Gastrointestinale Tumorpatienten leiden bei ihrer Akutaufnahme im Krankenhaus und in der sich anschließenden Chemotherapie unter somatischen, psychischen und sozialen Belastungen, die sie psychoonkologisch behandlungsbedürftig erscheinen lassen. Bei 60 % dieser Patienten wurde ein solcher Behandlungsbedarf festgestellt. Das Anliegen der Arbeit war es, neben der Ermittlung des psychoonkologischen Betreuungsbedarfs, die Teilnahmebereitschaft dieser Patienten an einer psychoonkologischen Intervention festzustellen und zwei unterschiedliche Therapieverfahren (kognitiv-verhaltenstherapeutisch ausgerichtete Gesprächstherapie und Entspannungstherapie in Form einer progressiven Muskelrelaxation) mit einer Kontrollgruppe (Darreichung von Informationsmaterial über das Krankheitsbild) zu vergleichen. Es konnte ein positiver Effekt der Intervention, besonders der Gesprächstherapie, auf die Reduktion der Angst und Depression bei hoch belasteten Tumorpatienten nachgewiesen werden. Der Betreuungsbedarf derjenigen Patienten, die nur Informationsmaterial über die bösartige Krankheit erhielten, veränderte sich dagegen in der Zeit ihrer Chemotherapie nicht. Verlaufsabhängig konnte gezeigt werden, dass die Veränderung des psychoonkologischen Betreuungsbedarfs bereits kurz nach der Intervention einsetzt. Es gab aber auch Patienten, die erst im Verlauf der Intervention während der Chemotherapie einen psychoonkologischen Betreuungsbedarf entwickelten, den sie zu Beginn der Untersuchung nicht hatten. Auch diese Patienten konnten durch die psychotherapeutischen Interventionsmaßnahmen erfolgreich behandelt werden. / Gastrointestinal cancer patients who are hospitalized and receiving chemotherapy suffer from somatic, psychological, and social stresses that can be counteracted with psycho-oncological treatment. In fact, 60% of this population has been found to be in need of such services. The aim of this study was to determine how many patients in need of these services would be willing to participate in a psychosocial intervention, and to compare the outcomes of groups receiving two different therapeutic approaches (cognitive behavioral talk therapy and relaxation therapy in the form of a progressive muscle relaxation) with those of a control group, who were simply given written materials about their illness that included information on relevant psychosocial issues. The interventions, especially the talk therapy, were observed to have a positive effect on alleviating depression and anxiety in highly burdened cancer patients. The patients who only received written information about their disease showed no changes in the degree to which they needed psycho-oncological support over the time they were receiving chemotherapy. While some patients experienced improvements soon after the interventions had begun, there were also cases of patients who hadn’t initially exhibited a need for psycho-oncological support but later came to develop this need over the course of undergoing chemotherapy. These patients were also successfully treated through the psychotherapeutic interventions.

Background This study examines the role of illness perceptions and fear of progression (FoP) in paediatric cancer patients and their parents for patient’s health-related quality of life (HRQoL), controlling for sociodemographic and medical variables. 4–18-year-old patients in acute treatment or follow-up care and one parent were examined. Methods N = 46 patient-parent dyads in acute treatment and n = 84 dyads in follow-up care completed measures on illness perceptions (Illness-Perceptions-Questionnaire for 12–18-year-old patients and parents or as age-adapted puppet interview for 4–11-year-old patients) and FoP (Fear-of-Progression-Questionnaire for 7–18-year-old patients and parents). Patients also completed the KINDL-R to measure HRQoL. Hierarchical multiple regression analyses were calculated. Results In acute treatment, patient’s perceptions of symptoms and cyclicity of their illness explained variation in their HRQoL in addition to sociodemographic and medical variables. In follow-up care, patient’s FoP and parent’s perception of consequences explained additional variation in patient’s HRQoL. Overall, sociodemographic and medical variables explained less variation in HRQoL in follow-up care than in acute treatment. Conclusions Our results stress the importance of psychological factors for the well-being of paediatric cancer patients, particularly in follow-up care, where sociodemographic and medical variables play a lesser role. We recommend screening for illness perceptions and FoP during and after acute treatment to support patients and parents. Furthermore, standardized interventions focussed on changing maladaptive illness perceptions should be developed and evaluated. As parents’ perceptions, thoughts, and feelings may also play an important role for the well-being of the patients, interventions should be family-focussed and include parents. Trial registration The study has been pre-registered at the German Clinical Trials Register (registered 30/06/2020; DRKS00022034) and at the Open Science Framework

