Gynaecological cancers (which include cancers of the ovary, cervix, uterus, vagina, endometrium, vulva and fallopian tube) account for 19% of all female cancers, and there are approximately 942,000 new cases diagnosed per year worldwide. Treatment for gynaecological cancer is often multi modal and consists of surgery, radiotherapy and chemotherapy. Current government policy has highlighted the need to focus on improving patient reported outcomes, including the patient experience of all aspects of cancer (including treatment), and the quality of life (QoL) of patients living with and beyond a cancer diagnosis. This thesis focuses on the effects of two different complementary interventions available to patients who were undergoing active treatment for gynaecological cancer at the Royal Derby Hospital between 2010 and 2012. Patient reported outcomes were explored in terms of the patients’ experience of the interventions and their reported levels of quality of life. The first study in this thesis explores the patient experience of an enhanced recovery programme (ERP) which was implemented for gynaecological cancer patients undergoing surgery at the Royal Derby Hospital in 2010. Previous research has found that ERPs (which complement traditional surgery) can decrease length of hospital stay, and they are now being implemented nationwide. However, there is a paucity of research into the patient experience of ERPs, especially in the field of gynaecological cancer. This study utilised a qualitative methodology to explore the experiences of 14 gynaecological cancer patients who took part in the ERP at Derby. Each patient was interviewed using a semi-structured format and the transcripts were analysed using Interpretative Phenomenological Analysis. The analysis highlighted that patients highly value the programme, and four main themes, fundamental to their experience, emerged from the data: taking part in the programme, the role of home, managing expectations and individual experiences outside of the programme. The second part of this thesis explores whether yoga can improve the quality of life (QoL) of patients undergoing treatment for gynaecological cancer when used as a complementary therapy. Previous research has found that participation in yoga can improve QoL in the breast cancer population, although there have been no similar studies conducted with UK gynaecological cancer patients to date. The study presented here utilised a randomised controlled design; 44 patients receiving treatment for gynaecological cancer were randomly allocated into a control group or a 10 week yoga intervention group. Outcomes were measured using the EORTC QLQ C30 questionnaire pre and post trial alongside visual analogue scales that were incorporated into a weekly diary. The results suggest that there was no significant effect of yoga on QoL, although there was encouraging data from one set of tests within the analysis, which suggested that patients on the yoga arm were seeing more improvement in QoL over time compared to the controls. Methodological improvements to clinical trials investigating complementary interventions are discussed in light of the results of this study. The overall findings of these two studies highlight that the utilisation of mixed methods is efficacious when exploring the effects of complementary interventions on the patient reported outcomes of those with gynaecological cancer. The use of qualitative methods to explore the patient experience of the ERP allowed for an in-depth, unique analysis to take place which was specific to the service delivered at The Royal Derby Hospital. The findings and recommendations from this part of the research have been incorporated into the on-going development of the pathway; it has indicated that more use of qualitative methods is needed in health services research to ensure that the patient experience is being fully explored, in line with the current government policy. Similarly, the second part of the research reported here indicates that further research in the area of yoga and gynaecological cancer is warranted. This requires a narrower focus with regards to both cancer type and point of treatment, to ensure that the number of variables is controlled. In addition, appropriate measurement and analysis techniques need to be considered (such as the generalised additive model used in this research) to preserve the richness of the data as this has not been considered (or utilised) in the many previous pieces of research in the area.

