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Perceived Positive and Negative Life Changes in Testicular Cancer SurvivorsVehling, Sigrun, Oechsle, Karin, Hartmann, Michael, Bokemeyer, Carsten, Mehnert-Theuerkauf, Anja 23 January 2024 (has links)
Background and objectives: Despite a generally good prognosis, testicular cancer can be a
life-altering event. We explored perceived positive and negative life changes after testicular cancer in
terms of frequency, demographic and disease-related predictors, and associations with depression
and anxiety. Materials and methods: All testicular cancer survivors receiving follow-up care at two specialized
outpatient treatment facilities were approached at follow-up visits or via mail. We assessed
a total of N = 164 patients (66% participation rate, mean time since diagnosis: 11.6 years, SD = 7.4)
by the Posttraumatic Growth Inventory (PTGI, modified version assessing positive and negative
changes for each of 21 items), Patient-Health-Questionnaire-9 (PHQ-9), and Generalized-Anxiety-
Disorder-Scale-7 (GAD-7). We conducted controlled multivariate regression analyses. Results: Most
survivors (87%) reported at least one positive change (mean number: 7.2, SD = 5.0, possible range:
0–21). The most frequent perceived positive changes were greater appreciation of life (62%), changed
priorities in life (62%), and ability rely on others (51%). At least one negative change was perceived
by 33% (mean number of changes: 1.1, SD = 2.5). Negative changes were most frequent for decreases
in self-reliance (14%), personal strength (11%), and ability to express emotions (9%). A higher socioeconomic
status was associated with more positive changes ( = 0.25, 95% CI 0.08 to 0.42); no other
association with demographic and disease-related predictors emerged. While positive life changes
were not associated with depression ( = 0.05, 95% CI 0.17 to 0.07) and anxiety ( = 0.00, 95%
CI 0.13 to 0.13), more negative life changes were significantly associated with higher depression
( = 0.15, 95% CI 0.03 to 0.27) and anxiety ( = 0.23, 95% CI 0.11 to 0.36). There was no significant
interaction of positive and negative changes on depression or anxiety. Conclusions: Although positive
life changes after testicular cancer are common, a significant number of survivors perceive negative
changes in life domains that have been primarily investigated in terms of personal growth. Early
identification of and psychosocial support for patients who perceive predominantly negative changes
may contribute to prevention of prolonged symptoms of anxiety and depression.
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Cognitive Function and Cardiorespiratory Fitness: A Study of Breast Cancer Survivors Prior to Chemotherapy or Radiation TreatmentDerry, Heather Michelle January 2017 (has links)
No description available.
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Development and Psychometric Performance of the Self-Efficacy to Communicate About Sex and Intimacy (SECSI) Scale in Women Treated for CancerArthur, Elizabeth K. 11 September 2018 (has links)
No description available.
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Stress Reactivity Patterns in Breast Cancer Survivors and the Implications of Various Psychosocial FactorsWan, Cynthia 06 September 2019 (has links)
The stress system comprises the hypothalamic-pituitary-adrenal (HPA) and the sympathetic-adrenal-medullary (SAM) axes. The two operate synergistically to regulate metabolic and biological processes, maintain homeostasis, and manage physiological responses towards various environmental challenges, known as stressors. Numerous studies have observed impaired HPA response among White breast cancer survivors followed by an eventual normalization of the HPA axis, but little is known about SAM functioning, the complementary relationship between physiological and psychological stress, and the influence of culturally related factors. This dissertation aims to address these gaps in the literature via three studies.
In Study 1, we examined the diurnal and reactive patterns of salivary alpha-amylase, a SAM biomarker, in a sample of predominantly White women with and without a prior diagnosis of breast cancer. The purpose was to establish an initial understanding of SAM functioning in relation to the participants’ HPA activity as measured by cortisol responses (complementary to a previously published study in the laboratory). Results of Study 1 revealed no abnormal response to stress. Virtually identical alpha-amylase slopes were observed between breast cancer survivors and control participants, except that breast cancer survivors had elevated basal levels of alpha-amylase, thus suggesting a “heightened sympathetic tone”.
In Study 2 acute and diurnal cortisol profiles and their accompanying psychological stress responses were examined in a sample of Chinese and White women with and without a prior diagnosis of breast cancer. In the same participants, we also examined chronic stress levels via hair cortisol concentrations which was the subject of Study 3. In both studies 2 and 3, we assessed the potential influences of cultural orientation and ethnocultural group membership on physiological and psychological stress patterns.
For the most part, Study 2 supported previous findings from the literature and our laboratory: Breast cancer survivors displayed a blunted cortisol response and their diurnal profile was comparable to that of control participants. But contrary to our hypotheses, ethnocultural membership and cultural orientation did not influence physiological patterns of stress. However, an interaction between ethnocultural group, health status, and time (i.e., from baseline to one hour after stress induction) was observed in the subjective appraisal of an acute stressor. Specifically, White breast cancer survivors reported significantly lower levels of perceived stress than the other three groups. These results suggest that health-related stress may supersede the effects of culturally related stress and indicate the potential presence of posttraumatic growth among our sample of White breast cancer survivors only.
