Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

Submitted by TALITA MAYARA ROSSI LEMOS null (italemos@yahoo.com.br) on 2016-04-29T02:18:06Z No. of bitstreams: 1 MESTRADO ACADÊMICO TALITA MAYARA ROSSI LEMOS.pdf: 1258975 bytes, checksum: c5bfc6a12426c7f7cbe81b9cf867861a (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-05-02T13:43:06Z (GMT) No. of bitstreams: 1 lemes_tmr_me_bot.pdf: 1258975 bytes, checksum: c5bfc6a12426c7f7cbe81b9cf867861a (MD5) / Made available in DSpace on 2016-05-02T13:43:06Z (GMT). No. of bitstreams: 1 lemes_tmr_me_bot.pdf: 1258975 bytes, checksum: c5bfc6a12426c7f7cbe81b9cf867861a (MD5) Previous issue date: 2016-03-03 / Estudo descritivo, correlacional, com abordagem quantitativa e delineamento transversal, cujo objetivo geral foi analisar a qualidade de vida em mulheres com diagnóstico de câncer de mama, submetidas à cirurgia conservadora e à mastectomia. Os objetivos específicos, propuseram levantar as características sociodemográficas, clínicas, potenciais de adoecimento e fatores de proteção para o câncer de mama, em mulheres submetidas à cirurgia conservadora e à mastectomia, comparar as médias dos escores dos questionários European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 e BR-23, das pacientes do grupo da cirurgia conservadora e da mastectomia, e correlacionar as escalas funcionais e de sintomas dos questionários EORTC em ambos os grupos, com a escala do estado global de saúde e qualidade de vida (QLQ C-30). A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa, da Faculdade de Medicina de Botucatu, parecer nº 607.171. A coleta dos dados ocorreu de maio de 2014 a maio de 2015, e a amostra total foi de 106 mulheres, sendo 66 submetidas à cirurgia conservadora, e 40 à mastectomia, acompanhadas pela equipe de mastologia do ambulatório de Ginecologia do Hospital das Clínicas de Botucatu. Para a captação dos dados foram utilizados: formulário destinado à caracterização da população, e questionários EORTC QLQ C-30 e BR-23. Pôde-se verificar que na escala funcional dos questionários EORTC, as mulheres submetidas à cirurgia conservadora apresentaram, na maioria dos domínios, médias maiores que o grupo da mastectomia. Entretanto, apenas o domínio imagem corporal apresentou-se significativo. Na escala de sintomas de ambos os questionários, o grupo da cirurgia conservadora apresentou menores médias nos domínios: dor, dispneia, insônia, constipação, dificuldade financeira e sintomas do braço e da mama, enquanto o grupo da mastectomia apresentou menores médias, nos domínios: fadiga, náusea, vômito, perda de apetite, diarreia e eventos adversos da terapia sistêmica, sendo apenas os domínios vômito e insônia significativos. Na escala do estado global de saúde e qualidade de vida, a maior média foi apresentada no grupo das mulheres submetidas à mastectomia. Quanto à correlação dos domínios dos questionários EORTC, das pacientes submetidas à cirurgia conservadora com a escala do estado global de saúde e qualidade de vida, verificou-se que os domínios que apresentaram correlação significativa foram: função física, desempenho de papéis, função emocional, função social, fadiga, dor, insônia, perda de apetite, diarreia, dificuldade financeira, eventos adversos da terapia sistêmica e sintomas do braço. Já a correlação dos domínios de ambos os questionários, no grupo das pacientes submetidas à mastectomia, com a escala de estado global de saúde e qualidade de vida, que apresentaram-se significativos foram: função emocional, insônia, dificuldade financeira e imagem corporal. Concluiu-se que, apesar do grupo da cirurgia conservadora ter apresentado médias