Bakgrund: Gynekologisk cancer drabbar ungefär 2800 kvinnor i Sverige varje år och är därmed bland kvinnor den näst största diagnosgruppen efter bröstcancer. Denna cancerform drabbar ett mycket privat område vilket innebär att den ofta omges av starka känslor och upplevs som svår att prata om.    Syfte: Syftet med denna studie var att beskriva kvinnors fysiska och psykosociala upplevelse av att ha överlevt gynekologisk cancer.  Metod: En litteraturstudie har gjorts utifrån granskning av åtta vetenskapliga artiklar. Via en manifest innehållsanalys har fyra huvudteman identifierats. Resultat: Att leva i en förändrad kropp: kvinnorna lever med en del kvarstående kroppsliga förändringar till följd av sjukdom och behandling. Det handlar om såväl konkreta fysiska symtom, men även om hur de här förändringarna påverkar kvinnorna, känslomässigt och psykosocialt. Ensamhet i mötet med sig själv och andra: kvinnornas upplevelse av överlevandet som en ensam process och avsaknad av stöd från närstående och sjukvård. Att skapa en ny plan för framtiden: att leva vidare efter sjukdom och behandling innebär att leva i spänningen mellan att försöka hantera det man gått igenom och söka något nytt samtidigt som man lever med en ständig oro inför framtiden. Positiv återgång till livet: sjukdomserfarenheten har inte enbart haft negativa följder utan många talar om erfarenheten som berikande och berättar om en större närvaro och uppskattning av livet.  Diskussion: Resultatet diskuteras i relation till Meleis transitionsteori samt relateras till tidigare forskning på området. Resultatet har visat att kvinnor som överlevt gynekologisk cancer är tvungna att hantera förändringar på olika nivåer och anpassa sig till livet på ett nytt sätt. Överlevandet kan beskrivas som en rörelse från ett tillstånd till ett annat, under vilken kvinnorna erfar såväl vinster som förluster. Att anpassa sig till livet efter cancer innebär att de måste lära sig att förhålla sig till och hantera de förändringar och omvandlingar de går igenom.

<p>Caregivers of survivors of pediatric cancer face ongoing social, emotional and financial challenges that may result in enduring illness- and caregiving-related distress. After patients complete treatment there are challenges that persist. Indeed, emerging physical and cognitive "late effects," resulting from the disease and treatment, require families to adapt to a new normal state that may require significant long-term follow-up and care by the survivor and their primary caregiver. This study compares the psychological adjustment of caregivers of pediatric cancer survivors with caregivers of healthy children. In addition, this study evaluates individual factors, such as family functioning and coping style, which may be associated with poorer adjustment among caregivers of pediatric cancer survivors. Caregivers of pediatric cancer survivors (n = 64) and caregivers of healthy children (n = 64) were recruited during regularly scheduled clinic visits to complete questionnaires including a demographic and illness questionnaire and measures of psychosocial functioning. A series of multivariate analyses of covariance were conducted to assess for differences in caregiver distress by group. Caregivers of survivors reported significantly more child-specific parenting stress and somatization than caregivers of healthy children. Hierarchical regression modeling revealed that Escape-avoidance coping and Supportive family functioning predicted 25-40% of the variance in parenting-related psychological adjustment among caregivers of survivors. Caregivers of pediatric cancer survivors face unique challenges that contribute to ongoing distress, particularly related to the parenting role. This population may benefit from interventions aimed at reducing avoidance based coping and improving family functioning.</p> / Dissertation

Common bottlenose dolphins (Tursiops truncatus) are apex predators and indicators of localized ecosystem health. Accurate characterization of population demography is crucial to parameter predictions. However, descriptions of age growth investigations of odontocetes are limited to the postnatal life. In contrast, the modeled scenario for terrestrial mammalian growth has been described along a continuum of pre- and postnatal data. Few age distribution data exist for the western Gulf of Mexico despite the fact that life tables enable demographic comparisons among populations. The objective of this study was to characterize age, growth, and population-level behavior of bottlenose dolphins along Texas. This objective was accomplished by two discrete studies: age analysis, and population-level behavior. Teeth from 290 stranded individuals were extracted for the purposes of age determination. Curvilinear models (the Gompertz and the von Bertalanffy) were fit to postnatal length-at-age data. Fetal age was determined for 408 suspected fetal length records using validated fetal growth trends and empirical measurements from late-term fetuses. Growth analysis indicated that a Gompertz model fit length-at-age data better than a von Bertalanffy model. A postnatal Gompertz model explained less variation than a combined pre- and postnatal model (R2 = 0.9 and 0.94 respectively). The absolute growth rate and rate of growth decay tripled with the inclusion of fetal length and age data. In the second study, life tables were constructed for 280 individuals. Survivorship curves, mortality rates, intrinsic capacity for increase, and the population growth rate were calculated. Bottlenose dolphin mortality did not differ significantly by sex or age class. Survivorship was best characterized by a type III curve. Analyses indicated no substantial increase (r = -0.07), and that the population is not replacing itself in the next time-step (y = 0.93). Bottlenose dolphins conform to a number of eutherian mammalian trends: the production of precocial young, calving seasonality, and rapid fetal growth rate. Population level behavior suggests a population retraction possibly as a compensatory response to ecosystem perturbation rather than a population decline. Reproductive information will confirm population status and stability in the future. This study is the first to demonstrate a significant impact of cetacean fetal growth parameters on postnatal growth trajectory.

