Aspectos conceituais teóricos e subjetivos da sobrevivência ao câncer: contribuições para a enfermagem oncológica / Theoretical conceptual and subjective aspects of cancer survivorship: contributions to cancer nursing

O progresso no diagnóstico precoce do câncer e terapias, bem como longevidade e o crescimento populacional, remete no aumento do número de indivíduos sobreviventes do câncer em todos os países, e com ele surge uma nova nomenclatura, a da sobrevivência ao câncer (SC). Este estudo teve como objetivo geral, analisar o conceito da SC na literatura de saúde e entre adoecidos adultos e/ou idosos diagnosticados com a doença. Para alcançar este propósito elaboramos mais quatro objetivos específicos que nos fez organizar a tese em três grandes etapas. A primeira etapa tem como objetivo analisar o conceito da SC apresentado na literatura de saúde, segundo o modelo evolucionário de análise conceitual de Rodgers. Este modelo está disposto em seis etapas, preconizando a análise dos estudos levantados pela análise temática indutiva e interpretados segundo o referencial teórico do conceito de cultura. Como resultado obtivemos os componentes do conceito, que nos auxilia na compreensão do mesmo, são eles: antecedente - ser diagnosticado com câncer; consequente - qualidade de vida dos sobreviventes do câncer (StC) e crescimento pessoal; atributos - processo de liminaridade e cuidado culturalmente congruente; termos substitutos - StC, sobrevivência em longo prazo e aquele que está vivendo após o diagnóstico do câncer, e por último os termos relacionados - sobrevida e reabilitação do câncer. Para a segunda etapa dessa pesquisa o propósito foi apreender os sentidos atribuídos a ser StC entre adoecidos, assim como, descrever os sentidos atribuídos ao conceito da SC entre adoecidos adultos e idosos por meio de sínteses narrativas. Desse modo, construímos um estudo qualitativo, com método narrativo e com referencial da antropologia médica. Realizamos entrevistas semi-estruturadas com 14 participantes diagnosticados com os diferentes tipos de câncer urológico de ambos os sexos, adultos e idosos, com no mínimo três meses pós-tratamento. Após transcrição dos dados, os mesmos foram analisados segundo a análise temática indutiva e duas sínteses narrativas foram elaboradas, a primeira delas é as dualidades da vida após o tratamento: da perda do autocontrole, da incerteza da recorrência da doença ao otimismo e esperança. Nessa síntese, discutimos acerca da experiência do sobrevivente com a doença, a perda de controle que a doença desencadeia e o consequente crescimento pessoal e aquisição do otimismo apesar das circunstâncias vividas. A segunda síntese é intitulada, o que eu sou? Sou um sobrevivente do câncer? Autorreflexão da identidade após o tratamento primário do câncer. Nela apreendemos a reflexão dos participantes sobre como se enxergam e veem a si mesmo e atribuem sentidos a ser ou estar doente, curado, vítima e principalmente StC. Com essas duas sínteses narrativas conseguimos descrever e nos aproximar dos sentidos atribuídos a SC. A terceira etapa foi desenvolvida em três tópicos, o primeiro consiste na comparação dos resultados da etapa um com a etapa dois, complementando com a importância da enfermagem oncológica no cuidado aos StC e uma reflexão sobre as políticas de saúde públicas atuais. Essa tese atualiza o conceito da SC e traz novas perspectivas sobre ele, contribuindo para a enfermagem oncológica

The progress in the early diagnosis of cancer and therapies, as well as the longevity and population growth remit to an increased number of cancer survivors around the world, giving rise to a new term, that of cancer survivorship (CS). The general objective in this study was to analyze the concept of CS in the health literature and among adult and/or elderly patients diagnosed with the disease. To achieve this objective, we elaborated four specific objectives, which made us organize the dissertation in three main phases. The objective of the first phase is to analyze the concept of CS presented in the health literature, according to Rodgers' evolutionary model of concept analysis. This model is arranged in six steps, recommending the analysis of the studies surveyed by means of inductive thematic analysis and their interpretation according to the theoretical framework of the culture concept. As a result, we obtained the components of the concept, which help us understand it. These are: antecedent - being diagnosed with cancer; consequent - quality of life of cancer survivors (StC) and personal growth; attributes - liminality process and culturally congruent care; substitute terms - StC, long-term survival and individuals living after the cancer diagnosis, and finally the related terms - cancer survival and rehabilitation. For the second phase, the purpose was to apprehend the meanings attributed to being StC among the patients, as well as to describe the meanings adult and elderly patients attribute to the CS concept through narrative syntheses. Thus, we built a qualitative study, using the narrative method and the reference framework of medical anthropology. We held semistructured interviews with 14 participants diagnosed with different types of urological cancer, male and female, adult and elderly, with at least three months post-treatment. After transcribing the data, they were analyzed according to inductive thematic analysis and two narrative syntheses were elaborated, the first being the dualities of life after the treatment; from loss of self-control, the uncertainty of the disease relapse to optimism and hope. In this synthesis, we discuss the survivor's experience with the disease, the loss of control the disease triggers and the consequent personal growth and gaining of optimism despite the circumstances experienced. The second synthesis is entitled: Who am I? Am I a cancer survivor? Self-reflection on the identity after the primary cancer treatment. In this synthesis, we apprehend the participants' reflection on how they see themselves and attribute meanings to being ill, cured, victim and mainly StC. These two narrative syntheses allowed us to describe and get closer to the meanings attributed to CS. The third phase was developed in three topics, the first being the comparison between the results of phase one and phase two, complemented with the importance of oncology nursing in care for StC and a reflection on the current public health policies. This dissertation updates the concept of CS and offers new perspectives, contributing to oncology nursing