Study 3 revealed no differences in hair cortisol concentrations between breast cancer survivors and control participants, nor between Chinese and White breast cancer survivors. However, it was observed that healthy Chinese women exhibited significantly higher levels of hair cortisol concentrations than their Western counterpart. Further analyses revealed that health status and cultural orientation did not significantly predict the observed patterns of physiological or psychological stress. Although non-significant, Study 3 results offered preliminary evidence that higher orientation towards both the dominant and non-dominant cultures is associated with higher levels of chronic physiological and psychological stress.
Collectively, our studies may provide support for the long-term recovery of the HPA axis via the examination of acute, diurnal, and chronic patterns of cortisol, but further research will be required. The dissertation also highlights several important key points regarding culturally related factors, health, and stress: (1) The perception of stress is influenced by one’s degree of cultural orientation and (2) effects of health-related stress may supersede those of culturally related stress, but (3) among healthy women, ethnocultural minorities may have more stressful encounters than their Western counterpart, thus having important clinical implications for ethnocultural minorities who are newly diagnosed with a chronic condition. Together, results of the studies highlight the importance of further investigating the enduring and acute implications of psychosocial variables – particularly the influence of cultural orientation – on the experience and perception of stress.
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Estudo observacional do prognóstico e terapêutica dos portadores de linfoma difuso de grandes células B e de IPIa de risco intermediário alto e alto / Observational Study of prognosis and therapeutics of Diffuse Large B Cell Lymphoma patients with high intermediate to high aIPI riskHallack Neto, Abrahão Elias 14 February 2008 (has links)
Pacientes com linfoma difuso de grande célula B (LDGCB) do mesmo grupo de risco pelos critérios do Índice de Prognóstico Internacional (IPI), tratados com quimioterapia convencional à base de antraciclina, podem ter resposta terapêutica não esperada para seu grupo de risco. Isso pode ser explicado pelo fato do prognóstico dos LDGCB, que têm origem no centro germinativo (CG), ser superior aos originados após o CG (NCG). No intuito de aprimorar a avaliação de prognóstico e a abordagem terapêutica em LDGCB de IPI ajustado para a idade (IPIa) de risco intermediário alto e alto, elaboramos projeto de pesquisa, para verificar o papel dos marcadores imuno-histoquímicos (IH) e do transplante de medula óssea autólogo (ATMO), em primeira remissão completa (RC), neste grupo de pacientes. Avaliamos o impacto da expressão dos marcadores CD10, Bcl-6, MUM-1, Bcl-2 e p63 na obtenção de RC, sobrevida livre de doença (SLD) e sobrevida global (SG), isoladamente e de acordo com a origem em CG e NCG. Avaliamos 82 pacientes abaixo dos 60 anos, dos quais 16 (19,5%) receberam ATMO em primeira RC, além de serem comparados com os pacientes tratados com quimioterapia convencional e mantidos em observação após RC. A IH foi avaliável em 73 casos, 24 (32,9%) tiveram origem no CG e 49 (67,1%) NCG, sem diferença de sobrevida entre os grupos. A proteína Bcl-2 foi positiva em 27 (37%) pacientes e foi o único fator preditivo independente para SG à análise multivariada, com tendência de significância para RC. As SG e SLD em cinco anos para os 16 pacientes que receberam ATMO foi de 75% e 85,2%, respectivamente, a taxa de recidiva de 6,5% e diferença estatisticamente significativa para SLD (p = 0,015) em comparação aos pacientes apenas observados. Concluímos que o ATMO foi seguro e capaz de melhorar a sobrevida em LDGCB de risco intermediário alto e alto, e que a expressão de Bcl-2 pode ser utilizada na programação terapêutica inicial desses pacientes. / Diffuse large B cell lymphoma (DLBCL) patients from the same risk group according to the International Prognostic Index (IPI) treated with conventional anthracycline-based chemotherapy may show an unexpected therapeutic response. This can be explained by the fact that the prognosis of DLBCL originating in germinal center (GC) cells is superior than that originating out of germinal center (NGC). In order to improve the prognostic evaluation and the therapeutic approach to DLBCL patients with high intermediate to high age-adjusted IPI (aIPI), a research project was designed for the analysis of immunohistochemical markers and the role of autologous stem cell transplantation (ASCT) in first complete remission (CR) for this group of patients. The impact of the expression of CD10, Bcl-6, MUM-1, Bcl-2 and p63 markers on complete remission (CR), disease-free survival (DFS) and overall survival (OS), either individually and according to cell origin was evaluated by means of immunohistochemistry. Eighty-two patients aged under 60 years old were assessed, of which 16 (19.5%) underwent ASCT in first CR and were compared to patients receiving conventional chemotherapy and being monitored after CR. Immunohistochemistry was assessable in 73 cases, 24 (32.9%) being classified as GC-type and 49 (67.1%) as NGC-type, with no