Bakgrund: Flera olika cancerbehandlingar som används idag kan leda till nedsatt reproduktionsförmåga hos både kvinnor och män. För biologiska män finns i det initiala sjukdomsskedet en tydlig rutin implementerad kring fertilitetsbevarande åtgärder. Samma rutin saknas för biologiska kvinnor och forskning visar på att information kring ämnet är bristfällig. Möjligheten att kunna bli förälder är en viktig faktor samt nära sammankopplat med kvinnlig identitet, något som visat sig gälla även dem som inte planerar att bilda familj. Syfte: Att undersöka betydelsen av information för kvinnor som ska genomgå eller har genomgått cancerbehandling och riskerar att drabbas av nedsatt reproduktionsförmåga. Metod: En kvalitativ litteraturstudie genomfördes där PubMed och Cinahl användes som databaser. Tio vetenskapliga artiklar med kvalitativ ansats som svarar mot syftet valdes till litteraturstudiens resultat. De vetenskapliga artiklarna analyserades genom kvalitativ innehållsanalys. Resultat: Informanterna upplevde att de sällan eller aldrig mottagit adekvat information om de olika cancerbehandlingarnas risker och biverkningar på fertiliteten och om vilka fertilitetsbevarande åtgärder som fanns att tillgå. Känslor som frustration och att befinna sig i ovisshet var vanligt förekommande och majoriteten av informanterna kände att deras situation inte togs på allvar. Fokus låg även på behovet av att som patient kunna fatta välgrundade beslut, vilket var omöjligt utan adekvatinformation. Konklusion: Bristen på adekvat fertilitetsrelaterad information lågofta som grund till de negativa känslor informanterna uttryckte och i många fallvar informationen bristfällig på grund av sjukvårdspersonalens bristande kunskapoch förståelse. Denna litteraturstudie önskar kunna bidra med bredare kunskap iämnet samt ökad förståelse för denna patientgrupp. / Background: Several different cancer treatments used today can lead to reducedreproductive capacity in both women and men. In the initial stage of the disease,there is a clear routine implemented around fertility preservation methods forbiological men. The same routine is lacking for biological women and researchshows that information on the subject is deficient. Having the opportunity tobecome a parent is an important factor and is closely linked to female identity,something that has proven to apply even to those who do not plan to start afamily. Aim: To investigate the importance of information for women who areundergoing cancer treatment and are at risk of impaired reproductive capacity.Method: A qualitative literature review was conducted where PubMed and Cinahlwere used as databases. Ten scientific articles with a qualitative approach thatcorresponded to the purpose were selected for the results of the literature review.The scientific articles were analyzed through qualitative content analysis. Results:The informants felt that they rarely or never received adequate information aboutthe risks and side effects of the various cancer treatments and about what fertilitypreservation methods were available. Emotions such as frustration and uncertaintywere common, and a majority of the informants felt that their situation were nottaken seriously. They also had a great disire to be able to make informeddecisions, which was impossible without adequate information. Conclusion: Thenegative feelings expressed by the informants were often based on the lack ofadquate fertility-related information. In many cases the information was deficientdue to lack of knowledge and understanding of the healthcare professionals. Thisliterature study means to contribute with broader knowledge in the subject andincreased understanding of this group of patients.