Prior research suggests that fear of cancer recurrence is very common among cancer survivors. This study examined the extent to which Protection Motivation Theory variables of threat appraisal and coping appraisal accounted for differences in fear of recurrence and performance of health behaviors in cancer patients who recently completed treatment. It was hypothesized that greater fear of recurrence would be related to a combination of high threat appraisal and low coping appraisal. Also, it was hypothesized that higher rates of health behaviors would be related to higher threat appraisals for cancer recurrence and higher coping appraisals for reducing risk of recurrence by improving diet or exercising. A sample of 155 early-stage breast cancer patients (mean age = 59 years) who completed surgery, chemotherapy, and/or radiotherapy between 6-24 months previously (mean = 12 months) completed measures of fear of recurrence, threat appraisal (perceived risk and severity of a potential cancer recurrence), fruit and vegetable intake in the past month, exercise for the past week, and coping appraisal (perceived response efficacy and self-efficacy to perform diet and exercise recommendations to reduce recurrence risk). Basic demographic and clinical information was also collected. The study findings supported the hypothesis that the combination of threat and coping appraisal beliefs explain which breast cancer survivors report higher fear of recurrence. However, the observed results did not support the hypothesized interaction between threat and coping appraisal for predicting either diet or exercise habits. Instead, coping appraisal alone predicted both fruit and vegetable consumption and exercise habits. Future research should focus on examining these relationships longitudinally and further assess coping appraisal and how it impacts fear of recurrence.

While incidence rates are increasing for many cancers in Puerto Rico, mortality rates are declining (Torres-Cintron, et al. 2010), resulting in growing numbers of survivors and creating a situation in which long-term survivorship concerns are beginning to emerge as priorities. The importance of quality-of-life among survivors of cancer is increasingly being recognized among healthcare providers, although there remains a gap in knowledge of how young adult survivors cope with long-term treatment-related physical effects, such as infertility, and of the impact of cancer on survivors' social relationships and future goals. Because understandings of "cancer survivorship," as well as of reproduction, vary according to cultural context, this study examined the physical and social impact of cancer on young adults in Puerto Rico, and specifically the importance of parenthood. A media analysis of women's magazines, key informant interviews with ten cancer researchers, as well as in-depth, semi-structured interviews with 23 young adult cancer survivors, 16 healthcare providers, nine cancer advocates, and two members of the clergy were conducted in order to shed light on the lived experiences, needs, and concerns of young Puerto Rican cancer survivors.

Behavioral studies have documented impaired working memory in childhood brain tumor survivors; however, neural mechanisms have yet to be identified using fMRI. The current study investigated BOLD response differences between twenty survivors (Mean age=23.1(4.14), 55% female) and twenty age- and gender-matched controls from the start to the end of a twenty minute 3-back task. There were no differences in task performance between groups or over time. Effects of practice were present in left prefrontal regions, with both groups showing decreases in activation as the task progressed. There were qualitative and quantitative differences in the brain regions that survivors recruited relative to controls in bilateral prefrontal (including the dorsolateral prefrontal cortex) and parietal cortices. Findings suggest that areas under top-down control of the dorsolateral prefrontal cortex become less activated with practice, and that survivors may require more top-down processing and attentional control to perform at similar levels to healthy controls.