survival difference between the two groups. Bcl-2 expression was found in 37% (27) of the patients and was the single independent predicting factor of OS prognosis according to multivariate analysis. A significant tendency of expression of this protein was also observed for achieving CR, which was essential for longer survival, as shown by multivariate analysis. OS and DFS within 5 years were of 75% and 85.2% respectively for the group of 16 patients treated with ASCT, which resulted in lower relapse rates (6.5%) with statistically significant difference for DFS (p=0.015) when compared to the group of patients who achieved CR and was kept under monitoring. In this study ASCT was found to be a safe procedure for improving survival rates of DLBCL patients with high intermediate to high aIPI risk. Also, the expression of Bcl-2 protein was found to be useful as one of the variables to be analysed in the therapeutic approach to these patients
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Avaliação da expressão gênica da proteína 2 ligante de SH3 ativadora da GTPase de Ras (G3BP2), do fator da tecidual (TF) e da isoforma asHTF como possíveis marcadores prognósticos em carcinoma epidermóide de cabeça e pescoço / Evaluation of gene expression GTPase activating protein (SH3 domain) binding protein 2 (G3BP2), tissue factor (TF) and its isoform asHTF as possible prognostic markers in head and neck squamous cell carcinomaBarbeta, Lilian Pires 28 September 2009 (has links)
Proteína 2 ligante de SH3 ativadora da GTPase de Ras (G3BP2) parece estar envolvido em vias importantes de sobrevivência celular como a via do NF-B. Já o fator tecidual (TF) e sua isoforma asHTF parecem estar envolvidos nos processos de angiogênese, proliferação e metástase. Assim, os genes G3BP2, TF e asHTF parecem possíveis fatores prognósticos em carcinoma epidermóide (CE) de cabeça e pescoço. Para avaliar a importância desses genes nesse tipo de câncer, foi realizada a quantificação da expressão do RNAm desses marcadores por PCR (reação em cadeia da polimerase) em tempo real em tumores primário e mucosas adjacente de 148 pacientes com CE de cavidade oral, língua e laringe e a proteína de TF e asHTF foi determinada por Western blotting em 17 pacientes com CE de cavidade oral. Os dados da expressão do RNAm foram correlacionados com variáveis clínico-patológicos e sobrevida dos pacientes. A expressão relativa do RNAm de G3BP2 foi menor nos tumores primários em relação à mucosa adjacente em todos os sítios analisados. TF e asHTF não apresentaram nenhuma correlação entre a expressão relativa no tumor primário e na mucosa adjacente para os três sítios analisados. Quando comparados aos tumores sem comprometimento linfonodal (pN0), tumores de cavidade oral e língua com comprometimento linfonodal (pN+) apresentaram maior expressão de TF (P=0,003; P=0,033, respectivamente) e de asHTF (P=0,004; P=0,018, respectivamente Teste não paramétrico de Mann-Whitney). Em seguida, construímos as curvas de sobrevida pelo método de Kaplan-Meier considerando como positivos os pacientes com expressão maior que a mediana para cada marcador. Para os CE de cavidade oral, pacientes com expressão positiva dos genes TF (P=0,034 Teste Log-rank) e asHTF (P=0,010) apresentaram pior sobrevida livre de doença na análise univariada. Quando realizado a análise multivariada tanto TF como asHTF mantiveram a significância estatística (P=0,002 para ambos os genes), sugerindo, assim, serem fatores prognósticos independent. A análise da proteína apontou 76,4% de concordância no padrão de expressão do RNAm de TF e 58,8% para a expressão do RNAm de asHTF. Não foi observada nenhuma correlação entre esses marcadores com outros dados clínico-patológicos e nem com a sobrevida dos pacientes para os tumores de língua e laringe. Assim, sugerimos que a expressão de TF e asHTF parecem ser marcadores prognósticos nos CE de cavidade oral principalmente em relação a sobrevida livre de doença. Apoio FAPESP 06/53755-5 / GTPase activating protein (SH3 domain) binding protein 2 (G3BP2) seems to be involved in pathways important for cell survival as NF- B pathway. Tissue factor (TF) and its isoform asHTF appear to be involved in angiogenesis, proliferation and metastasis. Thus, the genes G3BP2, TF and asHTF seem possible prognostic factors in head and neck squamous cell carcinoma (SCC). To assess the importance of these genes in this type of cancer, we performed mRNA expression analysis of these markers by real time PCR (polymerase chain reaction) in primary tumors and adjacent mucosa of 148 patients with oral cavity, tongue and larynx SCC. TF and asHTF protein was determined by Western blotting in 17 patients with oral cavity SCC. mRNA expression levels were correlated with clinical and pathological variables and survival of patients. G3BP2 mRNA expression was lower in primary tumors as compared to adjacent mucosa at all sites analyzed. No difference was found between TF and asHTF expression in primary tumors and adjacent mucosa in the whole group. TF and asHTF levels mRNA expression were higher in pN+ tumors as compared to pN0 in oral cavity (P=0.003, P = 0.004, respectively) and tongue (P= 0.033, P= 0.018, respectively - Mann-Whitney test) tumors. For Kaplan Meier survival analysis patients were categorized positive (expression > tumor median relative expression) and negative (expression tumor median relative expression). For oral cavity SCC, patients with positive expression of TF (P =0.034 - log-rank test) and asHTF (P =0.010) genes presented shorter disease-free survival in univariate analysis. In multivariate analysis both TF as asHTF retained statistical significance (P=0.002 for both genes), suggesting, therefore, are independent prognostic factors. Protein analysis showed 76.4% agreement with mRNA expression for TF and 58.8% for asHTF. In patients with tongue and larynx tumors there correlation were not found. Thus, we suggest that the TF and asHTF expression seem to be prognostic markers in oral cavity SCC especially in relation to disease-free survival. Supported by FAPESP 06/53755-5
