Dissertations / Theses: 'Supportive medicines in cancer'

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du, Plessis Johannes. "Family experiences and viewpoints of palliative and supportive care for children with cancer: Can we do better?" Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25066.

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Background: The palliative and supportive care needs of children with cancer and their families are unique and require special attention. Children and their families in Africa facing lifethreatening/ life-limiting diseases have unique needs and have the right to achieve effective and evidence-based care. Development of appropriate services sensitive to the needs of families and based on observed evidence has become more and more recognized. As an introduction to develop and improve supportive and palliative care services for children with cancer, families were questioned regarding their experiences and suggestions for improvements. Methods: Sixteen family members of children with cancer and treated at Universitas Academic Hospital, Bloemfontein, South Africa, were questioned regarding their children's standard oncology and supportive/palliative care. Their responses were studied and repeating themes were identified. Results: A number of areas of need were identified: erratic psychosocial support, minimal financial support, poor parental access to basic needs and food provision, preventable errors in procedures and lack of sibling support. Staff were also not always sufficiently equipped to attend to palliative care patients. Conclusions: Supportive and palliative care for children with cancer needs to be improved. Family members are a valuable resource and the interviews identified a number of themes, valuable to consider in the expansion of a supportive/palliative care service. The intension of the study was to create the awareness that by making small and affordable changes, the quality of care that children and families receive can be improved.

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Farley, Amanda Claire. "Health and supportive care needs of surgical lung cancer patients, and the prognostic significance of smoking." Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/4979/.

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Aims: This thesis investigated the health and supportive care needs of surgical lung cancer patients to address gaps in the evidence base and inform future service developments. Additionally, the prognostic significance of smoking behaviour was investigated. Methods: Semi-structured interviews were conducted with 29 surgical (VATS and thoracotomy) lung cancer patients to explore health, functioning, smoking, satisfaction with recovery and preferences for a tailored rehabilitation programme. Interviews were analysed using framework approach. Systematic literature searches were conducted to review evidence of the association between smoking history or continued smoking after diagnosis and prognosis. Survival estimates were combined where possible using a random effect inverse variance model. Results: Most participants experienced difficulty during recovery. Breathlessness and pain emerged as dominant health challenges. Participants were open to being offered smoking cessation support. From 78 and 10 studies, preliminary evidence was found that both smoking history and continued smoking are associated with prognosis, respectively. Analyses indicated that smoking-associated increased risk may be mediated through cancer-related pathways. Conclusions: Many surgical lung cancer patients’ supportive care needs are not being met. Well-developed treatments and services for management of breathlessness, pain and smoking cessation may improve quality of life and health outcomes after lung cancer surgery, and require further testing.

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Wong, Margurite Elvina. "Supporting Chinese-speaking cancer patients to make safe and informed complementary medicine decicions." Thesis, University of British Columbia, 2012. http://hdl.handle.net/2429/42129.

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Clinical observation indicated that there were a substantial number of Chinese-speaking cancer patients receiving care at the British Columbia Cancer Agency (BCCA) located in Vancouver, where the second largest Chinese Canadian population resides. CAM has been popular among Chinese-speaking cancer patients around the world, but little research has been done to examine the prevalence of CAM use in these patients in Canada. It was found that almost half of these patients used CAM and their preferred choice of CAM therapy was biological-based therapy that included natural health products (NHPs) and traditional Chinese medicine (TCM). The use of CAM is controversial because of its potential to interact with conventional cancer treatment and other medications. Due to a lack of culturally relevant CAM information and decision support intervention, many Chinese-speaking patients were using CAM without adequate support. This type of support is urgently needed to help these patients to make safe and informed CAM decisions. Knowledge about their CAM decision-making experiences and the types of CAM information and decision supports needs are required to create such interventions. A sequential multi-method research design was used for this study, which occurred in two phases: a quantitative secondary data analysis and qualitative semi-structured interviews. In this study, we found that more than 65% of the Chinese-speaking cancer patients surveyed reported to have used CAM since their diagnoses, and the prevalence of its use was significantly higher than that used by the mainstream cancer population. There were two types of CAM decision-making experience: Spontaneous and deliberate. The spontaneous decision makers relied heavily on their peers to help with decision making, whereas the deliberate decision makers gathered information from multiple sources and selected the CAM therapies that were safe and fitted their cultural health beliefs and their previous CAM use experience. In addition, the group of patients also had unique CAM information and decisions supports needs. All this newly gained knowledge would contribute to the development of future interventions to help theses patients to make safe and informed CAM decisions.

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Salas-Vega, Sebastian. "Cancer medicines : clinical impact, economics, and value." Thesis, London School of Economics and Political Science (University of London), 2017. http://etheses.lse.ac.uk/3647/.

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Background and Importance: There has been much debate recently over rapidly growing drug expenditures. Cancer medicines, in particular, have driven new brand spending over recent years, and US oncological expenditures have risen faster than for many other disease areas, in part because of rapidly growing drug prices, as well as increased rates of use. Objective: In the face of ongoing debates on how to reasonably control growth in pharmaceutical spending, while also providing patients with the best possible care, this thesis sets out to help address the question of whether growing pharmaceutical expenditures are providing value-for-money to patients and society. Novelty and Empirical Contributions: This thesis is based in part on a systematic review with narrative synthesis of English-language HTA appraisals of the comparative clinical risks and benefits of new cancer medicines, as well as on the novel use of methods to generate comparative evidence on their use and cost. Adapting established methods, these data are then used to examine existing questions over whether growing expenditures are worth the cost to patients and society. This thesis makes five major contributions to the literature on value-based spending on cancer medicines: 1) approximately one in three newly licensed cancer medicines provide no known overall survival benefit, while one in five provide no known overall survival, quality of life, or safety benefit; 2) novel use of methodologies to model treatment course and duration reveals that cancer drug use and costs vary greatly between individual medicines, and across Australia, France, the UK, and the US; 3) the monetized value of survival gains attributable to cancer drug innovation, net of growth in cancer drug spending, varies across individual medicines, and, at a country-level, remains unambiguously positive in Australia, France, and the UK, but negative in the US; 4) spending on new cancer medicines is often only weakly associated with their clinical benefits; and 5) the strength of this association nevertheless varies across countries, with the UK demonstrating the strongest evidence of value-based spending on new cancer medicines. Clinical and Policy Implications: Findings from this thesis provide a resource for valuebased clinical decision-making by patients and physicians. Moreover, growing expenditures on cancer medicines may only weakly be associated with meaningful clinical benefits, though the extent to which this is true differs across countries. These findings highlight the important role that health policy can have in encouraging valuebased cancer drug spending. In particular, it is argued that managed access schemes promoting access and evidence development, as well as the use of value-based spending policies, can help expedite access to new treatments, incentivize the development of clinically meaningful medicines, and rationalize growing cancer drug expenditures. Future Research Directions: The comparative clinical risks and benefits from new cancer medicines using real-world data, and how they compare with trial-based results; how evidence on the comparative impact from new treatments is measured, weighted, and rewarded in decision-making by regulators and payers; and how it is effectively linked through policy and regulation to cancer drug spending.

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譚郭雅欣 and Gloria Tam. "Non-small cell lung cancer clinical trials on new medicines." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B41711956.

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Fang, Rui. "Investigation of some traditional Chinese medicines used to treat cancer." Thesis, King's College London (University of London), 2006. https://kclpure.kcl.ac.uk/portal/en/theses/investigation-of-some-traditional-chinese-medicines-used-to-treat-cancer(c889892f-19cd-4a7a-908c-faaeec106eb7).html.

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The aim of the present project is to study five Traditional Chinese Medicines (TCM) used traditionally in China for the treatment of cancer. They are Dolichos lablab L., Gekko swinhonis Gunther, Illicium verum Hook. f, Lonicera japonica Thunb. and Iris tectorum Maxim. Solvent extractions of the TCMs were subjected to bioassay-guided fractionation and isolation, yielding series of fractions with increasing purity and cytotoxicity. The cytotoxicity assay used comprised four human cancer cell lines (COR-L23, C32, MCF-7 and HepG2) and two human normal cell lines (MRC-5 and 16HBE14o-). The separation of organic components was carried out mainly by means of TLC, VLC and HPLC. Isolation and purification of bioactive compounds from the active extract of I. tectorum, the most potent source tested, led to the identification of two known flavonoids (tectorigenin and 7-0-methyl-aromadendrin), two known triterpenes (isoiridogermanal and iridobelamal A) and two novel triterpenes. The structures of the latter were determined by mass spectrometry and infrared and 2D nuclear magnetic resonance spectroscopic techniques. Induction of apoptosis by the isolated compounds was investigated using flow cytometry with quadrant analysis, and confirmed by fluorescence microscopy. Furthermore, cell cycle specific cytotoxicity was determined by DNA analysis. The selectivity of cytotoxicity activity, modes of action and structure-activity relationships of the compounds are discussed. Also, a cell culture-based prodrug assay was established for high-throughput screening of potential glucosides, which are inactive in vitro but may be metabolized to active aglycones in vivo. In summary. the results obtained showed that selection based on ethnopharmacology, together with a robust and reliable method to detect biological activity, can be a useful approach for exploring traditional medicines for novel cytotoxic substances.

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Tam, Gloria. "Non-small cell lung cancer clinical trials on new medicines." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B41711956.

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Beesley, Vanessa Lea. "The experience of gynaecological cancer survivors : supportive care needs and use." Thesis, Queensland University of Technology, 2006. https://eprints.qut.edu.au/16355/1/Vanessa_Beesley_Thesis.pdf.

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Gynaecological cancer survivorship has been addressed in only a limited body of research. After completion of treatment, women with gynaecological cancer face many challenges. It is pertinent that we understand the wellbeing and morbidity issues of this group of survivors, as well as their supportive care needs and use. With this understanding, it will be possible to better target health care initiatives and services to those gynaecological cancer survivors who require help. Accordingly, the objectives of this study were to determine the prevalence of site-specific morbidities, support being utilised, and unmet needs, as well as to determine the correlates of supportive care needs and use. To address this, a cross-sectional mail survey of 1774 Queensland gynaecological cancer survivors three months to five years post-diagnosis was conducted in 2004 (56.5% response rate, n=802 of 1420 eligible participants). Women were recruited from the Queensland Gynaecological Cancer Registry, which covered approximately 85% of all gynaecological cancer patients in Queensland at the time of this study. The questionnaire measured a range of factors to reflect a social-ecological perspective. This broader perspective was utilised to extend the current understanding which is limited to a biopsychosocial approach. Main outcomes were measured with standardised and validated instruments where possible, including the Supportive Care Needs Survey, Functional Assessment of Cancer Therapy, Duke-UNC Functional Social Support Questionnaire and the Active Australia Survey. The results of this survey showed that while quality of life was high on average (median 91, range 30-108), some women experienced debilitating site-specific conditions. Ten percent reported being diagnosed with lower limb lymphoedema and eight percent of women reported that their gynaecological cancer had made sexual relations too difficult or too uncomfortable. Women accessed multiple sources of support within their communities including a variety of support services (54%) and complementary therapies (29%). Characteristics associated with use of support services include: younger age, being retired, having been diagnosed with a gynaecological cancer other than uterine, having had open bowel resection, having been treated at multiple centres, being in remission, being obese. On average, women reported having excellent social support (median 37, range 8-40). Some women made changes to healthier behaviours following their cancer diagnosis, such as increasing their fruit and vegetable intake (23%) or physical activity levels (10%) or decreasing their alcohol consumption (24%) or cigarette smoking (10%); however, nearly half (44%) of women decreased their physical activity level. A population comparison of health behaviours between gynaecological cancer survivors and Queensland women highlighted the significantly lower level of sufficient physical activity and higher level of obesity in the cancer survivor population, as well as the low levels of adequate vegetable intake in both populations. Forty-three percent of gynaecological cancer survivors reported having at least one moderate or high level unmet supportive care need. In particular, needing help with fear about the cancer spreading, concerns about the worries of those close to them, uncertainty about the future, lack of energy/tiredness, and not being able to do things they used to do, were most important to this group. These leading need items were all within the psychological and physical/daily living supportive care domains. Some unmet sexuality and health system/information needs were also reported. Groups with higher odds of unmet needs included those women who more recently completed treatment, whose disease was still present, who had children still living in the home, who had diagnosed lymphoedema, who experienced treatment-related menopause, who were unable to work due to illness and who lived in rural and remote regions of Queensland. These results indicate that women with gynaecological cancer in Queensland are doing quite well overall; however, there is still room for improvement in a few key areas of public health importance. In line with the social-ecological model, resources need to be targeted at all levels of support including personal, social, health care and broader organisational, community, policy and media levels. In particular, the following recommendations are made: 1. Assistance with the particular reported unmet psychological and physical/daily living needs is a priority. Support services should be tailored to the identified groups of survivors who had higher odds of unmet needs, both in terms of development of written materials that reflect these groups' circumstances and implementation of programs or workshops specific to these groups. In particular, the development of a number of programs or workshops are recommended that discuss the specific psychological and physical/ daily living outcomes of women who a) live with cancer, b) live with children after cancer treatment, c) live with lymphoedema, d) have had treatment-related menopause or e) are unable to work due to illness, and how and where women can get help with managing these. These programs should be implemented by support organisations in the period closely following treatment completion and should consider technologies such as video-conferencing to reach women who are in rural and remote areas. 2. More specific written information for cancer survivors about things they can do to help themselves get well is needed, in lay-person friendly format. This information should address the value of particular dietary items, complementary therapies and types of physical activities that are safe and beneficial to cancer survivors' quality of life. 3. An evidenced-based physical activity intervention, targeting overweight and obese gynaecological cancer survivors is recommended, to reduce the weight issues of this population. 4. To facilitate the triage of cancer survivors to appropriate health care information and other support initiatives, cancer survivors' awareness of the Queensland Cancer Fund needs to be raised substantially. Practitioner education and discharge planning directives are recommended to ensure information about the Queensland Cancer Fund is disseminated. 5. To address the substantially unmet information and physical/ daily living needs specific to lymphoedema sufferers, it is recommended that self-management information and referral information for suppliers and services for lymphoedema management be given to women in high lymphoedema risk groups, as part of the hospital discharge procedure, as well as when symptoms are diagnosed, to ensure a continuum of care is maintained. 6. Clinical practice guidelines for cancer care and, correspondingly, support programs, need to expand from acute care to managing the long-term psychological, physical and sexual health consequences. Several topics for research are likely to be important in the future, including more specific research into why uterine cancer survivors reported higher odds of unmet psychological needs and yet were less likely to use support services, what specific help women with unmet needs would prefer, the effects of lower limb lymphoedema on survivors' quality of life, and why there isn't greater use of existing support services, especially among women with morbidity such as lymphoedema and issues associated with treatment-related menopause.

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9

Beesley, Vanessa Lea. "The experience of gynaecological cancer survivors : supportive care needs and use." Queensland University of Technology, 2006. http://eprints.qut.edu.au/16355/.