superiores nos escores da maioria dos domínios de ambos os questionários EORTC, o grupo da mastectomia apresentou maior média na escala do estado global de saúde e qualidade de vida, demonstrando que as mulheres submetidas à mastectomia, apresentaram melhor qualidade de vida e de saúde global, após cirurgia, comparadas às submetidas à cirurgia conservadora. / This is a correlational descriptive study with a quantitative approach and cross-sectional design whose main objective is to analyze the quality of life in women with breast cancer undergoing breast-conserving surgery and mastectomy. Among the specific objectives, it was intended to raise elements such as the sociodemographic and clinical characteristics, the potential illness, and the protective factors for breast cancer in women undergoing breast-conserving surgery and mastectomy; to compare the mean scores of the European Organization for Research and Treatment of Cancer (EORTC) questionnaires QLQ-C30 and BR-23 of patients who underwent breast-conserving surgery and mastectomy; and also to correlate the functional and symptom scales of the EORTC questionnaires in both groups with the global health and quality-of-life scale (QLQ-C30). The Research Ethics Committee of Botucatu Medical School approved to perform the research with verdict No. 607.171. The data collection period was from May 2014 to May 2015, and the total sample was of 106 women. From these patients, 66 underwent breast-conserving surgery and 40 underwent mastectomy, and they were followed up by the mastology team of the Gynecology Outpatient Service of Botucatu University Hospital. Among the main results, it was verified that, in the functional scale of the EORTC questionnaires, the patients who underwent breast-conserving surgery had averages higher than those of the mastectomy group in most domains. However, only the body image domain was significant. In the symptom scale of both questionnaires, the breast-conserving surgery group had lower averages in these domains: pain, dyspnea, insomnia, constipation, financial difficulties, and arm and breast symptoms. On the other hand, the mastectomy group had lower averages in these domains: fatigue, nausea, vomiting, loss of appetite, diarrhea, and side effects of systemic therapy. The only significant domains were vomiting and insomnia. Regarding the global health and quality-of-life scale, it was found that the highest average was shown in the group of patients who underwent mastectomy. As for the correlation between the domains of the EORTC questionnaires of patients undergoing conservative surgery with the global health and quality-of-life scale, it was found that the domains showing statistically significant correlations were: physical function, role playing, emotional function, social function, fatigue, pain, insomnia, loss of appetite, diarrhea, financial difficulties, adverse events of the systemic therapy, and arm symptoms. In the correlation of the domains of both questionnaires in the group of patients undergoing mastectomy with the global health and quality-of-life scale, the significant ones were emotional function, insomnia, financial difficulties, and body image. The conclusion was that, despite the fact that the breast-conserving surgery group presented higher averages in the scores of most domains of both EORTC questionnaires, the mastectomy group had a higher average on the global health and quality-of-life scale, which demonstrates that the patients who underwent mastectomy had better quality of life and global health after the surgery compared to those who underwent breast-conserving surgery.