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Avaliação do risco de metástases linfonodais no câncer do endométrio, através de parâmetros clínicos, laboratoriais, radiológicos e anatomopatológicos / Risk assessment of lymph node metastasis in endometrial cancer through clinical, laboratory, radiological and anatomopathological parameters.Anton, Cristina 11 August 2015 (has links)
INTRODUÇÃO: O câncer de endométrio é a sexta neoplasia maligna mais frequente nas mulheres no mundo. Com o crescimento mundial da obesidade, fator associado ao desenvolvimento do câncer de endométrio, estima-se que haja avanço no número de casos da doença. O tratamento cirúrgico do câncer de endométrio inclui a linfadenectomia pélvica e para-aórtica para o conhecimento do status linfonodal utilizado para determinação do tratamento adjuvante segundo a FIGO. Este é um procedimento que requer profissionais com treinamento cirúrgico avançado e não é isento de complicações. Algumas pacientes não se beneficiam da realização sistemática da linfadenectomia. O estudo das características clínicas, laboratoriais, radiológicas e anatomopatológicas das pacientes com câncer de endométrio em nossa população é fundamental para entendermos quais pacientes poderiam prescindir da linfadenectomia. MÉTODOS: Foram avaliadas 408 pacientes atendidas no Instituto do câncer do Estado de São Paulo entre janeiro de 2009 a março de 2015 com diagnóstico de carcinoma de endométrio submetidas ao tratamento cirúrgico. Foram avaliados parâmetros clínicos, laboratoriais, radiológicos e anatomopatológicos e sua capacidade de predizer metástases linfonodais. Foram construídas curvas Kaplan Meyer de sobrevivência. Além disso, as complicações relacionadas à realização da linfadenectomia também foram avaliadas. RESULTADOS: Das 405 pacientes elegíveis para o estudo 236(58,3%) foram submetidas à linfadenectomia pélvica e para-aórtica e não foi obtida amostra linfonadal em 73(18%). Os parâmetros significativos predição de acometimento linfonodal obtido através de regressão logística foram infiltração miometrial > 50%, presença de invasão linfovascular, presença de acometimento linfonodal pélvico por exame de imagem e CA125 > 21,5U/mL. A ausência dos quatro parâmetros implica em um risco de acometimento linfonodal de 2,7% enquanto que na presença de todos os quatro parâmetros o risco é de 82,3%. Nas curvas de sobrevida global (p=0,0001) e livre de doença (p=0,0004), a realização da linfadenectomia teve impacto positivo nas pacientes submetidas à linfadenectomia quando comparadas as não submetidas a este procedimento. CONCLUSÕES: A avaliação do risco de metástases linfonodais em pacientes com carcinoma do endométrio, baseadas em parâmetros clínicos, laboratoriais, radiológicos e anatomopatológicos foi capaz de identificar quatro variáveis com significativo valor preditivo de acometimento linfonodal que foram: linfonodos pélvicos pela imagem, CA125 com valor de corte 21,5U/mL, infiltração miometrial e invasão linfovascular. Na presença desses quatro parâmetros a probabilidade de acometimento linfonodal é de 82,3% / BACKGROUND: Endometrial cancer is the sixth most common malignancy in women worldwide. Obesity is a factor associated with this type of cancer development. Thus, the increase of obesity among women leads to a higher number of endometrial cancer cases. The surgical treatment of endometrial cancer includes pelvic lymphadenectomy and para-aortic to the knowledge of lymph node status used for determining the adjuvant treatment according to FIGO. This procedure requires professionals with advanced surgical training and is associated to complication. Moreover, some patients do not benefit from systematic lymphadenectomy. The study of clinical, laboratory, radiological and pathological data of patients with endometrial cancer in our population is critical to understand which patients could dispense lymphadenectomy. METHODS: This study analyzed 408 patients with the diagnosis of endometrial carcinoma undergoing surgical treatment at the Sao Paulo Cancer Institute between January 2009 and March 2015. Clinical, laboratory, radiologic and pathologic parameters were used to test the ability to predict lymph node metastasis. In addition, Kaplan Meyer survival curves were constructed. Complications related to lymphadenectomy were also evaluated. RESULTS: Out of 405 patients eligible for the study, 236 (58.3%) underwent pelvic and para-aortic lymphadenectomy and 73 (18%) had no lymph node samples. Significant parameters prediction of lymph node involvement obtained through logistic regression were myometrium infiltration > 