Full text

Abstract:

Gynaecological cancer survivorship has been addressed in only a limited body of research. After completion of treatment, women with gynaecological cancer face many challenges. It is pertinent that we understand the wellbeing and morbidity issues of this group of survivors, as well as their supportive care needs and use. With this understanding, it will be possible to better target health care initiatives and services to those gynaecological cancer survivors who require help. Accordingly, the objectives of this study were to determine the prevalence of site-specific morbidities, support being utilised, and unmet needs, as well as to determine the correlates of supportive care needs and use. To address this, a cross-sectional mail survey of 1774 Queensland gynaecological cancer survivors three months to five years post-diagnosis was conducted in 2004 (56.5% response rate, n=802 of 1420 eligible participants). Women were recruited from the Queensland Gynaecological Cancer Registry, which covered approximately 85% of all gynaecological cancer patients in Queensland at the time of this study. The questionnaire measured a range of factors to reflect a social-ecological perspective. This broader perspective was utilised to extend the current understanding which is limited to a biopsychosocial approach. Main outcomes were measured with standardised and validated instruments where possible, including the Supportive Care Needs Survey, Functional Assessment of Cancer Therapy, Duke-UNC Functional Social Support Questionnaire and the Active Australia Survey. The results of this survey showed that while quality of life was high on average (median 91, range 30-108), some women experienced debilitating site-specific conditions. Ten percent reported being diagnosed with lower limb lymphoedema and eight percent of women reported that their gynaecological cancer had made sexual relations too difficult or too uncomfortable. Women accessed multiple sources of support within their communities including a variety of support services (54%) and complementary therapies (29%). Characteristics associated with use of support services include: younger age, being retired, having been diagnosed with a gynaecological cancer other than uterine, having had open bowel resection, having been treated at multiple centres, being in remission, being obese. On average, women reported having excellent social support (median 37, range 8-40). Some women made changes to healthier behaviours following their cancer diagnosis, such as increasing their fruit and vegetable intake (23%) or physical activity levels (10%) or decreasing their alcohol consumption (24%) or cigarette smoking (10%); however, nearly half (44%) of women decreased their physical activity level. A population comparison of health behaviours between gynaecological cancer survivors and Queensland women highlighted the significantly lower level of sufficient physical activity and higher level of obesity in the cancer survivor population, as well as the low levels of adequate vegetable intake in both populations. Forty-three percent of gynaecological cancer survivors reported having at least one moderate or high level unmet supportive care need. In particular, needing help with fear about the cancer spreading, concerns about the worries of those close to them, uncertainty about the future, lack of energy/tiredness, and not being able to do things they used to do, were most important to this group. These leading need items were all within the psychological and physical/daily living supportive care domains. Some unmet sexuality and health system/information needs were also reported. Groups with higher odds of unmet needs included those women who more recently completed treatment, whose disease was still present, who had children still living in the home, who had diagnosed lymphoedema, who experienced treatment-related menopause, who were unable to work due to illness and who lived in rural and remote regions of Queensland. These results indicate that women with gynaecological cancer in Queensland are doing quite well overall; however, there is still room for improvement in a few key areas of public health importance. In line with the social-ecological model, resources need to be targeted at all levels of support including personal, social, health care and broader organisational, community, policy and media levels. In particular, the following recommendations are made: 1. Assistance with the particular reported unmet psychological and physical/daily living needs is a priority. Support services should be tailored to the identified groups of survivors who had higher odds of unmet needs, both in terms of development of written materials that reflect these groups' circumstances and implementation of programs or workshops specific to these groups. In particular, the development of a number of programs or workshops are recommended that discuss the specific psychological and physical/ daily living outcomes of women who a) live with cancer, b) live with children after cancer treatment, c) live with lymphoedema, d) have had treatment-related menopause or e) are unable to work due to illness, and how and where women can get help with managing these. These programs should be implemented by support organisations in the period closely following treatment completion and should consider technologies such as video-conferencing to reach women who are in rural and remote areas. 2. More specific written information for cancer survivors about things they can do to help themselves get well is needed, in lay-person friendly format. This information should address the value of particular dietary items, complementary therapies and types of physical activities that are safe and beneficial to cancer survivors' quality of life. 3. An evidenced-based physical activity intervention, targeting overweight and obese gynaecological cancer survivors is recommended, to reduce the weight issues of this population. 4. To facilitate the triage of cancer survivors to appropriate health care information and other support initiatives, cancer survivors' awareness of the Queensland Cancer Fund needs to be raised substantially. Practitioner education and discharge planning directives are recommended to ensure information about the Queensland Cancer Fund is disseminated. 5. To address the substantially unmet information and physical/ daily living needs specific to lymphoedema sufferers, it is recommended that self-management information and referral information for suppliers and services for lymphoedema management be given to women in high lymphoedema risk groups, as part of the hospital discharge procedure, as well as when symptoms are diagnosed, to ensure a continuum of care is maintained. 6. Clinical practice guidelines for cancer care and, correspondingly, support programs, need to expand from acute care to managing the long-term psychological, physical and sexual health consequences. Several topics for research are likely to be important in the future, including more specific research into why uterine cancer survivors reported higher odds of unmet psychological needs and yet were less likely to use support services, what specific help women with unmet needs would prefer, the effects of lower limb lymphoedema on survivors' quality of life, and why there isn't greater use of existing support services, especially among women with morbidity such as lymphoedema and issues associated with treatment-related menopause.

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Gardner, Robert B. "A Holistic Assessment of the Perceived Supportive Care Needs of Cancer Patients during Treatment." ScholarWorks@UNO, 2008. http://scholarworks.uno.edu/td/823.

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The purpose of the study was to describe the personal experience of individuals undergoing cancer treatment in an outpatient clinic by examining their perceived supportive care needs. The theoretical basis of the study lies in Alfred Adler's holistic view of human beings as unique and indivisible (1927/1954). Six individuals recently diagnosed with cancer were recruited from the same regional outpatient cancer clinic located at a major university medical center. A semi-structured interview process with open-ended questions was utilized to understand how people individually and collectively experience cancer and cancer treatment. The 17 factors of the wellness model (Witmer, Sweeney, & Myers, 1998) were used to assess the perceived supportive care needs of the study's participants. Data were analyzed using Interpretative Phenomenological Analysis (Smith, 1998) to ascertain emergent themes and interpret the meanings of the perceptions patients have of their cancer experience. The data resulted in eight major themes being present including facing mortality; uncertainty about the future; understanding cancer diagnosis and treatment; reliance on faith; maintaining control; love and support from family; physical impact of cancer; and importance of self-care. These themes provide insight into the perceived supportive care needs that patients experience during cancer treatment. With the exception of cultural and gender domains, the holistic assessment process identified patients' needs. The factors of wellness appear to capture the experience of individuals during cancer treatment. As an approach to assessing the coping skills of cancer patients, the wellness model seems appropriate for use by clinical mental health counselors. Implications for counselor theory, training, and practice with this unique client population are discussed.

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Evans, Maggie. "The role of holistic assessment in the supportive care of patients with cancer." Thesis, University of Bristol, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.508057.

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Buchanan, Deans. "The clinical care of patients with lung cancer : identifying and supporting those with unmet care needs." Thesis, University of Dundee, 2010. https://discovery.dundee.ac.uk/en/studentTheses/43cf70da-fac1-41d5-be95-213521128c52.

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Lung cancer has developed from a rare condition into the leading cause of cancerrelated death in the United Kingdom. Lung cancer patients face a disease with a high symptom burden, increased psychosocial needs and a high mortality. Supportive care needs are often relevant from diagnosis. Despite this there are no clear follow-up structures for lung cancer patients that address both cancer management and supportive care. The aims of this study were to evaluate supportive care needs, assess predictors of such needs and identify factors which could aid service provision within Stobhill lung cancer services. Methods Supportive care needs were measured using an adapted Palliative Outcome Scale (POS), incorporated within a larger questionnaire. All lung cancer patients attending the clinic could complete this questionnaire. Respiratory symptoms, performance status, service usage, preferences and satisfaction were also assessed. Data were stratified to allow evaluation of three clinical groupings: all patients, newly diagnosed patients and patients in the last three months of life. Analyses were phased: descriptive analyses, univariate tests of association and multivariate regression. Results Three hundred and fifty three lung cancer patients completed questionnaires. The high symptom burden in lung cancer was confirmed. Anxiety, pain and dyspnoea were identified as the key issues. Poor performance status was identified to be an independent predictor of increased POS score, increased anxiety, increased pain and increased dyspnoea. There was no independent relationship between POS and survival. Although the majority of patients were satisfied with the care received, there was uncertainty regarding who was in charge of care and some disparity in preferred structure for follow-up. Conclusions Despite recent advances in lung cancer management, improvements are still required to address unmet supportive care needs of patients. Particular attention should be given to those with poorer performance status to effectively identify and meet such needs.

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Coyle, C. "Repurposing medicines for the adjuvant treatment of cancer : an evaluation of aspirin and metformin." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10050892/.

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Introduction: Evidence from pre-clinical studies and observational data suggest that metformin and aspirin are good candidates for adjuvant therapies, though definitive phase III trials have not been completed. Prior to the initiation of this work, the Add-Aspirin trial had been conceived and funded with several potential challenges related to the implementation and design identified. Evidence to support the evaluation of metformin in a phase III adjuvant basket trial had not been systematically evaluated. Methods: I examined the implementation and conduct of the Add-Aspirin trial during its first year at individual UK research centres. Baseline clinical characteristics, and the feasibility and effect of the run-in period, in the first 500 participants was also examined. Additionally, I conducted a systematic review and meta-analysis to investigate the effect of metformin use on survival outcomes for individual tumour types in the adjuvant setting. Results: Centres recognised the efficiencies offered from a basket trial design particularly in terms of gaining approvals, staffing and data entry, though some unanticipated set-up and recruitment challenges have been identified. The baseline clinical characteristics were largely as expected. Overall, 88% of participants were randomised. The run-in period was effective in identifying, and preventing randomisation of participants who had less than 80% adherence (5.0%), and participants who developed significant aspirin related toxicities (1.2%). Other nonrandomisations were mostly due to minor toxicity and/or personal choice. A systematic review and meta-analysis found that metformin use was associated with significant benefits in recurrence-free survival, overall survival and cancer-specific survival in early-stage colorectal and prostate cancer. Conclusion: Opening a large multi-tumour type basket trial with an active run-in period was found to be feasible, but minor conduct modifications have been recommended and protocol amendments implemented. Metformin could be a useful adjuvant agent, and randomised control trials in colorectal and prostate cancer are advocated.

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Ferrario, Alessandra. "Access to cancer medicines in Europe : an analysis of existing challenges and countries' responses." Thesis, London School of Economics and Political Science (University of London), 2016. http://etheses.lse.ac.uk/3535/.

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Access to new cancer medicines, particularly their coverage and affordability, is a matter of great concern to payers, patients and the pharmaceutical industry. Yet, little comparative evidence on actual use and its determinants is available. This thesis aimed to analyse the extent to which access to cancer medicines varies across a sample of European countries, what determines these differences, whether they matter, and what are countries doing to improve access. These objectives were achieved through the use of quantitative and qualitative methods including multilevel mixed effects models, survival analysis and the complementary log-log transformation of the Cox proportional hazard model, literature reviews and interviews to inform the development of conceptual frameworks, and a comparative longitudinal analysis of the implementation of MEAs. Results show that there are wide cross-country differences in access to cancer medicines in Belgium, Estonia, Scotland, and Sweden. These differences were determined by time to entry of new medicines, medical need (i.e. incidence of the disease) and factors affecting treatment decisions (e.g. coverage, prices, and financing mechanisms). The added clinical value of medicines explained the shorter time to launch in Estonia and higher consumption in Scotland but not in the other countries. This emphasises the importance of health technology assessment processes in identifying and making cost-effective medicines available and limiting the utilisation of non-cost-effective ones. The latter is particularly important given the opportunity cost of funding new cancer medicines. Managed entry agreements have increasingly been implemented to address issues of uncertainty and high prices when making coverage decisions. Through their action on price, effectiveness and use, they are able to influence cost-effectiveness and budget impact, two key variables guiding reimbursement decisions. Some of the most important contributions from this thesis include: (1) the development of a blueprint to analyse access to cancer medicines in Europe quantitatively and qualitatively; (2) the identification of likely determinants of differences in access to cancer medicines which can guide policy-makers efforts in managing access to new therapies; and (3) the development of a conceptual framework for managed entry agreements which can support their design and evaluation.

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Akuoko, Cynthia Pomaa. "Exploring health service and supportive care needs of women with advanced breast cancer in Ghana." Thesis, Queensland University of Technology, 2021. https://eprints.qut.edu.au/211292/1/Cynthia_Akuoko_Thesis.pdf.

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This mixed methods PhD project explored the health service and supportive care needs of women with advanced breast cancer in Ghana from their perceptions as well as from those of relevant healthcare professionals and key informants from breast cancer organisations. The thesis provides evidence that this cohort has numerous and complex needs. The project’s findings can help guide health policy and the development of evidence-based tailored health and supportive care services, programs and interventions in Ghana to address these women’s needs, which will empower the women to better manage their day-to-day lives to maintain and/or improve their quality of life.

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Collett, Joan M. "Oncology Nurses' Impact Scores for Obstacles and Supportive Behaviors at the End of Life." BYU ScholarsArchive, 2011. https://scholarsarchive.byu.edu/etd/2673.

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Introduction: Oncology nurses provide end-of-life (EOL) care to their patients daily. Oncology nurses' perceptions regarding how to provide quality care to dying patients could be an important addition to the ongoing research on quality EOL care. The purpose of this study was to determine the impact of specific obstacle and supportive behaviors in EOL care as perceived by hospital-based oncology nurses. This study extended the work of Beckstrand, Moore, Callister, and Bond (2009). Methods: A 69-item questionnaire adapted from previous studies (Beckstrand & Kirchhoff, 2005; Beckstrand, Smith, Heaston, & Bond, 2008) was sent to 1,000 nurses who were members of the Oncology Nursing Society (ONS) and who had provided EOL care to dying oncology patients. Three mailings of the questionnaire yielded 380 usable responses from 907 eligible respondents, which resulted in a 41.9% return rate. Oncology nurses were asked to rate obstacle and supportive items on both size and frequency of occurrence as they related to oncology patients in a hospital setting. Results: Obstacle items which received the three highest perceived impact scores were: (1) dealing with anxious family members, (2) families not accepting what the physician is telling them about the patient's poor prognosis, and (3) being called away from the patient and family because of the need to help with a new admit or to help another nurse care for his/her patients. Supportive behavior items which received the three highest impact scores were: (1) allowing family members adequate time to be alone with the patient after he or she has died, (2) providing a peaceful, dignified bedside scene for family members once the patient has died, and (3) allowing families unlimited access to the dying patient even if it conflicts with nursing care at times. Implications: Oncology nurses are dedicated to providing the best EOL care to their patients and patients' families. This study identified obstacle and supportive behavior items with the largest impact on providing quality EOL care. Recommendations: Results of this research demonstrated the need for more EOL education and guidance in forming teams of nurses, social and palliative care workers, and physicians to support the giving of quality care. Nurses also reported the need for more time to support the dying patient and family.