Orientador: Maria de Lourdes da Silva Marques Ferreira / Resumo: Estudo descritivo, correlacional, com abordagem quantitativa e delineamento transversal, cujo objetivo geral foi analisar a qualidade de vida em mulheres com diagnóstico de câncer de mama, submetidas à cirurgia conservadora e à mastectomia. Os objetivos específicos, propuseram levantar as características sociodemográficas, clínicas, potenciais de adoecimento e fatores de proteção para o câncer de mama, em mulheres submetidas à cirurgia conservadora e à mastectomia, comparar as médias dos escores dos questionários European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 e BR-23, das pacientes do grupo da cirurgia conservadora e da mastectomia, e correlacionar as escalas funcionais e de sintomas dos questionários EORTC em ambos os grupos, com a escala do estado global de saúde e qualidade de vida (QLQ C-30). A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa, da Faculdade de Medicina de Botucatu, parecer nº 607.171. A coleta dos dados ocorreu de maio de 2014 a maio de 2015, e a amostra total foi de 106 mulheres, sendo 66 submetidas à cirurgia conservadora, e 40 à mastectomia, acompanhadas pela equipe de mastologia do ambulatório de Ginecologia do Hospital das Clínicas de Botucatu. Para a captação dos dados foram utilizados: formulário destinado à caracterização da população, e questionários EORTC QLQ C-30 e BR-23. Pôde-se verificar que na escala funcional dos questionários EORTC, as mulheres submetidas à cirurgia conservadora apresentaram, na maioria dos... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This is a correlational descriptive study with a quantitative approach and cross-sectional design whose main objective is to analyze the quality of life in women with breast cancer undergoing breast-conserving surgery and mastectomy. Among the specific objectives, it was intended to raise elements such as the sociodemographic and clinical characteristics, the potential illness, and the protective factors for breast cancer in women undergoing breast-conserving surgery and mastectomy; to compare the mean scores of the European Organization for Research and Treatment of Cancer (EORTC) questionnaires QLQ-C30 and BR-23 of patients who underwent breast-conserving surgery and mastectomy; and also to correlate the functional and symptom scales of the EORTC questionnaires in both groups with the global health and quality-of-life scale (QLQ-C30). The Research Ethics Committee of Botucatu Medical School approved to perform the research with verdict No. 607.171. The data collection period was from May 2014 to May 2015, and the total sample was of 106 women. From these patients, 66 underwent breast-conserving surgery and 40 underwent mastectomy, and they were followed up by the mastology team of the Gynecology Outpatient Service of Botucatu University Hospital. Among the main results, it was verified that, in the functional scale of the EORTC questionnaires, the patients who underwent breast-conserving surgery had averages higher than those of the mastectomy group in most domains. However... (Complete abstract click electronic access below) / Mestre

No description available.

Thesis (M. A. (Nursing Science)) -- University of Limpopo, 2021 / Background: Mastectomy is one of the treatments for breast cancer. It causes a change in the appearance of the breast thus causing a major effect on women’s self‑image and a decreased sense of femininity that can lead to anxiety and depression to such an extent that they avoid visiting public places. The study explored and described experiences of women who had undergone mastectomy at Mankweng Hospital, Limpopo Province, South Africa. Study design: This study used a phenomenological approach to perform a qualitative, exploratory, descriptive, and contextual research. Using a non-probability purposive sample of about 15 women who had undergone mastectomy in Mankweng hospital. Data were gathered through semi-structured interviews. The semi-structured interviews' audio recordings were transcribed verbatim. Seven steps procedure for data analysis using Colaizzi method was used to interpret the data. Results: The most challenging experience by women who had undergone mastectomy defined as a feeling of being disabled, anxious, relieved, acceptance, and financial constraints. Conclusion: Strategies to address the challenges faced by women who had undergone mastectomy has been developed to assist them with coping mechanism post mastectomy and living a normal life. Key concepts: Breast Cancer, Mastectomy, Women