Background : Cervical cancer is the second commonest gynaecological cancer amongst women worldwide and the leading cause of cancer deaths in developing countries – contributing 83% of new cases and 85% of all deaths annually to the burden of this disease. Information and awareness of this illness in the developing world is still inferior, and mortality is increasing. In the developing world, late presentation, advanced-stage disease and a poorly run screening programme (covering only 55% of the South African population) are all contributing factors to this statistic. Approximately 20% of all South African women in their reproductive age are also HIV positive. With the rising burden of cervical cancer and the emergence of HIV as an influencing comorbidity, South Africa adopted a national cervical screening programme, rolled out in 2000 as well as an HCT (HIV counselling and testing) programme formalised in 2011. With these initiatives now in place, this study examined trends and compared 5-year survival outcomes between two decades for cervical cancer among young women. Methods : The study undertook a retrospective audit of files and information on the pre-existing cervical cancer database, and appropriate data was extracted (HREC REF 344/2011). Survival and disease outcomes at five years, as well as time to recurrence, was assessed, together with other demographics of the study population. Patients included in the study were non-pregnant female patients, aged 40 years and younger at the time of registration with the Groote Schuur Hospital (GSH) Oncology Unit (LE 33). The diagnosis of cervical cancer had to have been confirmed histologically, as either squamous cell carcinoma or adenosquamous carcinoma or adenocarcinoma. Patients must have attended at the LE 33 unit on or from 1 January 1993 until and including 31 December 2012. The two decades were studied and 5-year outcomes from each decade were analysed and reviewed using Kaplan-Meier curves and univariate analyses. The study compared data using Log Rank tests and p-values. Findings : The two decade-groups under study showed no difference in trends of survival regarding age, treatment type and histology. Albeit small numbers, adenocarcinoma was the histology that had the best probability of survival during both decades. There were more patients with early-stage cancer (stage 1 and 2) diagnosed in decade B (2003 – 2012) than A (1993 – 2002). Within this early-stage cervical cancer cohort, there is a trend toward more locally-advanced (stage 2) cancer in the more recent decade. The proportion of patients presenting with stage 1a and 1b cancer with tumours 4 cm and less has halved from decade A to decade B. The proportion of stage 2 cancers presenting with tumours 2 – 4cm in size during decade B has risen almost 3-fold to that of decade A. This suggests a developing trend of presentation of more locally-advanced cancer. During both decades, stage 1 cervical cancers had the best probability of survival, with an improvement in mean survival from decade A (average of 44 months) to decade B (average of 58 months). The trend of stage 2 disease has deteriorated, with a decrease in mean survival (from 48 months in decade A to 21 months in decade B), an increase in cancer-related deaths and a shorter time to relapse. The number of patients presenting with late-stage disease (stages 3 and 4) has declined. HIV positive status played an influential role in tumour size on presentation and probability of 5-year disease-free survival. Young women who were HIV positive also fared less favourably when compared to NP (not positive) women in terms of mean survival. Due to the small sample size and that the majority of patients in decade A were untested, further HIV comparisons were not credible. Interpretation : The study suggests a moving trend towards young patients that are being diagnosed with the more locally-advanced early-stage disease in the more recent decade than ten years prior. HIV status seemingly played an influential comorbid role in patients diagnosed with cervical cancer. Patients with the locallyadvanced disease appear to have worse outcomes in the latter decade. In an attempt to curb this potentially curable disease in this subset of young women, a greater focus on earlier screening interventions, prompt diagnosis and appropriate and timeous treatment of cervical cancer, together with optimisation of comorbidities like HIV are needed.

No

Key words: Gynaecological experiences, virginity, premarital sexuality, women's health, gynaecological health, Turkey. This study explores the relationship of ideas about virginity and gynaecological health experiences of women in Ankara, Turkey. I conducted in depth semi-structured interviews with ten heterosexual, 23-30 years old, college-graduate Turkish women. Using intersectionality as a methodological lens, I seek to understand how gender, age, class and religion play a role in the correlation of virginity and gynaecology experiences. Five main themes illuminated the participant women's experiences: (1) feeling of inclusion, (2) the effect of religion, (3) class difference, (4) selection of doctors (5) access to information on gynaecological health. Findings revealed that participants define virginity as a taboo and a barrier during gynaecological healthcare experiences. In accordance with the previous researches, I have found that dominant virginity discourse limit women's access to knowledge on their gynaecological health. This study also dwelled on the differences in the experiences of women according to participant women's age, religion, class and social status. In addition to previous research, this study revealed that judgemental comments of the doctors and high fees of private clinics...