Background Long-term side effects associated with the treatment of Hodgkin’s lymphoma (HL) have frequently been reported during the last decades. Studies have shown increased mortality in HL survivors. Following Hodgkin’s lymphoma, second malignancies (SM) and cardiovascular disease (CVD) are the most common causes of death in individuals treated for HL. This study investigates the incidence of side effects such as SM, CVD and infections in a cohort diagnosed with HL in Sweden between 1965 and 1995. In addition, this study identifies covariate risk factors for late side effects in order to develop strategies that prevent morbidity and mortality in HL survivors. Methods Using the Swedish Cancer Registry (SCR) at the National Board of Health and Welfare and the Multi-Generation Registry at Statistics (MGR) Sweden, we identified 6946 individuals diagnosed with HL between the years 1965 and 1995, and their first degree relatives (FDR) (n=17 858). In addition we identified the malignancies and inpatient care for CVD and infections for the HL cohort and their FDR. The standard incidence ratio (SIR) was calculated for the risk of SM, CVD and infections. For SM and CVD the risk also was stratified and calculated for family history of disease. The Swedish Hodgkin Intervention and Prevention study (SHIP), a prospective study, invited 702 individuals treated for HL at the age of 45 years or younger and who were treated in the region of Skåne, Uppsala or Umeå. The participants completed a questionnaire and were invited to an out-patient visit to an oncologist with clinical examination and blood tests. Any pathological findings were referred for further investigation. Results An increased risk for SM in HL long-term survivors was observed and seems to increase with the number of FDRs with cancer. There was also an increased risk for inpatient care due to congestive heart failure (CHF) and coronary artery disease (CAD). A family history of CHF and CAD further increased the risk for these diseases. The risk for inpatient care due to infections was increased and remained increased after 20 years or longer. The risk for infections was associated with splenectomy and hypothyroidism. Radiotherapy was an independent risk factor for cardiovascular disease in the cohort of the prospective study. ConclusionLong-term survivors from HL have an increased risk for developing late side effects such as SM, CVD and infections. Since many HL patients are young and the cure rate from the disease is high, it is of great importance to offer focused surveillance programs to selected individuals who are at high risk, e.g. individuals who received radiotherapy as part of their treatment and who have other known risk factors for cardiovascular disease such as hypertension, hypercholesterolemia, family history and smoking.

Breast cancer incidence in Chinese women is rising in North America. However, a critical review of the empirical research reveals a clear under-representation of the breast cancer survivorship experiences of ethnic minority women, particularly those of Chinese origin. A breast cancer diagnosis not only disrupts a woman’s everyday life but also, and more importantly, her self-identity: who she was before the cancer diagnosis and who she becomes after the diagnosis. The purpose of this study was to understand the lived survivorship experience of Chinese women with breast cancer, in particular the way they reconstruct their self-identity while living under the constant threat of premature mortality. A hermeneutic phenomenology was employed to illuminate the essence of the lived experience. A purposeful sample of 24 Chinese women was recruited, and audiotaped face-to-face semi-structured interviews were conducted in English or Mandarin. An iterative process was carried out to identify themes and interwoven them into the four existentials of lifeworld to lend structural meaning to the lived experience. The self-identity of Chinese women living with breast cancer did not fit the current combative survivor identity and narrative as represented in the North America media. Rather, a ‘quiet’, modest and practical narrative underscoring the Chinese virtues of self-reliance, endurance, and social responsibility and harmony characterized their lived experience and self-identity. They endured unexpected major life events and accepted what life offers in an effort to move on with their lives of being a normal person again. An understanding of the way Chinese women manage the impact of breast cancer and their survivorship experience will significantly contribute to building our knowledge about this minority population within the Canadian context. In turn, this understanding will support health care professionals with the development of culturally sensitive psychosocial/supportive care services to maximize adaptation and recovery.

Little is known about the receipt of cancer screening for new primary cancers among Canadian cancer survivors. The objectives of this thesis are to i) synthesize evidence comparing receipt cancer screening between cancer survivors and non-cancer controls; and ii) analyze breast and cervical cancer screening receipt among Nova Scotian colorectal cancer (CRC) survivors. This thesis consists of a systematic review and meta-analysis, and a population-based cohort study of Nova Scotian CRC survivors. We found that while cancer survivors were more likely to receive cancer screening than the general population, a significant proportion of cancer survivors were not screened. We observed significant heterogeneity between studies, most of which remained unexplained after subgroup and sensitivity analyses. 30.1% and 47.9% of Nova Scotian CRC survivors never received a breast and cervical cancer screen after their CRC diagnosis. Receipt of pre-CRC diagnosis screening was strongly predictive of receiving screening post-diagnosis.

Purpose: The purpose of this thesis was to perform a scoping review of the current literature and available clinical practice guidelines to generate an understanding of the primary health care needs of women following treatment for breast cancer. Methods: Based on an extensive scoping review of the literature, research findings regarding the complications of breast cancer treatments and corresponding primary care interventions were synthesized. Additionally, validation of the findings of the scoping review was performed through semi-structured interviews with two primary care physicians and three post-treatment breast cancer patients. Results: Eleven broad categories related to the primary health care needs of women after undergoing treatments for breast cancer were identified. These included concerns related to: surgical complications, lymphedema, gynecologic and menopausal symptoms, psychosocial issues, additional primary cancers, cardiovascular implications, osteoporosis, lifestyle changes, fatigue, cognitive dysfunction, and pregnancy. Additionally, it was determined that the majority of existing clinical practice guidelines for breast cancer were outdated, and related to cancer detection and treatment as opposed to survivorship care. Summary: Findings from the scoping review and interviews demonstrate the vast range of primary care needs of women after undergoing treatment for breast cancer. Additionally, these results highlight the critical need for the development of a comprehensive set of current clinical practice guidelines which target primary care physicians and are specifically focused on the survivorship needs of women following breast cancer treatment. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2011-07-22 16:09:35.682