Bakgrund: Profylaktisk mastektomi är en behandling där brösten avlägsnas kirurgiskt i förebyggande syfte. Det finns olika indikationer till att profylaktisk mastektomi övervägs. Begreppet beslutsfattande kräver förståelse för att kunna beskriva kvinnors beslut vid profylaktisk kirurgi med anledning av att den individuella osäkerheten kring behandlingsval ska minska. Information och stöd är viktiga aspekter för en sjuksköterska att ge för att främja patientens integritet, självbestämmande och delaktighet. Syftet med litteraturstudien var att beskriva faktorer relaterade till beslutsfattandet hos kvinnor vid profylaktisk mastektomi. Metoden som användes var en allmän litteraturstudie med induktiv ansats där tio vetenskapliga artiklar med anknytning till aktuellt syfte valdes ut för att utforma ett resultat. Resultatet utmynnade i tre olika kategorier varav en med två underkategorier och en med tre underkategorier. Oro, föräldraskap, genmutation och upplevelse av information visade sig influera beslutsfattandet. Få skillnader i beslutsfattandet påvisades mellan kvinnor som var bärare och ickebärare av genmutation. Konklusion: Kvinnor som stod inför ett beslutsfattande vid profylaktisk mastektomi var alla egna individer och hade därmed olika preferenser i avseende behov av stöd, delaktighet i beslutsfattandet, mottagandet av information samt vad som influerat beslutet. Vårdprofessionella ska presentera adekvat, evidensbaserad samt enhällig information för att underlätta kvinnors beslutfattande. / Background: Prophylactic mastectomy is a treatment where the breasts are surgically removed for preventive purposes. There are various indications why prophylactic mastectomy is being considered. Understanding the concept of decision making is required to describe women’s decision about prophylactic surgery in order to reduce individual uncertainty about treatment choices. Information and support are important aspects for a nurse to provide in order to encourage patient integrity, self-determination and participation. The aim of this literature study was to describe factors related to decision making among women regarding prophylactic mastectomy. The method was a literature study with an inductive approach. Ten scientific articles related to the current purpose were selected to form a result. The result emerged in to three different categories, one with two subcategories and one with three subcategories. Concerns, parenting, gene mutation and experience of information were found to influence the decision making. Few differences in decision making were detected between women who were carriers and non-carriers of gene mutation. Conclusion: Women who faced a decision making in prophylactic mastectomy were all individuals and there for had different preferences regarding need for support, participation in decision making, receiving information and what influenced the decision. Health care professionals should present adequat, evidence based and unanimous information to ease women’s decision making.

Mastektomi är en vanlig behandlingsform vid bröstcancer vilket innebär att hela bröstet opereras bort. Upplevelsen av en mastektomi är individuell och framkallar olika känslor. Det är därför viktigt att sjuksköterskan har kunskap om hur kroppsuppfattningen kan påverkas hos kvinnan efter en mastektomi. Syftet med studien var att belysa kvinnors kroppsuppfattning efter en mastektomi. En litteraturstudie genomfördes och relevanta sökord användes i databassökningen utifrån syftet. Studiens resultat bestod av 12 vetenskapliga artiklar som granskades och analyserades. I studien framkom två teman och sex kategorier vilka var Förlust i relation till kroppsuppfattning: Att förlora ett bröst, Att förlora sin femininitet och identitet samt Tacksamhet över förlusten och Kvinnans förhållningssätt efter mastektomin: Kvinnans begränsningar i vardagen, Att distansera sig och Att sträva efter en förbättrad kroppsuppfattning. Resultatet visade att det var vanligt med en negativ kroppsuppfattning efter mastektomin. Det fanns även kvinnor som inte upplevde att mastektomin förändrade deras kroppsuppfattning. Det är viktigt att sjuksköterskan får mer kunskap om kvinnors kroppsuppfattning efter en mastektomi för att kunna identifiera och vårda dessa kvinnor. Vidare forskning behövs angående vilka omvårdnadsåtgärder en sjuksköterska kan utföra för en kvinna med negativ kroppsuppfattning.

