Purpose: Many lives are affected by cancer. The number of people in England who have had a diagnosis of cancer exceeds one million. Previous research shows that one third of patients have unmet needs post-discharge from cancer treatment, including psychological issues such as negative impacts on self-identity and a lack of meaning in life. Studies have identified identity as an important factor in meaning making, but evidence regarding cancer’s impact on identity is limited to specific cancer sites and specific identity roles. Little is known about cancer’s general impact on global identity or how threats to identity relate to meaning making. The aim of this study was to understand patients’ experiences of cancer’s impact on their identity and what sense they made of these experiences. Methods: Twelve participants in the post-treatment phase of cancer shared their experiences in individual semi-structured interviews. Key themes regarding identity and meaning making in the post-treatment phase were identified using interpretative phenomenological analysis (IPA). Results and Conclusions: Four key themes in the participants’ experiences were identified. These were 1) disrupted identity roles, 2) highlights what is important, 3) focused on priorities, and 4) reducing awareness of loss and uncertainty. Relevant literature and implications for future research and clinical practice are discussed.

Introdução: O carcinoma hepatocelular (CHC) é o câncer primário de fígado mais comum. A cirrose hepática é o principal fator de risco para esse tumor. O rastreamento para o CHC em pacientes com cirrose tem sido recomendado há anos. Acredita-se que a detecção e o tratamento precoce do CHC melhorem a sobrevida dos pacientes. O objetivo deste estudo foi analisar a sobrevida dos pacientes cirróticos com CHC pequeno e identificar fatores preditivos de sobrevida no Brasil. Casuística e Métodos: Entre janeiro de 1998 e dezembro de 2003, 74 pacientes cirróticos com CHC foram avaliados. Eles preenchiam os seguintes critérios: CHC com até três nódulos e no máximo 30 mm de diâmetro cada. Os fatores preditores de sobrevida foram identificados através do método de Kaplan-Meier e o modelo de Cox. Resultados: A média de idade foi de 58 anos (32-77); 71% dos pacientes eram do sexo masculino; 64% tinham hepatite C; 60% eram Child-Pugh A, o valor mediano da pontuação de MELD foi de 11; 79% tinham hipertensão portal. No momento do diagnóstico, 71% tinham uma única lesão; o tamanho do principal tumor era menor que 20 mm em 47%; o valor médio de AFP foi de 131 ng/ml. Três pacientes tinham trombose de veia porta, sugestiva de invasão vascular. Cinqüenta pacientes (67,5%) foram incluídos na lista de transplante hepático, que foi realizado só em quatro pacientes. A ressecção cirúrgica do tumor foi possível em quatro pacientes. Quarenta e oito (64,8%) pacientes receberam tratamento ablativo percutâneo (ablação por radiofreqüência ou injeção percutânea de etanol). Nove pacientes não receberam nenhum tratamento específico para o tumor. A taxa de sobrevida geral foi de 80%; 62%; 41% e 17% em 12, 24, 36 e sessenta meses, respectivamente. O tempo médio de seguimento após o diagnóstico do CHC foi de 23 meses (mediana de 22 meses, variando de um a 86 meses) para todo o grupo. Durante o seguimento, ocorreram 39 óbitos ocorreram relacionados com insuficiência hepática ou progressão do CHC. A análise univariada dos 74 pacientes mostrou que escore MELD maior que 11 (p = 0,016), classificação de Child-Pugh B e C (p = 0,007), AFP > 100 ng/ml (p = 0,006), mais de uma lesão (p = 0,041), diâmetro do tumor > 20 mm (p = 0,009) e presença de invasão vascular (p < 0,0001) foram preditores independentes de sobrevida. A análise de regressão de Cox identificou invasão vascular (RR = 14,60 - IC 95% = 3,3 - 64,56 - p < 0,001) e tamanho do tumor > 20mm (RR = 2,14 - IC 95% = 1,07 - 4,2 - p = 0,030) como preditores independentes de pior sobrevida. O tratamento do CHC esteve relacionado com melhor sobrevida. Conclusão: A identificação de CHC pequeno com até 20 mm de diâmetro está relacionada com melhores taxas de sobrevida. Por outro lado, a presença de invasão vascular, apesar do tamanho pequeno das lesões, é um fator associado a péssimo prognóstico. / Introduction: Hepatocellular carcinoma (HCC) is the most common primary liver cancer. Liver cirrhosis is the major risk factor for this tumor. Screening for HCC in patients with cirrhosis has been recommended, in the belief that detection and treatment of early HCC improves patient survival. The aims of this study were to analyze the overall survival of small HCC in cirrhotic patients and identify independent predictors of survival, in Brazil. Methods: Between January 1998 and December 2003, seventy-four cirrhotic patients with hepatocellular carcinoma were evaluated satisfying the following criteria: HCC of 30 mm or smaller and a maximum of three lesions. Predictors of survival were identified using the Kaplan-Meier and the Cox model. Results: Mean age was 58 years-old (32-77), 71% of patients was male, 64% had hepatitis C, 60% were Child-Pugh A, mean MELD score was 11 and 79% had portal hypertension. At the time of diagnosis, 71% had one tumor, the size of the main tumor was smaller than 20 mm in 47%, mean AFP level was 131 ng/ml. Three patients had portal vein thrombosis, suggesting vascular invasion. Fifty patients (67.5%) were included in the liver transplant list, but it was performed in only four patients. Tumor resection was possible in four patients. Forty-eight (64.8%) patients received percutaneous treatment (radiofrequency ablation or percutaneous ethanol injection). Nine patients did not receive any cancer treatment. The overall survival rates were 80%, 62%, 41% and 17% at 12, 24, 36 and 60 months, respectively. The mean length of follow-up after HCC diagnosis was 23 months (median 22 months, range 1-86 months) for the entire group. During follow-up a total of 39 deaths related to liver failure or HCC progression occurred. Univariate analysis of the 74 patients showed that MELD score greater than 11 (p = 0.016), Child-Pugh classification (p = 0.007), AFP > 100 ng/ml (p = 0.006), more than one lesion (p = 0.041), tumor diameter > 20 mm (p = 0.009) and presence of vascular invasion (p < 0.0001) were significant predictors of survival. Cox regression analysis identified vascular invasion (RR = 14.60 - IC 95% = 3.3 - 64.56 - p < 0.001) and tumor size > 20mm (RR = 2.14 - IC 95% = 1.07 - 4.2 - p = 0.030) as independent predictors of decreased survival. Treatment of HCC was related to increased overall survival. Conclusion: Identification of small tumors of up to 20 mm diameter is related to increase survival. Nevertheless, vascular invasion, in spite of the small diameter of the lesions, is a factor associated with dismal prognosis.