L’annonce d’un diagnostic de cancer provoque souvent une forte réaction émotionnelle et un stress important tant chez les adultes que chez les adolescents et leurs parents. Certains d’entre eux cherchant à soulager cette détresse se tournent vers des méthodes alternatives positives de gestion de stress, dans le but d’atténuer les effets psychologiques indésirables du cancer. Les thérapies ciblant à la fois le corps et l’esprit gagnent en popularité dans ces populations. Une avenue prometteuse est la méditation de pleine conscience (MPC), inspirée de la philosophie bouddhiste et adaptée dans le cadre d’interventions thérapeutiques pour améliorer la qualité de vie des patients souffrant de maladies chroniques. À ce jour, des études dans le domaine de la santé ont suggéré que la MPC pouvait avoir des effets bénéfiques sur les symptômes et la gestion de plusieurs maladies chroniques dont le cancer, faisant d’elle une avenue thérapeutique intéressante dans le traitement des effets psychologiques indésirables liés à ces maladies. La recherche émergente en pédiatrie suggère des effets comparables chez les enfants et adolescents. L’objectif de la présente thèse a été de développer un essai clinique randomisé visant à évaluer les effets de la MPC sur la qualité de vie, le sommeil et l’humeur chez des adolescents atteints de cancer, en documentant les étapes d’implantation du projet, les embuches qui ont été rencontrées durant son implantation et les résultats obtenus. La thèse est présentée sous la forme de deux articles scientifiques. Le premier article présente la méthodologie qui avait été planifiée pour ce projet mais qui n’a pu être réalisée en raison d’embuches rencontrées dans la complétion de ce pilote. Ainsi, les étapes préliminaires du développement de ce projet de recherche, en accordant une place prépondérante au manuel d’intervention rédigé à cette fin. La mise en place et la structure de ce projet, nommément le devis méthodologique employé, la taille d’échantillon visée, les méthodes de recrutement mises en place et les stratégies de randomisation prévues, sont décrites en détail dans cet article. Pour les fins de ce projet, un manuel d’intervention de MPC a été rédigé. L’intervention en MPC, menée par deux instructeurs formés en MPC, s’est échelonnée sur une durée de huit semaines, à raison d’une séance d’une heure trente par semaine. Une description détaillée de chaque séance est incluse dans cet article, dans un but de dissémination du protocole de recherche. Des analyses intragroupe serviront à évaluer l’impact de l’intervention en méditation de pleine conscience sur la qualité de vie, le sommeil et l’humeur pré-à-post intervention et au suivi à six mois. Des analyses intergroupes prévues sont décrites afin de comparer les effets de l’intervention entre les participants du groupe contrôle et du groupe expérimental. Les limites potentielles de ce projet, notamment la participation volontaire, le risque d’attrition et la petite taille d’échantillon sont décrites en détail dans cet article. Le deuxième article présente, dans un premier temps, le déroulement du projet de recherche, en mettant en lumière les embuches rencontrées dans son implantation. Ainsi, les leçons à tirer de l’implantation d’un tel essai clinique en milieu hospitalier au Québec sont décrites selon trois axes : 1) les défis liés au recrutement et à la rétention des participants; 2) l’acceptabilité et la compréhensibilité de l’intervention en pleine conscience; et 3) le moment où l’intervention s’est déroulée (timing) et l’impact sur l’engagement requis des participants dans le projet. Durant une période de recrutement de neuf mois, 481 participants potentiels ont été filtrés. 418 (86,9 %) d’entre eux ont été exclus. 63 participants potentiels, vivant à moins d’une heure de Montréal, ont été approchés pour prendre part à ce projet. De ce nombre, seulement 7 participants (1,4%) ont accepté de participer aux rencontres de MPC et de compléter les mesures pré-post intervention. Un bassin d’éligibilité réduit, ainsi que des taux de refus élevés et des conflits d’horaire avec les activités scolaires ont eu un impact considérable sur la taille d’échantillon de ce projet et sur l’absentéisme des participants. Malgré l’intérêt manifeste des équipes médicales pour la recherche psychosociale, les ressources requises pour mener à terme de tels essais cliniques sont trop souvent sous- estimées. Les stratégies de recrutement et de rétention des participants méritent une attention spéciale des chercheurs dans ce domaine. Dans un deuxième temps, le deuxième article de cette thèse a pour objectif de présenter les résultats de l’intervention en MPC chez des jeunes ayant le cancer, en examinant spécifiquement l’impact de l’intervention sur la qualité de vie, le sommeil et l’humeur des jeunes pré-post intervention et lors du suivi à six mois. Faisant écho aux embuches décrites préalablement décrites, les analyses statistiques n’ont permis