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Background Family physicians (FPS) play a role in aspects of personalized medicine in cancer, including assessment of increased risk because of family history. Little is known about the potential role of FPS in supporting cancer patients who undergo tumour gene expression profile (GEP) testing. Methods We conducted a mixed-methods study with qualitative and quantitative components. Qualitative data from focus groups and interviews with FPS and cancer specialists about the role of FPS in breast cancer GEP testing were obtained during studies conducted within the pan-Canadian canimpact research program. We determined the number of visits by breast cancer patients to a FP between the first medical oncology visit and the start of chemotherapy, a period when patients might be considering results of GEP testing. Results The FPS and cancer specialists felt that ordering GEP tests and explaining the results was the role of the oncologist. A new FP role was identified relating to the fp-patient relationship: supporting patients in making adjuvant therapy decisions informed by GEP tests by considering the patient's comorbid conditions, social situation, and preferences. Lack of FP knowledge and resources, and challenges in fp-oncologist communication were seen as significant barriers to that role. Between 28% and 38% of patients visited a FP between the first oncology visit and the start of chemotherapy. Conclusions Our findings suggest an emerging role for FPS in supporting patients who are making adjuvant treatment decisions after receiving the results of GEP testing. For success in this new role, education and point-of-care tools, together with more effective communication strategies between FPS and oncologists, are needed. [ABSTRACT FROM AUTHOR]

Purpose The purpose of the present study was to assess whether current cancer follow-up care practices meet the needs of young adult cancer survivors in Canada. Methods This qualitative study used a constructivist grounded theory framework to analyze telephone interviews with cancer survivors from across Canada diagnosed between the ages of 18 and 39 years. The focus was specifically on cancer follow-up care (cFc). Results Interviews were conducted with 55 participants, and 53 interviews were used for the analysis. The overall theme that emerged from the data was the lack of age-specific CFC. Some of the subthemes that emerged were the absence or inadequacy of fertility and infertility treatment options; of psychological services such as family, couples, and sexuality counseling; of social supports such as assistance with entry or re-entry into the education system or workplace; of access to supplemental health insurance; and of survivorship care plans. Based on the data resulting from the interviews, we developed a conceptual model of young-adult CFC incorporating the major themes and subthemes that emerged from our study. The proposed model aims to ensure a more age-appropriate and comprehensive approach to CFC for this group of cancer patients. Conclusions Current Canadian CFC practices are inadequate and do not provide comprehensive care for young adult cancer survivors in Canada. The conceptual model presented here aims to ensure a more comprehensive approach to CFC that meets the needs of this unique cancer population and reduces further possible physical, psychological, or social cancer sequelae. [ABSTRACT FROM AUTHOR]