50%, lymphovascular space invasion, pelvic lymph node involvement by imaging and CA125 > 21,5U/mL. The absence of the four parameters implies a risk of lymph node metastasis of 2.7%, whereas in the presence of all four parameters the risk is 82.3%. The overall survival curves (p = 0.0001) and the disease-free survival curves (p = 0.0004), had a positive impact on patients undergoing lymphadenectomy compared to the subject without lymphadenectomy. CONCLUSIONS: The assessment of lymph node metastasis in patients with carcinoma of the endometrial, based on clinical, laboratorial, radiologic and pathologic parameters was able to identify four variables with significant predictive value of lymph node metastasis. Those were pelvic lymph nodes by the image, CA125 > 21,5U/ml, myometrium infiltration > 50% and lymphovascular space invasion. In the presence of these four parameters, the probability of lymph node involvement is 82.3%
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Aspectos conceituais teóricos e subjetivos da sobrevivência ao câncer: contribuições para a enfermagem oncológica / Theoretical conceptual and subjective aspects of cancer survivorship: contributions to cancer nursingOliveira, Rafaela Azevedo Abrantes de 22 September 2017 (has links)
O progresso no diagnóstico precoce do câncer e terapias, bem como longevidade e o crescimento populacional, remete no aumento do número de indivíduos sobreviventes do câncer em todos os países, e com ele surge uma nova nomenclatura, a da sobrevivência ao câncer (SC). Este estudo teve como objetivo geral, analisar o conceito da SC na literatura de saúde e entre adoecidos adultos e/ou idosos diagnosticados com a doença. Para alcançar este propósito elaboramos mais quatro objetivos específicos que nos fez organizar a tese em três grandes etapas. A primeira etapa tem como objetivo analisar o conceito da SC apresentado na literatura de saúde, segundo o modelo evolucionário de análise conceitual de Rodgers. Este modelo está disposto em seis etapas, preconizando a análise dos estudos levantados pela análise temática indutiva e interpretados segundo o referencial teórico do conceito de cultura. Como resultado obtivemos os componentes do conceito, que nos auxilia na compreensão do mesmo, são eles: antecedente - ser diagnosticado com câncer; consequente - qualidade de vida dos sobreviventes do câncer (StC) e crescimento pessoal; atributos - processo de liminaridade e cuidado culturalmente congruente; termos substitutos - StC, sobrevivência em longo prazo e aquele que está vivendo após o diagnóstico do câncer, e por último os termos relacionados - sobrevida e reabilitação do câncer. Para a segunda etapa dessa pesquisa o propósito foi apreender os sentidos atribuídos a ser StC entre adoecidos, assim como, descrever os sentidos atribuídos ao conceito da SC entre adoecidos adultos e idosos por meio de sínteses narrativas. Desse modo, construímos um estudo qualitativo, com método narrativo e com referencial da antropologia médica. Realizamos entrevistas semi-estruturadas com 14 participantes diagnosticados com os diferentes tipos de câncer urológico de ambos os sexos, adultos e idosos, com no mínimo três meses pós-tratamento. Após transcrição dos dados, os mesmos foram analisados segundo a análise temática indutiva e duas sínteses narrativas foram elaboradas, a primeira delas é as dualidades da vida após o tratamento: da perda do autocontrole, da incerteza da recorrência da doença ao otimismo e esperança. Nessa síntese, discutimos acerca da experiência do sobrevivente com a doença, a perda de controle que a doença desencadeia e o consequente crescimento pessoal e aquisição do otimismo apesar das circunstâncias vividas. A segunda síntese é intitulada, o que eu sou? Sou um sobrevivente do câncer? Autorreflexão da identidade após o tratamento primário do câncer. Nela apreendemos a reflexão dos participantes sobre como se enxergam e veem a si mesmo e atribuem sentidos a ser ou estar doente, curado, vítima e principalmente StC. Com essas duas sínteses narrativas conseguimos descrever e nos aproximar dos sentidos atribuídos a SC. A terceira etapa foi desenvolvida em três tópicos, o primeiro consiste na comparação dos resultados da etapa um com a etapa dois, complementando com a importância da enfermagem oncológica no cuidado aos StC e uma reflexão sobre as políticas de saúde públicas atuais. Essa tese atualiza o conceito da SC e traz novas perspectivas sobre ele, contribuindo para a enfermagem oncológica / The progress in the early diagnosis of cancer and therapies, as well as the longevity and population growth remit to an increased number of cancer survivors around the world, giving rise to a new term, that of cancer survivorship (CS). The general objective in this study was to analyze the concept of CS in the health literature and among adult and/or elderly patients diagnosed with the disease. To achieve this objective, we elaborated four specific objectives, which made us organize the dissertation in three main phases. The objective of the first phase is to analyze the concept of CS presented in the health literature, according to Rodgers\' evolutionary model of concept analysis. This model is arranged in six steps, recommending the analysis of the studies surveyed by means of inductive thematic analysis and their interpretation according to the theoretical