de déceler aucun effet statistiquement significatif de notre intervention. Aucune différence significative n’est notée entre les participants du groupe expérimental et les participants du groupe contrôle. Les difficultés rencontrées dans de la complétion des devoirs et de la pratique de techniques de méditation entre les séances, décrites en détail cet article, expliquent en partie ces résultats. Globalement, le contexte développemental spécifique à l’adolescence, ayant possiblement eu un impact sur l’adhérence des participants à la thérapie proposée et à leur motivation à prendre part aux rencontres, les scores sous-cliniques lors du premier temps de mesure, l’impact du soutien social inhérent au contexte de thérapie de groupe, ainsi que les caractéristiques personnelles des thérapeutes, pourraient avoir influencé les résultats de ce pilote. Les résultats de ce projet pilote nous laissent croire que la prudence est de mise dans la généralisation des bienfaits et de l’efficacité de la pleine conscience observés chez les adultes atteints de cancer dans son application aux adolescents en oncologie. En conclusion, la présente thèse contribue à enrichir la recherche dans le domaine de la MPC chez les jeunes en questionnant néanmoins la pertinence d’une telle intervention auprès d’une population d’adolescents souffrant de cancer. Ainsi, il convient d’analyser les résultats obtenus en tenant compte des limites méthodologiques de ce projet et de poser un regard critique sur la faisabilité et la reproductibilité d’un projet d’une telle envergure auprès d’une même population. Les leçons tirées de l’implantation d’un tel projet en milieu hospitalier pédiatrique se sont avérées d’une importance centrale dans sa complétion et feront partie intégrante de toute tentative de réplication. D’autres essais cliniques de cette nature seront inévitablement requis afin de statuer sur l’efficacité de la MPC chez des adolescents atteints cancer et sur la faisabilité de l’implantation de cette méthode d’intervention auprès d’une population pédiatrique hospitalière. / News of a cancer diagnosis often elicits a strong emotional reaction in teenagers and their parents. To address these emotional challenges, various psychosocial approaches have been developed, including mind-body therapies. Mindfulness-based meditation, inspired from the Buddhist tradition, and adapted to improve quality of life in patients suffering from chronic illnesses, constitutes a promising option. Altogether, authors have suggested that mindfulness meditation could have beneficial effects on physical and psychological symptoms among adults with different chronic illnesses, namely cancer, and could hence be an interesting therapeutic avenue in the treatment of these conditions. The emerging research in pediatrics is suggesting similar effects in children and adolescents. The goal of this thesis was to develop a randomized clinical trial with the aim to evaluate the effects of a mindfulness- based intervention on quality of life, sleep and mood in adolescents with cancer, while documenting lessons learned from this experience and obtained results. This thesis is comprised of two scientific articles. The first article presents the initial study protocol that was planned for this study, although this could not be implemented because of multiple feasibility challenges that were met along the way. Preliminary steps in developing this research project, giving prominence to its intervention manual. The structure of the project, namely the choice of design and participant flow, the targeted sample size, along with recruitment and randomization strategies, are described in this article. For the purposes of this project, an intervention manual was written. The mindfulness-based intervention, given by two trained instructors, comprised of eight weekly sessions, lasting 90 minutes each. A detailed description of each weekly session was included in this article, in order to foster the dissemination of our research protocol. The second article is firstly based on our experience of carrying out a mindfulness- based clinical trial with a group of teenagers treated for cancer. While the initial goal of the trial was to expand the field of mindfulness research of youth with cancer, it became clear that much was to be learned from the challenges we met along the way. The goal of this article was therefore to document lessons learned from completing this trial to improve feasibility of future similar trials. Our findings are described in terms of the challenges encountered according to the following three categories: 1) recruitment and retention challenges; 2) treatment acceptability; 3) timing and commitment. Over 9 months of recruitment, 481 youth were screened for participation in the present project. Of these, 418 (86,9 %) were excluded. Of the 63 that were approached, only 7 (1,4%) agreed to participate in the project, gave consent and provided a complete dataset. A narrow pool of eligible participants, along with high refusal rates, scheduling