Aspectos conceituais teóricos e subjetivos da sobrevivência ao câncer: contribuições para a enfermagem oncológica / Theoretical conceptual and subjective aspects of cancer survivorship: contributions to cancer nursing

O progresso no diagnóstico precoce do câncer e terapias, bem como longevidade e o crescimento populacional, remete no aumento do número de indivíduos sobreviventes do câncer em todos os países, e com ele surge uma nova nomenclatura, a da sobrevivência ao câncer (SC). Este estudo teve como objetivo geral, analisar o conceito da SC na literatura de saúde e entre adoecidos adultos e/ou idosos diagnosticados com a doença. Para alcançar este propósito elaboramos mais quatro objetivos específicos que nos fez organizar a tese em três grandes etapas. A primeira etapa tem como objetivo analisar o conceito da SC apresentado na literatura de saúde, segundo o modelo evolucionário de análise conceitual de Rodgers. Este modelo está disposto em seis etapas, preconizando a análise dos estudos levantados pela análise temática indutiva e interpretados segundo o referencial teórico do conceito de cultura. Como resultado obtivemos os componentes do conceito, que nos auxilia na compreensão do mesmo, são eles: antecedente - ser diagnosticado com câncer; consequente - qualidade de vida dos sobreviventes do câncer (StC) e crescimento pessoal; atributos - processo de liminaridade e cuidado culturalmente congruente; termos substitutos - StC, sobrevivência em longo prazo e aquele que está vivendo após o diagnóstico do câncer, e por último os termos relacionados - sobrevida e reabilitação do câncer. Para a segunda etapa dessa pesquisa o propósito foi apreender os sentidos atribuídos a ser StC entre adoecidos, assim como, descrever os sentidos atribuídos ao conceito da SC entre adoecidos adultos e idosos por meio de sínteses narrativas. Desse modo, construímos um estudo qualitativo, com método narrativo e com referencial da antropologia médica. Realizamos entrevistas semi-estruturadas com 14 participantes diagnosticados com os diferentes tipos de câncer urológico de ambos os sexos, adultos e idosos, com no mínimo três meses pós-tratamento. Após transcrição dos dados, os mesmos foram analisados segundo a análise temática indutiva e duas sínteses narrativas foram elaboradas, a primeira delas é as dualidades da vida após o tratamento: da perda do autocontrole, da incerteza da recorrência da doença ao otimismo e esperança. Nessa síntese, discutimos acerca da experiência do sobrevivente com a doença, a perda de controle que a doença desencadeia e o consequente crescimento pessoal e aquisição do otimismo apesar das circunstâncias vividas. A segunda síntese é intitulada, o que eu sou? Sou um sobrevivente do câncer? Autorreflexão da identidade após o tratamento primário do câncer. Nela apreendemos a reflexão dos participantes sobre como se enxergam e veem a si mesmo e atribuem sentidos a ser ou estar doente, curado, vítima e principalmente StC. Com essas duas sínteses narrativas conseguimos descrever e nos aproximar dos sentidos atribuídos a SC. A terceira etapa foi desenvolvida em três tópicos, o primeiro consiste na comparação dos resultados da etapa um com a etapa dois, complementando com a importância da enfermagem oncológica no cuidado aos StC e uma reflexão sobre as políticas de saúde públicas atuais. Essa tese atualiza o conceito da SC e traz novas perspectivas sobre ele, contribuindo para a enfermagem oncológica