No

Placental alkaline phosphatase (PLAP) is a membrane bound enzyme normally synthesized by the syncytiotrophoblasts in the human placenta. Recent studies have indicated that trace amounts of placental-like alkaline phosphatases also are present in several normal organs like testes and endocervix. PLAP and PLAP-1ike enzymes are furthermore synthesized by some tumors and can be detected in sera of approximately 12 % of patients with any type of cancer, more often in patients with genital tumors. This synthesis has been considered to be ectopic.PLAP is known to be electrophoretically highly polymorphic. Both poly- and monoclonal antibodies were used to study this enzyme. One of the monoclonal antibodies was able to discriminate between different phenotypes of PLAP and thus immunochemical approaches to elucidate enzyme polymorphism were established.To evaluate the potential clinical use of PLAP as a tumor marker serum levels of the enzyme were measured by a radioimmunoassay in 100 patients with the testicular tumor seminoma. Elevated levels of PLAP were found in 43 % of the patients with primary tumors and in 75 % of the patients with recurrent or metastatic disease. After successful treatment of seminoma the PLAP levels decreased. This indicates that measuring PLAP give useful information during follow up of treatment of seminomas.The content of PLAP-like enzymes in seminoma tumors was determined in 13 typical seminomas. The levels, of enzyme found in the tumor tissue ranged from 870-13 404 ng/g wet weight, which should be compared to around 100 ng/g in normal testes. Analysis using monoclonal antibodies and enzyme inhibitors showed the PLAP-like enzymes present in seminomas to be similar to the enzymes in normal testes. This suggests that the increased expression of PLAP-like enzymes in seminomas results from an enhanced eutopic expression of enzymes found in normal testis.A sensitive catalytic assay was used to quantify enzyme levels in sera from women with malignant gynaecological tumors. In the group of patients with cervical carcinoma 68 % had values exceeding the normal limit. For patients with ovarian cancer and carcinoma of the breast the percentages were 35 and 23 respectively.Monoclonal and polyclonal antibodies against PLAP were evaluated for tumor immunolocalization of human PLAP-producing tumors in nude mice.The antibodies were labeled with "125j and injected into mice with tumors. The distribution of 25j_an-ti-PLAP in various tissues showed that the labeled antibodies were enriched in the tumors, with a mean concentration ratio of 7. This indicates that there is a potential use of PLAP in localizing tumors in humans. / <p>S. 1-37: sammanfattning, s. 39-88: 5 uppsatser</p> / digitalisering@umu

Yes / Germ cell tumours (GCTs) are a heterogeneous group of rare neoplasms that present in different anatomical sites and across a wide spectrum of patient ages from birth through to adulthood. Once these strata are applied, cohort numbers become modest, hindering inferences regarding management and therapeutic advances. Moreover, patients with GCTs are treated by different medical professionals including paediatric oncologists, neuro-oncologists, medical oncologists, neurosurgeons, gynaecological oncologists, surgeons, and urologists. Silos of care have thus formed, further hampering knowledge dissemination between specialists. Dedicated biobank specimen collection is therefore critical to foster continuous growth in our understanding of similarities and differences by age, gender, and site, particularly for rare cancers such as GCTs. Here, the Malignant Germ Cell International Consortium provides a framework to create a sustainable, global research infrastructure that facilitates acquisition of tissue and liquid biopsies together with matched clinical data sets that reflect the diversity of GCTs. Such an effort would create an invaluable repository of clinical and biological data which can underpin international collaborations that span professional boundaries, translate into clinical practice, and ultimately impact patient outcomes. / ALF, JFA, and MJM declare funding from St Baldrick’s Foundation; grant reference number 358099.

<p>Sexualitet är ett grundläggande behov som ingår i människans</p><p>natur. Förutom att det är viktig för fortplantningsförmågan har den</p><p>stor betydelse för den fysiska och psykiska hälsan. Varje år drabbas</p><p>cirka 2600 kvinnor i Sverige av gynekologisk cancer som är en av</p><p>de mest förekommande cancerformerna. Sjukdomen och</p><p>behandlingen av den kan leda till problem med sexualiteten och</p><p>genom det påverka relationen till partnern. Syftet med denna studie</p><p>var att belysa kvinnors sexualitet vid gynekologisk cancer. Den</p><p>metod som användes var en litteraturstudie baserad på tolv</p><p>vetenskapliga artiklar.</p><p>Resultatet visade att gynekologisk cancer och dess behandling</p><p>påverkade kvinnors sexualitet negativt genom fysiologiska och</p><p>psykosociala konsekvenser. Det fanns även en stor</p><p>informationsbrist när det gällde konsekvenserna på sexualiteten.</p><p>Denna informationsbrist berodde till stor del på att både</p><p>vårdpersonal och patienter upplevde det svårt att samtala om</p><p>sexualitet. Informationsbehovet när det gällde sexualitet i samband</p><p>med gynekologisk cancer anses upplevas som viktigare hos yngre</p><p>kvinnor. Sexualiteten upplevdes mer angelägen efter att det gått en</p><p>tid efter avslutad behandling och kvinnorna hunnit återhämta sig</p><p>och eventuella sexuella problem uppstått. Kvinnorna önskade att</p><p>behandlingens konsekvenser på sexualitet tagits upp av</p><p>vårdpersonal i samband med behandling så att dessa kunnat</p><p>förebyggas. Det vore önskvärt att sjuksköterskor får utbildning för</p><p>att kunna samtala med dessa patienter och därmed förbättra</p><p>omvårdnaden. Dessutom behövs mer forskning för att få en</p><p>fördjupad insikt i hur kvinnor med gynekologisk cancer upplever</p><p>sin sexualitet.</p>