conflicts with school and absenteeism had a significant impact on sample size in this project. Although there is manifest interest from the medical care community and scientific merit to conducting clinical trials, the resources needed for implementing these types of projects are often underestimated. Effective recruitment and retention merits particular attention. Secondly, this article presents results of our mindfulness-based intervention in adolescents with cancer, specifically in terms of quality of life, sleep and mood. Participants from the experimental group completed follow-up measures. Testing revealed no significant differences on any variable between participants from the experimental group and participants from the control group pre-to-post assessment. This could be explained by a lack of exposure to mindfulness techniques following the eight weeks program, limiting the generalization potential beyond therapy sessions. Moreover, encountered difficulties with homework, previously mentioned, could explain the absence of a mindfulness skills acquisition. Globally, our results could be explained by the inherent developmental changes of adolescence, impacting participants’ openness and adherence to mindfulness. Sub-clinical psychological symptoms could also strongly impact the usefulness of mindfulness meditation in youth with cancer. Data from this pilot study suggests that caution is required in generalizing the results used to determine the effectiveness of mindfulness interventions in adults with cancer, as they are not a guarantee of success and effectiveness for adolescent oncology populations. In conclusion, the present thesis helps advance the state of knowledge in mindfulness and youth research, namely by presenting data that questions the relevance of mindfulness interventions for teenagers with cancer. It is necessary to be cautious in analysing results from this thesis, especially when taking into consideration the methodological limitations that were faced in its completion and their impact on feasibility and reproducibility of such a project on a larger scale. Thus, lessons learned from the implementation of a mindfulness intervention project in pediatric oncology were of crucial importance in the completion of this project and will be an essential part of any attempt to replicate a project of this nature. Further research in this field will be necessary to conclude whether mindfulness interventions are beneficial for teenagers with cancer and whether they are feasible with pediatric populations.

Apesar dos avanços médicos, o câncer ainda é sinônimo de morte, o que acarreta dificuldades no enfrentamento da doença em suas diferentes fases, que começam a partir do momento do diagnóstico. Propõe-se um estudo aprofundado sobre as formas com as quais a criança com câncer lida e enfrenta a doença, bem como expressões emocionais e os recursos psicológicos presentes no processo de adoecimento. Partiu-se da hipótese de que o adoecimento por doença grave na infância acarrete prejuízos no desenvolvimento psicológico dessas crianças. A coleta de dados foi realizada em uma instituição filantrópica de apoio à criança com câncer, em um ambulatório especializado em onco-hematologia da rede pública e em uma escola pública do Estado de São Paulo. Foram avaliadas, no total, 60 crianças, sendo 30 crianças da população escolar para o grupo controle e 30 crianças do grupo clínico, com diagnósticos diversos de câncer, com idades entre 7 e 13 anos, de ambos os sexos. Foi realizada uma entrevista individual com cada criança, em que foram aplicados o H-T-P (Teste do Desenho da Casa-Árvore-Pessoa) e o Teste do Desenho da Pessoa na Chuva. Também foram considerados os familiares das crianças com câncer, totalizando a participação de 32 familiares, com os quais foi realizada uma entrevista semiestruturada. Foram utilizados o Método Quantitativo e Qualitativo para análise dos resultados, a partir da abordagem psicanalítica, em que foi feita uma comparação entre o grupo clínico e o grupo controle. Os desenhos das crianças foram analisados quantitativamente, enquanto, para os dados obtidos a partir das entrevistas semiestruturadas com os familiares, utilizou-se a análise qualitativa. Foi realizada uma comparação, por meio da análise estatística, entre as produções gráficas dos grupos controle e clínico. Os resultados revelaram, nas crianças com câncer, em comparação com as crianças sem a doença, a presença de maior desequilíbrio intra e interpessoal, pobre ou fuga do contato com a realidade, falta de recursos para obter satisfação do meio, sobrecarga emocional, instabilidade e desequilíbrio emocional e sentimentos de insegurança, impotência e viii desproteção, além de dificuldades em entrar em contato com o próprio corpo. O trabalho demonstra o impacto no desenvolvimento psicológico e os recursos presentes na criança com câncer. Conclui-se que, devido a um crescente número de sobreviventes de câncer infantil, torna-se importante pensar em formas de tratamento que preservem não