientific articles were Public Medline [PubMed] and Cumulate Index to Nursing and Allied Health Literature [CINAHL]. The data was analysed using an integrated analysis. Results: The result showed that adolescents and young adults experienced mental health to varying degrees and that the mental health was affected by different factors. Personal development and new values of lives was the most common descriptions of mental health while depression, anxiety, posttraumatic stress syndrome, fear of cancer recurrence and complications and uncertainty about the future was common conditions of impaired mental health. Insufficient follow-up care, information and rehabilitation implicated a risk for impaired mental health amongst adolescents and young adults after completion of cancer treatment. Conclusions: Adolescents and young adults that have completed their cancer treatment showed high risk for impaired mental health. Especially the fear of cancer recurrence and future health problems contributed to depression and psychological distress. Further research is required to design a program for aftercare and follow-up care to meet the specific needs of adolescents and young adults after completion of cancer treatment.