Introduktion Autolog stamcellstransplantation är idag en vanlig behandling vid myelom och högmaligna lymfom hos patienter <65 år utan omfattande komorbiditet. Behandlingen delas upp i fem faser: induktionsbehandling, stamcellsmobilisering, stamcellsskörd, konditionering med högdoscytostatika och stamcellsåtergivning/transplantation. Initialt behandlades alla patienter som genomgick autolog stamcellstransplantation inom slutenvården under den sista behandlingsfasen, det vill säga i samband med konditionering och stamcellsåtergivning. Sedan 1990-talet har man dock på många håll i världen övergått till poliklinisk vårdform för denna patientgrupp. Detta innebär att patienten genomgår stamcellstransplantationen inom slutenvården men efter detta behandlas som öppenvårdspatient med fasta återbesök på sin hemklinik under posttransplantfasen. Poliklinisk vårdform har visat sig vara en säker, uppskattad och kostnadseffektiv vårdform som inte medför större risker för patienten och som inte ökar mortalitet och/eller morbiditet i samband autolog stamcellstransplantation. Syfte Syftet med denna studie är att undersöka om det föreligger skillnad i grad av cytostatikarelaterat fördröjt illamående och kräkningar mellan patienter som vårdats polikliniskt jämfört med patienter som vårdats inneliggande på vårdavdelning efter autolog stamcellstransplantation. Metod Studiepopulationen utgörs av 91 patienter varav 33 vårdades polikliniskt och 58 vårdades inom slutenvården efter autolog stamcellstransplantation. Patienterna fyllde i en illamåendedagbok i samband med behandlingen varpå dessa analyserades utifrån variabler gällande cytostatikarelaterat fördröjt illamående och kräkningar. Resultat Resultatet visar att de polikliniserade patienterna mår generellt bättre än de icke- polikliniserade patienterna vad gäller cytostatikarelaterat fördröjt illamående och kräkningar. Sammanfattning Föreliggande studie indikerar ett positivt samband mellan poliklinisk vårdform och lägre incidens av cytostatikarelaterat fördröjt illamående och kräkningar hos patienter som genomgår autolog stamcellstransplantation. / Introduction Treatment for myeloma and lymphoma today typically involves autologous stem cell transplantation for patients <65 years without coexisting comorbidity. The treatment consists of five stages: induction treatment, stem cell mobilisation, stem cell harvest, conditioning with high dose chemotherapy and stem cell rescue (transplantation). Historically all patients treated with autologous stem cell transplantation received treatment as inpatients but this practice has since the 1990ies, due to for instance financial reasons, gradually shifted into an outpatient approach to this line of care. Thus, for the patient the outpatient approach entails myeloablative conditioning and stem cell transplantation as inpatient followed by post transplant care as outpatient part of the home clinic’s outpatient program. Outpatient care following autologous stem cell transplantation has proven to be a safe, highly appreciated and cost effective method of care without any adverse effects on behalf of the patients with regards to clinical outcome, mortality and/or comorbidity. Objectives The aim of this study is to ascertain whether or not there is a difference in degree of chemotherapy-induced delayed nausea and vomiting between an outpatient population and an inpatient population following autologous stem cell transplantation. Methods A total of 91 patients, 33 of whom were included in an outpatient program while remaining 58 were treated as regular inpatients, participated in the study. Patients each day filled out a diary with regards to nausea and emesis during the entire treatment phase. Submitted data was then analysed concerning parameters related to chemotherapy-induced delayed nausea and vomiting. Results The result shows that the outpatient population suffers less in general than the inpatient population in terms of chemotherapy-induced delayed nausea and vomiting. Conclusion To conclude, this study suggests a positive correlation between outpatient care following autologous stem cell transplantation and a lower incidence of chemotherapy-induced delayed nausea and vomiting.

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The word "cancer" has different meanings for different people. In general, it is synonymous with fatality, either imminent or in the forseeable future. How each person perceives and attributes meaning to this personal experience, varies according to idiosyncratic factors. These factors are constituted by each individual's unique internal make up and by external influences and it is the combination of the multiplicity of factors that bring about the personal attributions of meaning for each individual. The thesis examines the attributions of meaning of a sample of 42 women with breast cancer, through administration of a semi-structured interview and questionnaire, with follow up interviews. The theoretical concepts which are explored, examine the shift away from the traditional, Newtonian, linear-causal, neutral observer model (as in the traditional medical model), towards an ecosystemic, a-causal, contextual, holistic stance. Ecosystemic thinking is utilised in this research work, and this way of thinking is applied to the findings. In addition, a qualitative, descriptive approach is adopted, so that an in depth emphasis rather than a quantitative, empirical view of the patients in the sample, is undertaken. The applied questionaire focuses on the patient's experience of cancer diagnosis, with more specific reference to the side effects of the chemotherapy. The emphasis is towards the issue of anticipatory nausea and emesis and the possible use of hypnosis in relation to these effects. Each patient's attribution of meaning to these aspects forms the core of the thesis. The study discloses the wide variety of attributions of meaning held by different women in a similar predicament towards different aspects of that predicament. Concomitantly, the study highlights the limitations of the traditional, medical model which contribute to diminishing the personal understanding of each patient, and the impact of this on both treatment and outcome for each patient. / Psychology / D.Phil. (Psychology)

The word "cancer" has different meanings for different people. In general, it is synonymous with fatality, either imminent or in the forseeable future. How each person perceives and attributes meaning to this personal experience, varies according to idiosyncratic factors. These factors are constituted by each individual's unique internal make up and by external influences and it is the combination of the multiplicity of factors that bring about the personal attributions of meaning for each individual. The thesis examines the attributions of meaning of a sample of 42 women with breast cancer, through administration of a semi-structured interview and questionnaire, with follow up interviews. The theoretical concepts which are explored, examine the shift away from the traditional, Newtonian, linear-causal, neutral observer model (as in the traditional medical model), towards an ecosystemic, a-causal, contextual, holistic stance. Ecosystemic thinking is utilised in this research work, and this way of thinking is applied to the findings. In addition, a qualitative, descriptive approach is adopted, so that an in depth emphasis rather than a quantitative, empirical view of the patients in the sample, is undertaken. The applied questionaire focuses on the patient's experience of cancer diagnosis, with more specific reference to the side effects of the chemotherapy. The emphasis is towards the issue of anticipatory nausea and emesis and the possible use of hypnosis in relation to these effects. Each patient's attribution of meaning to these aspects forms the core of the thesis. The study discloses the wide variety of attributions of meaning held by different women in a similar predicament towards different aspects of that predicament. Concomitantly, the study highlights the limitations of the traditional, medical model which contribute to diminishing the personal understanding of each patient, and the impact of this on both treatment and outcome for each patient. / Psychology / D.Phil. (Psychology)