só a vida e o corpo, mas também as dimensões psicológicas e sociais; desse modo, o tratamento deve visar o ser biopsicossocial, sendo necessário se pensar na qualidade de vida dessas crianças durante e após o tratamento. Essa criança sobrevivente terá ainda uma vida pela frente e essa vida tem de poder ser usufruída com menor número de sequelas e com a melhor qualidade possível. O estudo presente traz contribuições para a área científica e clínica de atuação junto às crianças com câncer e seus familiares / Despite medical advances, cancer is still synonymous with death, which causes difficulties in coping with the disease in its different phases that begin at the time of diagnosis. An in-depth study is proposed, investigating approaches employed by the child with cancer to deal and face the disease, as well as the emotional expressions and psychological resources present in the process of becoming ill. It is hypothesized that severe illness in childhood leads to losses in the psychological development of these children. Data collection was performed at a philanthropic institution in support of children with cancer, in an outpatient clinic specializing in public network onco-hematology and at a public school in the state of São Paulo. A total of 60 children were evaluated, including 30 children from the school population for the control group and 30 children with different diagnoses of cancer for the clinical group. Children were between 7 and 13 years of age, from both sexes. An individual interview was conducted with each child, in which the H-T-P (House-Tree-Person Drawing) and the Person\'s Drawing Test in the Rain were applied. Family members of children with cancer were also considered, totaling the participation of 32 family members, with whom a semi-structured interview was conducted. Quantitative and qualitative methods were utilized to analyze the results, based on the psychoanalytic approach, in which a comparison was made between the clinical group and the control group. The children\'s drawings were analyzed quantitatively, while the qualitative analysis was used to analyze the data obtained from the semi-structured interviews with the family members. The study employed statistical analyses (Chi-square and Student´s t test) to compare drawings from both groups. The results revealed the presence of greater intra and interpersonal imbalance in children with cancer, compared to children without the disease. Also, children with cancer demonstrated poor contact with reality, lack of resources to obtain environmental satisfaction, emotional overload, instability and emotional imbalance, feelings of insecurity, impotence and lack of protection, and difficulties in getting in touch with their own body. The results x demonstrate the impact of the diagnosis on the psychological development of the children with cancer. It is possible to conclude that, due to an increasing number of survivors of childhood cancer, it is important to develop new methods of treatment that preserve not only the physical aspect, but also the psychological and social domains. Therefore, treatment should aim at the biopsychosocial aspect of these children, considering quality of life pre and post-treatment and that this \"survivor\" child still has a whole life ahead of him/her, which should be enjoyed with as fewer sequels as possible and with the best quality possible. The present study brings contributions to the scientific literature and the clinical area, providing insights about children with cancer and their relatives

Made available in DSpace on 2016-04-28T20:38:42Z (GMT). No. of bitstreams: 1 Fabiana Rocha Biagigo.pdf: 934226 bytes, checksum: 77ae4574316234df5b706b4d1f22e764 (MD5) Previous issue date: 2013-05-24 / The overarching objective of this study is to investigate 197 women in treatment stage diagnosed with either breast or gynecologic cancer in regard to their beliefs about the causes of their very own diseases. Specifically, the present study aims to establish correlations of these subjects reported causal beliefs with selected sociodemografic and clinical variables. All subjects found themselves under treatment at a public hospital located in São Paulo, where the data was collected. The tools adopted specifically for data collection were a sociodemografic and clinical questionnaire as well as the Causes subscale from Illness Perception Questionnaire Revised (IPQ-R). A quantitative method was implemented and Analytical Psychology used for theoretical reference. Subjects reported several factors as causes for their cancer and attributed an important role to stress and emotional factors. The predominant causes mentioned were: stress or worry (77,2%), worries or family problems (77,2%), emotional state (69,5%), poor medical care administered in the past (54,3%), changes in the body defense system (52,3%) and fate or bad luck (45,3%). The sociodemografic and clinical variables (age, educational level, household income, type of cancer, tobacco addiction, changes in healthcare