framework of the culture concept. As a result, we obtained the components of the concept, which help us understand it. These are: antecedent - being diagnosed with cancer; consequent - quality of life of cancer survivors (StC) and personal growth; attributes - liminality process and culturally congruent care; substitute terms - StC, long-term survival and individuals living after the cancer diagnosis, and finally the related terms - cancer survival and rehabilitation. For the second phase, the purpose was to apprehend the meanings attributed to being StC among the patients, as well as to describe the meanings adult and elderly patients attribute to the CS concept through narrative syntheses. Thus, we built a qualitative study, using the narrative method and the reference framework of medical anthropology. We held semistructured interviews with 14 participants diagnosed with different types of urological cancer, male and female, adult and elderly, with at least three months post-treatment. After transcribing the data, they were analyzed according to inductive thematic analysis and two narrative syntheses were elaborated, the first being the dualities of life after the treatment; from loss of self-control, the uncertainty of the disease relapse to optimism and hope. In this synthesis, we discuss the survivor\'s experience with the disease, the loss of control the disease triggers and the consequent personal growth and gaining of optimism despite the circumstances experienced. The second synthesis is entitled: Who am I? Am I a cancer survivor? Self-reflection on the identity after the primary cancer treatment. In this synthesis, we apprehend the participants\' reflection on how they see themselves and attribute meanings to being ill, cured, victim and mainly StC. These two narrative syntheses allowed us to describe and get closer to the meanings attributed to CS. The third phase was developed in three topics, the first being the comparison between the results of phase one and phase two, complemented with the importance of oncology nursing in care for StC and a reflection on the current public health policies. This dissertation updates the concept of CS and offers new perspectives, contributing to oncology nursing
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Análise de polimorfismos do gene ciclooxigenase-2 (COX-2) no câncer colorretal / Analysis of the cyclooxygenase-2 (COX-2) gene polymorphisms in colorectal cancerTomitão, Michele Tatiana Pereira 03 February 2016 (has links)
A População brasileira apresenta elevada diversidade genética devido à multietnicidade, que têm implicações clínicas/genéticas importantes. O estudo de genes polimórficos pode auxiliar na detecção de pessoas com maior risco de desenvolver câncer, caracterização de evolução diferenciada, resposta distinta ao tratamento quimioterápico ou radioterápico e prognóstico. A ciclooxigenase-2 (COX-2) é induzida em resposta ao fator de crescimento e citocinas, sendo expressa nas doenças inflamatórias, lesões pré-malignas e tumores colorretais. Este trabalho teve como objetivos avaliar a influência dos polimorfismos 1195A > G e 8473T > C do gene COX-2 como fatores de risco para o desenvolvimento de câncer colorretal e investigar o impacto dos polimorfismos na progressão e sobrevida de pacientes submetidos ao tratamento cirúrgico por câncer colorretal. Avaliaram-se SNPs (polimorfismos de nucleotídeo único) em 230 pacientes submetidos à ressecção cirúrgica no Hospital das Clínicas (SP), seguidos por 5 anos e 196 controles, operados por doença benigna na mesma instituição, pareados quanto ao sexo e idade, sem histórico individual ou familial de câncer. Isolou-se o DNA dos leucócitos utilizando-se do kit de extração e purificação PureLink DNA Minikit, seguido de amplificação pela reação em cadeia da polimerase (PCR). Utilizou-se a análise do PCR em Tempo Real para determinar os genoótipos os polimorfismos através dos ensaios TaqMan ® SNP Genotyping Assay. Os resultados encontrados foram associados aos dados epidemiológicos e clinicopatológicos dos pacientes. Determinaram-se as frequências genotípicas, alélicas e estimaram-se as frequências de haplótipos dos polimorfismos do COX-2 -1195A > G e 8473T > C. As populações estão em equilíbrio de Hardy-Weinberg, a exceção do grupo controle para o polimorfismo 8473T > C (p=0,02). As frequências foram similares nos grupos caso e controle para genótipos e haplótipos, portanto, não há associação entre esses polimorfismos e risco de CCR. Em relação às variáveis epidemiológicas e anatomopatológicas do grupo caso, demonstraram-se associação das mesmas com alguns perfis genotípicos. Encontrou-se frequência elevada do genótipo polimórfico -1195GG na população oriental, grupo constituído em sua maioria por japoneses, e dos genótipos 8473TC e CC em afrodescendentes (p < 0,05). Neste grupo, o genótipo -1195GG é ausente. Foi encontrada. Encontrou-se associação entre invasão angiolinfática e genótipo polimórfico 8473 CC (p < 0,05). Na análise de sobrevida, houve associação, no modelo codominante e dominante, do genótipo COX-2 -1195GG com menor sobrevida global (AAxGG: RR = 2,78; IC95% = 1,13-6,84; p < 0,020 e AA/AG x GG: RR = 2,59; IC95% = 1,07-6,27; p < 0,04), utilizando o modelo de regressão múltipla, ajustado para as variáveis de confusão. Assim, pode-se concluir que as variantes -1195A > G e 8473T > C não participam da suscetibilidade genética ao CCR na população brasileira. O polimorfismo -1195A > G, associado à menor sobrevida, pode atuar como marcador prognóstico nestes pacientes / Brazilian population displays very high levels of genomic diversity due to the multi-ethnicity, which have important clinical/genomic implications. Polymorphic genes\' study may aid in the detection of people at higher risk of developing cancer, characterization of differentiated outcome, distinctive response to chemotherapy or radiotherapy and prognosis. Cyclooxygenase-2 (COX-2) is induced in response to growth factor and cytokines, and it is expressed in inflammatory diseases, precancerous lesions and colorectal tumors. This study aimed to evaluate the influence of COX-2 -1195A> G and 8473T> C gene polymorphisms as a risk factor for developing colorectal cancer and to investigate the impact of polymorphisms on progression and survival in patients who have undergone surgical treatment for colorectal cancer. We evaluated SNPs (Single nucleotide Polymorphism) of 230 colorectal cancer resected patients admitted at the Hospital das Clinicas (SP), followed by 5 years, and 196 controls, operated for benign disease at the same institution, matched for age and sex, and no individual or familial history of cancer. DNA was isolated from leukocyte using PureLink (TM) Genomic DNA Mini Kit, followed by amplification by polymerase chain reaction (PCR). Real-time analysis was used for genotyping of polymorphisms, through the TaqMan ® SNP Genotyping Assay. The results of the polymorphisms were associated to epidemiological, clinicopathological and immunohistochemical features of the patients. Were determined genotype and allelic frequencies, and were estimated the haplotype frequencies of COX-2 -1195A > G and 8473T > C polymorphisms. The populations are in Hardy-Weinberg equilibrium, except for the control group to the 8473T > C polymorphism (p = 0,02). The frequencies were similar in case and control groups for genotypes and haplotypes, therefore, there is no association between these polymorphisms and risk of CCR. Regarding the epidemiological and pathological variables in the case group, we demonstrate their association with some genotypic profiles. A high frequency of the polymorphic genotype -1195GG was found in an Asiatic population, group composed in its majority by Japaneses, and 8473TC and CC genotypes in African descent (p < 0,05). In this group, the 1195GG genotype is absent. Association was found between angiolymphatic invasion and polymorphic genotype 8473 CC (p < 0,05). In survival analysis, there was an association, in co-dominant and dominant model, of the COX-2 genotype -1195GG with decreased overall survival (AAxGG: RR = 2,78, 95% CI 1,13-6,84; p < 0,020 and AA / AG x GG: RR = 2,59, 95% CI 1,07-6,27; p < 0,04), using the multiple regression model, adjusted for confounding variables. Therefore, -1195A variants > G and 8473T > C does not appear participate in genetic susceptibility to CCR in the Brazilian population, but the polymorphism -1195A > G, associated with decreased survival, may act as a prognostic marker in these patients
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Impacto da drenagem venosa nas complicações pós-operatórias imediatas e sobrevida tardia no transplante ntervivos de fígado adulto com enxerto de lobo direito / Impact of venous return on postoperative complications and survival in adult living donor liver transplant recipients using right lob graftsSilva, Andre Luiz Aleluia da 17 December 2015 (has links)
INTRODUÇÃO: O transplante de fígado intervivos (TXi) foi desenvolvido no Brasil em 1989. Neste país, beneficia portadores de encefalopatia e ascite, muitas vezes, incapacitados ou limitados profissionalmente. Em alguns casos, estes pacientes são impedidos legalmente de receber enxertos de doadores falecidos por não alcançarem pontuação mínima no escore de gravidade que permita o seu cadastro em fila de transplantes (MELD > 11 exceto São Paulo cujo MELD mínimo aceito para cadastro técnico é > 15). Entretanto, o TXi, raramente, é realizado no Brasil. O transplante de fígado intervivos empregando enxerto de lobo hepático direito entre adultos (TXiLD) é amplamente realizado na Ásia, onde a escassez de enxertos e a cultura religiosa limitam o uso de doador falecido. Particularidades anatômicas permitem diferentes reconstituições venosas durante o implante de enxerto de lobo direito (ExLD) no receptor. As consequências da quantidade e do tipo de veias de drenagem do ExLD são pouco estudadas. No presente trabalho, analisam-se as complicações e sobrevidas de receptores e enxertos relacionadas à reconstituição da drenagem venosa no TXiLD entre adultos. MÉTODO: Foram estudados, retrospectivamente, 140 pacientes adultos, submetidos a TXiLD, no Hospital Israelita Albert Einstein, São Paulo, Brasil, entre janeiro de 2002 e junho de 2006. Estes foram agrupados e analisados em diferentes situações: de acordo com a quantidade de veias do ExLD, utilizadas em sua drenagem. Posteriormente, o menor grupo de pacientes foi excluído e as análises refeitas. Finalmente, os mesmos foram também distribuídos de acordo com o uso da veia hepática média (VHM) do ExLD. Analisou-se: insuficiência renal aguda, uso de hemodiálise, tromboses arterial, portal e das veias de