Latina breast cancer survivors, especially those who have undergone chemotherapy, may face major disruptions to their diet and eating habits; and a major concern is their ability to function in daily life roles throughout survivorship. Food and nutrition are suggested to be significant factors that can influence the process of cancer development, yet little research has been done to understand the nutritional needs, roles, and expectations among Latina breast cancer survivors. The purpose of this study was to understand Latina breast cancer survivors’ perceptions of the role of diet and nutrition in helping them cope with the effect of chemotherapy treatment. This study was guided by the Transactional Model of Stress and Coping and employed a qualitative research design. A purposive sample of Latina breast cancer survivors (n=32), caregivers identified by the survivors (n=8), and key informants (n=6) were interviewed in their language of preference (Spanish or English) using a semi-structured, open-ended interview guide that explored how coping with a cancer diagnosis influences cancer survivors and caregivers’ nutritional needs and practices. The data were analyzed using an inductive approach to develop an a priori codebook. Thematic analysis was performed using MAXQDA, and emergent codes were added as appropriate. The results yielded that Latina breast cancer survivors emphasized the value and meaning of nutrition; this was accomplished by increasing their nutritional awareness to restore health, improve the body’s immunity, and regain/maintain agency and control of their food consumption. Food provided by friends and family, assistance from nutritional organizations, doctors’ recommendations, and negative chemotherapy side effects influenced Latina breast cancer survivors and caregivers’ decisions about diet and nutrition during and after treatment. Negative chemotherapy side effects and positive support from husbands, family members, and friends affected the role of Latina women as the ‘nutritional gatekeepers’ in the family, since breast cancer diagnosis and treatment disrupt or limit the role of Latinas within the household unit. Findings from the interviews with Latina breast cancer survivors, caregivers, and key informants indicated that cultural expectations among this population shape the kinds of support and assistance that are provided by family members. Lastly, this research study revealed unmet information needs: Latina breast cancer survivors relied on organizational and online nutrition-related resources but identified a gap in culturally and linguistically tailored information related to diet and nutrition following diagnosis. The study concluded that Latina breast cancer survivors and caregivers mentioned no routine dietary assessment for cancer survivors after beginning chemotherapy and during treatment. Additionally, caregivers specified needing instrumental support to better meet the nutritional needs of Latina breast cancer survivors. This study added to our understanding of Latina breast cancer survivors’ unmet needs that could contribute to the creation of future nutrition education programs and interventions most appropriate during cancer survivorship for diagnosed individuals and their caregivers.