behavior, religion, family or own history of cancer and psychological treatment) influenced the causal beliefs reported by the subjects. Marital status was not observed as having influence over causal attribution. Low educational level on top of lack of information as well as low family income presented great influence in causal beliefs in regard to these subjects. Educational campaigns are crucial initiatives to the studied subjects, especially those targeting causes and factors that if acted upon might mitigate risk of cancer / Este estudo tem como objetivo geral investigar as crenças de 197 mulheres diagnosticadas com câncer de mama ou ginecológico, em fase de tratamento, a respeito das causas de sua própria doença. O objetivo específico é de correlacionar as crenças causais relatadas pelas participantes com as variáveis sociodemográficas e clínicas. Todas as participantes encontravam-se em tratamento em um hospital público da cidade de São Paulo. Os instrumentos utilizados na coleta de dados foram: questionário clínico e sociodemográfico e a subescala de Causas do Illness Perception Questionnaire Revised (IPQ-R). O método utilizado foi quantitativo e o referencial teórico foi o da Psicologia Analítica. As participantes citaram diversos fatores como causa de sua doença e atribuíram papel importante para o estresse e os fatores emocionais. Entre as causas mais mencionadas estiveram: estresse ou preocupação (77,2%), preocupações ou problemas familiares (77,2%), estado emocional (69,5%), pouca assistência médica no passado (54,3%), alteração das defesas do organismo (52,3) e destino ou má sorte (45,3%). As variáveis sociodemográficas e clínicas (idade, nível de escolaridade, renda familiar, tipo de câncer, tabagismo, mudanças nos cuidados com a saúde, religião, histórico anterior da doença, histórico familiar e realização de acompanhamento psicológico), influenciaram as crenças causais relatadas pelas participantes. A condição marital das pacientes não teve influência significativa sobre as atribuições causais. O baixo nível de escolaridade, somado à falta de informação, e a baixa renda familiar foram variáveis que apresentaram grande influência sobre as crenças causais das participantes da amostra. Campanhas educativas, que tenham como foco as causas do câncer e os fatores de risco que podem ser modificados a fim de reduzir o risco da doença, são de grande importância para a amostra estudada

The aim of the thesis is to describe and analyse how a group of women experience that their every-day lives are affected during and after primary breast cancer treatment. The thesis is a consecutive, longitudinal study that takes an explorative qualitative approach. Seventy-one women younger than 60 years of age with primary breast cancer were consecutively included in the study. The women were interviewed four or five times over a period of 4 to 6 years from end of radiotherapy. The analyses of the interviews were inspired by grounded theory and narrative analysis.  The thesis encompasses four papers. Paper I focused on the women’s contact with health care. The results of this study indicate that it is crucial for patients in a vulnerable situation to be admitted into a supportive system – ‘admitted into a helping plan’ – that, more or less explicitly, displays a well-thought-out plan of care. This is a process built on individual relationships with members of the health-care staff, but it ends up in a relationship to health care as a helping system, a ‘safe haven’ to attach to. Study II explored the women’s ideas about what motivated and discouraged their return to work. The results illustrate that the meaning of work fluctuates over time and that the processes of returning to work are conditioned by the patients’ individual life situations. Returning to work was regarded as an important part of the healing process because of how it generated and structured the women’s everyday lives. Returning to work meant demonstrating well-being and normalcy after breast cancer. Study III examined how life was lived and valued during and after treatment for breast cancer compared to pre-cancer life. The analysis showed that being afflicted with breast cancer was evaluated from a context of the women’s former everyday lives and stressed that how the women experienced breast cancer was a matter of personal circumstances. Study IV focused on how the women experienced and dealt with their altered bodies. The results showed that the women followed three different body-mind trajectories that depended to a significant extent on the severity of side effects and bodily alterations that resulted from their treatments. Being afflicted by breast cancer implies vulnerability and losses, but it can also involve benefits and provide new perspectives on life. How the overall breast cancer experience is valued seems to be very much a matter of circumstances in everyday life. This thesis highlights circumstances that focus in particular on contacts with health care, the body, the work situation, and the family situation.