Thesis (MSc (Radiography))--Cape Peninsula University of Technology, 2018 / Background: Breast cancer is one of the most commonly diagnosed among woman in South Africa, and a more resilient effort should be focused on treatment improvements. Worldwide, proton therapy is increasingly used as a radiation treatment alternative to photon therapy for breast cancer, mostly to decrease the risk for radiation-induced cardiovascular toxicity. This in vitro study aims to determine a better understanding of the radiosensitivity of both tumour and normal breast cell lines to clinical proton irradiation. In addition, we propose to investigate whether the increase in linear energy transfer (LET) towards the distal part of the proton beam results in an increase in relative biological effectiveness (RBE) for both cell lines. Methods: Malignant (MCF-7) and non-malignant (MCF-10A) breast cells were irradiated at different water equivalent depths in a 200 MeV proton beam at NRF iThemba LABS using a custom-made Perspex phantom: the entrance plateau, 3 points on the Bragg peak, the D80% and the D40%. A cytokinesis-block Micronucleus (CBMN) assay was performed and Micronuclei (MNi) were manually counted in binucleated cells (BNCs) using fluorescent microscopy. Reference dosimetry was carried out with a Markus chamber and irradiations were performed with a clinical proton beam generated at NRF iThemba LABS that was degraded to a R50 (half-value depths) range of 120 mm, with a field size of 10 cm x 10 cm and a 50 mm SOBP. The phantom could be adjusted to accommodate different perspex plates depending on the depth required within the proton beam. Cells were then exposed to 0.5, 1.0, 2.0, 3.0 and 4.0 Gy doses for each cell line independently and for each dose point. Results and Discussion: For the CBMN results, a program was developed on Matlab platform to calculate the 95% confidence ellipse on the co-variance parameters α and β. These values were determined by fitting the linear quadratic dose response curve to the average number of radiation induced MNi per 1000 BN cells. The ellipse region around a coordinate (the average MN frequency) for both MCF-7 and MCF-10A cells at the plateau region was defined by the mean estimate of the α-value and the β-value that were plotted on the X-axis and Y-axis respectively. The ratio of the two parameters, α/β, is a measure of the impact of fractionation to determine the biological effective dose. In fractionated proton therapy, the MCF10A cells will repair less between two fractions compared to the MCF7 cells. This is not an indication of therapeutic gain from a fractioned treatment protocol. For this reason, the hypofractionated stereotactic treatment protocols that can be applied with protons could be to the befit of the breast cancer patient. The above argument is based only on the radiosensitivity of the two cell lines exposed in the plateau region. Further analysis of the 95% confidence ellipse of both cell lines also showed a clear increase of the alpha value toward the distal portion of the beam and indicates an increase in energy transfer in this region. The gradual increase in α and β parameters with depth for protons for both cells is of clinical importance, since it implicates a non-homogeneous dose within the targeted area and an unwanted high dose behind the targeted area. Distal energy modulation could be investigated especially with larger breast tumours. RBE was calculated as the ratio of the dose at the different positions to the dose at the entrance plateau position (reference) to obtain an equal level of biological effect. A statistically significant difference in radiosensitivity could be observed between malignant and non-malignant cells at all positions (p<0.05). The variation in RBE was between 0.99 to 1.99 and 0.92 to 1.6 for the MCF-7 and MCF10A cell respectively. Conclusions: There is a variation in RBE along the depth-dose profile of a clinical proton beam. In addition, there is difference in radiosensitivity between the cancerous cells and the normal breast cells. While this study highlights a variation in sensitivity between cells it could be used by the modelling community to further develop biologically motivated treatment planning for proton therapy.

Introduction: The role of positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) is currently under evaluation in urologic oncology. The aim of the present study was to investigate the use of [18F]FDG positron emission tomography ([18F]FDG-PET) in the detection and treatment control of malignant germ cell tumors compared to computed tomography (CT). Materials and Methods: Thirty-two PET studies and CT scans were carried out in 23 patients with histologically proven germ cell tumors (10 seminomas, 12 non-seminomatous germ cell tumors (NSGCT), 1 unclassified serologic recurrent disease) Lugano stage I–III. The scans were done either after initial diagnosis (n = 21) and/or within 3–45 days after chemotherapy was completed (n = 11). PET and CT were validated either by histology (n = 7) or clinical follow-up of 6–11 months after the last PET study has been performed (n = 16). Sensitivity, specificity, accuracy, positive and negative predictive values were determined for PET and CT. Differences between PET and CT for parameters of diagnostic value were evaluated by =χ2 test. Results: Although not statistically significant, the sensitivity, accuracy and negative predictive value were higher for PET than for CT with respect to the detection of metastatic infradiaphragmatic and supradiaphragmatic lesions after initial diagnosis. The specificity and positive predictive value of PET and CT were comparable. After chemotherapy, PET was found to be significantly superior in specificity and accuracy compared to CT with respect to infradiaphragmatic lesions (p < 0.05). False-positive PET findings in supradiaphragmatic lesions after chemotherapy occurred in the case of inflammatory processes and resulted in a loss of specificity and accuracy compared to CT (p < 0.05). Conclusions: These preliminary results demonstrate [18F]FDG-PET to be a useful diagnostic tool for the initial staging and treatment control in patients with germ cell tumors. Possible advantages compared to CT, however, are as yet not clearly defined. The possibility of false-positive PET findings due to reactive supradiaphragmatic inflammatory processes early after chemotherapy have to be considered. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Evidence-based guidelines are important sources of knowledge in everyday clinical practice. In 2005, the German Society for Urology decided to develop a highquality evidence-based guideline for the early detection, diagnosis and treatment of the different clinical manifestations of prostate cancer. The guideline project started in 2005 and involved 75 experts from 10 different medical societies or medical organizations including a patient organization. The guideline was issued in September 2009 and consists of 8 chapters, 170 recommendations, and 42 statements. Due to the broad spectrum of clinical questions covered by the guideline and the high number of participating organizations and authors, the organizers faced several methodological and organizational challenges. This article describes the methods used in the development of the guideline and highlights critical points and challenges in the development process. Strategies to overcome these problems are suggested which might be beneficial in the development of new evidence-based guidelines in the future. / Evidenzbasierte Leitlinien sind wichtige Quellen komprimierten Wissens für die tägliche klinische Praxis. Die Deutsche Gesellschaft für Urologie beschloss im Jahr 2005, eine qualitativ hochwertige evidenzbasierte Leitlinie zur Früherkennung, Diagnose und Behandlung der verschiedenen klinischen Manifestationen des Prostatakarzinoms zu erstellen. Das Leitlinienprojekt begann im Jahr 2005 unter Mitwirkung von 75 Experten und Patientenvertretern aus 10 verschiedenen Fachgesellschaften und Organisationen. Die Leitlinie wurde im September 2009 veröffentlicht und besteht aus 8 Kapiteln mit insgesamt 170 Empfehlungen und 42 Statements. Das breite thematische Spektrum der Leitlinie und die hohe Zahl teilnehmender Autoren und Organisationen stellten die Organisatoren vor verschiedene methodische und logistische Herausforderungen. Dieser Beitrag stellt die angewendete Methodik bei der Leitlinienerstellung dar und betont kritische Punkte und Probleme der Erstellung. Die beschriebenen Lösungsansätze können bei der Planung und Durchführung künftiger evidenzbasierter Leitlinienprojekte hilfreich sein. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Micromotors are recognized as promising candidates for untethered micromanipulation and targeted cargo transport. Their future application is, however, hindered by the low efficiency of drug encapsulation and their poor adaptability in physiological conditions. To address these challenges, one potential solution is to incorporate micromotors with biological materials as the combination of functional biological entities and smart artificial parts represents a manipulable and biologically friendly approach. This dissertation focuses on the development of custom-designed micromotors combined with sperm and their potential applications on targeted diseases treatment. By means of 2D and 3D lithography methods, microstructures with complex configurations can be fabricated for specific demands. Bovine and human sperm are both for the first time explored as drug carriers thanks to their high encapsulation efficiency of hydrophilic drugs, their powerful self-propulsion and their improved drug-uptake relying on the somatic-cell fusion ability. The hybrid micromotors containing drug loaded sperm and constructed artificial enhancements can be self-propelled by the sperm flagella and remotely guided and released to the target at high precision by employing weak external magnetic fields. As a result, micromotors based on both bovine and human sperm show significant anticancer effect. The application here can be further broadened to other biological environments, in particular to the blood stream, showing the potential on the treatment of blood diseases like blood clotting. Finally, to enhance the treatment efficiency, in particular to control sperm number and drug dose, three strategies are demonstrated to transport swarms of sperm. This research paves the way for the precision medicine based on engineered sperm-based micromotors.

Few studies focus on sexual dysfunction among young women diagnosed with breast cancer. The aim of this study was to examine prevalence of sexual dysfunction over time among this group and to identify factors associated with sexual dysfunction. The specific research questions were 1) How does sexual function in young women with breast cancer change from 1.5 years to 3 years after diagnosis? 2) What factors are associated with sexual dysfunction in young women 3 years after receiving a breast cancer diagnosis? This study investigated several biopsychosocial factors such as current cancer treatment, sexual self-efficacy (SSE), body image, emotional distress, having children and relationship status and their associations with sexual dysfunction. Sexual dysfunction was assessed with the scale PROMIS® SexFS. Participants consisted of 260 women, who responded to a survey 1,5 respectively 3 years after being diagnosed with breast cancer at age 18-39. Dependent t-test and McNemar tests wereconducted to identify differences in sexual function over time. Multiple logistic regression analysis was conducted to identify factors associated with sexual dysfunction. Results showed that sexual dysfunction remained a common problem 3 years after diagnosis. Sexual dysfunction was more common among women who did not have children, was currently undergoing treatment, reported lower SSE, and more depressive symptoms. Future research should focus on developing interventions to improve SSE in order to improve sexual function for breast cancer survivors. Clinical implications include following up sexual function through dialogue with patients and offering medical aid and treatment. / Få studier fokuserar på sexuell dysfunktion bland unga kvinnor som diagnostiserats med bröstcancer. Syftet med denna studie var att undersöka prevalensen av sexuell dysfunktion över tid hos denna grupp och identifiera faktorer associerade med sexuell dysfunktion. De specifika forskningsfrågorna var 1) Hur förändras sexuell funktion hos unga kvinnor med bröstcancer från 1,5 år till 3 år efter diagnos? 2) Vilka faktorer är associerade med sexuell dysfunktion hos unga kvinnor 3 år efter att de erhållit en bröstcancerdiagnos? Den här studien undersökte flera biopsykosociala faktorer såsom nuvarande cancerbehandling, sexuell self-efficacy (SSE), kroppsuppfattning, ångest, depression, att ha barn samt relationsstatus och deras samband med sexuell dysfunktion. Sexuell dysfunktion undersöktes med skalan PROMIS® SexFS. Deltagarna bestod av 260 kvinnor, som svarade på en enkät 1,5 respektive 3 år efter att de fått diagnosen bröstcancer i ung vuxen ålder (18-39 år). Beroende t-test och McNemar-tester genomfördes för att identifiera skillnader i sexuell funktion över tid. Multipel logistisk regressionsanalys utfördes för att identifiera faktorer associerade med sexuell dysfunktion. Resultaten visade att sexuell dysfunktion var ett fortsatt vanligt problem 3 år efter cancerdiagnosen. Sexuell dysfunktion var vanligare bland kvinnor som inte hade barn, som hade en pågående cancerbehandling, som rapporterade lägre SSE och hade mer depressiva symtom. Framtida forskning bör fokusera på att utveckla interventioner för att förbättra sexuellfunktion genom att höja SSE för bröstcancer-överlevare. Kliniska implikationer inkluderar att följa upp sexuell funktion genom dialog med patienter, samt att erbjuda medicinsk hjälp och behandling.

La presente investigación plantea como objetivo establecer la relación entre el sentido de coherencia y esperanza en mujeres con cáncer de mama en tratamiento de Lima Metropolitana. El diseño es cuantitativo de tipo correlacional porque busca establecer una correlación existente entre dos variables en una misma muestra de sujetos que se encuentran en un contexto particular (Rusu, 2011). La muestra es no probabilística de tipo intencional y está conformada por 150 mujeres con cáncer de mama en Lima Metropolitana con edades de 40 a 79 años (M = 58.69). Los instrumentos aplicados son una ficha sociodemográfica, consentimiento informado, el Cuestionario de Sentido de Coherencia y la Escala de Esperanza de Herth. Los resultados encontrados fueron una correlación significativa entre las dimensiones de comprensibilidad y agencia (r= .264; p <.05) y de manejabilidad y optimismo (r= .294; p <.05). El hallazgo presenta implicancias a nivel individual, clínico y social a las mujeres con cáncer de mama. / The present research aims to establish the relationship between the sense of coherence and hope in women with breast cancer undergoing treatment in Metropolitan Lima. The design is quantitative of the correlational type because it seeks to establish the degree of correlation between two variables in the same sample of subjects who are in a particular context (Rusu, 2011). The sample is non-probabilistic of the intentional type and is made up of 150 women with breast cancer in Metropolitan Lima, aged 40 to 79 years (M = 58.69). The instruments applied are a sociodemographic record, informed consent, the Sense of Coherence Questionnaire, and the Herth Hope Scale. The results found were a significant correlation was found between the dimensions of comprehensibility and agency (r = .264; p <.05) and of manageability and optimism (r = .294; p <.05). Therefore, there is a relationship between sense of coherence and hope in women with breast cancer undergoing treatment in Metropolitan Lima. The finding presents implications at the individual, clinical and social level for women with breast cancer. / Tesis