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McCallum, Megan. "Gynecological Cancer: Practical Implications for Identifying and Meeting Supportive Care and Sexual Health Needs After Treatment." Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/26282.

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Women treated for a gynecological cancer report longstanding post-treatment difficulties for which they rarely seek or receive help. Few intervention studies have successfully improved global sexual health within this population. Research in this domain is challenging due to inconsistent measurements of sexuality, low response rates and high attrition rates. The overarching study objectives were: (a) To contribute to the advancement of research on supportive care needs (including sexual health needs), desire for help, and predictors of needs; and, (b) To inform the development of services for gynecological cancer survivors. In Study 1, a qualitative interview study explored the experiences of 15 gynecological cancer survivors. Interviews were conducted and analysed based on the Interpretive Description approach . In Study 2 (for which results were analyzed in two parts), a descriptive, cross-sectional needs assessment was conducted to measure supportive care needs, desire for help, sexual health and vaginal changes, and service format preferences in 113 patients. In Part 1 of Study 2, descriptive and regression analyses explored patient needs, desire for help and potential predictors of these variables. In Part 2, a descriptive analysis explored sexual health needs and vaginal changes, desire for help with sexual health needs, and their associations with sociodemographic and medical variables. Qualitative results from Study 1 suggested that psychological, emotional and relational aspects of sexuality were as important to the participants as physiological sexual response. In the needs assessment, the strongest predictors of greater unmet needs and increased readiness for help were younger age and shorter time since treatment. Moderate to high sexual and social needs were equally prevalent in women recently treated and those treated several years prior to the study, suggesting that sexual and social needs may remain unaddressed over time. Further, many women who reported a need did not desire help, demonstrating the subjectivity of needs and distress, as well as the potential presence of barriers to seeking help. Both studies revealed a common finding, where sexual health needs were a product of the discordance between participants’ current sexual experiences and their perceptions of ideal sexual health. Overall, the two studies indicate that a significant subgroup of patients experience unmet needs in cancer survivorship, most of which are non-physical; also, while some needs were higher following treatment, unmet social and sexual health needs show little relationship with time since treatment. Ambivalence about receiving help with unmet needs is related to beliefs about the role of the health care team in meeting non-physical needs, as well as other perceived barriers. Patient’s perceived sexual health needs and barriers to receiving help should be evaluated within a comprehensive framework of needs and discussed one-on-one. Future research should explore the added predictive value of other groups of medical and psychological variables.

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Johnson-Ajinwo, Okiemute Rosa. "Identification, semi-synthesis and evaluation of anti-ovarian cancer compounds from plants used in traditional medicines." Thesis, Keele University, 2017. http://eprints.keele.ac.uk/3773/.

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Ovarian cancer is the second leading cause of death among women in the gynaecological category of cancers. The current post surgery treatment which involves the use of platinum-based therapy with its attendant adverse drug-resistance often results in the return of the cancer. This research work, explored the role of natural products as the major source of new drugs by the evaluation of the anti-ovarian cancer activities of three selected medicinal plants and the semi-synthesis of analogues of an anti-cancer agent; thymoquinone from Nigella sativa. Using a bioassay-guided approach, an investigation of the cell growth inhibition of the extracts/fractions of these plants on four human ovarian cancer cell lines, A2780, OVCAR 4, OVCAR 8, and CIS-A2780 showed that Acalypha wilkesiana, Margaritaria discoidea and Rutidea parviflora had promising anti-ovarian cancer activities. This is the first report of the anti-cancer activities of M. discoidea and R. parviflora. The bioactive compounds of the plants were isolated by HPLC, identified by mass spectrometry/NMR spectroscopy and investigated for cytotoxicity. Gallic acid, (IC50 range of 6.2±0.3 – 26.9±4.1 μM) was the active compound in A. wilkesiana. The significantly bioactive compounds of M. discoidea were securinine, (IC50 range of 2.7±0.7 – 8.7±0.1 μM), betulinic acid, (IC50 of 16.0±1.9 μM) and gallic acid. While palmatine, (IC50 range of 5.5±0.9 – 7.9±0.5 μM) was the major active compound in R. parviflora. Twenty-one thymoquinone analogues including eleven semi-synthetic ones were evaluated for cytotoxicity. A synthetic 2-dimethylamino-5-methyl-1,4-benzoquinone demonstrated optimum activity (IC50 range of 4.7±0.5 – 11.2±1.9 μM) and superior aqueous solubility. Palmatine, securinine and 2-dimethylamino-5-methyl-1,4-benzoquinone showed induction of apoptosis via increased caspase 3/7 activity. Palmatine demonstrated PAPR cleavage by western blot analysis. 2-dimethylamino-5-methyl-1,4-benzoquinone showed synergy with carboplatin and paclitaxel. These studies have provided scientific evidences for the potential treatment of ovarian cancer with these traditional medicinal plants and hit compounds for future optimization towards clinical trials.

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Chawatama, Brighton Itayi. "Knowledge-based integration of Zimbabwean traditional medicines into the National Healthcare System: A case study of prostate cancer." University of the Western Cape, 2017. http://hdl.handle.net/11394/7009.

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>Magister Scientiae - MSc
This study sought to identify the bottlenecks in the promotion of Zimbabwean Traditional Medicines (ZTMs) towards improving the national healthcare delivery system. The indigenous medicines lost value and recognition to the Conventional Western Medicines introduced by the British colonialist since 1871 and is still dominating the national healthcare delivery system. There are growing challenges to ensure accessibility of affordable drugs especially for primary healthcare. The World Health Organization (WHO) and United Nations (UN) is in support of re-engaging indigenous medical interventions to achieve the Millennium development goals. Indigenous Traditional Medicine Knowledge-Based Systems (ITMKS) form the basis of the main source of health care for about 80% of the population in the developing countries. The implementation of the Zimbabwe Traditional Medicines Policy (ZTMP) has been at a stand-still since inception in 2007. The research used mixed methods involving qualitative and quantitative approaches. Data was collected through desk and field research. Questionnaires and focus group discussions were used to record perceptions and attitudes of key informants. The stakeholders included Traditional Health Practitioners (THPs), Medical Doctors, Pharmacists, Medical Research Council of Zimbabwe (MRCZ) staff, Medicines Control Authority of Zimbabwe (MCAZ), Traditional Medical Practitioner’s Council (TMPC), Zimbabwe National Traditional Healers Association (Zinatha), Ministry of Health and Childcare, WHO, Higher Education Institutions (UZ School of Pharmacy staff and students), Christian Groups, NGOs and Prostate Cancer Patients in Harare CBD. The stakeholders sampling framework was obtained from the list of registered practitioners. The stakeholder mapping involved selection of 5 key informants from each focus group obtained through random selection. The Snowball sampling technique was used to follow the closest 5 key informants in each focus group. The key findings established that 80% of respondents agreed to the integration of ZTM. The major bottlenecks were lack of modern dosage forms and standardization to determine quality, safety and efficacy of the ZTM. The study suggests that in order to fast track the integration process, a bottom up implementation strategy providing ZTM advocacy, capacity building in the institutionalization and training of ZTMPs, pharmacists and CMP need to be engaged for a favorable and quick buy-in. The study also recommends further analysis of the Indigenous Knowledge Systems (IKS) areas of specialization in pharmaceutical practice in order to improve treatment outcomes.

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Perone, Jennifer A., Taylor S. Riall, and Kelly Olino. "Palliative Care for Pancreatic and Periampullary Cancer." W B SAUNDERS CO-ELSEVIER INC, 2016. http://hdl.handle.net/10150/622658.

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Most patients with pancreatic cancer will present with metastatic or locally advanced disease. Unfortunately, most patients with localized disease will experience recurrence even after multimodality therapy. As such, pancreatic cancer patients arrive at a common endpoint where decisions pertaining to palliative care come to the forefront. This article summarizes surgical, endoscopic, and other palliative techniques for relief of obstructive jaundice, relief of duodenal or gastric outlet obstruction, and relief of pain due to invasion of the celiac plexus. It also introduces the utility of the palliative care triangle in clarifying a patient's and family's goals to guide decision making.

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21

Morris, Sara Margaret. "The dialogue of support : in the context of supportive health care services for women recently diagnosed with breast cancer." Thesis, Lancaster University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.286987.

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Au, Ho-yee Angel, and 區可兒. "What are the unmet supportive care needs among Hong Kong Chinese womenwith advanced breast cancer?: do they changeover time?" Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48521814.

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Background: Advanced breast cancer (ABC) is affecting substantial number of Chinese women in Hong Kong. Understanding their unmet supportive care needs (SCNs) is important for health care system to precisely allocate resources to areas demanded for help the most and for patients to achieve better quality of life. Objectives: (1) To validate Chinese version of Supportive Care Needs Survey Questionnaire (SCNS-SF34), (2) to address the prevalence of unmet SCNs at baseline (newly diagnosis of ABC) and explore relevant factors associating with baseline unmet SCNs, (3) to identify the trajectories of unmet SCNs from baseline, 6-week, 12-week, 18-week to one-year post-diagnosis of ABC among Hong Kong Chinese women and identify the predictors related to individual resources. Methods: The study consisted of two phases. In Phase I, breast cancer (BC) patients were recruited from six public hospitals and the SCNS-SF34 (which covers five domains of needs) was administered concurrently with measures of psychological distress CHQ-12 (Chinese Health Questionnaire-12), HADS (Hospital Anxiety and Depression Scale), symptom distress (MSAS-SF), and patient satisfaction (ChPSQ-9) to explore factor structure by using Exploratory Factor Analysis (EFA) and to examine internal consistency, and convergent, divergent and discriminant validities of the identified factor structure. In phase II, women newly diagnosed with ABC were recruited and followed up to assess their unmet SCN trajectories one year after diagnosis. Prevalence of initial baseline SCNs and associated demographic, medical and psychological factors were identified. Linear Mixed Modeling (LMM) was performed to assess trajectories for each SCNs domain. Hypothesized variables reflecting personal and social resources (optimism, trait hope, social support, psychological distress and patient satisfaction) were examined for association with the changes of unmet SCNs after adjusting for demographic and medical characteristics. Results: Instead of five-factor structure identified in the original SCNS-SF34, a four-factor structure with 33 items was identified, comprising: 1) Health system, information and patient support needs (HSIPS), 2) Psychological needs (PSYC), 3) Physical and daily living needs (PDL) and 4) Sexuality needs (SEX). The SCNS-SF33-C demonstrated moderate-to-good internal consistency (Cronbach’s alphas=0.75-0.92) across all domains. Acceptable convergent and divergent validity were demonstrated. Discriminant validity was demonstrated in the SCNS-SF33-C’s ability to differentiate between clinically distinct patient groups (ABC vs. localized BC and active treatment vs. no active treatment). Of the top 15 unmet SCNs, all belonged to the HSIPS domain. There were significant linear declines in unmet HSIPS and PSYC needs over the year after diagnosis, but not in PDL and SEX. After adjusting for demographic and medical factors, LMM identified symptom distress, patient satisfaction and patient satisfaction x time are predictors of HSIP. Total symptom distress, optimism, anxiety and anxiety x time predicted PSYC. Total symptom distress was predictor of PDL. Anxiety was predictor of SEX. Conclusions: The SCNS-SF33-C has a suitable factor structure and psychometric properties for the use in assessing unmet psychosocial SCN among Chinese women with BC. Generally, unmet HSIP and PSYC tended to decline, while levels of unmet PDL and SEX tended to persist over time. Specific individual resources predicted the future change of unmet SCNs.
published_or_final_version
Community Medicine
Master
Master of Philosophy

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23

Frode, Linda, and Håkan Marsh. "Faktorer som påverkar deltagande : Psykosocialt stöd vid prostatacancer." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-165519.

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Aim: The aims of this essay were first to see if there were any factors that could have an inpact on participating in supportive care groups and activities after a prostatic cancer diagnosis. The second aim was to examine what kind of support the patients would chose. Methods: Data was collected with a survey handed out to the prostate cancer patients visiting the urologist reception at the hospital in Uppsala, during two weeks in the fall of 2011. Main Results: Men show very little interest in participating in supportive care groups and activities. When asked to chose which kind of support they could consider, individual sessions and group sessions were the most common choice. Conclusion: Men diagnosed with prostate cancer chose not to participate in supportive care. Further studies are required to determine what may be the reason to that.
Syfte: Syftet med detta arbete var att se om olika faktorer kunde påverka deltagande i stödverksamhet efter att patienten fått diagnosen prostatacancer, samt vilken form av psykosocialt stöd patienterna föredrar. Metod: Metoden som använts var en enkätstudie med både kvantitativ ansats, som delades ut under hösten 2011 till prostatacancerpatienter på urologmottagningen, Akademiska sjukhuset. Huvudresultat: Män anger att de inte är intresserade av att delta i stödverksamhet efter diagnos och eventuell behandling. Vid behov ansåg de att enskilda eller gruppsamtal var mest relevanta som stödverksamheter. Informanterna ansåg att rehabilitering med samtal och yoga hade minst relevans. Slutsats: Män som drabbats av prostatacancer väljer att inte delta i stödverksamhet. Behov finns därför av att utföra mer studier för att klargöra orsakerna till detta.

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Oliveira, Carla Maria da Costa. "Fitoterapia na prevenção do cancro." Master's thesis, [s.n.], 2013. http://hdl.handle.net/10284/4182.

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Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências Farmacêuticas
A Fitoterapia é uma terapêutica não convencional que tem vindo, ao longo das últimas décadas, a despertar o interesse da comunidade geral e científica, nomeadamente pelo seu possível papel na prevenção do cancro. Esta patologia constitui, ainda, uma das principais causas de morte no mundo. Algumas plantas têm demonstrado um potencial papel preventivo na ocorrência e/ou progressão do cancro (tal como outras doenças crónicas). Na primeira parte deste trabalho, apresenta-se uma abordagem aos conceitos de Fitoterapia, fitofármaco e fitoterápico. Segue-se uma perspetiva histórica do conceito de fitoterapia, evidenciando o crescente interesse demonstrado pela comunidade geral e científica nesta área. Como consequência deste interesse generalizado expõem-se, em seguida, aspetos importantes relacionados com a qualidade, eficácia e segurança na utilização de plantas medicinais, ou seja, critérios específicos e questões legais que envolvem e regem o seu uso. Na segunda parte desta contextualização teórica, apresenta-se uma breve exposição sobre o cancro e de seguida descreve-se, com base numa revisão da literatura, o impacto das plantas medicinais na prevenção desta patologia. No terceiro ponto, são analisadas pormenorizadamente as plantas com maior impacto na prevenção do cancro. Sobre as mesmas abordar-se-ão os seus compostos ativos, os mecanismos de ação subjacentes, efeitos secundários, interações com fármacos e, por fim, a respectiva influência na prevenção do cancro. Phytotherapy is an unconventional therapy that has, over the past decades, to arouse the interest of the scientific community generally and especially for its implication in cancer prevention. This pathology is also a major cause of death all over the world. Some plants have demonstrated a potential preventive role in the occurrence and/or progression of cancer (such as other chronic diseases). The first part of this work, consists of an approach to the concepts of phytotherapy, herbal medicine and phytochemical. Then follows a historical perspective of the concept of herbal medicine, highlighting the growing interest shown by the general community and this area. As a result of the widespread interest on phytotherapy, important aspects related to the quality, efficacy and safety in the use of medicinal plants, ie, specific criteria and legal issues that surround and govern your use were addressed. In the second part of this study, a brief exposition of the cancer is presented and then described, based on a literature review, the impact of medicinal plants in the prevention of this disease. Finally, the plants with the greatest impact on cancer prevention, we analyzed in detail. Namely, the active compounds, the effects, drug interactions, and ultimately, their influence on cancer prevention.

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Burt, Stephanie. "Re-Branding Palliative Care: Assessing Effects of a Name Change on Physician Communicative Processes During Referrals." Thesis, University of North Texas, 2011. https://digital.library.unt.edu/ark:/67531/metadc67964/.

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Although provision of palliative care on the United States is growing, referrals to the service are often late or non-existent. The simultaneous care model provides a blueprint for the most progressive form of palliative care, which is palliation and disease-oriented treatments delivered concurrently. Research indicates the existence of a widespread misconception that associates palliative care with imminent death, and some organizations have chosen to re-brand their palliative care services to influence this perception. The goal of this study was to assess the effects of a name change from palliative care to supportive care on the communicative process during referrals to the service.

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Robson, E. "Taking a holistic approach to supportive cancer care : a qualitative study exploring patients' experiences and perceived impact of attending a wellbeing group." Thesis, City, University of London, 2018. http://openaccess.city.ac.uk/20186/.

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Introduction: Physical and psychosocial support is essential for people living with and beyond cancer. An increase in cancer survival rates has prompted a greater need for widely accessible patient-centred support services that integrate self-management techniques alongside routine care. Well-being groups, such as yoga therapy and creative writing, could improve QOL, enhance self-esteem and empower patients to make confident treatment decisions. Aims: (1) To understand why people living with and beyond cancer attend groups, (2) explore patients’ experiences and attitudes towards wellbeing groups, and (3) identify the perceived impact that attending a group may have. Method: A qualitative design using semi-structured interviews was employed (n=20). Participants were recruited via an NHS Cancer Centre in Central London. All participants had received a cancer diagnosis and had participated in at least three group wellbeing sessions (yoga and/or creative writing). Transcripts were analysed using an inductive approach to thematic analysis. Results: Upon completion of data analysis, 3 key themes and 9 sub-themes were established: (1) Identity, perception and reflection, (2) Feeling lost after cancer treatment ends, and (3) Always accepted, never judged. Discussion: Generally, participants reported positively on their experiences of attending a wellbeing group with many suggesting that it had enhanced their patient experience. Groups fulfill the social needs of cancer patients who seek face-to-face interactions with others who have shared similar experiences. People also crave a sense of belonging and safety after cancer treatment ends, which may explain why many patients continue to attend groups based in clinical settings. Conclusion: Further research should explore holistic cancer support further in order to raise awareness among health professionals and ensure that those living with and beyond cancer are being offered suitable psychosocial support that is right for them.

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COSTA, GIULIO. "FROM THE PSYCHOLOGICAL ASSESSMENT TO THE SUPPORTIVE-EXPRESSIVE GROUP THERAPY FOR WOMEN WITH BREAST CANCER AND THEIR CAREGIVERS. A MULTI-METHOD DESIGN." Doctoral thesis, Università Cattolica del Sacro Cuore, 2008. http://hdl.handle.net/10280/330.

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Il presente lavoro di tesi si colloca all'interno di un più ampio programma di intervento clinico per pazienti oncologici. Facendo riferimento ad una cornice teorica basata sul modello relationship-centered care, l'obiettivo di tale programma di intervento è quello di ricercare ed attivare modalità di coping diadico funzionali per fronteggiare la malattia oncologica attraverso i quali si articola questa ricerca, vogliono esplorare tre modalità di coping e caregiving: individuale, diadico e di gruppo. Nel primo studio verranno indagate le strategie di coping e di adattamento interpersonale di donne con cancro al seno, e se tali variabili sono in grado di predire l'adesione ad un trattamento clinico che implichi il paziente medesimo ed un caregiver da lui scelto. Il secondo studio sarà dedicato all'assesssment diadico, dove le coppie formate da paziente e caregiver saranno descritte in funzione di specifiche variabili quali la depressione, l'ottimismo e le caratteristiche di personalità; a questo proposito verrà indagato se tali tipologie di coppia sono in grado di predire lo stile di coping del paziente. Il terzo studio, di processo, è centrato sull'efficacia di un intervento clinico di gruppo in cui sono coinvolti i pazienti e i loro caregiver.
This dissertation examines the psychological assessment for women with breast cancer and their chosen caregivers. It will be wholly presented the longitudinal research design in which the three studies of this dissertation are included. The first study aims not only to standardize the sampling procedure, but it also has the clinical purpose to verify whether coping strategies and interpersonal adjustment preedict end moderate the acceptance to a Supportive-Expressive Group Therapy (SEGT). In the second study the unit of analysis is the couple, which allows for a more accurate description of dyadic coping processes. It will be described and examined specifics couple's typologies or couple matching depending on symptoms and psychological factors such as, life orientations, depression and personality traits. The third study is totally centred on the SEGT. It will be described the nature of intervention and the structure of each session, exploring how the contents and the styles of the therapeutic action change.

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Scotté, Florian. "Description et évolution de l'organisation entre les phases curatives et palliatives autour des soins et de la iatrogénie : Les soins de support en cancérologie." Thesis, Paris 5, 2012. http://www.theses.fr/2012PA05T055.

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La prise en charge d’un patient atteint d’un cancer impose, au soignant, la recherche du meilleur traitement antinéoplastique possible en association avec un engagement d’accompagnement depuis l’annonce du diagnostic jusqu’à la phase après cancer ou le décès. Au cours de son parcours de soin, le malade et ses proches vont être confrontés à différentes équipes, différentes visions du traitement et différentes approches du soin. Le travail présenté consiste en une analyse nationale française sur l’organisation des soins d’accompagement ainsi que la gestion de la iatrogénie liée à trois grandes familles de thérapeutiques symptomatiques : les érythropoïétines, les biphosphonates et les morphiniques. Basé sur cette photographie du soin d’accompagnement en cancérologie, le développement de ces soins sur un établissement sera alors présenté depuis la gestion ambulatoire en hospitalisation de jour, jusqu’à l’hospitalisation complète dans une unité pilote. Le lien, les différences et les complémentarités entre les équipes aux phases curatives et palliatives seront alors discutés, permettant de définir la place et l’importance du regard global et réunificateur par le biais des soins de support en cancérologie
The management of a cancer patient requires, to the caregivers, finding the best antineoplastic therapy in combination with support involvement from the diagnosis to the stage after cancer or death. During the course of care, patient and family will be confronted with different teams, different visions and different treatment approaches of their care. The work presented starts threw an analysis of French organizations of supportive care and management of iatrogenic effects due to three main types of symptomatic therapeutics: erythropoietins, bisphosphonates and opioids. Based on this photograph of accompanying cancer care, the development in an institution of an health care will be presented for ambulatory management of day hospital for chemotherapy administration, until full hospitalization in a pilot unit. The link, the differences and complementaries between the teams in curative and palliative phases will be discussed to define the role and importance of the overall look and unifying supportive care in oncology

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Vieira, Henry Walber Dantas. "Validade de Constructo do Supportive care needs survey-short form 34 (SCNS-SF34) para a avaliação das necessidades de cuidados em pacientes oncológicos atendidos em Manaus." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-14072017-110913/.

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Introdução: Com o aumento dos casos de câncer no mundo, instrumentos validados e confiáveis para avaliação das necessidades de cuidados de suporte a pacientes oncológicos são fundamentais para o oferecimento de serviços adequados a pessoas com câncer. Objetivo: Analisar evidências de validade da versão brasileira do Supportive care needs survey - short form 34 (SCNS-SF34) para avaliar necessidades de cuidados de pacientes oncológicos atendidos em Manaus. Método: Estudo psicométrico, com amostra de conveniência composta por 691 pacientes adultos com câncer, atendidos na Fundação Centro de Controle de Oncologia do Estado do Amazonas (FCECON), no período de Abril a Julho de 2016. A fonte de informação para a coleta dos dados foi um formulário com dados sociodemográficos e clínicos e a versão brasileira do Instrumento SCNS-SF34. A amostra foi composta por 691 pacientes, divididos em duas subamostras (Amostra A=350 e Amostra B=341) para as análises psicométricas, de modo a garantir pelo menos 10 pacientes para cada item do SCNS-SF 34 nas análises de constructo. O teste t Student foi usado para a comparação de médias das variáveis sociodemográficas e clínicas (sexo, grupo etário, tempo de tratamento) com a pontuação total da escala SCNS-SF34. Análises fatoriais, exploratória (AFE) e confirmatória (AFC), foram realizadas para a validade de constructo. Para o cálculo da consistência interna foi realizado o alfa de Cronbach. Foi feita análise de invariância do modelo fatorial em função do gênero (masculino vs feminino), do grupo etário (adultos vs idosos) e tempo de tratamento ( 6 vs 6 meses). A análise da validade convergente do SCNS-SF34 foi realizada com o índice Katz para atividade de vida diária. As análises foram realizadas por meio dos softwares Factor 10.3, MPLUS 7.3 e SPSS v22. Resultados: Do total de 691 pacientes, 92.6% eram provenientes do Estado do Amazonas, dos quais 68,2% da cidade de Manaus. A maioria era do sexo feminino (72.6%), com idade < 60 anos, (64.4%), média de 53.7 + 13.28 anos, viviam com companheiro (54.5%) e não necessitavam de cuidadores (55.3%). O tumor mais frequente foi localizado no sistema reprodutor masculino e feminino (55.6%), com predomínio do câncer de mama feminino (33.9%), seguido pelo sistema digestório (17,7%), com os tumores de estômago (6.3%). Quanto ao tratamento, a maioria dos pacientes foi submetida à cirurgia (56.1%) e à Quimioterapia (60.8%); o tempo de diagnóstico e de tratamento seis meses foi de, respectivamente, 74.4% e 54.4% pacientes. A média da pontuação total da escala foi de 76,06 + 23,50, mínimo de 35 e máximo de 170, sendo que pacientes adultos apresentaram maior necessidade de cuidados do que idosos, respectivamente, 77.7 + 23.9 e 72.97 + 22.74 pontos (p=0,010). Segundo SCNS-SF34, os pacientes apresentaram baixa necessidades de cuidados de suporte. Após as AFE e AFC a escala ficou formada por 34 itens e quatro domínios: Físico e vida diária (itens 1-5), Psicológico (6-14 e 17) e Sexualidade (15, 16 e 31); os itens 18 e 19 foram agrupados no domínio denominado Cuidado e Suporte (21-30 e 32- 33). Os índices de ajustamento obtidos por meio da AFC para o novo modelo (X2 = 1828,981; df = 520; X2/df = 3,51, p<0,001; CFI = 0,926; TLI= 0,918; RMSEA = 0,084 (I.C. 90%= 0,082 - 0,090) foram classificados como bons. A análise da invariância entre os diferentes grupos (sexo, grupo etário e tempo de tratamento) mostrou-se invariante para todos os grupos, sem prejuízo nos índices em nenhum dos níveis da invariância. A validade convergente entre os domínios do SCNS-SF34 e Índice de Katz para atividade de vida diária foi estatisticamente significante. Conclusão: O SCNS-SF34, composto por quatro domínios e 34 itens, mostrou-se um instrumento com boas evidências de validade e precisão para medir as necessidades de cuidados de pacientes com câncer atendidos na cidade de Manaus, Amazonas, independente do sexo, grupo etário e tempo de tratamento. No entanto, a estrutura fatorial encontrada ainda é passível de aprimoramentos para o melhor ajustamento do modelo.
Introduction: With the increase of cancer cases worldwide, validated and reliable instruments to assess care needs of oncologic patients are fundamental in offering proper services to people with cancer. Objective: To analyze evidence of validity of the Brazilian version of the Supportive Care Needs Survey - Short Form 34 (SCNS-SF34) in assessing the oncological healthcare needs of patients assisted in Manaus. Methods: A methodological study with a convenience sample composed of 691 adult cancer patients, assisted at Fundação Centro de Controle de Oncologia do Estado do Amazonas (FCECON), from April to July 2016. The source of information for the data collection was a form with sociodemographic and clinical data, as well as, the SCNS-SF34 survey approved for Brazilian Portuguese. For the sample, 20 patients were considered for each item of SCNS-SF34. A total of 691 patients were divided into two sub-samples (Sample A=350 and Sample B=341) for the psychometric analysis. The t student test was used to compare sociodemographic and clinical variables (sex, age group, treatment time) and SCNS-SF34 total score. Exploratory factor analysis (EFA) and Confirmatory factor analysis (CFA) were performed by using statistical software FACTOR 10.3. In order to calculate internal consistency, the Cronbach\'s alpha was performed and the statistical software Mplus 7.3 was used to evaluate the invariance of the factorial model across gender (male vs female), age group (adult vs elderly) and length of treatment ( 6 vs 6 months). The convergent validity analysis of SCNS-SF34 was performed with the Katz index for daily life activity. Results: Out of 691 patients, the majority (92.6%) were from the state of Amazonas, of which 68.2% were from the city of Manaus. The patients were female (72.6%), with an age < 60 (64.4%), a mean age 53.7 ± 13.28, lived with companion (54.5%) and did not need caregivers (55.3%). The most frequent tumor was located in the male and female reproductive systems (55.6%), with the predominance of female breast cancer (33.9%), followed by the digestive system (17.7%) with tumors of the stomach (6.3%). Regarding treatment, the majority of patients underwent surgery (56.1%) and chemotherapy (60.8%), and the diagnostic and treatment time six months was, respectively, 74.4% and 54.4%. The total mean score of the scale was 76.06 ± 23.50, with a minimum of 35 and a maximum of 170, given that adult patients had a higher need for care than the elderly, respectively, 77.7 ± 23.79 and 72.97 + 22.74 points (p = 0.010). According to the SCNS SF-34 the patients presented low level of supportive care needs. After EFA and CFA, the scale consisted of 34 items and four domains: Physical and daily life (items 1-5), Psychological (6-14 and 17) and Sexuality (15, 16 and 31). The items 18 and 19 were grouped into the domain called Care and Support (21-30 and 32-33). The adjustment indexes obtained through the AFC for the new model (X2 = 1828,981; df = 520; X2/df = 3,51, p<0,001; CFI = 0,926; TLI= 0,918; RMSEA = 0,084 (I.C. 90%= 0,082 - 0,090) were classified as good. The invariance analysis across the different groups (sex, age group and treatment time) was invariant for all groups, without affecting the indices at any of the levels of invariance. The convergent validity between the domains of SCNS-SF34 and Katz Index for daily life activity was statistically significant. Conclusion: The SCNS SF-34, composed by four domains and thirty-four 34 items, has proved to be a valid and reliable instrument to measure the healthcare needs of cancer patients assisted in the city of Manaus, Amazonas, regardless of sex, age group and treatment time. However, the factor structure found is still capable of improvements to the best fit of the model. The use of the SCNS-SF-34 in the clinical settings can contribute to improve the quality of care for this group of patients.

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Baudry, Anne-Sophie. "Compétences émotionnelles et besoins en soins de support des proches-aidants en oncologie." Thesis, Lille 3, 2019. http://www.theses.fr/2019LIL3H007/document.

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Le diagnostic de cancer et les traitements associés vont entrainer un bouleversement de la vie du patient mais aussi de son entourage, et en particulier des proches-aidants. Ces derniers devenant « aidant » doivent assumer de nouvelles responsabilités qui peuvent entrainer des problèmes de santé, une altération de leur qualité de vie et ainsi de manière générale des difficultés d’ajustement face à la maladie (e.g., altération du fonctionnement émotionnel, physique, social et professionnel, symptômes somatiques, détresse émotionnelle). Les proches-aidants ont ainsi besoin du soutien des professionnels de santé pour faire face à leur rôle d’aidant mais ils rapportent souvent des besoins en soins de support insatisfaits. Ce travail de thèse, inscrit dans un programme de recherche plus global, vise ainsi à mieux appréhender les besoins en soins de support des proches-aidants de patients atteints d’un cancer et leurs déterminants, à travers notamment l’implication des processus émotionnels. La première étude de ce travail a consisté à valider en français une échelle évaluant les besoins en soins de support des proches-aidants de patients atteints d’un cancer. La deuxième étude visait à déterminer des profils de proches-aidants plus à risques d’avoir au moins un besoin en soins de support insatisfait moyen ou fort selon des facteurs intrapersonnels (i.e., symptômes anxieux-dépressifs) et sociodémographiques et médicales (e.g., âge des patients et des proches-aidants, cancer métastatique ou non). Enfin, la troisième étude visait à tester le modèle théorique, validé en amont auprès des patients, selon lequel les compétences émotionnelles des proches-aidants auraient un effet bénéfique sur leurs besoins en soins de support insatisfaits via moins de symptômes anxieux-dépressifs. Ces résultats montrent l’importance de dépister et prendre en charge les besoins en soins de support des proches-aidants, surtout liés à la prise en charge du patient, à l’information et au soutien psychologique et émotionnel. Certains profils de proches-aidants pourraient représenter une population particulièrement à risques de difficultés qui nécessiteraient une attention particulière des professionnels de santé. Enfin, tenir compte des processus émotionnels, notamment des compétences émotionnelles et des symptômes anxieux-dépressifs, parait important pour la prise en charge en soins de support des proches-aidants
Cancers causes a disruption in the lives of patients and their caregivers. They must assume new responsibilities that can lead to health problems, altered quality of life, and adjustment difficulties (e.g., impaired emotional, physical, social, and professional functioning, somatic symptoms, emotional distress). Thus, caregivers need support from health professionals to cope with their role but they frequently report unmet supportive care needs. This thesis work is a part of a more global research program and aims to better understand the supportive care needs of caregivers of cancer patients and their determinants, in particular through emotional processes. The first study of this work validated the French version of a scale assessing the unmet supportive care needs of caregivers of cancer patients. The second study identified profiles of caregivers at higher risk of having at least one moderate or high unmet supportive care need from intrapersonal factors (i.e. emotional distress) and socio-demographic and medical variables (e.g., age of patients and caregivers, metastatic cancer). Finally, the third study tested the theoretical model of the thesis work, already validated for cancer patients, which considers that the emotional competence of caregivers can reduce their unmet supportive care needs by reducing their anxiety and depression symptoms. The results highlight the importance of identifying and addressing the unmet supportive care needs of caregivers, especially related to cancer care, information, and psychological and emotional support. Some profiles of caregivers may represent a population at higher risk of having difficulties and requiring more attention from professionals. Finally, taking into account emotional processes, including emotional competence and anxiety and depression symptoms, may be essential in the supportive care of caregivers

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Suissa, Veronique. "Médecine non-conventionnelle et psycho-oncologie : évaluation de l’impact des Médecines Complémentaires et Alternatives (MCA) chez les patients atteints de cancer." Thesis, Paris 8, 2017. http://www.theses.fr/2017PA080066/document.

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Cette étude porte sur le mouvement non conventionnel en oncologie et tend à évaluer l’impact des MCA conjointement en termes de bénéfices, de risques et de dérives chez les patients atteints de cancer. Notre démarche comparative explore le vécu de 32 patients utilisant ou non les MCA, de façon complémentaire ou alternative aux traitements curatifs. Un entretien semi-directif unique a été mené auprès de chaque patient dans l’objectif d’identifier les processus communs et distincts entre les différents groupes. Un livret de questionnaire leur a également été remis afin de rendre compte des caractéristiques du mouvement hétérodoxe. L’analyse du discours révèle que le recours aux MCA influence positivement le vécu de la maladie sur l’ensemble des dimensions de la personne, mais détériore la représentation de la médecine allopathique et la relation soignant/soigné. Le refus de traitements curatifs chez les utilisateurs de MCA est lié à un univers de croyances invalidantes qu’ils développent. L’analyse des échelles suggère que le recours aux MCA améliore la perception de la santé globale, réduit la symptomatologie dépressive, mais reste sans effet sur l’anxiété. Le recours alternatif aux MCA est lié aux croyances d’attribution causale interne et de contrôle religieux, mais pas à celle d’un contrôle sur l’évolution de la maladie. L’intégration des MCA en oncologie apparaît pertinente et nécessaire pour améliorer la prise en charge des malades, mais doit pouvoir se déployer avec prudence et de façon progressive au regard des risques et des dérives de certaines pratiques hétérodoxes
This study examines the unconventional movement in Oncology and aim to assess the impact of CAM jointly in terms of benefits, of risks and derivatives in patients with cancer.Our comparative approach explores the experience of 32 patients using or not the CAM of complementary or alternative to curative treatments. A unique semi directive interview was conducted with each patient in order to identify common and distinct processes between differents groups. A questionnaire booklet was also been handed them to end to account characteristics of the unconventional movement.Analysis of the speech shows that the use of CAM affects positively the experience of the illness across the dimensions of the person, but deteriorates the representation of allopathic medicine and the patient-caregiver relationship. The refusal of curative treatments among users of CAM is linked to a universe of disabling beliefs they develop.The analysis of scales suggests that the use of CAM improves the perception of global health, reduces the depressive symptomatology, but has no effect on anxiety. The alternative use of CAM is related to internal causal attribution and control beliefs, but not to control over the course of the disease. The integration of CAM in oncology appears relevant and necessary to improve the care of patients, but should be able to be deployed with caution and progressively in the light of the risks and derivatives of certain heterodox practices

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Paterson, Catherine I. E. "Exploring prostate cancer survivors' self-management behaviours and social supportive experiences using questionnaires and electronic behavioural diaries : does social support buffer the relationship between coping and health-related quality of life?" Thesis, University of Dundee, 2013. https://discovery.dundee.ac.uk/en/studentTheses/22089faa-ef63-420f-92df-72ff81ce4a14.

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Background: Prostate cancer is now the most common type of cancer in men in the UK. Physical effects of treatments have been well documented; however, the extent to which psycho-social factors may impact upon health-related quality of life (HRQoL) is limited. Little is known about the self-management behaviours of men affected by prostate cancer or how they cope with prostate cancer. Men living with and beyond prostate cancer have reported a lack of support in their pursuit to cope with the physical and psychological sequelae. Social support may help men with self-management, but may also buffer the relationship between coping and HRQoL. Most healthcare research has been conducted between individuals and is limited to aggregate group level effects, and has overlooked the importance of within-person experience and change over time. Any future theoretically driven intervention study should be supported empirically at the level it is intended: “the individual man”. Aim: To assess the mechanism effect between the relationship that links coping and social support to HRQoL in a sample of men affected by prostate cancer using between individuals and within individual methodological approaches. In addition, this thesis aimed to identify the actual self-management behaviours and social supportive experiences of men over the cancer journey, between and within individuals over time. Methods: A quantitative approach consisted of a prospective, longitudinal survey and single-case electronic diary data. Clinical, demographic and survey data were collected at baseline (before treatment) and at 6 months follow-up. A sub-sample of n=12 participants completed an electronic behavioural diary for 1 month. Men completed the electronic behavioural diary in the month following their treatment. The duration, timing and design of the behavioural diary were guided by methodological considerations, service users and clinicians’ comments. Findings: The prospective longitudinal survey identified that baseline perceived social support was the most important social support construct that predicted HRQoL (ß=0.266, p=0.021) and depression (ß=0.243, p=0.029) at 6 months and explained approximately 30% of the variance of the dependent variables. Moderation and mediation effects were not identified from the prospective longitudinal findings. Testing theoretical models “within-individuals” over time demonstrated different results for main, moderating and mediating pathways that linked coping and social support to emotional outcome. Men performed a number of self-management behaviours for urinary, bowel and sexual dysfunction, but often with little relief. Discussion/Relevance: Real time data collection moves far beyond traditional retrospective evaluations, enabling a much clearer understanding of the individual patient experience over time. The results from the series of single-case studies have demonstrated the one size does not fit all. The findings from the prospective longitudinal study and the 11 single-case studies suggest that men may benefit from a supported self-management intervention study tailored to the “individual’s needs” of prostate cancer survivors.

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Riechelmann, Rachel Simões Pimenta [UNIFESP]. "Risco de interações medicamentosas em pacientes com câncer e recebendo cuidados de suporte exclusivo." Universidade Federal de São Paulo (UNIFESP), 2009. http://repositorio.unifesp.br/handle/11600/10066.

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Made available in DSpace on 2015-07-22T20:50:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-11-25. Added 1 bitstream(s) on 2015-08-11T03:25:34Z : No. of bitstreams: 1 Publico-020a.pdf: 165301 bytes, checksum: 478022db64b034bbea30c204bbaf2cb9 (MD5). Added 1 bitstream(s) on 2015-08-11T03:25:34Z : No. of bitstreams: 2 Publico-020a.pdf: 165301 bytes, checksum: 478022db64b034bbea30c204bbaf2cb9 (MD5) Publico-020b.pdf: 118674 bytes, checksum: 3222abfa356d637cdb4ac8248c91cf7a (MD5). Added 1 bitstream(s) on 2015-08-11T03:25:35Z : No. of bitstreams: 3 Publico-020a.pdf: 165301 bytes, checksum: 478022db64b034bbea30c204bbaf2cb9 (MD5) Publico-020b.pdf: 118674 bytes, checksum: 3222abfa356d637cdb4ac8248c91cf7a (MD5) Publico-020c.pdf: 2073396 bytes, checksum: 04ba8e01c6f7b4dd2421e5babffdd4b9 (MD5)
Um número desconhecido de pacientes com câncer experimenta reações e interações de drogas graves, podendo resultar em hospitalização e até em morte. Particularmente, pacientes portadores de neoplasia maligna comumente recebem um grande número de medicamentos, além de receberem drogas com alto risco de efeitos adversos. Desta forma, dois estudos foram realizados como base para esta tese: uma revisão sistemática e em estudo retrospectivo. A revisão sistemática da literatura avaliou os estudos publicados sobre a epidemiologia de interações medicamentosas em pacientes com câncer. A busca identificou 8 estudos: 7 artigos publicados no PubMed e um resumo publicado nos proceedings do congresso da sociedade americana de oncologia (ASCO). A maioria dos estudos era retrospectiva e avaliou potenciais interações medicamentosas, com apenas dois estudos publicados sobre reais interações medicamentosas. Aparentemente, um terço dos pacientes oncológico ambulatoriais recebe combinações de drogas com risco de interação. Os principais fatores de risco para interações medicamentosas são: idade avançada, número crescente de medicações, presença de lesões cerebrais (primárias ou secundárias) e pacientes que recebem drogas consideradas de risco como anticonvulsivantes, varfarina e anti-inflamatórios hormonais e não-hormonais. O segundo estudo desta tese avaliou a prevalência de potenciais interações medicamentosas entre pacientes com câncer terminal. Desta forma, nós revisamos retrospectivamente os prontuários de todos os pacientes com câncer que foram atendidos no ambulatório de Cuidados Paliativos, do Hospital Princess Margaret, Toronto, Canadá, num período de 8 meses. As listas de medicações foram rastreadas para interações pelo programa eletrônico Drug Interaction Facts, que classifica as interações por nível de gravidade (maior, moderada e menor) e evidência científica (1 a 5, onde 1 = maior nível de evidência). Dentre os 372 pacientes avaliados, 250 interações medicamentosas potenciais foram identificadas em 115 pacientes (31%, 95% Intervalo de Confiança 26 - 36%), predominantemente envolvendo varfarina e fenitoína. A maioria das potenciais interações foi classificada como de gravidade moderada (59%) e 41,5% possuíam níveis de evidência 1-3. Na análise multivariada, idade crescente (p<0,001), pelo menos uma comorbidade (p=0,001), tipo de câncer (tumores cerebrais, p<0,001) e número crescente de medicamentos utilizados (p<0,001) foram associados a risco de interações medicamentosas. Portanto, concluiu-se que potenciais interações medicamentosas são comuns entre pacientes oncológicos que estejam recebendo cuidados de suporte exclusivos, sendo que a maioria envolve varfarina e/ou anticonvulsivantes. Fatores de risco incluem idade avançada, pacientes com múltiplas comorbidades, tumores cerebrais e aqueles que utilizam muitas medicações.
Background: Drug-drug interactions (DDIs) comprise an important problem in medical oncology practice. We systematically reviewed the frequency of DDIs in oncology. Methods: We searched PubMed for eligible articles and online databases abstracts of major oncology meetings. Results: Eight studies reported on the frequency of DDIs: six evaluated the frequency of potential DDIs while 2 studies reported on real DDIs, i.e. interactions that had clinical consequences. Studies of potential DDIs found that approximately one third of patients are exposed to dangerous drug doublets, with the most common ones involving warfarin and anticonvulsants. One study of real DDIs found that 2% of hospitalized cancer patients had a DDI as the cause of admission. Conclusion: Drug interactions comprise an important issue in oncology, with approximately one third of ambulatory cancer patients being at risk of DDIs. Data are limited on the clinical consequences of drug interactions among cancer patients.
TEDE
BV UNIFESP: Teses e dissertações

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Jacquinot, Quentin. "Bénéfices d’un programme de réentrainement à l’effort chez des patientes atteintes d’un cancer du sein HER2-positif, en cours de traitement par trastuzumab en adjuvant. : impact sur la toxicité cardiaque, le déconditionnement, la fatigue et la qualité de vie relative à la santé." Thesis, Bourgogne Franche-Comté, 2018. http://www.theses.fr/2018UBFCE021.

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La surexpression du récepteur du facteur de croissance épidermique humain (HER2) dans le cancer du sein est de mauvais pronostic. La thérapie ciblée par trastuzumab améliore la survie globale des patientes mais est associé à une cardiotoxicité, avec notamment une diminution de la fraction d'éjection ventriculaire gauche (FEVG). L’objectif de ce travail de thèse a été d’étudier, chez des patientes suivies en oncologie médicale pour un cancer du sein HER2-positif, traitées exclusivement par trastuzumab, les effets d’un programme de réentrainement à l’effort, individualisé (12 semaines, 55 minutes, 3 fois/semaine), sur cycloergomètre, combinant des intensités modérées et élevées, d’une part sur la toxicité cardiaque, évaluée par la FEVG et la déformation longitudinale du ventricule gauche (DLVG) grâce à une échographie cardiaque et d’autre part sur les adaptations physiologiques à l’exercice, la fatigue, la douleur et la qualité de vie relative à la santé (QdVS). Cinquante-huit patientes ont été randomisées en deux groupes : contrôle (GC ; n=28 ; 49,9 ± 9 ans) et entrainé (GE ; n=30 ; 50,4 ± 7,8 ans). Toutes les variables ont été analysées en pré (T0), en post-intervention (T3) et 3 mois après celle-ci (T6). À T0, la VO2 pic (mL.min-1.kg-1), mesurée par une épreuve d’effort incrémentée, maximale, est faible dans les deux groupes (GE : 24,7 ± 1,4 et GC : 23,8 ± 1,3) sans que la différence ne soit significative. À T3, la FEVG et la DLVG n’ont pas diminué significativement, comparées aux valeurs basales (T0). De plus, le pourcentage de patientes n’ayant pas présenté de toxicité cardiaque est plus important dans le GE (89,3%) que le GC (84%) et chez celles qui ont développé une cardiotoxicité (n=7) la FEVG a diminué de 10,8% à T3. Par ailleurs, la puissance maximale (PM), la VO2 pic et le VO2/FC maximal sont significativement améliorés et les seuils d’adaptation ventilatoire (SV1) et de désadaptation ventilatoire (SV2) sont atteints pour des puissances et VO2 plus élevées dans le GE. En dépit d’une PM plus élevée, la lactatémie de fin d’effort n’est pas significativement différente, témoin d’une moindre acidose métabolique. Les intensités d’entrainement ont augmenté passant de 70 à 87 W en base et de 92 à 110 W au pic. Par ailleurs, les scores de la fatigue générale et physique, de l’interférence et de l’intensité de la douleur sont diminués et ceux de la QdVS sont plus élevés dans le GE. Les augmentations de PM et de VO2 pic sont associées à une moindre fatigue générale et à une plus faible interférence de la douleur et à une meilleure QdVS. Enfin, ni la PM, ni la VO2 pic sont associées à l’augmentation des scores des différentes dimensions du QLQ-C30, excepté l’âge qui est significativement associé à la dimension « fatigue » (OR : 0,081 ; IC95% [0,007-0,893] ; p<0,04). Ainsi, les patientes de plus de 50 ans ont plus de risque d’augmenter leur fatigue.À T6, bien que certaines variables soient légèrement diminuées par rapport à celles mesurées à T3, elles restent supérieures à celles observées à T0. Nos résultats démontrent qu’un programme d’entrainement encadré de 12 semaines est une stratégie efficace qui limite la toxicité cardiaque du trastuzumab, les capacités cardiorespiratoires et métaboliques à l’exercice, diminue la fatigue, la douleur et in fine améliore la qualité de vie des patientes atteintes de cancer du sein. Ces bénéfices ont été retrouvés 3 mois après l’intervention. L’AP doit ainsi faire partie intégrante des soins oncologiques de support pendant et après les traitements
Overexpression of the human epidermal growth factor receptor 2 (HER2) in breast cancer is associated with poor prognosis. Trastuzumab improves overall survival but it is associated with cardiotoxicity, including a decrease in left ventricular ejection fraction (LVEF). The objective of this thesis work was to evaluate, in patients followed in medical oncology for HER2-positive breast cancer, and treated exclusively with trastuzumab, the effects of a supervised, tailored exercise program (55 minutes, 3 days/week, 12 weeks), combining moderate and high intensities, on cardiotoxicity, as assessed by LVEF and left ventricular longitudinal deformation (LVLD) measured by echocardiography; and on cardiorespiratory fitness, fatigue, pain and health-related quality of life (HRQoL). Fifty-eight patients were randomized into two groups: control (CG, n=28, 49.9±9 years) and training (TG, n=30, 50.4±7.8 years). All variables were analyzed pre- (T0) and post-intervention (T3) and 3 months later (T6). At T0, VO2 peak (mL.min-1.kg-1), measured by a maximal graded exercise, was low in both groups (GE: 24.7 ± 1.4 and GC: 23.8 ± 1.3) without the difference being significant. At T3, LVEF and LVLD did not decrease compared to baseline values. The percentage of patients who did not have cardiac toxicity was greater in the TG (89.3%) than in the CG (84%). In those who developed cardiotoxicity (n=7), LVEF decreased by 10.8% at T3. Maximal workload (MW), VO2 peak and VO2/HR were greater compared to values recorded at T0. Training improves aerobic capacity highlighted by delayed onset of both ventilatory thresholds with higher average workload and VO2 in the TG. Lactatemia was not significantly different but the MW was greater than those developed in pre-training, indicating lower metabolic acidosis. Training intensities increased from 70 to 87 W at base and from 92 to 110 W at peak. In addition, scores for general and physical fatigue, interference and pain intensity decreased, and those for HRQoL increased. Improvements in MW and VO2 peak were associated with less general fatigue, lower pain interference and better HRQoL. Finally, no variable was associated with the scores of the various dimensions of the QLQ-C30, except for age, which was significantly associated with the "fatigue" dimension (OR: 0.081, 95% CI [0.007-0.893]; p<0.04). Accordingly, patients over 50 years old are more likely to feel increased fatigue. At T6, although some variables were slightly lower than those measured at T3, they remained higher than those observed at T0.Our results demonstrate that patients with HER2-positive breast cancer undergoing adjuvant trastuzumab tolerated the exercise training well, without side-effects. Furthermore, this supervised exercise program is an effective strategy to limit the cardiac toxicity of trastuzumab. Moreover, training improves cardiorespiratory and metabolic capacity during exercise (maximum and sub maximal), reduces fatigue and pain, and ultimately improves the quality of life of breast cancer patients. These beneficial effects were prolonged 3 months after the intervention. Tailored training may therefore provide additional benefits on top of the usual cancer treatment and prevent exacerbations of physiological toxicities that occur as a result of treatment

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Fournié, Claire. "Activité physique adaptée et cohérence cardiaque en soins de support : leurs effets sur la variabilité de la fréquence cardiaque et la qualité de vie en post-traitement d’une hémopathie maligne." Thesis, La Réunion, 2020. http://www.theses.fr/2020LARE0009.

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Introduction : Les cancers hématologiques sont de survenues brutales et nécessitent des traitements agressifs, notamment de la chimiothérapie intensive et parfois des greffes de cellules souches hématopoïétiques. Les répercussions induites par le cancer et ses traitements sont responsables d’une altération majeure de la qualité de vie, autant qu’une fatigue chronique et des difficultés de réadaptation sociales et professionnelles. Les programmes d’Activité Physique Adaptée (APA) en hématologie ont montré leur efficacité sur l’état physique et la fatigue principalement mais restent peu concluants sur les dimensions psycho-émotionnelles de la qualité de vie. Des recherches récentes en neuro-cardiologie ont par ailleurs montré les bénéfices d’un entraînement à la Cohérence Cardiaque (CC) sur l’équilibre du Système Nerveux Autonome (SNA) et sur l’état psycho-émotionnel. Méthode : Les travaux de recherche entrepris dans cette thèse ont pour objectifs d’évaluer les effets d’une intervention non-médicamenteuse sur la qualité de vie de patients adultes en post-traitement d’une hémopathie maligne. La récupération d’un équilibre physiologique est indexée par la Variabilité de la Fréquence Cardiaque (VFC), reconnue comme une fenêtre d’observation du SNA. Nous présentons quatre études : une étude expérimentale auprès de sujets sains pour mieux comprendre les mécanismes de la VFC lors d’une respiration lente et profonde ; une étude de faisabilité portant sur la mise en œuvre d’un programme APA en hématologie ; puis les résultats préliminaires d’un essai contrôlé randomisé évaluant les effets d’un programme combinant APA et CC sur la VFC, la qualité de vie, la fatigue et l’état anxiodépressif ; et enfin une étude qualitative évaluant le déroulement du programme et les effets des deux interventions. Résultats : Nos résultats montrent d’abord la faisabilité de l’APA et de la CC chez ces patients. Même si les résultats portant sur l’analyse de la VFC sont difficiles à interpréter avec précision, ils tendent à confirmer qu’une intervention en CC entraîne une stimulation du tonus vagal. L’évaluation qualitative nous apporte de nombreux éléments déterminants dans l’adéquation entre les interventions et les besoins singuliers des patients et dans leur efficacité sur l’optimisation d’un retour à une vie active et autonome. Discussion : Ces travaux de recherche apportent par de nouveaux faits expérimentaux, des éléments supplémentaires dans la compréhension des mécanismes de la CC et de ses applications en milieu clinique. D’autres expérimentations sont encore nécessaires pour approfondir nos connaissances dans le cadre d’une approche psychophysiologique en APA et cancer
Introduction: Hematologic malignancies require aggressive treatment, including intensivechemotherapy and sometimes hematopoietic stem cell transplantation. The repercussions of cancer and its treatment is recognized for their significant long-term adverse effects on health-related quality of life. As a part of cancer treatment, physical exercise is known to improve mainly physical functioning and fatigue, but there are still questions regarding its impact on psychological and emotional functioning. Nonetheless, heart rate variability biofeedback (HRVB) is recognized for its positive effects on autonomic nervous system balance and emotional self-regulation. Recent research in neurocardiology has shown the benefits of Cardiac Coherence (CC) training on the autonomic balance and the psycho-emotional state. Method: The objectives of the research undertaken in this thesis are to evaluate the effects of a nonpharmacological intervention on quality of life in adult hematologic patients in post-treatment time. The recovery of physiological balance is indexed by the Heart Rate Variability (HRV), which is recognized as a window of the Autonomic Nervous System (ANS). We present four studies: an experimental study in healthy subjects to better understand the mechanisms of HRV during slow and deep breathing; a feasibility study on the implementation of an APA program in hematology; preliminary results of a randomized controlled trial evaluating the effects of a program associating APA and CC on HRV, quality of life, fatigue and anxiety-depression; and a qualitative study evaluating the program’s implementation and the effects of the both interventions. Results: Our results first show the feasibility of APA and CC in these patients. Although the results of the HRV analysis are inconclusive, they tend to confirm that CC intervention results in stimulation of vagal tone. Qualitative evaluation provides us with many important insights into the appropriateness of the interventions to the specific needs of the patients and their effectiveness in optimizing a return to the active daily life. Discussion: This research provides new experimental evidence in understanding the mechanisms of cardiac coherence and its applications in the clinical setting. Further experimentation is still needed to deepen our knowledge in the context of a psychophysiological approach in APA on cancer

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Engle, Susan. "Acupuncture holds promise as supportive care in cancer treatment." 2008. http://www.ocomlibrary.org/images/PDF/studentpapers/susanengle.pdf.

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Klafke, Nadja. "Interpersonal factors impacting the decision to (continue to) use complementary and alternative medicine (CAM) in men with cancer: a mixed-methods study." Thesis, 2014. http://hdl.handle.net/2440/97249.

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There has been an increase in the use of Complementary and Alternative Medicine (CAM) in cancer populations, with reported higher prevalence rates in women than in men. Men with a variety of cancers have been understudied in CAM research, as well as the contribution and involvement of their significant others, like close family members or/and close friends. The aim of this thesis was to investigate the use of CAM in men after a diagnosis of cancer. Specifically, the research aimed to explore how significant others impact on men’s decisions to (continue to) use CAM, how they negotiate, talk, and practice CAM in everyday life, and how this affects their interpersonal relationship. A mixed methodological approach with two independent but related studies addressed the research aims: one quantitative study (survey) and one qualitative study (semi-structured interviews). The results are presented in two published and three submitted papers that contribute to our understanding of CAM use in men affected with cancer and how their CAM uptake is shaped by their social networks. Paper one reports the results of an integrative review of the literature, and indicates that significant others of patients with cancer often act as information seekers, advocates, and/or role models in patients’ decision-making about CAM. Despite the limited number of reviewed studies about familial involvement available, the results suggest that there may be important interpersonal consequences following patients’ decision to use or not use CAM, that need to be further explored. Paper two reports the results from the Study 1 survey involving 403 Australian men affected with cancer, a convenience sample of consecutive patients visiting two public and two private outpatient cancer clinics in Metropolitan Adelaide. The results indicate that the majority of male cancer patients (61.5%) have experience with CAM at some point during their cancer treatment, while more than half of the study sample (52.9%) were currently using CAM whilst receiving conventional medical treatment. It was also shown that family were the most frequent providers of information about CAM, and were significantly more often involved in patients’ discussions about CAM use than medical professionals. Papers three, four, and five report the results of Study 2, involving qualitative analysis of 43 semi-structured interviews with 26 men and 24 significant others, thereby exploring in-depth participants’ perceptions and experiences of CAM. Paper three indicates that men with cancer use CAM for individual and social/interpersonal reasons, a unique category augmenting those previously discussed in the literature. Discourse analysis highlighted how the interpersonal dimension impact on men’s decisions to uptake CAM, and how the use of CAM functions to connect the male cancer patient with his social network. Paper four reports on the variations of significant others’ involvement in men’s CAM uptake and maintenance, and indicates that CAM is sometimes practised as a shared and/or private activity in everyday life. The shared practice of CAM was associated with interpersonal benefits, working to strengthen the bond between men and their significant others, but there were instances when men expressed a need to practice CAM as a private activity. It was found that CAM benefited both men and their significant others to reduce uncertainty and to regain control. Paper five reports on how regular and habitual male CAM users integrate CAM routines and CAM rituals in their everyday life. The discursive analysis illustrates how CAM routines provide male cancer patients with certainty and control. By contrast, CAM rituals function for cancer patients and their significant others as a means to create and maintain meaning, thereby working to counter fear and uncertainty consequent upon a diagnosis of cancer. In summary, the results of these studies have shown that the majority of men with a variety of cancers use CAM in addition to conventional cancer care. Family members and/or close friends are a significant source of influence in men’s CAM uptake and maintenance. The interactions about CAM between men and their significant others functioned to help them to connect with each other or strengthen their social bond, and constitute a beneficial effect of CAM use. In addition, it was found that regular CAM use helped men and their significant others to regain control and to reduce uncertainty. These findings may help healthcare professionals to better understand how interpersonal processes impact on men’s CAM decisions. The results might also be translated into clinical practice, for example, in designing supportive cancer care programmes tailored specifically to men affected with cancer, with or without involvement of their significant others.
Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 2014

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Edwards, Zoe, Alison Blenkinsopp, Lucy Ziegler, and M. Bennett. "Cancer patients’ views on community pharmacy pain medicines consultations in advanced cancer." 2016. http://hdl.handle.net/10454/8346.

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Every year in England and Wales, 105,000 people sufferfrom uncontrolled cancer pain and are rarely offered community pharmacy medicine consultations (e.g. Medicines Use Reviews -MURs)[1]. Our aim was to examine how patients with cancer pain deal with their pain medication and to investigate their experiences of and attitudes towards community pharmacy.

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Beauchemin, Melissa Parsons. "Supporting Clinical Decision Making in Cancer Care Delivery." Thesis, 2019. https://doi.org/10.7916/d8-70wy-w603.

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Background: Cancer treatment and management require complicated clinical decision making to provide the highest quality of care for an individual patient. This is facilitated in part with ever-increasing availability of medications and treatments but hindered due to barriers such as access to care, cost of medications, clinician knowledge, and patient preferences or clinical factors. Although guidelines for cancer treatment and many symptoms have been developed to inform clinical practice, implementation of these guidelines into practice is often delayed or does not occur. Informatics-based approaches, such as clinical decision support, may be an effective tool to improve guideline implementation by delivering patient-specific and evidence-based knowledge to the clinician at the point of care to allow shared decision making with a patient and their family. The large amount of data in the electronic health record can be utilized to develop, evaluate, and implement automated approaches; however, the quality of the data must first be examined and evaluated. Methods: This dissertation addresses gaps the literature about clinical decision making for cancer care delivery. Specifically, following an introduction and review of the literature for relevant topics to this dissertation, the researcher presents three studies. In Study One, the researcher explores the use of clinical decision support in cancer therapeutic decision making by conducting a systematic review of the literature. In Study Two, the researcher conducts a quantitative study to describe the rate of guideline concordant care provided for prevention of acute chemotherapy-induced nausea and vomiting (CINV) and to identify predictors of receiving guideline concordant care. In Study Three, the researcher conducts a mixed-methods study to evaluate the completeness, concordance, and heterogeneity of clinician documentation of CINV. The final chapter of this dissertation is comprised of key findings of each study, the strengths and limitations, clinical and research implications, and future research. Results: In Study One, the systematic review, the researcher identified ten studies that prospectively studied clinical decision support systems or tools in a cancer setting to guide therapeutic decision making. There was variability in these studies, including study design, outcomes measured, and results. There was a trend toward benefit, both in process and patient-specific outcomes. Importantly, few studies were integrated into the electronic health record. In Study Two, of 180 patients age 26 years or less, 36% received guideline concordant care as defined by pediatric or adult guidelines, as appropriate. Factors associated with receiving guideline concordant care included receiving a cisplatin-based regimen, being treated in adult oncology compared to pediatric oncology, and solid tumor diagnosis. In Study Three, of the 127 patient records reviewed for the documentation of chemotherapy-induced nausea and vomiting, 75% had prescriber assessment documented and 58% had nursing assessment documented. Of those who had documented assessments by both prescriber and nurse, 72% were in agreement of the presence/absence of chemotherapy-induced nausea and vomiting. After mapping the concept through the United Medical Language System and developing a post-coordinated expression to identify chemotherapy-induced nausea and vomiting in the text, 85% of prescriber documentation and 100% of nurse documentation could be correctly categorized as present/absent. Further descriptors of the symptoms, such as severity or temporality, however, were infrequently reported. Conclusion: In summary, this dissertation provides new knowledge about decision making in cancer care delivery. Specifically, in Study One the researcher describes that clinical decision support, one potential implementation strategy to improve guideline concordant care, is understudied or under published but a promising potential intervention. In Study Two, I identified factors that were associated with receipt of guideline concordant care for CINV, and these should be further explored to develop interventions. Finally, in Study Three, I report on the limitations of the data quality of CINV documentation in the electronic health record. Future work should focus on validating these results on a multi-institutional level.

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Huang, Szu-Ting, and 黃詩婷. "The Effectiveness of Supportive Psychotherapy for Children of Parents With Cancer." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/38389466856224672882.

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碩士
臺北醫學大學
護理學研究所
98
The major purpose of this study was explored the effectiveness of supportive psychotherapy for children of parents with cancer. The research design was to adopt experimental method and randomized controlled trial. The subjects were children of parents with cancer (aged 10~24) recruited from a local teaching hospital Oncology department in Taipei City. The subjects separated for experimental group (group A) and control group (group B) randomly. Control group only received general medical care. Experimental group not only received general medical care but also supportive psychotherapy which included supportive group and nursing health consultation two parts. The supportive group was leading by psychiatric registered professional nurse and counseling psychologist as group therapist and collaborative therapist in around 90 minutes each week for six weeks. Nursing health consultation group used telephone interviews and guided by health education sheet to concern the experimental group adapted to parent diseased process, emotional distress, parent-children relationship… etc. The research instruments used included the Children’s Depression Inventory, Beck Anxiety Inventory, Chinese version of the Positive and Negative Suicidal Ideation, Parents and Children Relationship Scale and Spirituality Assessment Scale. Statistical analysis used descriptive and inferential statistics and effectiveness analysis used Repeated Measures ANCOVA. Other group issues were discussed by qualitative analysis. Statistical results found experimental group improved obviously in depressive symptoms, negative suicidal ideation, parents-children relationship and spirituality health than in control group. Supportive group issues analysis categories were ambiguous cancer, transform of growth, seeking support strength and hope for future. The results showed supportive psychotherapy could ameliorate children of parents with cancer’s emotional distress effectively, reinforce perception of parents-children relationship and advance the power of inside support. These results will help clinical nurses use supportive psychotherapy to improve children of parents with cancer’s psychological adaption.

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Liu, Li-Ni, and 劉莉妮. "The Effectiveness of a Continuing Supportive Caring Model for Breast Cancer Women." Thesis, 2003. http://ndltd.ncl.edu.tw/handle/90444184911258511160.

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碩士
輔仁大學
護理學系碩士班
91
The aim of this study was to investigate the effectiveness of a continuing supportive caring model on social support and disease uncertainty for breast cancer women. Quasi-experimental research design was used in this study. Patients were selected by purposive sampling from two surgical clinics of two teaching hospitals in Taipei. The eligible women were assigned to either control or experimental group based on the different time interval. The control group received standard care and the experimental group received standard care plus interventions based on a continuing supportive caring model. Participants completed questionnaires at three time points: baseline between two weeks after diagnosis, one month post-operation, and three months after diagnosis. The questionnaire included demographic data, social support scale, and disease uncertainty scale. A total of 61newly diagnosed breast cancer women were recruited in this study, including 31 women of the experimental group and 30 women of the control group. After three months of diagnosis, 56 women accomplished the follow-up including 27 women in the experimental group and 29 women in the control group. The results were analyzed using SPSS 10.0 software. The results of this study showed: (1) The social support of the experimental group increased significantly at one month following baseline and then kept in flat, but the control group decreased significantly at one month following baseline and then kept in flat. Both groups showed significant changes on three time points on social support；(2) The disease uncertainty of the experimental group decreased significantly at one month following baseline and then decreased, but the control group kept in flat first and then decreased significantly. Both groups showed significant changes on three time points on disease uncertainty；(3) In the experimental group, social support and disease uncertainty improved significantly than the control group on one month post-operation and three months post-diagnosis. The results of this study may help clinical nurses and hospital managers in care of newly diagnosed breast cancer women, and may contribute to improving the quality of breast cancer patients’ care in Taiwan.

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Lu, Xiao Mei. "Primary and secondary prevention of cancer using the supportive-educative role of the oncology nurse." Thesis, 2010. http://encore.tut.ac.za/iii/cpro/DigitalItemViewPage.external?sp=1000641.

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Thesis (MTech. degree in Nursing)--Tshwane University of Technology, 2010.
Cervical cancer, breast cancer and Kaposi's sarcoma are the three most common cancers in women in sub-Saharan Africa. The health care providers in developing countries regularly encounter women with advanced, incurable cervical cancer. Cervical cancer can however, be prevented, even among women at high risk for the disease, through screening using relatively simple technologies. The purpose of the study was to determine whether the supportive-educative role of the oncology nurse can contribute to the prevention of primary and secondary cervical cancer, breast cancer and Kaposi's sarcoma in women living in Soshanguve, South Africa.

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Wu, Jung-Ju, and 吳蓉茹. "The radiosensitizing effect of Chinese herbal medicines in cultured breast cancer cells." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/95912705581212401459.

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碩士
中國醫藥大學
中國醫學研究所
93
The incidence and mortality of breast cancer in Taiwan are increasing year by year. Breast conserving therapy including conserved mastectomy combined with radiation therapy is the contemporary choice of treatment. Radiosensitizers are often used in radiation therapy program to augment the anti-tumor effect. However, the clinical application of traditional radiosensitizers is limited due to their serious side effects. In this thesis, the radiosensitizing effect of Chinese herbal medicines in cultured breast cancer cells was examined to search for new radiosensitizers with high therapeutic effects but low side effects. First, the effects of 20 Chinese herbal medicines within the categories of clearing away heat and detoxication as well as promoting circulation and dispelling stagnant blood (such as Artemisia apiacea, Taraxacum mangolicum, Patrinia scabiosaefolia, Viola yedoensis, Hedyotis diffusae, Lonicera japonica, Paeonia suffruticosa, Polygonum cuspidatum, Isatis indigotica, Scutellaria baicalensis, Phellodendron amurense, Savia tatarica, Carthamus tinctorius, Sparganium stoloniferum, Curcuma zedoaria, Panxa pseudo-ginseng var.notoginseng, Curcuma longa, Vaccaria pyramidata、Glycyrrhiza uralensis, and Prunella vulgaris) on cell growth of MDA-MB-231 (p53-, Rb-, ER-) human breast cancer cells were examined. The components of some herbal medicines, such as Epigallocatechin gallate, baicalin, and baicalein, were also examined. Roscovitine, a known radiosensitizer in MDA-MB-231 cells, was used as a positive control. The growth inhibition induced by herbal medicines was measured by MTS assay. Some herbal medicines, such as Curcuma longa, Sparganium stoloniferum, Taraxacum mangolicum, and Isatis indigotica, showed no significant growth inhibition in MDA-MB-231 cells (P>0.05). Some herbal medicine and their components, such as Scutellaria baicalensis, Phellodendron amurense, Vaccaria pyramidata, baicalin, and baicalein, induced significant growth inhibition in a dose-dependent manner in MDA-MB-231 cells (P<0.05). The 50% inhibitory concentrations (IC50s) of roscovitine, baicalin, baicalein, Phellodendron amurense, Vaccaria pyramidata, and Scutellaria baicalensis were 10.3, 13.8, 26.0, 32.3, 36.9 and 207.7 μg/ml, respectively. On the contrary, most of the herbal medicines demonstrated no significant growth inhibition in MCF-7 (p53＋, Rb＋, ER＋) human breast cancer cells by MTS assay, except Phellodendron amurense. Using MTS assay, these is no significant radiation–induced growth inhibition observed in both MDA-MB-231 and MCF-7cells 24、48、72、96 hours after 3～7 Gy irradiation. In contrast, radiation (2、3、4、5 Gy) exhibited significant dose-related growth inhibition in MDA-MB-231 cells by clonogenic survival assay. The growth inhibition rates of 2, 3, 4, and 5 Gy were 26%, 39%, 54%, and 65%, respectively, as compared with negative control. The radiosensitizing effects of herbal medicines in MDA-MB-231 cells were examined by clonogenic survival assay. Some herbal medicines, such as Scutellaria baicalensis, Curcuma zedoaria, Hedyotis diffusae, Phellodendron amurense, Sparganium stoloniferum, Baicalin, and Baicalein, showed significant enhancement of radiation-induced growth inhibition as compared to radiation alone. Compared with radiation (3 Gy) alone, the enhanced growth inhibition rates for radiation in the presence of 5.0 μM Roscovitine, 12.5 μg/ml Scutellaria baicalensis, 25 μg/ml Scutellaria baicalensis, 500 μg/ml Curcuma zedoaria, 250 μg/ml Hedyotis diffusae, 500 μg/ml Hedyotis diffusae, 6 μg/ml Phellodendron amurense, 12.5 μg/ml Phellodendron amurense, 18 μg/ml Phellodendron amurense, 25 μg/ml Phellodendron amurense, 6.25 μg/ml Baicalin, 12.5 μg/ml baicalin, 3 μg/ml Baicalein, or 6.25 μg/ml Baicalein, were 26.8%, 19.5%, 59.3%, 32.9%, 41.5%, 47.4%, 27.7%, 54.5%, 57.0%, 74.9%, 49.0%, 71.8%, 32.0% and 55.4%, respectively (p<0.05)。 Furthermore, the molecular basis for the enhanced growth inhibition of MDA-MB-231 breast cancers by a combination of radiation and herbal medicines was examined. The effects of radiation and herbal medicines on the cell cycle were examined by flow cytometric analysis. There was a significant increase in the accumulation of cells at the G2-M phase of the cell cycle after 5 Gy irradiation exposure. Scutellaria baicalensis and Phellodendron amurense combined with radiation (4 Gy) showed no significantly increase in Sub G1 and G2-M phase, compared with radiation alone. Moreover, radiation induced a 3~4 fold increase in micronuclei formation (a marker of chromosome damage) in MDA-MB-231 cells. Scutellaria baicalensis and Phellodendron amurense combined with radiation (4 Gy) showed no significantly increase in micronuclei formation, compared with radiation alone. In conclusion, Scutellaria baicalensis、Phellodendron amurense、Vaccaria pyramidata showed significant radiosensitizing effect on MDA-MB-231 breast cancer cells, suggesting their potential for the development of novel radiosensitizers. Further study is needed to understand the underlying mechanisms.

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Secombe, Kate Rebecca. "Exploration of the gut microbiome as a predictive factor for cancer treatment-induced gastrointestinal toxicity." Thesis, 2021. https://hdl.handle.net/2440/134012.