When a child is diagnosed with cancer, the roles and responsibilities of family members change to accommodate the demands of the illness. The current study aimed to explore the experiences of mothers of children with cancer, focusing on their constructed roles within the family context and their social support. A case study design within the qualitative research approach was employed, underpinned by social constructionism as a theoretical framework. Three mothers were selected, using a combination of purposive and snowball sample techniques. Rich descriptive data were collected from three mothers through semi-structured interviews and reflective essays, and analysed using thematic analysis techniques. Results showed that although mothers of children with cancer experience some common themes, there are contextual differences influencing how they construct their stories. The following main themes were identified in the comparative analysis: events leading to the diagnosis, emotions, life changes, the effect of the illness and coping. / Psychology / M.A. (Psychology)

Apesar dos avanços médicos, o câncer ainda é sinônimo de morte, o que acarreta dificuldades no enfrentamento da doença em suas diferentes fases, que começam a partir do momento do diagnóstico. Propõe-se um estudo aprofundado sobre as formas com as quais a criança com câncer lida e enfrenta a doença, bem como expressões emocionais e os recursos psicológicos presentes no processo de adoecimento. Partiu-se da hipótese de que o adoecimento por doença grave na infância acarrete prejuízos no desenvolvimento psicológico dessas crianças. A coleta de dados foi realizada em uma instituição filantrópica de apoio à criança com câncer, em um ambulatório especializado em onco-hematologia da rede pública e em uma escola pública do Estado de São Paulo. Foram avaliadas, no total, 60 crianças, sendo 30 crianças da população escolar para o grupo controle e 30 crianças do grupo clínico, com diagnósticos diversos de câncer, com idades entre 7 e 13 anos, de ambos os sexos. Foi realizada uma entrevista individual com cada criança, em que foram aplicados o H-T-P (Teste do Desenho da Casa-Árvore-Pessoa) e o Teste do Desenho da Pessoa na Chuva. Também foram considerados os familiares das crianças com câncer, totalizando a participação de 32 familiares, com os quais foi realizada uma entrevista semiestruturada. Foram utilizados o Método Quantitativo e Qualitativo para análise dos resultados, a partir da abordagem psicanalítica, em que foi feita uma comparação entre o grupo clínico e o grupo controle. Os desenhos das crianças foram analisados quantitativamente, enquanto, para os dados obtidos a partir das entrevistas semiestruturadas com os familiares, utilizou-se a análise qualitativa. Foi realizada uma comparação, por meio da análise estatística, entre as produções gráficas dos grupos controle e clínico. Os resultados revelaram, nas crianças com câncer, em comparação com as crianças sem a doença, a presença de maior desequilíbrio intra e interpessoal, pobre ou fuga do contato com a realidade, falta de recursos para obter satisfação do meio, sobrecarga emocional, instabilidade e desequilíbrio emocional e sentimentos de insegurança, impotência e viii desproteção, além de dificuldades em entrar em contato com o próprio corpo. O trabalho demonstra o impacto no desenvolvimento psicológico e os recursos presentes na criança com câncer. Conclui-se que, devido a um crescente número de sobreviventes de câncer infantil, torna-se importante pensar em formas de tratamento que preservem não só a vida e o corpo, mas também as dimensões psicológicas e sociais; desse modo, o tratamento deve visar o ser biopsicossocial, sendo necessário se pensar na qualidade de vida dessas crianças durante e após o tratamento. Essa criança sobrevivente terá ainda uma vida pela frente e essa vida tem de poder ser usufruída com menor número de sequelas e com a melhor qualidade possível. O estudo presente traz contribuições para a área científica e clínica de atuação junto às crianças com câncer e seus familiares / Despite medical advances, cancer is still synonymous with death, which causes difficulties in coping with the disease in its different phases that begin at the time of diagnosis. An in-depth study is proposed, investigating approaches employed by the child with cancer to deal and face the disease, as well as the emotional expressions and psychological resources present in the process of becoming ill. It is hypothesized that severe illness in childhood leads to losses in the psychological development of these children. Data collection was performed at a philanthropic institution in support of children with cancer, in an outpatient clinic specializing in public network onco-hematology and at a public school in the state of São Paulo. A total of 60 children were evaluated, including 30 children from the school population for the control group and 30 children with different diagnoses of cancer for the clinical group. Children were between 7 and 13 years of age, from both sexes. An individual interview was conducted with each child, in which