Background and Purpose: In 2007, the WHO classification of brain tumors was extended by three new entities of glioneuronal tumors: papillary glioneuronal tumor (PGNT), rosette-forming glioneuronal tumor of the fourth ventricle (RGNT) and glioneuronal tumor with neuropil-like islands (GNTNI). Focusing on clinical characteristics and outcome, the authors performed a comprehensive individual patient data (IPD) meta-analysis of the cases reported in literature until December 2012. Methods: PubMed, Embase and Web of Science were searched for peer-reviewed articles reporting on PGNT, RGNT, and GNTNI using predefined keywords. Results: 95 publications reported on 182 patients (PGNT, 71; GNTNI, 26; RGNT, 85). Median age at diagnosis was 23 years (range 4–75) for PGNT, 27 years (range 6–79) for RGNT, and 40 years (range 2–65) for GNTNI. Ninety-seven percent of PGNT and 69% of GNTNI were located in the supratentorial region, 23% of GNTNI were in the spinal cord, and 80% of RGNT were localized in the posterior fossa. Complete resection was reported in 52 PGNT (73%), 36 RGNT (42%), and 7 GNTNI (27%) patients. Eight PGNT, 3 RGNT, and 12 GNTNI patients were treated with chemo- and/or radiotherapy as the primary postoperative treatment. Follow-up data were available for 132 cases. After a median follow-up time of 1.5 years (range 0.2–25) across all patients, 1.5-year progression-free survival rates were 52±12% for GNTNI, 86±5% for PGNT, and 100% for RGNT. The 1.5-year overall-survival were 95±5%, 98±2%, and 100%, respectively. Conclusions: The clinical understanding of the three new entities of glioneuronal tumors, PGNT, RGNT and GNTNI, is currently emerging. The present meta-analysis will hopefully contribute to a delineation of their diagnostic, therapeutic, and prognostic profiles. However, the available data do not provide a solid basis to define the optimum treatment approach. Hence, a central register should be established.

Cancer incidence is high for aging minority and underserved populations, yet research is limited about patient-provider communications with aging racial and ethnic minority populations. Achieving high-quality cancer care is crucial to reducing health disparities for this population. However, potential shortages in professional health personnel, the cost to treat cancer, a strained health care system, and large aging populations contribute to the problem. The purpose of this qualitative study was to understand the personal experiences of aging minorities during cancer treatment decision making when communicating with their cancer care providers. Purposive sampling methods were used to recruit 10 minority women and men born between 1946 and 1964 who had experienced communicating with providers and making cancer treatment decisions. In-depth semi-structured interviews and thematic analysis of qualitative data was conducted. Important findings were barriers related to miscommunication with providers, the need for more time with the cancer doctor, and mistrust of the medical profession. Participants perceived poor interpersonal communication with providers as causing a lack of understanding regarding their cancer treatment options, which affected their decision making regarding their treatment. Barriers to communication included long wait times at public or teaching health care systems for follow up cancer care services. The findings of this study could be useful to assist health care providers in improving communication with their cancer patients, reducing cancer health disparities, and increasing the quality of cancer care for this population.

Lung cancer is a disease with a high mortality rate for the U.S. Black population. There had been considerable research done on different population demographics, necessary to achieve the Healthy People 2020 overarching goals to eliminate health disparities, gain health equity and maintain quality health. Yet, the African-born Black (AFBB) population has been understudied for nonsmall cell lung cancer (NSCLC). This study sought to determine whether within race differences in stage at diagnosis and treatment of NSCLC exists between AFBB and American-born Blacks (AMBB) populations in the United States. The study data is secondary data collected as part of the National Cancer Institute's Surveillance Epidemiologic and End Result (SEER) Program from 2004-2011. Athough no significant difference was found between AFBB (n = 119) and AMBB (n = 238) relative to NSCLC stage at diagnosis, differences in treatments were found. The proportion of AFBB patients with early stage (I and II) NSCLC who underwent surgery differed significantly from that of AMBB (p < 0.05); AFBB patients were more likely to receive surgical therapy. The proportion of AFBB patients with stages I-IV of the disease who received radiation treatment also differed significantly from that of AMBB patients (p < 0.05); the latter were more likely to receive radiation therapy. Results from logistic regression analysis indicate that AFBB patients were more likely to receive surgical treatment while AMBB patients were more likely to receive radiation treatment. This study outcome can inform other NSCLC research to provide better insights to the cause of the treatment differences within the race from differing birth places, and efficient planning, evaluation of control programs and management of the disease.