Estudo exploratório, descritivo, com abordagem qualitativa, que teve como objetivo analisar a influência de um núcleo de reabilitação para mastectomizadas na vida das mulheres que o frequentam e identificar quais tipos de mudanças ocorreram em suas vidas. Participaram 13 mulheres com idade entre 49 e 82 anos, que frequentavam o grupo de reabilitação há no mínimo três meses. Os dados foram obtidos por meio de entrevistas, com perguntas abertas. Procurou-se identificar unidades temáticas pela Análise de Conteúdo, nas seguintes categorias: 1. Deparando-se com uma nova realidade; 2. Encontrando uma forma de enfrentamento da nova realidade; 3. Mudando comportamentos e maneiras de pensar. Os resultados mostraram que após terem sido encaminhadas ao serviço de reabilitação, as mulheres começaram a entender que havia uma forma de enfrentar, com um pouco menos de sofrimento, a dura realidade de ter câncer de mama, uma doença estigmatizante, que lhes gerava dúvidas e medos em relação ao presente e ao futuro. A frequência ao serviço de reabilitação fez com que elas se descobrissem como membros do grupo e acolhidas, tanto pelas outras mulheres como pelos profissionais; sentiram nestes últimos uma verdadeira preocupação em atender todas as suas necessidades físicas, emocionais e psicossociais. Compartilharam experiências, compreenderam a importância de dividir seus problemas com o grupo, conseguiram pedir e oferecer ajuda. Encontraram um grupo de \"iguais\", e sentiram-se à vontade para compartilhar experiências, criar novas amizades e até mesmo uma \"nova família\". Conseguiram ressocializar-se. Reconheceram-se mais fortes para enfrentar o câncer, sentiram que podiam melhorar e que podiam e deviam participar de sua reabilitação, chegando a modificar comportamentos e maneiras de pensar sobre a doença e suas consequências, sobre as pessoas e sobre si mesmas. Reconheceram o serviço de reabilitação, ou seja, o grupo de mulheres e profissionais, como o grande responsável pelas mudanças positivas que ocorreram em suas vidas; conseguiram lidar melhor até mesmo com as questões da própria finitude e manifestaram a apropriação do senso crítico, quando propuseram, ainda que de forma discreta, algumas sugestões para aprimoramentos na assistência oferecida pelo serviço. O serviço de reabilitação é o lugar onde encontram ânimo para seguir a vida, com segurança para rir e chorar, falar e calar, ouvir e ser ouvida, sem reprimendas. Consideram um privilégio poder desfrutar de tudo o que serviço oferece, inclusive atividades de lazer e sem gastos financeiros. Fazer parte desse grupo significou para as participantes deste estudo um presente de Deus, a chance de vislumbrar uma nova vida. / Exploratory, descriptive, qualitative approach, which aimed to examine the influence of a full mastectomy rehabilitation group in women who lives attend it and identify what kinds of changes in their lives. Participants included 13 women aged between 49 and 82 years who attended the rehabilitation group for at least three months. Data were obtained through interviews with open questions. We sought to identify thematic units through content analysis, the following categories: 1. finding a new reality, 2. finding a way to face the new reality; 3. changing behavior and way of thinking.The results showed that after being sent to rehabilitation services, women began to understand that there was a way to deal with a little less suffering, the harsh reality of having breast cancer, a stigmatizing disease, they generated questions and fears about the present and the future. Attendance at the rehabilitation service meant that they were discovered as members of the group and accepted by both other women and professionals, experienced in the last a genuine concern to meet all their physical, emotional and psychosocial factors. Shared experiences, understood the importance of sharing their problems with the group, could ask for and offer help. They found a group of \"equal\" and felt free to share experiences, new friendships and even a \"new family\". They managed to re-socialize. Acknowledged to be stronger to cope with cancer, they felt they could improve and that could and should participate in them rehabilitation, getting to change behaviors and ways of thinking about disease and its consequences, about people and about themselves. Acknowledged the service of rehabilitation, the group of women and professionals, as largely responsible for the positive changes occurring in their lives got better even with the issues of their own finitude and expressed the appropriation of critical sense, when they proposed , albeit discreetly, some suggestions for improvements on the care offered. The rehabilitation service is the place where they find the courage to follow the life safely to laugh and cry, talk, listen and be heard without reprimand. They consider it a privilege to enjoy all that service offers, including leisure activities and no financial expenditure. Being part of this group has meant to the participants in this study a godsend chance to glimpse a new life.

Metastasis is the most fearsome aspect of breast cancer (BC) a common disease in women, because it drives mortality. Although BC can invade almost any organ, it is most often found to invade the bone (31-79%), the brain (3-12%), the liver (8-18%) and the lung (11-13%). The site of distant metastasis is often associated with cause of death and length of survival. This dissertation examines whether the presence of select lifestyle and clinical factors can predict metastatic spread to the lung and/or the liver for a particular woman with advanced breast cancer. A systematic review of the literature identified tobacco use as a risk factor for lung metastasis in women with BC and suggested that obesity, hormone replacement therapy prior to BC diagnosis, hormonal therapy post diagnosis, and post-mastectomy radiation therapy may have an impact on this association. The review also uncovered that liver disease (i.e. hepatic steatosis, chronic hepatitis B infection, cirrhosis) is associated with the occurrence of liver metastasis in patients with colorectal cancer and that hyperglycemic and oxidative stress conditions as well as alcohol consumption were found to be associated with liver metastasis in colorectal or BC patients. We conducted a retrospective hospital-based case-control study of the association of select lifestyle and clinical factors with metastases detected in the lung and the liver among women diagnosed with stages II-IV BC and seen at the Columbia University Medical Center from 2008 to 2013. Select relevant clinical variables were extracted from the hospital patient charts and lifestyle factors from patients’ responses to a questionnaire developed for the purposes of this research. We examined whether smoking and / or post-mastectomy radiation therapy to the breast and/or the chest area were associated with an increased risk of 1st site lung metastasis in our sample of women with metastatic BC. We found that lifestyle factors such as smoking history or BMI at diagnosis did not affect the likelihood of 1st site lung metastasis in our sample of women. We also investigated whether a history of alcohol intake or chronic liver disease was associated with risk of developing a 1st site liver metastasis. Our analyses suggested that lifestyle factors such as alcohol intake or obesity might not affect the likelihood of 1st site liver metastasis in women with metastatic BC. We also report that a history of chronic liver disease significantly increased the odds of 1st site liver metastasis. Given our findings around adjuvant post mastectomy radiation therapy and chronic liver disease, we suggest collecting adjuvant treatment or relevant comorbid information in larger cohort studies. A better understanding of the relationship between these factors and the sites of metastasis has the potential to increase our understanding of the metastatic process. If we can find ways to identify women at high risk of metastatic disease, or develop preventive or therapeutic measures against lung or liver metastasis, we can hope to reduce mortality from metastases.

El objetivo de la investigación fue explorar la relación entre calidad de vida y estrategias de afrontamiento en 130 mujeres, entre 30 y 86 años, con diagnóstico de cáncer de mama y tratamiento quirúrgico de mastectomía radical modificada. Los instrumentos psicológicos empleados fueron: Brief COPE para medir las estrategias de afrontamiento y EORTC QLQ-C30 para calidad de vida. Los resultados principales demostraron que existen relaciones significativas entre algunas de las dimensiones de calidad de vida con ciertas estrategias de afrontamiento y que su influencia es positiva para la calidad de vida y salud, en términos globales. Lamentablemente no se encontraron diferencias importantes entre estas dimensiones de calidad de vida y estrategia de afrontamiento según el tratamiento recibido (mastectomía radical modificada o MRM con un tratamiento adicional) ni la edad; sin embargo, existen antecedentes científicos que lo presentarían como una opción interesante en una muestra más amplia.  En conclusión, la hipótesis planteada ha sido comprobada parcialmente, ya que sólo algunas estrategias de afrontamiento se llegan a correlacionar con ciertas dimensiones de calidad de vida significativamente. / The objective of the research was to explore the relationship between quality of life and coping strategies in 130 women, between 30 and 86 years, with a diagnosis of breast cancer and surgical treatment of modified radical mastectomy. The psychological instruments used were: Brief COPE to measure coping strategies and EORTC QLQ-C30 for quality of life. The main results showed that there are significant relationships between some of the dimensions of quality of life with certain coping strategies and their influence is positive, in global terms, for the quality of life and health. Unfortunately, there were not important differences between these dimensions of quality of life and coping strategy according to the treatment received (modified radical mastectomy or MRM with additional treatment) or age; however, there is a scientific background that would present it as an interesting option in a larger sample. In conclusion, the hypothesis raised has been partially verified, since only some coping strategies can be correlated with certain dimensions of quality of life significantly. / Tesis