the H-T-P (House-Tree-Person Drawing) and the Person\'s Drawing Test in the Rain were applied. Family members of children with cancer were also considered, totaling the participation of 32 family members, with whom a semi-structured interview was conducted. Quantitative and qualitative methods were utilized to analyze the results, based on the psychoanalytic approach, in which a comparison was made between the clinical group and the control group. The children\'s drawings were analyzed quantitatively, while the qualitative analysis was used to analyze the data obtained from the semi-structured interviews with the family members. The study employed statistical analyses (Chi-square and Student´s t test) to compare drawings from both groups. The results revealed the presence of greater intra and interpersonal imbalance in children with cancer, compared to children without the disease. Also, children with cancer demonstrated poor contact with reality, lack of resources to obtain environmental satisfaction, emotional overload, instability and emotional imbalance, feelings of insecurity, impotence and lack of protection, and difficulties in getting in touch with their own body. The results x demonstrate the impact of the diagnosis on the psychological development of the children with cancer. It is possible to conclude that, due to an increasing number of survivors of childhood cancer, it is important to develop new methods of treatment that preserve not only the physical aspect, but also the psychological and social domains. Therefore, treatment should aim at the biopsychosocial aspect of these children, considering quality of life pre and post-treatment and that this \"survivor\" child still has a whole life ahead of him/her, which should be enjoyed with as fewer sequels as possible and with the best quality possible. The present study brings contributions to the scientific literature and the clinical area, providing insights about children with cancer and their relatives

The thesis focuses on a social development of 10-12 years old oncologically ill children, more specifically on a social cognition and relations to objects. Projective interview test evaluated with a SCORS scale has been chosen as a main scientific tool. Theoretical part describes a relationship between an oncological disease and a psychosocial development. It also focuses on an early-adolescence as described in a developmental psychology, brings an explanation of a Projective interview and Westen's interpretative system - Social cognition and object relations scale SCORS. The second part of the thesis consists of a research which verifies the hypothesis that possible differences in the test results of healthy and oncologically ill children could be found. There have not been found any significant differences in a social development of oncologicaly ill children and a control group of healthy children on a quantitative level of statistical analysis. The results of the research can not be situated on a pathological scale and can be thus considered in a norm. Qualitative analysis has discovered differences in a perception of a family, school environment, friends and emotions. Keywords: Oncological diseases at children, psycho-oncology, Projective inteview, SCORS, social deficit and somatically ill persons

Background: Patients with newly diagnosed lung cancer have one of the highest rates of psychosocial distress which may be reduced by identifying factors associated with psychosocial distress. This dissertation examined the association of neighborhood-level Social Determinants of Health (SDOH) and delay in treatment initiation with psychosocial distress. It also qualitatively explored perceptions and practices of the lung cancer care team regarding psychosocial distress screening. Methods: Sociodemographic, clinical, and SDOH data of patients newly diagnosed with lung cancer between 2017 and 2021 was analyzed via logistic regression. Thematic analysis was done for interviews conducted with the lung cancer care team. Results: SDOH and delay in treatment were not significantly associated with psychosocial distress. However, a high deprivation level of SDOH was associated with delay in treatment initiation. Qualitatively, four principal themes emerged: (1) Timing and frequency of screening: Multiple screenings at different time points may be more effective; (2) Training needs: All staff would benefit from training; (3) Staffing needs: More psychologists and social workers are needed to address identified patient psychosocial distress and; (4) Opportunity for holistic patient care: Consistent communication of distress screening information to physicians and surgeons may enhance a holistic care model for patients. Conclusions: The lung cancer care team valued psychosocial distress screening and identified opportunities for improving screening processes. The finding of association of high deprivation level of SDOH with greater delay in treatment initiation suggests that targeted interventions to reduce delay in treatment initiation, focusing on economically marginalized groups may be warranted.