博士（経済学） / 甲第457号 / 124p / Hitotsubashi University

Bakgrund: Bröstcancer är den cancersjukdom som förekommer i störst omfattning bland kvinnor. Med åren har diagnostik och behandling förbättrats, vilket resulterat i ett ökat insjuknande samtidigt som dödligheten minskar. Begreppet survivorship i relation till cancer innebär fokus på personens hälsa och välbefinnande från det att diagnosen konstaterats till livets slut. Begreppet survivorship omfattar olika områden, bland annat kroppsliga, känslomässiga, sociala och ekonomiska där cancer kan påverka personer från diagnos till restenav livet. Inom den empiriska forskningen har roller och relationer lyfts fram inom bröstcancer och survivorship. Syfte: Att beskriva kvinnors upplevelser av roller och relationer vid bröstcancer. Metod: Litteraturstudien utgjordes av två självbiografier som analyserades med utgångspunkt i kvalitativ innehållsanalys med induktiv ansats. Resultat: Analysen resulterade i tre kategorier: Försöka behålla vardagsliv medan cancern bryter rutiner och roller, Det behövs kärlek och självmedkänsla för att tillägna sig det nya livet, Döden äventyrar relationer när de behövs som mest i livet. Slutsats: Kvinnor med bröstcancer upplevde att roller och relationer var viktiga, men utmanades av bröstcancern. Med ett personcentrerat förhållningssätt och en helhetssyn kan sjuksköterskan främja hälsa och lindra lidande för kvinnor med bröstcancer, men även för deras närstående.

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Loggerheads (Caretta caretta) are listed as Threatened and green turtles (Chelonia mydas) are listed as Endangered under the United States Endangered Species Act. While green turtle nest production in Florida has increased markedly in recent years, loggerhead nest production has followed a more tenuous path. Reasons for these differences are unknown. Limited demographic information is available for these species of conservation concern. I used Barker models, which incorporated mark-recapture, live-resight and dead recovery data, implemented in Program MARK. These models were used to estimate apparent survival for immature loggerhead (

Background: Since the early 1960s, survival rates among cancer survivors have been increasing. Surviving cancer can be a stressful experience due to the multifaceted changes that come with diagnosis, treatment, and recovery. Therefore, studying the mental health of cancer survivors is vital for their well-being. Among queer groups (including those identifying as gay, lesbian, or bisexual), poor mental health is more prevalent than among heterosexuals. However, cancer survivorship among queer populations is not well studied. This study examines the association between cancer survivorship and poor mental health, focusing on potential sexual orientation differences. Methods: Data are from the 2019-2021 National Health Interview Survey. Participants identified as straight (n=65,006), gay or lesbian (n=1,271), or bisexual (n=1,100). Diagnosis of anxiety and depression as well as the frequency of anxiety and depressive symptoms were regressed on cancer survivorship (assessed based on cancer diagnosis) using logistic models. Using a subsample of 2019 rotating core participants, we assessed anxiety, using the Generalized Anxiety Disorder-7 (GAD-7) scale, and depression, using the Patient Health Questionnaire-8 (PHQ-8) symptoms, to account for a potential lack of diagnosis. Models were adjusted for sociodemographic covariates and were stratified by sex. Results: After adjusting for sociodemographic characteristics there was no significant association between cancer diagnosis and mental health in the overall sample. However, when examining sexual identity-specific estimates, among bisexual males, cancer survivors had higher odds of “daily” anxiety [OR=8.07 CI (1.23,52.81)] and “weekly or monthly” depressive symptoms [OR=15.23 CI (3.17, 73.22)]. While among bisexual females, cancer survivors had significantly higher odds of anxiety diagnosis [OR=3.03 CI (1.37, 6.71)] than those who never had cancer. Moreover, bisexual male cancer survivors had higher GAD-7 [β =10.39 (4.03, 16.75)] and PHQ-8 [β =13.59 (6.03, 21.16)] scores than those who never had cancer. No other significant associations were found for other sexual identity groups. Our test for effect modification based on sexual identity on the association between cancer diagnosis and mental health outcomes suggested that the association between cancer diagnosis and mental health outcomes were similar across sexual identity groups. The p-values ranged from 0.11 to 0.92. Conclusion: Bisexual cancer survivors may experience poorer mental health than those who have not had cancer, suggesting a potential need for more targeted mental health intervention and cancer survivorship support. However, small sample sizes suggest that additional work with larger samples of cancer survivors is needed to corroborate these findings.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24832号 / 医博第5000号 / 新制||医||1067(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 武藤, 学, 教授 今中, 雄一, 教授 阪上, 優 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM