Cancer

Background: It is stated that the communication and disease experiences of paediatric patients, especially paediatric oncology patients, with healthcare professionals are completely different from those of adults. Objective: The aim of this study was to determine the definitions of a good physician and good nurse provided by elementary school-age oncology patients. Research design: In this qualitative research, data were collected through semi-structured individual interviews. The data were evaluated thorough thematic analysis. Participants and research context: Eighteen children hospitalised due to cancer (...) in paediatric oncology and haematology clinics of a university hospital in Turkey. Ethical considerations: Permission to conduct the study was obtained from the Institution’s Ethics Committee. The objectives of this study were explained to the participants and families, and written consent was obtained from them. Also, participants were assured that necessary measures would be taken to protect their anonymity and confidentiality. Findings: The definitions of children were based on five main themes: interpersonal relationships, virtues, professional responsibility, security and individual characteristics. Conclusion: Children conveyed important messages to health professionals. They emphasised that a good physician and good nurse should communicate well, not only with themselves but also with their family. In addition, children were sensitive about health professionals who played with them and actively participated in the treatment by informing them about the disease. Meeting the expectations of children can be possible by improving the communication skills of physicians and nurses and by adding games and activities to the treatment and care plan. (shrink)

Lockdown measures in response to the COVID-19 pandemic involve placing huge burdens on some members of society for the sake of benefiting other members of society. How should we decide when these policies are permissible? Many writers propose we should address this question using cost-benefit analysis, a broadly consequentialist approach. We argue for an alternative non-consequentialist approach, grounded in contractualist moral theorising. The first section sets up key issues in the ethics of lockdown, and sketches the apparent appeal of addressing (...) these problems in a CBA frame. The second section argues that CBA fundamentally distorts the normative landscape in two ways: first, in principle, it allows very many morally trivial preferences—say, for a coffee—might outweigh morally weighty life-and-death concerns; second, it is insensitive to the core moral distinction between victims and vectors of disease. The third section sketches our non-consequentialist alternative, grounded in Thomas Scanlon’s contractualist moral theory. On this account, the ethics of self-defence implies a strong default presumption in favour of a highly restrictive, universal lockdown policy: we then ask whether there are alternatives to such a policy which are justifiable to all affected parties, paying particular attention to the complaints of those most burdened by policy. In the fourth section, we defend our contractualist approach against the charge that it is impractical or counterintuitive, noting that actual CBAs face similar, or worse, challenges. (shrink)

Built-in decision thresholds for AI diagnostics are ethically problematic, as patients may differ in their attitudes about the risk of false-positive and false-negative results, which will require that clinicians assess patient values.

It is not uncommon for families to wait in hopes of receiving test results that show a treatable mutation, such as in the case of lung cancer. Waiting for such test results can distract families from focusing on a patient’s current pain and suffering, especially when families experience heightened emotions and anticipatory grief. The substituted judgement standard can be helpful in resolving ethical dilemmas by encouraging families to think about what decision a patient would have made if competent, thus preventing (...) unnecessary pain and suffering. This case study sheds light on how the substituted judgement standard was used with a patient’s family and how the family’s hope for a treatable mutation affected their perception of the patient’s clinical condition. (shrink)

The coronavirus disease 2019 pandemic had a negative psychological impact on the population at scale, yet it is possible that vulnerable patient populations may experience a heavier burden with increased feelings of anxiety and distress. Cancer patients have to trade-off between the fear of exposing themselves to the virus and the need to continue life-saving medical procedures. The present study investigated the prevalence of generalized anxiety and post-traumatic stress symptoms in a population of Italian cancer patients and healthy participants in (...) the months following the COVID-19 outbreak. Using standardized measures of PTSS and generalized anxiety, we found that patients experienced higher levels of adverse mental health outcomes. Several variables were found to negatively affect PTSS and anxiety in this population, including the younger age of respondents, having children, and the impossibility to attend regular medical check-ups. These findings stress the importance of maintaining a clear and regular communication with patients throughout future waves of the pandemic and ensure continuity of care in this vulnerable population. Furthermore, this study indicates the need to establish psychological interventions aimed at patients with cancer, targeting especially younger generations who are more likely to experience adverse psychological outcomes. (shrink)

BackgroundThe impact of a cancer diagnosis may be traumatic, depending on the psychological resources used by patients. Appropriate coping strategies are related to better adaptation to the disease, with coping flexibility, corresponding to the ability to replace ineffective coping strategies, demonstrated to be highly related with self-efficacy to handle trauma. The Perceived Ability to Cope with Trauma scale is a self-rated questionnaire that assesses the perceived ability to cope with potentially traumatic events, providing a measure of coping flexibility. The current (...) study aimed at examining the psychometric properties of the PACT Scale in Portuguese patients with breast cancer.MethodsThe study included 172 patients recently diagnosed with early breast cancer. Participants completed a Portuguese version of the PACT scale, and instruments of self-efficacy for coping with cancer, of quality of life, and of psychological distress that were used as convergent and divergent measures, thus assessing construct validity. A confirmatory factor analysis was performed to test the factor structure of the Portuguese version of PACT scale and reliabilities were examined.ResultsResults from the CFA confirmed the two-factor structure, consistent with the original Forward and Trauma focus subscales. The two subscales demonstrated high internal consistencies. Convergent and divergent validities were confirmed: the PACT scale was related to high self-efficacy to cope with cancer, to high perceived quality of life, and to low psychological distress.DiscussionOverall, the current results support and replicate the psychometric properties of the PACT scale. The scale was found to be a valid and reliable self-reported measure to assess Portuguese breast cancer patients regarding beliefs about their capabilities in managing the potentially traumatic sequelae of cancer. The PACT is a simple and brief measure of coping flexibility to trauma, with potential relevance for application in clinical and research settings. (shrink)

Narrative analysis is well established as a means of examining the subjective experience of those who suffer chronic illness and cancer. In a study of perceptions of the outcomes of treatment of cancer of the colon, we have been struck by the consistency with which patients record three particular observations of their subjective experience: the immediate impact of the cancer diagnosis and a persisting identification as a cancer patient, regardless of the time since treatment and of the presence or absence (...) of persistent or recurrent disease; a state of variable alienation from social familiars, expressed as an inability to communicate the nature of the experience of the illness, its diagnosis and treatment; and a persistent sense of boundedness, an awareness of limits to space, empowerment and available time. These subjectivities were experienced in varying degree by all patients in our study. Individual responses to these experiences were complex and variable. The experiences are best understood under the rubric of a category we call “liminality”. We believe that all cancer patients enter and experience liminality as a process which begins with the first manifestations of their malignancy. An initial acute phase of liminality is marked by disorientation, a sense of loss and of loss of control, and a sense of uncertainty. An adaptive, enduring phase of suspended liminality supervenes, in which each patient constructs and reconstructs meaning for their experience by means of narrative. This phase persists, probably for the rest of the cancer patient’s life. The experience of liminality is firmly grounded in the changing and experiencing body that houses both the disease and the self. Insights into the nature of the experience can be gained from the Existentialist philosophers and from the history of attitudes to death. Understanding liminality helps us to understand what it is that patients with cancer seek from the system to which they turn for help. Its explication should therefore be important for those who provide health care, those who educate health care workers and those concerned to study and use outcomes as administrative and policy making instruments. (shrink)

BackgroundParents affected by cancer are confronted with challenges such as communicating with their children about the disease and dealing with changes in their parental role. Providing appropriate information could support affected parents and their children. Still, high-quality and information booklets are rare. Therefore, we developed an information booklet for affected families. The study aims are: investigating the acceptability and usability of the information booklet, determining parental information needs, and collating suggestions for implementation. Finally, we adapted the booklet according to the (...) findings.MethodsWe interviewed five experts in psychosocial care of parental cancer and nine affected parents using a semi-structured interview guideline. Participants received the developed booklet after giving the consent to participate. Interviews on acceptability and usability of the booklet and information needs were conducted about 1 week after receiving the booklet. The interviews were analyzed using structuring content analysis.Results Experts and parents reported that the information booklet addresses the experiences of affected families and that the content combination makes it useful in an unprecedented way indicating both acceptance and usability. Following dimensions were identified as information needs: communication, support offers, children’s disease understanding and needs, organization of family life, competence in parenting, and sources of additional information material. The booklet should be handed out personally by, e.g., healthcare professionals and might be accompanied by a personal counseling. Minor adaptations on language and content were conducted based on the findings.ConclusionIndicated acceptance and usability of the developed information booklet for parents with cancer suggest a low-threshold, basic support for affected families and health professionals. The diverse parental information needs are covered. The long-term effects of the booklet, e.g., on the use of psychosocial support offers, parental self-efficacy and psychological distress will be quantitatively investigated. (shrink)

IntroductionThe present study aims at analysing how social support received and provided by parents of children, adolescents and young adults diagnosed with cancer, as well as their sociodemographic and clinical variables, affect those parents’ stress levels and life and family satisfaction.Materials and MethodsA total of 112 parents of children and AYAs who had been diagnosed with cancer and who received treatment in Malaga participated in the study. In the study, participated all parents who voluntarily agreed to fulfil the questionnaire. The (...) main inclusion criterion was that their child had cancer. Instruments used were Questionnaire on the Frequency of and Satisfaction with Social Support, Paediatric Inventory for Parents, Life Satisfaction Scale and Family Satisfaction Scale.ResultsIn the mean difference analyses, male parents showed 3.38 in social support received and female parents showed M = 3.08. Conversely, in social support provided, female parents showed 3.22 and male parents showed M = 3.55. Significant differences were also found in family satisfaction, where female parents feel more satisfied than male parents. Parents of children aged between 0 and 14 years feel more stress than those parents of children aged 15–21. The correlation analysis shows that there is a negative and significant relation between stress levels experienced by parents when facing different situations related to the child’s disease and both types of support, received r = −0.411, p < 0.001 and provided r = −0.282, p < 0.01. There is also a positive and significant relation between life satisfaction and social support received r = 0.292, p < 0.01, and social support provided r = 0.409, p < 0.001. There is a positive and significant relation between family satisfaction and social support received r = 0.330, p < 0.01, in the same way as with social support provided r = 0.222, p < 0.05. The regression analysis related to stress levels of parents indicates that social support received predicts levels of stress significantly p < 0.001, with the variable of number of children being the one that showed to be significant p < 0.05. Social support provided showed the most significant results p = 0.001, meaning that social support provided increased life satisfaction. Social support received explains family satisfaction, as it increases the family satisfaction of parents of children with cancer.DiscussionAnalysing social support received and provided, as well as sociodemographic and clinical variables, allowed us to broaden the knowledge on the effect social support has on stress levels, life satisfaction and family satisfaction in parents of children and AYAs diagnosed with cancer. This may have relevant practical implications for the design of interventions that would improve parents’ lives. (shrink)

Introduction: In 2020, according to the Global Cancer Observatory, nearly 10 million people died of cancer. Amongst all cancers, breast cancer had the highest number of new cases and lung cancer had the highest number of deaths. Even though the literatures suggest a possible connection between psychological factors and cancer risk, their association throughout studies remains inconclusive. The present systematic review studied the connection between psychological factors and the risk of breast and lung cancer, prior to a cancer diagnosis. The (...) psychological factors of trauma, grief, and depression were studied.Methods: The current systematic review was carried out across multiple databases in two phases, an initial exploratory research in June 2020, refined with a second electronic research in December 2020. The inclusion criteria included studies describing the association between trauma, posttraumatic stress disorder, grief, and depression with breast and lung cancer risk. The psychological data collection must have been carried out prior to a confirmed breast or lung cancer diagnosis, and accessed through self-report measures, questionnaires, clinical interviews, or clinical diagnoses. Study reports had to contain information about the incidence of cancer and effect size. The exclusion criteria were studies in which psychological factors were collected after cancer diagnosis.Results and Conclusion: A total of 26 studies were included. Although non-consensual, the findings from the present systematic review suggest that, in addition to the known risk factors, psychological factors may play an important role in the etiology of both breast and lung cancer. To include psychological factors as a variable that affects cancer development may be fundamental to opening new avenues for prevention and intervention.Systematic Review Registration: [www.ClinicalTrials.gov], identifier [CRD42020209161]. (shrink)

Theories of embodied cognition hypothesize interdependencies between psychological well-being and physical posture. The purpose of this study was to assess the feasibility of objectively measuring posture, and to explore the relationship between posture and affect and other patient centered outcomes in breast cancer survivors with persistent postsurgical pain over a 12-week course of therapeutic Qigong mind-body training. Twenty-one BCS with PPSP attended group Qigong training. Clinical outcomes were pain, fatigue, self-esteem, anxiety, depression, stress and exercise self-efficacy. Posture outcomes were vertical (...) spine and vertical head angles in the sagittal plane, measured with a 3D motion capture system in three conditions: eyes open, eyes open relaxed and eyes closed. Assessments were made before and after the Qigong training. The association between categorical variables was measured by Cramer’s V. In the EO condition, most participants who improved in fatigue and anxiety scales also had better vertical head values. For the EOR condition, a moderate correlation was observed between changes in vertical head angle and changes in fatigue scale. In the EC condition, most of the participants who improved in measures of fatigue also improved vertical head angle. Additionally, pain severity decreased while vertical spine angle improved. These preliminary findings support that emotion and other patient centered outcomes should be considered within an embodied framework, and that Qigong may be a promising intervention for addressing biopsychosocially complex interventions such as PPSP in BCSs. (shrink)

Objective:Prior research examining sexual and intimacy concerns among metastatic breast cancer patients and their intimate partners is limited. In this qualitative study, we explored MBC patients’ and partners’ experiences of sexual and intimacy-related changes and concerns, coping efforts, and information needs and intervention preferences, with a focus on identifying how the context of MBC shapes these experiences.Methods:We conducted 3 focus groups with partnered patients with MBC [N = 12; M age = 50.2; 92% White; 8% Black] and 6 interviews with (...) intimate partners [M age = 47.3; 83% White; 17% Black]. Participants were recruited through the Fox Chase Cancer Center Tumor Registry and the Cancer Support Community. Qualitative data were analyzed using the Framework Method and Dedoose software.Results:Qualitative analyses revealed several key themes reflecting ways in which MBC shapes experiences of sex/intimacy: the heavy disease/treatment burden leads to significant, long-term sexual concerns and consequent heightened emotional distress for both patients and partners ; viewing the relationship as having “an expiration date” influences patients’ and partners’ concerns related to sex/intimacy and complicates coping efforts; and information needs extend beyond managing sexual side effects to include emotional aspects of intimacy and the added strain of the life-limiting nature of the disease on the relationship. The heightened severity of sexual concerns faced by patients with MBC, compounded by the terminal nature of the disease, may place patients and partners at risk for significant adverse emotional and interpersonal consequences.Conclusion:Findings suggest unique ways in which sex and intimate relationships change after a diagnosis of metastatic breast cancer from both patients’ and partners’ perspectives. Consideration of the substantial physical and emotional burden of MBC and the broader context of the relationship and intimacy overall is important when developing a sexuality-focused intervention in this population. Addressing sexual concerns is a critical part of cancer care with important implications for patients’ health and quality of life. (shrink)

IntroductionThe aim of the present study is to carry out a multidimensional analysis on the relation between satisfaction with social support received, resilience and optimism in cancer patients and their quality of life.Materials and MethodsData were gathered through questionnaires fulfilled by 142 cancer patients. Data relate to sociodemographic, health, quality of life, social support, resilience and optimism.ResultsSatisfaction with the sources and types of support, resilience and optimism relates positively with quality of life. Predictive models show that informational support from friends (...) is the variable that most increases patients’ general health, while emotional support from the partner is the one that best improves how patients cope with the disease. In the same line, emotional support from the partner, together with informational support from family are the ones that most contribute to reduce patients’ symptoms. Resilience improves general health and functioning, and reduces symptoms. Patients’ optimism and resilience also reduce symptoms. Gender differences were found, with females showing lower quality of life than males, mainly in how they cope with cancer. Patients in the stage of treatment showed lower quality of life and higher symptoms. Such increase was observed in patients who received hormonotherapy or chemotherapy.DiscussionImportant practical implications can be drawn from results, which could help improve cancer patients’ quality of life through intervention strategies aimed at increasing their resilience, optimism and the social support provided by their closer sources. (shrink)

ContextColon cancer is the 3rd most common cancer in the world. The diagnosis leads the patient and his relatives into a process of mourning for their health and previous life. The literature highlights the impact of the disease on couples. Cancer can either alter or strengthen the relationship. The disease will directly or indirectly affect both partners. Such impact starts with the diagnosis and lasts long after treatments. No study has analyzed both emotional and sexual interactions between partners throughout the (...) illness so far.ObjectiveThis research aims to identify and describe whether congruence within couples tends to improve emotional and sexual adjustment.MethodThirteen couples took part in this research by answering a set of questionnaires investigating, in particular, dyadic coping strategies, marital and sexual satisfaction. Non-parametric analyses were performed on the quantitative data.ResultsEmotional satisfaction is good among the couples in our study. There are important similarities in partners’ emotional adjustment. Patients who are most satisfied with their couple typically have a partner who is also satisfied. This was an expected result based on the literature. Overall, sexual satisfaction is described as average, which is either related to a low frequency of sexual intercourse, or a gap between the ideal and actual frequency of intercourse. In terms of dyadic coping, similarities within couples tend to improve emotional and sexual adjustment. Couples in which communication about stress between the patient and their partner is congruent tend to report good marital satisfaction. We found the same results for delegated coping of both the patient and the partner, and for negative coping of the partner. Sexual adjustment is linked to a similar perception within the couple of a common dyadic coping.ConclusionEmotional and sexual adjustment is largely linked to the quality of the partner’s support. The congruence of couple support strategies has been identified as an important factor in emotional satisfaction. In addition, the more couples implement joint stress management, the better their sexual satisfaction. (shrink)

ObjectiveHormone positive breast cancer patients bear side effects of endocrine therapy and that may be related to depression and anxiety. We sought to find an association between mental health and side effects of endocrine therapy.MethodsA total of 398 patients participated. Sociodemographic, disease profile, and side effects questionnaires were administered. We screened for depressive and anxiety disorders by using the SDS and SAS.ResultsThe prevalence of depression and anxiety in our study were 33.4% and 13.3%, respectively. Depression was linked to education level, (...) night sweats, vaginal dryness, and fatigue ; anxiety was associated with education level, time to diagnosis, osteopenia, loss of hair, and fatigue. A stratified analysis according to age was performed as an exploratory. None of factor-age interactions was statistically significant.ConclusionSide effects of endocrine therapy were significantly associated with anxiety and depression. Side effects deserve greater emphasis and clinical interventions are needed to reduce anxiety and depression in breast cancer patients accepting ET. (shrink)

While cancer survivors commonly experience fear and anxiety, a substantial minority experience an enduring and debilitating fear that their cancer will return; a condition commonly referred to as fear of cancer recurrence. Despite recent advances in this area, little is known about FCR among people from Indigenous or other ethnic and racial minority populations. Given the high prevalence and poor outcomes of cancer among people from these populations, a robust understanding of FCR among people from these groups is critical. The (...) current review identified and aggregated existing literature on FCR amongst adult cancer survivors from Indigenous and minority populations. The protocol of this review was registered with PROSPERO in July 2020. A systematic search of bibliographic databases was conducted for relevant articles published from 1997 to November 2019. Data from eligible articles were extracted and appraised for quality by two independent reviewers. Nineteen articles from four countries met the inclusion criteria, including 14 quantitative, 4 qualitative and 1 mixed-methods study. Only one article reported on an Indigenous population. Few studies reported on FCR prevalence or severity. While the variation in tools used to measure FCR hindered a robust estimate of severity, results suggested some differences in FCR severity between minority and dominant populations, although these may have been due to study metholodological differences. Few factors were reported as being associated with FCR in minorities across multiple studies. The qualitative synthesis found five themes associated with the lived experience of FCR: variations in the lived experience of FCR; spirituality and worldview impacting on FCR; the importance of staying positive; complexities around support; and increasing cancer knowledge. The findings of this review highlight differences in FCR across cultures and contexts, which reinforces the need for culturally-specific approaches to this condition. The dearth of research in this area is of concern given the significant burden of cancer in these populations. A deeper understanding of this condition among Indigenous and minority populations is critical to developing and delivering appropriate and effective psychosocial care for cancer survivors from these groups. Systematic Review Registration: identifier [CRD42020161655]. (shrink)

The oncological disease experience is counted as a wound in the body and mind attributable to a traumatic experience that fragments and disorients the person’s biography. The neoplasia leaves marks and scars in both somatic and existential level. The illness experience suggests to patient to look for meaning that cannot be unheard. The literature associating the concept of liminality in oncological disease to understand the process of meaning making. The definition of new horizons of meaning, generated by crossing the limen, (...) opens up a new self-awareness and worldview. The autopoietic dimension present in oncological disease reveals new scenarios of generativity and existential planning in the direction of self-realization in the cipher of the possible. The contribution presents the story of Anastasia, a 41-years-old nurse. A few months after her new marriage and close to a professional promotion, she receives the diagnosis of cholangiocarcinoma: a very aggressive, low-incidence, neoplasia, without specific therapeutic lines and with a negative prognosis. Anastasia’s words, thoughts and emotions, collected in the course of some testimonies in a university classroom, are analyzed and deciphered within the pedagogical paradigm, refering to the perspective of pedagogical problematicism and phenomenological pedagogy. (shrink)

The coronavirus disease 2019 pandemic has strongly affected oncology patients. Many screening and treatment programs have been postponed or canceled, and such patients also experience fear of increased risk of exposure to the virus. In many cases, locus of control, coping flexibility, and perception of a supportive environment, specifically family resilience, can allow for positive emotional outcomes for individuals managing complex health conditions like cancer. This study aims to determine if family resilience, coping flexibility, and locus of control can mitigate (...) the negative affect caused by the pandemic and enhance positive affect in breast cancer patients. One hundred and fifty-four female patients with breast cancer completed the Walsh’s Family Resilience Questionnaire, the Perceived Ability to Cope With Trauma Scale, the Positive-Negative Affect Schedule, and the Mini Locus of Control Scale. Family resilience and internality of locus of control contribute significantly to positive affective responses. Family resilience is responsible for mitigating the negative affect perceived during the pandemic and is enhanced by external locus of control. Evidence suggests that clinical psychologists should develop and propose programs to support oncology patients’ family resilience, coping flexibility, and internal locus of control, allowing for decreased stress and improved adaptability for effectively managing cancer treatment during the pandemic. (shrink)

Cancer diagnosed during pregnancy is a rare event. The most common type of malignancy diagnosed in pregnant women is breast cancer, whose incidence is expected to raise in the next future due to delayed childbirth, as well as to the increased occurrence of the disease at young age. Pregnant women diagnosed with breast cancer are exposed to multiple sources of stress, which may lead to poorer obstetric outcomes, such as preterm birth and low birth weight. In addition, pregnancy involves physiological (...) changes in the breasts that may blur the signs of cancer, with delayed diagnosis and poor prognosis. However, the lived experience of these women was investigated in very few studies. Given this scenario, we conducted this qualitative study to describe and understand women’s subjective experience of being diagnosed with breast cancer during pregnancy. The study was conducted following the principles of Interpretative Phenomenological Analysis. Participants were five women with breast cancer diagnosed during pregnancy, purposefully recruited at a public hospital during medical visits and interviewed at treatment initiation. The interview transcripts were analyzed using thematic analysis. The textual analysis led to the identification of three main themes related to: the emotional storm experienced after cancer diagnosis, and the importance of receiving appropriate information and being focused on treatment decisions; physical changes and comparisons with healthy women, associated with feelings of sadness and inadequacy; being positive, feeling free to disclose all kinds of emotions, religion and spirituality as sources of strength. The paradoxical coexistence of pregnancy and cancer represents a stressful experience for women and their loved ones. Adopting a systemic perspective may be important to understand the effects of such a complex condition, also considering its impact on healthcare workers. (shrink)

Background: The number of cancer patients is constantly growing. Both WHO and IARC report that this number may reach up to 24 million new diagnosed cases in the next two decades. The proposed treatment and especially the diagnosis can have a significant impact on an individual's approach to the disease, as well as on the patient's quality of life.Objectives: The study aimed to assess the quality of life, feelings, and fear of cancer-treating oncological patients, before and during the COVID-19 pandemic.Material (...) and Methods: The study used the standardized WHOQOL quality of life questionnaire in a shortened version, the COVID-19 fear scale, and the AIS disease acceptance scale. The questionnaire survey was conducted among patients of cancer clinics. The study was conducted in two stages–before the COVID-19 pandemic and during the COVID-19 pandemic. Data from 450 correctly completed questionnaires were analyzed statistically. The obtained data were statistically processed using the Kruskal-Wallis and Mann-Whitney U test.Results: Among the surveyed patients of the cancer clinic, the quality of life during the COVID-19 pandemic decreased by 2%, compared to the period before the pandemic. The frequency of negative feelings associated with cancer increased during the COVID-19 pandemic–by 11% more men, and 4.4% of women determined the frequency of negative feelings to be 2–3 times a week. The level of fear associated with COVID-19 was moderate, with women having a higher level of fear.Conclusion: The development of the epidemic is very important in terms of public health. COVID-19 should be considered as one of the factors that bring about sudden changes in the mental health of the population, which may result from the dynamic development of this disease, dramatic media coverage, and own experiences. It has been shown that the sudden appearance of such a large stressor causes a decrease in patients' quality of life and an increase in negative feelings associated with chronic disease. (shrink)

Previous studies examining EEG and LORETA in patients with chronic pain discovered an overactivation of high theta and low beta power in central regions. MEG studies with healthy subjects correlating evoked nociception ratings and source localization described delta and gamma changes according to two music interventions. Using similar music conditions with chronic pain patients, we examined EEG in response to two different music interventions for pain. To study this process in-depth we conducted a mixed-methods case study approach, based on three (...) clinical cases. Effectiveness of personalized music therapy improvisations versus preferred music on chronic pain was examined with 16 participants. Three patients were randomly selected for follow-up EEG sessions three months post-intervention, where they listened to recordings of the music from the interventions provided during the research. To test the difference of EM versus preferred music, recordings were presented in a block design: silence, their own composed EM, preferred music, and a non-participant’s EM as a control. Participants rated their pain before and after the EEG on a 1–10 scale. We conducted a detailed single case analysis to compare all conditions, as well as a group comparison of entrainment-healing condition versus preferred music condition. Power spectrum and according LORETA distributions focused on expected changes in delta, theta, beta, and gamma frequencies, particularly in sensory-motor and central regions. Intentional moment-by-moment attention on the sounds/music rather than on pain and decreased awareness of pain was experienced from one participant. Corresponding EEG analysis showed accompanying power changes in sensory-motor regions and LORETA projection pointed to insula-related changes during entrainment-pain music. LORETA also indicated involvement of visual-spatial, motor, and language/music improvisation processing in response to his personalized EM which may reflect active recollection of creating the EM. Group-wide analysis showed common brain responses to personalized entrainment-healing music in theta and low beta range in right pre- and post-central gyrus. We observed somatosensory changes consistent with processing pain during entrainment-healing music that were not seen during preferred music. These results may depict top–down neural processes associated with active coping for pain. (shrink)

This chapter focuses on the dual roleDual role of the physician-researcherPhysician-researcher in clinical trialsClinical trial involving childhood cancerCancer. As the cure rate of childhood cancerCancer has improved from less than 10% in the 1950’s to nearly 80% currently, it is important to note that this is due to dedicated empirical collaborative clinical trialsClinical trial, without which these achievements would not have been possible. However, there are several ethical issues involved in childhood cancerCancer research as the disease is life-threatening. These ethical (...) issues include the tension between the dual roleDual role of being clinician-researcher, recruitment issues, and the translation of clinical research findings into clinical care. Other issues such as proxyProxyconsentConsent and therapeutic misconceptionTherapeutic misconception have been discussed in other chapters. (shrink)

Genetic cancer predisposition testing in the paediatric population poses unique ethical dilemmas. Using the hypothetical example of a teenager with cancer with a high probability of having an underlying cancer predisposition syndrome, we discuss the ethical considerations that affect the decision-making process. Because legally these decisions are made by parents, genetic testing in paediatrics can remove a child’s autonomy to preserve his or her own ‘open future’. However, knowledge of results confirming a predisposition syndrome can potentially be beneficial in modifying (...) treatment and surveillance plans and enabling at-risk family members to obtain cascade testing for themselves. Considering virtue ethics to envision the best characters of the patient, parents and healthcare providers can guide them to the better choice to test or not to test, with the ultimate goal of achieving the best outcome for survival and eudaimonia, human flourishing reliably sought out. There are no data in this work. (shrink)

Prostate cancer is one of the the most common cancers in men. A blood test called prostate-specific antigen has a potential to pick up this cancer very early and is used for screening of this disease. However, screening for prostate cancer is a matter of debate. Level 1 evidence from randomised controlled trials suggests a reduction in cancer-specific mortality from PCa screening. However, there could be an associated impact on quality of life due to a high proportion of overdiagnosis and (...) overtreatment as part of the screening. The US Preventive Services Task Force in 2012 recommended that PSA-based PCa screening should not to be offered at any age. However, considering the current evidence, USPSTF recently revised its recommendation to offer the PSA test to men aged 55–69 years with shared decision-making, in line with earlier guidelines from the American Cancer Society and the American Urological Association. A shared decision making is necessary since the PSA test could potentially harm an individual. However, the literature suggests that clinicians often neglect a discussion on this issue before ordering the test. This narrative discusses the main controversies regarding PCa screening including the PSA threshold for biopsy, the concept of overdiagnosis and overtreatment, the practical difficulties of active surveillance, the current level 1 evidence on the mortality benefit of screening, and the associated pitfalls. It offers a detailed discussion on the ethics involved in the PSA test and highlights the barriers to shared decision-making and possible solutions. (shrink)

PurposeCancer can be a burden on the relationship and even lead to relationship dissolution. Previous studies about the impact of cancer on close relationships almost exclusively involve cancer patients. So far, little is known about the views of spouses. Therefore, this study focuses on partners or ex-partners of cancer patients.MethodsIn this cross-sectional study, N = 265 partners or ex-partners of cancer patients are examined regarding a possible separation, the reasons for separation and the influence of the cancer on the relationship. (...) In addition, predictors of separation and the positive or negative perception of the impact of cancer on the relationship were investigated.ResultsThe separation rate was marginally lower than in the general population in Germany. The most frequent reason for separation was the death of the cancer patient, followed by relationship problems, and the cancer disease itself. Among those who were separated, 57.4% reported that cancer contributed to the separation. On average, the influence of cancer on relationship dissolution is indicated with 82.9%. Also, for those who stayed together, 83.7% reported an impact of the cancer on the relationship, of which 55.9% reported a negative impact. Logistic regressions indicated that higher levels of depression were associated with greater odds of a more negative perception of the influence of cancer on the relationship, whereas a more satisfied relationship tended to be associated with a more positive perception. Those who had no psychological treatment in the past, lower anxiety levels and lower relationship satisfaction had an increased risk of separation. Overall, relationship satisfaction was significantly lower than in the general population in Germany.ConclusionIn particular, psychological factors such as depression and anxiety as well as relationship satisfaction appear to be factors influencing separation and the perception of the influence of cancer on the relationship as positive or negative. Therefore, it seems to be reasonable to consider these aspects in the psychosocial support and also to include the partners in order to achieve a stable and satisfied relationship which has a positive effect on health and psychological well-being. (shrink)

Introduction: Novel coronavirus is having a devastating psychological impact on patients, especially patients with cancer. This work aims to evaluate mood disorders of cancer patients undergoing radiation therapy during COVID-19 in comparison with cancer patients who underwent radiation therapy in 2019.Materials and Methods: We included all the patients undergoing radiation therapy at our department in two-time points and during the COVID-19 outbreak. All the patients were asked to fulfill a validated questionnaire, the Symptom Distress thermometer, and the Beck Depression Inventory (...) v.2. We took into account the COVID-19 outbreak and also sex, age, week of radiation treatment, and disease.Results: We included 458 patients, with a median age of 64 years. STAI-Y1 median score was 40, whereas the median score of SDT was five and BDI-2 median score was 11. STAI-Y1, SDT, and BDI-2 were significantly correlated with the COVID-19 outbreak, sex, week of treatment, and disease.Conclusions: The prevalence of mood disorders in patients undergoing radiation therapy is higher than expected and even higher during the COVID-19 outbreak. These measurements could be useful as a baseline to start medical humanities programs to decrease these scores. (shrink)

ObjectivesDepression and anxiety persist in cancer patients, creating an additional burden during treatment and making it more challenging in terms of management and control. Studies on the prevalence of depression and anxiety among cancer patients in the Middle East are limited and include many limitations such as their small sample sizes and restriction to a specific type of cancer in specific clinical settings. This study aimed to describe the prevalence and risk factors of depression and anxiety among cancer patients in (...) the inpatient and outpatient settings.Materials and MethodsA total of 1,011 patients formed the study sample. Patients’ psychological status was assessed using the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire, and the Generalized Anxiety Disorder 7-item scale. The prevalence rate of depressive and anxious symptomatology was estimated by dividing the number of patients who exceeded the borderline score: 10 or more for each subscale of the HADS scale, 15 or more for the GAD-7 scale, and 15 or more in the PHQ-9 by the total number of the patients. Risk factors were identified using logistic regression.ResultsThe prevalence of depressive and anxious symptomatology among all patients was 23.4% and 19.1–19.9%, respectively. Depressive symptomatology was more prevalent across patients who were hospitalized compared with patients in the outpatient setting. Similarly, anxious symptomatology was more prevalent in the inpatient setting. In the inpatient setting, depressive symptomatology was more prevalent among patients with bladder cancer, while severe anxious symptomatology was more prevalent across patients with lung cancer. In the outpatient setting, depressive and anxious symptomatology was more prevalent among breast and prostate cancer patients, respectively. Despite that, around 42.7% and 24.8% of the patients, respectively, reported that they feel anxious and depressed, and only 15.5% of them were using medications to manage their conditions.ConclusionOur study findings demonstrated a higher prevalence of depressive and anxious symptomatology in the inpatient setting and advanced disease stages. In addition, the underutilization of antidepressant therapy was observed. There is a need to consider mental disorders as part of the treatment protocol for cancer patients. Enhanced clinical monitoring and treatment of depression and anxiety of cancer patients are required. (shrink)

Cancer is typically spoken of as a “complex” disease. But, in what sense are cancers “complex”? Is there one sense, or several? What implications does this complexity have – both for how we study, and how we intervene upon cancers? The aim of this paper is first, to clarify the variety of senses in which cancer is spoken of as "complex" in the scientific literature, and second, to discover what explanatory and predictive roles such features play.

Background: Psychological distress is common among patients with cancer, with severe consequences on their quality of life. Anxiety and depression are the most common clinical presentation of psychological distress in cancer patients, but in some cases cancer may represent a traumatic event resulting in posttraumatic stress disorder. Currently, Eye Movement Desensitization and Reprocessing therapy is considered an evidence-based treatment for PTSD, but recent studies also showed its effectiveness for anxiety and depression. The aim of the present systematic review is to (...) summarize the current literature on the effect of EMDR on cancer-related psychological distress.Methods: A literature search was conducted for peer-reviewed articles about “EMDR” and “cancer patients” in the following electronic databases: PubMed, MEDLINE, Science Direct, Google Scholar, and Cochrane library.Results: Our search identified 7 studies in which EMDR was used with a total of 140 cancer patients. The psychiatric diagnosis was PTSD in 3 studies. Otherwise, the diagnosis concerned the anxious and depressive disorder spectrum. Overall, EMDR treatment schedules used were highly heterogeneous, with a different number of sessions and a different duration of therapy. However, across all studies analyzed EMDR therapy was judged to be adequate in reducing symptoms of psychological distress in this population.Conclusions: According to the results of our analysis, the level of evidence regarding EMDR efficacy in cancer patients is limited by the scarcity of studies and their low methodological quality. Although better quality research is needed, available data suggest that EMDR could be a promising treatment for psychological distress in patients with cancer. (shrink)

Cancer patients are interested in complementary and alternative therapies. Providing complementary therapies to them should be based on the four principles of medical ethics. Ignoring these principles creates many ethical challenges in treating these patients. Shared decision-making between physician and patient is essential for the choice of complementary therapies. The use of complementary medicine that does not have the evidence on effectiveness causes that shared decision-making is not based on precise information, and therefore, patient autonomy is not achieved. When the (...) conventional treatment of a cancer patient is replaced by a treatment for which there is no evidence of effectiveness, the principle of beneficence is violated. Failure to follow the basic standards of care in the provision of complementary medicine causes the patient to face profound side effects, indicating a lack of compliance with the principle of nonmaleficence. In the moral analysis of two patients’ treatment, we encounter violations of the principles of medical ethics. The traditional doctor must fully observe the principles of medical ethics in caring for their patients. The need for this is especially significant in patients with complex and severe disease. (shrink)

Introduction. The paper aims to establish whether cancer discourse can alter when being communicated via social networks. We supposed that every platform has intrinsic characteristics which might affect the way certain topics are being delivered. Because there has been much criticism from the cancer community about the media representation, we decided to observe what might be called an alternative discourse of cancer of social networks. Therefore, we chose to review Instagram accounts of two cancer influencers, who aspire to revise existing (...) stereotypes about people with an incurable disease.Methodology and sources. The chosen methodology includes the statistical concordance analysis, Metaphorical Identification Procedure, structural semantic and syntactic studies of two narratives organized as a minicorpus. The combined approach was employed to reveal lexical markers of both cancer discourse and Instagram narratives in the narratives of two Insta influencers Nicky Newman and Laura Hughes.Results and discussion. The results of the study suggest that Instagram narratives of cancer patients differ from other texts about cancer. Bloggers strive to maintain constant simultaneous communication with a large number of people; therefore, their texts are designed to be entertaining, involving and diverse in subject matter. When narrating about their life with the cancer diagnosis, bloggers broadcast a positive media image of a happygo-lucky person. In the narratives chosen for this study, there is hardly an example of the CANCER-WAR metaphor. The main ways of conceptualizing cancer are the CANCERCONSPIRACY, CANCER-JOURNEY, CANCER-COHABITANT metaphors.Conclusion. Quantitative analysis of the English language corpus aimed at identifying key words and concordances of the lexeme ”cancer”, does not help fully define the cancer discourse. It is necessary to further research into the obtained data. Consequently, it is necessary to take into account the genre of ”cancer” narratives. (shrink)

Religious coping and spiritual struggles were qualitatively analyzed in 15 semi-structured interviews with Norwegian Hodgkin’s disease survivors. We asked, How is religious coping expressed in 15 Norwegian Hodgkin’s disease survivors? The analyses were theory-driven, using religious coping and spiritual struggles theories as explorative tools. Especially we focused on coping processes, coping dynamics, coping styles, and coping activities. The analyses show that religiousness functioned as a positive factor in coping with cancer in 14 of the 15 participants, equally distributed as conservational (...) and transformational coping. The combination of the belief in a good, present God, eventually positive divine power, accessible through prayer, and religious support from people around the participants, were the most prominent activities in the religious coping processes. The religious coping had a character of being collaborative for almost all of the participants. Many participants had severe spiritual struggles. For many of the participants, it was difficult not only to be sick, but also to be a survivor. Theories on religious coping and spiritual struggles were useful and adaptable to a Norwegian sample regarding the main dynamics in the religious coping and spiritual struggles processes. The analyses detected a few different religious coping activities in this Norwegian sample compared to those identified in American samples, with the importance of meeting God in nature as the most significant difference. (shrink)

ABSTRACT Breast cancer affects well-being and life quality. Despite being labeled as a woman’s disease, the incidence of breast cancer in men is increasing. Men with breast cancer are diagnosed at later stages and experience stigmatization within the health care system. As such, they are prone to gender-based inequalities in health care. This paper examines epistemic injustice in health care professionals and male breast cancer patients’ encounters through analysis of research on the experiences of male breast cancer patients. Research indicates (...) that care professionals often do not seriously consider the complaints of men with breast cancer and do not accurately interpret their symptoms. (shrink)

In this paper, we developed an Artificial Neural Network (ANN) for detect the absence or presence of lung cancer in human body. Symptoms were used to diagnose the lung cancer, these symptoms such as Yellow fingers, Anxiety, Chronic Disease, Fatigue, Allergy, Wheezing, Coughing, Shortness of Breath, Swallowing Difficulty and Chest pain. They were used and other information about the person as input variables for our ANN. Our ANN established, trained, and validated using data set, which its title is “survey lung (...) cancer”. Model evaluation showed that the ANN model is able to detect the absence or presence of lung cancer with 96.67 % accuracy. -/- . (shrink)

El objetivo de este artículo es analizar el uso del término cáncer desde una perspectiva social y su representación en la prensa española a comienzos del siglo xx, en los periódicos La Vanguardia y ABC. A partir de la hemeroteca digital de ambos medios se seleccionaron todas y cada una de las veces que se pudo identificar el término «cáncer» y su aplicación metafórica desde una perspectiva de problemática social, procediéndose a la descripción de los rasgos significativos y al análisis (...) del discurso. Encontramos un uso de la palabra cáncer como metáfora social a lo largo del periodo estudiado, siendo común extender la metáfora del cuerpo enfermo a situaciones de orden político o social. El cáncer es una enfermedad con un gran impacto en nuestra sociedad, cuya utilización metafórica es descriptiva y expresa el deseo del cambio, pero su empleo puede comportar la estigmatización de los enfermos afectados por esta patología. Palabras clave: cáncer, metáfora, sociedad, prensa, España.The objective of this article is to analyze the use of the term cancer from a social perspective and its representation in the Spanish press at the beginning of the 20th Century, in the newspapers La Vanguardia and ABC. From the digital mass media library, each and every one of the times that the term «cancer» and its metaphorical application could be identified from a perspective of the social problem was selected, proceeding to the description of the essential features and the discourse analysis. A use of the word cancer as a social metaphor was found throughout the studied period, being common to extend the metaphor of the sick body in situations of political or social order. Cancer is a disease with a great impact on our society, metaphorical use is descriptive and expresses the desire for change, but its use may involve the stigmatization of patients affected by this pathology. Key words: cancer, metaphor, society, press, Spain. (shrink)

The standard process for starting anamnesis in the follow-up cancer consultation is for the doctor to ask a ‘How are you?’ question. This question gives the patient the opportunity to give a gloss of their general condition and offer the first topic of discussion. Findings in earlier analyses of US and UK data in a broad array of medical contexts show that the question is ambiguous and hence patients may interpret it as social rather than medical. A discourse analysis of (...) a corpus of 28 video-taped consultations shows that the ‘How are you?’ question in the context of Dutch follow-up cancer consultations is consistently interpreted by both doctor and patients as a holistic medical question, making relevant a – frequently complex and nuanced – medically oriented response. We suggest that this difference may have to do with the interactional norms of hospital visits in the Netherlands, and with the specific contextual parameters of return visits, more specifically with follow-up cancer consultations, which affect the way the HAY question is placed, intended and understood. (shrink)

This article explores the ways in which predictive information technologies are used in the field of personalized medicine and the relations between this use and how patients and disease are perceived. This is examined in a qualitative case study of a personalized cancer clinical trial, where oncologists made clinical decisions for each patient based on drug matchings and efficacy predictions produced by bioinformatic technologies and algorithms. I focus on personalized practice itself, as a postgenomic phenomenon, rather than on epistemic, ethical (...) and institutional critiques. Personalized medicine aims to process molecular, clinical, environmental and social data into individually tailored decisions. In this case, however, the engagement of clinicians with data and digital artefacts that processed multiple information sources resulted in treatment choices that were paradoxically both immutable and uncertain. In contrast to the situatedness of the body in postgenomics, this practice subverted the personalized medical approach while decontextualizing both cancer and patients. (shrink)

This essay argues that the emotional rhetoric of today’s breast cancer discourse—with its emphasis on stoicism and ‘positive thinking’ in the cancer patient, and its use of sympathetic feeling to encourage charitable giving—has its roots in the long 18th century. While cancer had long been connected with the emotions, 18th-century literature saw it associated with both ‘positive’ and ‘negative’ feelings, and metaphors describing jealousy, love and other sentiments as ‘like a cancer’ were used to highlight the danger of allowing feelings—even (...) benevolent or pleasurable feelings—to flourish unchecked. As the century wore on, breast cancer in particular became an important literary device for exploring the dangers of feeling in women, with writers of both moralising treatises and sentimental novels connecting the growth or development of cancer with the indulgence of feeling, and portraying emotional self-control as the only possible form of resistance against the disease. If, as Barbara Ehrenreich suggests, today’s discourse of ‘positive thinking’ has been mobilised to make patients with breast cancer more accepting of their diagnosis and more cooperative with punitive treatment regimens, then 18th-century fictional exhortations to stay cheerful served similarly conservative political and economic purposes, encouraging continued female submission to male prerogatives inside and outside the household. (shrink)

Cancer is a chronic disease that causes the most deaths in the world, being a public health problem nowadays. Even though breast cancer affects the daily lives of patients, many women become resilient after the disease, decreasing the impact of the diagnosis. Based on a positive psychology approach, the concept of co-vitality arises understood as a set of socio-emotional competencies that enhance psychological adaptation. In this sense, emotional intelligence is one of the main protective factors associated with resilience. However, it (...) is not always as beneficial as it seems, and can lead to collateral effects on psychological adjustment. Given this controversy, this study aims to find the specific processes through which the dimensions of Perceived Emotional Intelligence can act as a risk or protective factor in the development of resilience. The total sample was 167 women, 46.7% were breast cancer survivors, and 53.3% were healthy controls. The selection of women with breast cancer carries out randomly, recruited through the Oncology Units. The sample completed measures of resilience and PEI, through Resilience Scale and TMMS-24. The results showed that breast cancer survivors showed higher age and greater levels of resilience and mood repair than healthy women. The mediation analysis revealed that breast cancer survival and PEI predicted 28% of the variance of resilience. The direct effects showed that emotional clarity and mood repair increased resilience levels. Although breast cancer did not predict resilience directly, it does through mood repair by an indirect process. Besides, the analysis showed that emotional attention played a role in vulnerability, decreasing mood repair, and resilience. These research support theories that point to a possible dark side of PEI, thus, a great level of emotional attention makes dark the positive effect of mood repair and personal growth if a clear perception of emotions does not complement it. These results provide empirical support concerning the need to work complementary each dimension of PEI to avoid unwanted effects on intrapersonal adjustment. (shrink)

Breast cancer is a disease that is difficult to face and that often hinders body acceptance. Body changes due to surgery can be very emotionally challenging for those who experience them. The aim of this study is to explore the differences on body image and psychological adjustment on women with breast cancer with high and low alexithymia according to the type of surgery. In this cross-sectional study, 119 women diagnosed with breast cancer were evaluated with different self-report questionnaires. Afterward, patients (...) were divided into two groups to analyze dependent variables according to the type of surgery. The results of the General Linear Model suggest that when patients show high alexithymia combined with having undergone a radical mastectomy, they show higher levels of Hopelessness. Furthermore, in patients with high alexithymia, higher scores of maladaptive coping styles and greater distortion of body image were found. Alexithymia seems to play an important role in the way in which women cope with their disease, especially in those with radical mastectomy. (shrink)

The study was aimed at scrutinizing the effects of the Public Service Awareness Messages about breast cancer detection among women in terms of developing precautionary measures for the life-threatening disease in order to fight against it before time. Breast Cancer is the most common cancer among the women around the world and especially in Pakistan. The study has been carried out with a survey with 300 women of Lahore, Pakistan and found that Public Service Awareness Messages have been significantly perceived (...) by them. PSAMs are important tool for providing information and spreading awareness regarding the disease. The fear appeal of the messages changed the behavior of the viewers for taking precautionary measures. Public Service Awareness Messages regarding healthcare make people conscious about their health and they believe that precautionary measures can prevent the dreadful comings of this disease. (shrink)

Long-term cancer survivorship is an emerging field that focuses on physical late-effects and psychosocial implications for the inflicted. This study wishes to cast light on the underlying ontological aspect of long-term survivorship by philosophically exploring how being in life post cancer is perceived by survivors. Sixteen in-depth interviews with 14 Danish cancer survivors were conducted by the author. Having faced a life-threatening disease but no longer being in imminent danger of dying, survivors still considered death a defining yet dynamic component (...) in their approach to life as a moving toward the end, sparking a sense of vitality in mortality. In order to unfold the interviewees’ renewed existential understanding post cancer, this study employs Martin Heidegger’s ontological analysis of death. In survivorship, my participants can thus be understood as being left with the perpetual choice between living in inauthenticity or in authenticity. The difference between the two modes of existence exhibits two diverging ways of relating to death, self, and being-in-the-world. At the same time, the role of death in long-term survivorship reflects back on the magnitude of the initial existential and moral upheaval triggered by the cancer diagnosis. Understanding the role of death in long-term survivorship can positively inform the field of cancer rehabilitation and long-term survivor care. (shrink)

IntroductionThe Managing Cancer and Living Meaningfully therapy for patients with advanced cancer was tested against a supportive psycho-oncological counseling intervention in a randomized controlled trial. We investigated whether CALM was delivered as intended ; whether CALM therapists with less experience in psycho-oncological care show higher adherence scores; and whether potential overlapping treatment elements between CALM and SPI can be identified.MethodsTwo trained and blinded raters assessed on 19 items four subscales of the Treatment Integrity Scale covering treatment domains of CALM. A (...) random sample of 150 audio recordings were rated on a three-point Likert scale with 1 = “adherent to some extent,” 2 = “adherent to a sufficient extent,” 3 = “very adherent.”ResultsAll 19 treatment elements were applied, but in various frequencies. CALM therapists most frequently explored symptoms and/or relationship to health care providers and allowed expression of sadness and anxiety about the progression of disease. The exploration of CALM treatment element SC_1 was most frequently implemented in a satisfactory or excellent manner, whereas the treatment element SMP_4: Therapist promotes acknowledgment that some life goals may no longer be achievable was not implemented in a satisfactory manner. In terms of treatment differentiation, no treatment elements could be identified which were applied significantly more often by CALM therapists than by SPI therapists.ConclusionResults verify the application of CALM treatment domains. However, CALM therapists’ adherence scores indicated manual deviations. Furthermore, raters were not able to significantly distinguish CALM from SPI, implying that overlapping treatment elements were delivered to patients. (shrink)

Cancer is fast becoming an alarming cause of human death. However, it has been reported that if the disease is detected at an early stage, diagnosed, treated appropriately, the patient has better chances of survival long life. Machine learning technique with feature-selection contributes greatly to the detecting of cancer, because an efficient feature-selection method can remove redundant features. In this paper, a Fuzzy Preference-Based Rough Set blended with Support Vector Machine has been applied in order to predict cancer biomarkers for (...) biological and gene expression datasets. Biomarkers are determined by deploying three models of FPRS, namely, Fuzzy Upward Consistency, Fuzzy Downward Consistency, and Fuzzy Global Consistency. The efficiency of the three models with SVM on five datasets is exhibited, and the biomarkers that have been identified from FUC models have been reported. (shrink)

Background: Chronic myeloid leukemia (CML) is a hematopoietic stem cell disease, associated with a reciprocal translocation between chromosomes 9 and chromosome 22, lead to the formation of the BCRABL fusion gene (Philadelphia chromosome). This fusion gene is believed to play golden role in the initial development of CML with constitutive tyrosine kinase activation. Successful use of tyrosine kinase inhibiters (TKIs) play a role in improve survival and increase prevalence of CML, but un fortunately mutations in the BCR-ABL kinase domain may (...) cause, or contribute to increase, resistance to TKIs in CML patients. . Objective: This study was designed to assess the association of five most common BCR-ABL kinase domain mutations (T315I, M351T, E255K, M244V and E255V) with resistance state of CML patients on TKIs in Iraqi Middle Euphrates region. Patients and methods: A retrospective case-control study in which 85 patients with chronic myeloid leukemia in chronic phase (45 patients as cases group and 40 patient as control group) were selected from three hemato-oncology centers in middle Euphrates in Iraq during the period from January 2016 till October 2016 out of a total of 240 CML patients (108 male and 132 female) who were registered during this period in these three centers and all patients on TKI (Imatinib and Nilotinib). Venous blood sampling done for BCRABL kinase domain mutations screening. Results: four patients from cases group (4/45) were carriers of one of five selected ABL kinase domain mutations and no one of control group. T315I mutation was detected in 3/45 (6.6 %) of resistant patients, with a significant risk association to develop resistance to TKI therapy (odd ratio and C. I.) (6.67, 0.3340 - 133.2255). E255V was detected in 1/45 (2.2 %) and also had significant risk association to develop resistance to TKIs (odd ratio, C.I.) (2.73, 0.1081 -68.9424). No one of these mutations had significance correlation with demographic or hematological features. M351T, E255K and M244V were not detected in any one of our study groups CML patients. Conclusions: T315I and E255V among five ABL kinas domain mutations were detected in our CML patients with resistance to TKIs. All of them may play a role in development variable degree of resistance to first and second generation TKIs weather primary or secondary.T315I mutation is most common mutation within BCR-ABL domain kinase gene. (shrink)

Explanation is one of the main aims of science. Scientists frequently seek to explain scientific phenomena. This paper addresses the relationship between scientific explanation and science denialism. In it, explanatory wars are introduced. An explanatory war is a situation in which the standard scientific explanation of a phenomenon is systematically denied by a group of people. It is argued that the mechanistic account of scientific explanation is helpful in order to face this kind of science denialism. Mechanistic explanations are resistant (...) to the arguments usually raised by denialists. The relevant role of mechanistic explanations is illustrated by the case of tobacco disease denialism during the second half of twentieth century. (shrink)

BackgroundThe diagnosis and treatment of cancer are associated with psychological distress that often leads to a significant reduction in emotional and physical well-being and quality of life. Early detection of psychological distress is therefore important. This study aims to assess the psychological distress of inpatient cancer patients using routine clinical data. Furthermore, variables and problems most strongly associated with psychological distress should be identified.Materials and MethodsN = 1,869 inpatients were investigated using the National Comprehensive Cancer Network Distress Thermometer and problem (...) checklist to assess distress as well as multiple possible problem areas. Visceral oncological cancer was the most common tumor diagnosis, followed by skin cancer and urological cancer.Results65.9% of the sample experienced high levels of distress. Female sex, stage 4 of disease, and visceral and head and neck cancer emerged as risk factors for high distress. A younger age was significantly correlated with higher distress. The most frequently self-reported problems were fears, worry, and fatigue. Patients with all 3 of these problems had 24 times higher risk [odds ratio = 23.9] for high levels of distress than patients without these problems. Women reported significantly more practical, emotional, and physical problems than men. Younger and middle-aged patients reported increased levels of practical, family, and emotional problems compared with older patients.DiscussionAlmost two-thirds of the sample reported high levels of distress. The most frequently reported problem areas were emotional and physical problems. These results can help to identify patients with high risk for psychological distress and, therefore, be used to optimize psychosocial and psycho-oncological care for patients with cancer. (shrink)