The progress in the early diagnosis of cancer and therapies, as well as the longevity and population growth remit to an increased number of cancer survivors around the world, giving rise to a new term, that of cancer survivorship (CS). The general objective in this study was to analyze the concept of CS in the health literature and among adult and/or elderly patients diagnosed with the disease. To achieve this objective, we elaborated four specific objectives, which made us organize the dissertation in three main phases. The objective of the first phase is to analyze the concept of CS presented in the health literature, according to Rodgers' evolutionary model of concept analysis. This model is arranged in six steps, recommending the analysis of the studies surveyed by means of inductive thematic analysis and their interpretation according to the theoretical framework of the culture concept. As a result, we obtained the components of the concept, which help us understand it. These are: antecedent - being diagnosed with cancer; consequent - quality of life of cancer survivors (StC) and personal growth; attributes - liminality process and culturally congruent care; substitute terms - StC, long-term survival and individuals living after the cancer diagnosis, and finally the related terms - cancer survival and rehabilitation. For the second phase, the purpose was to apprehend the meanings attributed to being StC among the patients, as well as to describe the meanings adult and elderly patients attribute to the CS concept through narrative syntheses. Thus, we built a qualitative study, using the narrative method and the reference framework of medical anthropology. We held semistructured interviews with 14 participants diagnosed with different types of urological cancer, male and female, adult and elderly, with at least three months post-treatment. After transcribing the data, they were analyzed according to inductive thematic analysis and two narrative syntheses were elaborated, the first being the dualities of life after the treatment; from loss of self-control, the uncertainty of the disease relapse to optimism and hope. In this synthesis, we discuss the survivor's experience with the disease, the loss of control the disease triggers and the consequent personal growth and gaining of optimism despite the circumstances experienced. The second synthesis is entitled: Who am I? Am I a cancer survivor? Self-reflection on the identity after the primary cancer treatment. In this synthesis, we apprehend the participants' reflection on how they see themselves and attribute meanings to being ill, cured, victim and mainly StC. These two narrative syntheses allowed us to describe and get closer to the meanings attributed to CS. The third phase was developed in three topics, the first being the comparison between the results of phase one and phase two, complemented with the importance of oncology nursing in care for StC and a reflection on the current public health policies. This dissertation updates the concept of CS and offers new perspectives, contributing to oncology nursing

One-Year Experience Managing a Cancer Survivorship Clinic Using a Shared-Care Model for Gastric Cancer Survivors in Korea

Given the rapid growth of the population of cancer survivors, increased attention has been paid to their health problems. Although gastric cancer is one of the most common cancers, empirical evidence of survivorship care is limited. The objectives of this study were to describe the health care status of gastric cancer survivors and to report the experience of using the shared-care model during a one-year experience at the cancer survivorship clinic in Seoul National University Hospital. This is a descriptive, single-center study of 250 long-term gastric cancer survivors who were referred to the survivorship clinic. The status of their health behaviors, comorbid conditions, secondary cancer screenings, and survivorship care status were investigated through questionnaires and examining the medical records. Among the survivors, 7.2% were current smokers, 8.8% were at-risk drinkers, and 32.4% were physically inactive. Among the patients who did not know their bone density status, the majority were in the osteopenic (37.1%) or osteoporotic range (24.1%). Screening among the eligible population within the recommended time intervals were 76.3% for colorectal cancer, but only 13.6% for lung cancer. All of the survivors were provided with counseling and medical management at the survivorship clinic, as appropriate. In conclusion, Long-term gastric cancer survivors have various unmet needs. Shared-care through survivorship clinics can be an effective solution for providing comprehensive care to cancer survivors.

Comparison of Distress and Body Image according to the Stages of Cancer Survivorship in Gynecological Cancer Patients

PURPOSE: This study was to compare distress and body image according to the stages of cancer survivorship in patients with gynecological cancer. METHODS: The subjects were 231 patients who visited for treatment or follow-up care at a university medical center in a city, Korea. These participants were divided into three groups based on the stages of cancer survivorship. The data were collected from November, 18, 2010 to January, 28, 2011 with the use of a structured questionnaire which measured the distress thermometer (DT) and problem list (PL), and body image. RESULTS: Distress scores were not significantly different among three stages of cancer survivorship, but the patients of acute cancer survival experienced the distress of 4.50 point of moderate level (DT>4). The problem list of distress score was significantly higher in the acute cancer survival than long-term cancer survival (F=3.04, p=.048). The score of body image was significantly lower in the acute cancer survival stage than long-term cancer survival (F=3.69, p=.026). CONCLUSION: Gynecological cancer patients in the acute cancer survival among the three stages will to need to provide a nursing intervention to decrease distress and improve body image.