Sexualitet är ett grundläggande behov som ingår i människans natur. Förutom att det är viktig för fortplantningsförmågan har den stor betydelse för den fysiska och psykiska hälsan. Varje år drabbas cirka 2600 kvinnor i Sverige av gynekologisk cancer som är en av de mest förekommande cancerformerna. Sjukdomen och behandlingen av den kan leda till problem med sexualiteten och genom det påverka relationen till partnern. Syftet med denna studie var att belysa kvinnors sexualitet vid gynekologisk cancer. Den metod som användes var en litteraturstudie baserad på tolv vetenskapliga artiklar. Resultatet visade att gynekologisk cancer och dess behandling påverkade kvinnors sexualitet negativt genom fysiologiska och psykosociala konsekvenser. Det fanns även en stor informationsbrist när det gällde konsekvenserna på sexualiteten. Denna informationsbrist berodde till stor del på att både vårdpersonal och patienter upplevde det svårt att samtala om sexualitet. Informationsbehovet när det gällde sexualitet i samband med gynekologisk cancer anses upplevas som viktigare hos yngre kvinnor. Sexualiteten upplevdes mer angelägen efter att det gått en tid efter avslutad behandling och kvinnorna hunnit återhämta sig och eventuella sexuella problem uppstått. Kvinnorna önskade att behandlingens konsekvenser på sexualitet tagits upp av vårdpersonal i samband med behandling så att dessa kunnat förebyggas. Det vore önskvärt att sjuksköterskor får utbildning för att kunna samtala med dessa patienter och därmed förbättra omvårdnaden. Dessutom behövs mer forskning för att få en fördjupad insikt i hur kvinnor med gynekologisk cancer upplever sin sexualitet.

There is a growing interest in the impact of waiting for surgery, a common experience for many Canadians. Pain and psychological symptoms prior to surgical management are frequently problems for women with gynaecological conditions, however minimal research was found to investigate pain and psychological symptoms in these women prior to surgery. Also pain is recognized to increase healthcare utilization, but this has not been previously examined in this population. The objectives of this research project were to examine levels of pain, psychological factors associated with pain and frequency of healthcare utilization due to pain in a population of women waiting for gynaecological surgery, predominantly undergoing hysterectomies. Four hundred and twenty nine women in a tertiary care centre in southeastern Ontario were included in the study. Anxiety was measured using the State Trait Anxiety Inventory (STAI), depression with the Centre for Epidemiologic Studies Depression Scale (CES-D), somatization using the Seven Symptom Screening Test (SSST) and catastrophizing was measured using an abbreviated coping strategies questionnaire (CSQ). Pain was assessed using the Brief Pain Inventory (BPI). Women also reported on their healthcare utilization for pain over the past 12 months. The length of wait was obtained from hospital waiting data. Results showed a moderate to severe pain intensity score occurred in 30.5% of women and a moderate to severe interference score in 31.5%. Being younger, married, employed and with high trait anxiety were factors associated with higher rates of healthcare utilization. High levels of depression, somatization and catastrophizing were associated with higher pain intensity and interference scores. This study supports the need for preoperative assessment of physical and psychological symptoms in women waiting for gynaecological surgery. Improving patients’ health prior to surgery will potentially reduce their healthcare demands on a financially constrained healthcare service. / Thesis (Master, Nursing) -- Queen's University, 2009-09-25 12:31:28.298