drenagem, disfunção primária do enxerto, rejeição celular aguda (Rca), novo transplante (Rtx), infecções, estenoses e fístulas biliares, dias de internação hospitalar e em UTI, sobrevida dos pacientes e dos enxertos. Foram comparadas as médias e percentuais utilizando Kruskal Wallis e Exato de Fisher. Realizou-se regressão logística para análise multivariada (regressão de Cox), índice de confiança (IC) de 95%, da influência do tipo de reconstituição da drenagem venosa do enxerto no surgimento de complicações no período pós-operatório imediato (POI) e das sobrevidas de pacientes e enxertos. Foi considerado p significativo <=0,05. RESULTADO: Dos 140 pacientes adultos 69,3% são do sexo masculino. A idade e MELD médios foram, respectivamente, 51,9 ± 11 anos e 15,4 ± 5,6. A relação média entre o peso do enxerto e o peso corpóreo dos receptores (Rel pc/pe) foi >1,2%. As distribuições de acordo com a quantidade de veias utilizadas na reconstituição venosa foram: A - uma (40%), veia hepática direita (VHD), B - duas (42,9%), VHD e VHM ou VHD, e veia hepática direita acessória (VHDa) e C - três (17,1%), VHD, VHM e VHDa. De acordo com o uso da VHM: M - uso da VHM (52,9%) e AM - ausência da VHM (47,1%). O grupo B alcançou maior sobrevida em 8 (A=71,4% B=90% C=66,7% p=0,01) e 10 anos (A=48,1% B=85,4% C=56,5% p=0,0001). Após a exclusão do menor grupo (C), o grupo B passou a alcançar menor incidência de infecções (A=47,4% B=27,1% p=0,03) e maiores sobrevidas em 1 ano (A=78,9% B=94,9% p=0,01), 5 anos (A=78,9% B=91,5% p=0,04), 8 anos (A=63,7% B=91,2% p=0,02) e 10 anos (A=47,2% B=86% p=0,001). O emprego da VHM apresentou menos infecções (M=31,1% AM=47% p=0,04) e maior sobrevida em 10 anos (M=85,4% AM=55,2% p=0,001). A análise multivariada mostra que o tempo de internação e uso de crioprecipitados influenciaram significativamente na sobrevida. CONCLUSÃO: Nos receptores estudados, o uso de duas veias do ExLD utilizadas na reconstituição de sua drenagem alcançou maior sobrevida em 8 e 10 anos. Ao avaliar o uso de apenas uma ou duas veias na drenagem do ExLD, o uso de duas veias alcança menor incidência de infecções no POI e maiores sobrevidas em 1, 5, 8 e 10 anos. O uso da VHM do ExLD apresentou menor incidência de complicações infecciosas e maior sobrevida em 10 anos / Introduction: Living donor liver transplantation was developed in Brazil in 1989. In this country it benefits patients with encephalopathy and ascites, who are many times socially and professionally unproductive. Sometimes those patients are legally prevented by the system from receiving grafts of deceased donors for those that don\'t have a minimal score of gravity to permit their enrolment in transplant waiting list (MELD >= 11 except in the state of São Paulo which is >= 15). Despite this advantage, the procedure is rarely carried out in Brazil. The living donor liver transplantation using graft of the right hepatic lobe between adults (LDTRG) is widely carried out in Asia, where the shortage of grafts and the religious culture limit the use of deceased donors. Owing to differences in the anatomical distribution and number of hepatic veins, venous reconstructions differ in patients receiving right lobe grafts (RLG), and the consequences are unknown. Herein we examined the postoperative complication and survival rates of graft recipients according to the number and type of hepatic veins used in venous restoration during LDTRG. Method: Adult patients (n = 140, 69.3% men) who underwent LDTRG at the Albert Einstein Israeli hospital in São Paulo, Brazil between January 2002 and June 2006 were studied retrospectively. Who were grouped according to the number of vein(s) of right lobe graft (RLG) used in drainage, and, subsequently, distributed according to the use of the middle hepatic vein (MHV) of the RLG. The mean patient age and model for end-stage liver disease score were 51.9 ± 11 years and 15.4 ± 5.6, respectively. The graft weight was > 1.2% of the recipient\'s body weight. Results: Group B had the best survival rate at 8 (90% versus 71.4% in group A and 66.7% in group C, p = 0.01) and 10 (85.4% versus 48.1% in group B and 56.5% in group C, p = 0.0001) years. After excluding the minor group (group C), group B had a lower infection incidence rate than did group A (27.1% versus 47.4%, p = 0.03) and a better surveillance rate at 1 (94.9% versus 78.9%, p = 0.01), 5 (91.5% versus 78.9%, p = 0,04), 8 (91.2% versus 63.7%, p = 0,02), and 10 (86% versus 47.2%, p = 0.001) years. Infection incidence rates were lower when the MHV was used than when it was not (31.1% versus 47%, p = 0.04) and surveillance rates at 10 years were higher (85.4% versus 55.2%, p = 0.001). Multivariate analysis demonstrated that days of hospitalization and cryoprecipitate use correlated significantly with surveillance rate. Conclusion: Survival rates were best and complications were fewer when two RLG`s veins including the RVH were used in the venous restoration of LDTRG recipients. After excluding the minor group, the use of two RLG`s veins in drainage restoration achieved less infectious complications during IPP and a greater survival rates between recipients in 1, 5, 8 and 10 years. The use of RLG\'s MHV demonstrates less infectious complications during IPP and a greater survival rates in 10 years between those patients
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