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Gastrointestinal toxicity is a significant side effect of many cancer treatments. Characterised by diarrhoea, abdominal pain and bleeding, this toxicity can affect up to 80% of patients, depending on treatment regimen. Currently, there are no highly effective intervention strategies for the vast majority of people affected, thus more evidence is required to improve future management. This thesis focussed primarily on gastrointestinal toxicity stemming from two major types of cancer treatment. These are chemotherapy, the most common form of cancer treatment, and small molecule tyrosine kinase inhibitors (SM-TKIs), a class of targeted therapies, often used in combination with chemotherapy. There is a clear gap in knowledge in understanding how these different cancer treatments cause gastrointestinal toxicity, and how the population of microorganisms in the intestine, the gut microbiome, links to these responses. This thesis therefore aimed to investigate the role of the gut microbiome in influencing the development and exacerbation of gastrointestinal toxicity stemming from cancer treatment. This was investigated in three main sections. Firstly, I aimed to examine the interaction between the gut microbiome and the innate immune system (chiefly the innate immune receptor Toll-like receptor 4 (TLR4)), and determine how this interaction could be involved in the development of gastrointestinal toxicity following chemotherapy. In order to achieve this aim, I characterised the microbial composition of a TLR4 conditional knockout mouse model and assessed changes due to chemotherapy treatment. There were no clear differences in the microbiome of wild type and TLR4 conditional knockout mice. Secondly, I aimed to characterise the role of the gut microbiome in diarrhoea stemming from the SM-TKI treatment neratinib, which causes high levels of diarrhoea. I found that, in a pre-clinical model, neratinib treatment does cause changes to microbial composition, however it was unclear if these changes were a key driver of diarrhoea development or simply a side effect of this diarrhoea. Therefore I analysed diarrhoea development following an initial, antibiotic-induced perturbation, showing that addition of narrow-spectrum antibiotics caused a significant decrease in diarrhoea severity and timespan. Finally, I clinically appraised the use of the gut microbiome in predicting risk of cancer treatment-induced gastrointestinal toxicity in two defined patient cohorts. A retrospective cohort showed that participants who went on to develop diarrhoea had significantly lower amounts of the bacterial genera Blautia and significantly higher amounts of the genera Collinsella. A longitudinal study was then developed. Pilot results did not show clear microbial clustering based on diarrhoea status. The results of my thesis demonstrate the emerging role gut microbiome composition has on the development of diarrhoea following cancer treatment. However I was unable to definitively identify any particular bacterial type that is a key mediator of this effect. The results presented here however provide strong rationale for further research in this area using specific machine learning and metabolomic techniques to identify compositional features that may be important in accurately predicting diarrhoea development following cancer treatment.
Thesis (Ph.D.) -- University of Adelaide, School of Biomedicine, 2021

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45

Pearce, Nancy Jane Mae. "Older Adults Living with Cancer: Supportive Care Needs and Utilization of Peer Support Services." Thesis, 2007. http://hdl.handle.net/10012/3168.

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BACKGROUND: Cancer is primarily a disease of older adults with sixty percent of all incidences occurring in individuals 65 years and over. Coping with cancer may entail additional challenges for older adults due to co-morbidities, declining mobility, reduced social networks and ageism. To date, the majority of research examining supportive care needs has focused on younger women with breast cancer. Little attention has been paid to older adults’ experience with cancer, particularly with respect to psychosocial support. PURPOSE: The aims of the present studies were twofold: (1) to learn more about peer support services in Ontario, specifically: the type and location of available programs; extent of utilization by older adults; and factors that might facilitate or inhibit use by older adults; and (2) to gain a better understanding of the experiences and challenges facing older adults living with cancer, strategies and resources used to meet these challenges, unmet support related needs, as well as awareness of support services, principally peer support. METHODS: First, peer support services in Ontario were identified through an environmental scan. Subsequently, interviews were conducted with 24 key contacts from a purposeful sample (based on type and geographic location) of 30 of these groups. Next, surveys were administered to participants (n=220) and facilitators (n=39) from these groups to establish a profile of current peer support users and deliverers, and examine the extent to which older adults (age ≥ 65) utilized these services. Finally, a preliminary, in-depth, qualitative exploration from the perspective of older adults living with cancer was conducted through a focus group (n=6) and interviews with 20 older adults. RESULTS: The environmental scan yielded a total of 177 peer support cancer programs across Ontario; predominately group-based (93%). Most were located in urban centers. Few programs targeted colon cancer. In the 30 groups examined, breast and prostate cancer were the most common focus (60%). Group facilitators were primarily female (75%) and most had personally experienced cancer (77%). The male facilitators were older (p <.05) and most likely to lead the prostate groups. None of the programs systematically collected client information. Clients ranged in age from 25 to 91 years (mean = 64 ± 10.7). Many were long-term cancer survivors (average five years post diagnosis). Overall, less than half the clients were aged 65 or older. Clients over age 65 were predominately men (86%; p <.001) with prostate cancer. Almost 70% of program directors and over 90% of facilitators were unaware most individuals with cancer are over the age of 65. Interview participants were recruited primarily through the Canadian Cancer Society (CCS). Not surprisingly, 46% had participated in peer support. Older adults identified several challenges with respect to physical functioning, sexuality, emotional distress, and obtaining information. Participants utilized a variety of resources to meet informational and emotional challenges including, the Internet and the support of family and friends. Accessing routine follow-up care after the transition from ‘patient’ to ‘survivor’ was a significant unmet need. CONCLUSIONS: The findings support the premise that cancer peer support services may be under-utilized by older adults, particularly older women. The reasons for these findings remain unclear although ageism may be a factor. Due to the reliance on a convenience sample, qualitative findings that older adults were generally able to meet their supportive care needs cannot be generalized to all older adults living with cancer. Large organizations such as the CCS need to begin systematically collecting demographic and other information on clientele to enhance program planning and delivery. Further research studies on older adults living with cancer are needed to examine their supportive care needs.

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46

Wu, Chang-Che, and 巫昌哲. "Fabrication of ZnO Paper by Co-Deposition of ZnO Nanoparticles and Anti-Cancer Medicines." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/36936471637217710850.

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碩士
國立暨南國際大學
電機工程學系
103
Deposition of ZnO nanoparticles or nanoclusters on paper substrate (so called ZnO paper) has been confirmed to be useful as a platform for anti-bacterial testing. Since paper substrate in nontoxic and biodegradable, ZnO paper is quite suitable for being used in the biomedical area. Therefore, the purpose of this work is to expand the applications of ZnO paper in the area of biomedical teting. In this thesis, we try to incorporate anticancer drugs into the solution for the zinc oxide nanoparticles growth such that anti-cancer drugs can be co-deposited onto the paper substrate simultaneously while depositing the zinc oxide nanopartilcles. As a result, anti-cancer drugs-containing ZnO paper will be obtained. In this work, the zinc oxide nanoparticles were obtained by using chemical reduction form the zinc acetate acide. Two anti-cancer drugs, Iressa and Staurosporine, were selected for the co-deposition with zinc oxide nanoparticles on cellulose paper. In order to confirm that the anti-cancer drugs do have been deposited onto the paper substrate, we used scanning electron microscope (SEM) for the surface morphology check making sure that the ZnO nanoparticles as well as anti-cancer drugs were deposited onto the cellulose paper. Enenery-Dispersive X-ray Sepectroscopy (EDX) and Fourier Transformed Infrared Spectroscopy (FTIR) were then used to check the bondings and deposited amount of ZnO nanoparticles and anti-cancer drugs. UV light illumination during the fist 5 and 10 min of the co-deposition process is proposed to be in favor of the loading of anti-cancer drugs on the ZnO nanoparticles. In the work, we checked the effet of UV illumination on the anti-cancer drugs loading for the ZnO nanoparticles deposited for 30h, 50 h and 72 h, respectively. From our experimental results, it isfound that both the co-deposition time of the ZnO paper and the amount of water during co-deposition affect the bonding of the co-deposited ZnO and anti-cancer drugs. For co-deposition of 250M Iressa in 100ml water, it is observed that the C-Cl and C-F bonds icrease with increasing co-deposition time, while the N-H bonds do not affect much by the co-deposition time. However, after being subjected to UV illumination, the N-H bonds also increases as co-depositon time. If the amount of co-deposition water increases to 200 ml, the effect of UV illumination on the N-H bonding enhance is weakened further and not been able to increase even after UV illumination due to the solution is diluted. For co-deposition of 100nM Staurosporine in 1 ml water, it is found that the intensity of N-H bonds is almost independent of the co-deposition time, but inreases rapidly at a co-depositon time of 72 h after UV illumination. We clearly observed that the intensity of C-H bonds increases with the co-deposition time after UV illumination when the amount of Staurosporine is increased to 200 nM. In conclusion, we confirmed that the chemical reduction method is effective to co-deposit the ZnO nanoparticles and anti-cancer drugs onto the cellulose paper as long as the growth condition is correct.

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47

Yeh, Chia Chi, and 葉家綺. "Symptom Distresses, Coping Strategies and Supportive Care Needs in Patients with Colorectal Cancer after Surgery." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/awnjye.

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48

AhwaliaAziza, Yulanticha Diaz, and 邱玲雅. "Psychological Distress and Unmet Supportive Care Needs of Parents as Caregiver of Children with Cancer." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/wmstrz.

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碩士
國立成功大學
護理學系
105
Background: Having children diagnosed with cancer is a stressful condition for parents, facing physical, psychosocial, and financial burdens in life. These problems parents face are frequently neglected by health care providers and people around them when in reality parents play a significant role in caregiving children with cancer. Purpose: To identify the top rank of unmet supportive care needs, the prevalence of psychological distress, and the correlation of unmet supportive care needs and psychological distress among parents of children with cancer in Indonesia. Methods: A cross-sectional study was conducted among 100 parents of children with cancer from pediatric ward of two public hospitals in Central and East Java, Indonesia. This study chose the Supportive Care Needs Survey for Partner and Caregiver (SCNS-P＆C45) Indonesian version to measure unmet supportive care needs, and Hospital Anxiety Depression Scale (HADS) Indonesian version to assessed psychological distress including anxiety and depression. Results: Of the 100 parents surveyed, 83% had more than ten unmet needs, 49% encountered anxiety, and 25% had depression. The highest need for supportive care was information needs (66.68±23.07). Anxiety not only correlated with the total score of needs (p〈.001; r=.351) but also each domain of needs including informational, health care service, psychological, work, and social needs. Conclusion and recommendation: Most common needs among parents of children with cancer were informational needs. Anxiety is strongly correlated to unmet supportive care needs. We recommend health care providers to activate support groups to decrease parents’ anxiety and depression. There is also a necessity to increase parental education to fulfill their needs of information.

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49

Zheng, Wei –Chang, and 鄭瑋昌. "Cytotoxicity Test of Cancer Cells by Using ZnO Paper Prepared with Co-Deposition of ZnO Nanoparticles and Anti-Cancer Medicines." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/51491426433738594776.

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碩士
國立暨南國際大學
電機工程學系
103
This paper forcuses on the chemical co-deposition of anti-cancer drugs and zinc oxide nanoparticles (ZnO NPs) on paper substrate to form the ZnO paper containing anti-cancer drug. The anti-cancer drug-containing ZnO paper was then used as a test plateform for cytotoxicity test for cancer cells. We investigated the changes of the surface morphology as well as the bondings of the ZnO NPs and anti-cancer drugs co-dpoisted paper substrate as a function of various co-deposition times. By using the MTT assay (3- (4,5-cimethylthiazol-2- yl)- 2,5-diphenyl tetrazolium bromide assay) analysis, we checked the cell viability of normal and cancer cells cultivated on the anti-cancer drug-containing ZnO paper. The purpose of this is to help us understand whether the ZnO NPs is useful for enhancing the cytotoxicity to cancer cells. In addition, we would like to confirm if the co-dposition can simply load the anti-cancer drugs on ZnO NPs. In oder to confirm the anti-cancer drugs were properly loaded onto the ZnO NPs, the surface of the ZnO NPs and anti-cacer durgs co-deposited paper was observed by scanning electron microscope (SEM) and the bonding of which was detected by Fourier transform infrared spectroscopy (FTIR). Cell viability of cells cultivated on ZnO paper was analyzed by MTT assay in combining with enzyme-linked immunosorbent assay (Enzyme-linked immunosobent assay, ELISA). In this work, we also studied the cytotoxicity effect of direct contact and indirect contact of the ZnO NPs with the cells by placing the ZnO papers at different places in the culture plate. ZnO NPs deposited on the fiber structure of the paper substrate can be observed clearly by SEM, and changes over time of the bonding of the anti-cncer drugs co-deposited with ZnO NPs can be discerned from the FTIR peaks. These results confirm that the anti-cancer drugs can be successfully loaded onto ZnO NPs through the proposed chemical co-deposition method. We then applied the ZnO NPs and anti-cancer drugs co-deposited ZnO paper to the cytotoxicity test of cancer cells. By comparing with the ZnO paper without adding anti-cancer drugs, it is found that the anti-cancer drugs co-deposited ZnO paper does help in enhancing the cytotoxicity to the cancer cells, and the cytotoxicity effect of the ZnO paper contacted directly with the cancer cells is stronger than that contacted indirectly with the the cancer cells, though the difference is not obvious. placing the ZnO paper directly cotact with the cancer cells. In conclusion, our experimental results confirm that co-dposition of the anti-cancer drug and ZnO NPs can load the anti-cancer drug onto the ZnO NPs, and the resultant ZnO paper does enhance the apoptosis of cancer cells. The ZnO paper can be apparently used as a platform for cell cytotoxicity test and new anti-cancer drug development.

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50

Edwards, Zoe, L. Ziegler, C. Craigs, Alison Blenkinsopp, and M. I. Bennett. "Pharmacist educational interventions for cancer pain management: a systematic review and meta-analysis." 2018. http://hdl.handle.net/10454/16804.

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Yes
Educational interventions by pharmacists for patients with cancer pain aim to improve pain management, but little is known about the different components of interventions and their effectiveness. Our aim was to assess the benefit of pharmacist delivered educational interventions for patients with cancer pain. A systematic review and meta‐analysis of experimental trials testing pharmacist delivered educational interventions for cancer pain was carried out to identify the components of interventions and effectiveness at improving pain‐related outcomes for patients with cancer. A literature review was conducted in EMBASE, MEDLINE, CINAHL, PsycINFO, ASSIA, Web of Science and CENTRAL from inception until January 2018 searching for educational interventions involving a pharmacist for patients with cancer pain. Four studies were included involving 944 patients. Meta‐analysis was carried out where possible. Meta‐analysis of three of the four studies found that mean pain intensity in the intervention group was reduced by 0.76 on a 0–10 scale (95% confidence interval), although only two of the studies used validated measures of pain. Improvements in knowledge, side effects and patient satisfaction were seen although with less reliable measures. Pharmacist educational interventions for patients with cancer pain have been found to show promise in reducing pain intensity. Studies were few and of varying quality. Further, good quality studies should be carried out in this area and these should be comprehensively reported. Trials measuring patient self‐efficacy and patient satisfaction are needed before the impact of the pharmacist delivered interventions on these outcomes can be established.

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