Purpose: Internationally, family physicians (FP) are not routinely involved in young adult cancer (YAC) care. In this short report, we would like to make a compelling argument for primary care involvement.Methods: Comparative descriptions and literature review.Results: Cancer among YAs is rare and usually not the first thing that comes into the FP's mind. Youth is sometimes mistakenly regarded as a protective factor. Across the countries, almost all YACs are treated in tertiary health care facilities with specialists providing the majority of care. Health care services are covered by the universal health insurance in Denmark, The Netherlands, and Canada but not in the US. Once the YAC has completed acute treatment and follow-up care, they often return to the care of the FPs who may potentially be expected to deal with and take action upon any possible medical, mental health, and psychosocial issues the YA cancer patient may present with. The role of the FP in follow-up care seems to be very limited.Conclusions: YACs in the western world seem to have comparable medical and psychosocial problems. However, the nature of health insurance is such that it impacts differently on the care of this group of cancer patients. Primary care features such as patient-centered, integrated, and comprehensive care over extended periods of time bring the FP into the unique position to provide follow-up for YAC. However, this will require integrating patient's perspectives on their care, professional continuing medical education (CME) initiatives, and an enhanced cooperative effort between those delivering and coordinating cancer care. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study qualitatively assesses the coping strategies of parents who care for a child with cancer. METHOD: Semi-structured interviews were conducted with 28 French and English families who had had a child diagnosed with cancer in the last ten years in two Eastern Canadian provinces. Interviews were transcribed verbatim and coded with a focus on parental coping strategies. RESULTS: Using coping behaviors as described and categorized in the Family Adjustment and Adaptation Response (FAAR) model as a foundation, we found that families used a variety of appraisal-, emotion-, and problem-focused coping. Appraisal-focused coping strategies involved trying to stay 'positive' and 'making positive comparisons.' Problem-focused coping involved behaviors such as being an advocate for the child and seeking information. The majority of parents, however, described using emotion-focused coping behaviors such as trying to avoid 'feeling too much' by hiding difficult emotions and 'escaping' from problems. Others used more positive emotion-focused coping behaviors such as humor, seeking support (informal or formal), or writing diaries. A small group of parents used ineffective coping strategies (alcohol abuse, misdirected anger) that added to family stress. These ineffective strategies have led to a modification of the FAAR model indicating that not all coping behaviors are beneficial to family adjustment in crisis. Overall, many parents felt that their coping strategies were effective; however, a few described having a complete 'coping breakdown'. SIGNIFICANCE OF RESULTS: Parents used a range of coping strategies of which emotion-focused coping was the most prominent. We have enhanced the FAAR model by including additional coping behaviors as well as a description of how some coping behaviors add to the daily stressors for parents dealing with a child's illness. Professional health care providers need to understand the variability of the coping behaviors in order to appropriately assist parents to avoid coping breakdowns. [ABSTRACT FROM AUTHOR]

BACKGROUND: Transgastric cholecystectomy has been shown to be feasible in animal models and human case reports but cumbersome with current available instrumentation. OBJECTIVE: To evaluate a prototype endoscope with 2 working channels with deflectors at the distal tip for performance of transgastric cholecystectomy. DESIGN: Animal study, nonsurvival and survival. ANIMALS: Sixteen male pigs. SETTING: University hospital. INTERVENTION: Transgastric cholecystectomy in 6 nonsurvival pigs by using several different dual-channel endoscopes and 10 survival pigs by using the Olympus dual-channel endoscope with an up-down deflecting channel to the left of the objective lens and a left-right deflecting channel located below the lens. Gallbladder fundic retraction was performed with the aid of one laparoscopic grasper. RESULTS: Cholecystectomy was successful in all survival animals. Median procedure time was 81 minutes (range 31-163 minutes), with a decrease over time. Visualization of all structures was achieved, and clipping of the cystic duct and artery was successful in all cases. Dissection of the gallbladder via the left-right channel was enhanced with retraction via the up-down deflecting channel. Nine of 10 animals survived without complications. One animal died, on postoperative day 2, secondary to peritonitis due to a leak from the gastrotomy site. CONCLUSIONS: This endoscope, with deflecting working channels, allows transgastric cholecystectomy in pigs. The endoscope was stable enough to be used without an overtube and facilitated retraction and dissection. This endoscope is promising for use in transgastric cholecystectomy in human beings. [ABSTRACT FROM AUTHOR]

Introduction: A Canadian research team is conducting a multi-centered, non-interventional national study with the objective of charting the course of arm morbidity after breast cancer surgery. This paper examined the relationship between arm morbidity and leisure and recreational activities of affected women.Methods: Five hundred and forty seven women with stage I-III breast cancer were recruited in four centers across Canada: Surrey (BC); Winnipeg (MB), Montreal (QB) and Fredericton (NB). Participants were enrolled in the study 6-12 months post surgery. Physical examination was used to assess arm and shoulder functioning and questionnaires were used to assess disability, pain, and participation in recreational and leisure activities.Results: At the first clinical assessment (T1), the mean number of months post breast cancer surgery was 8.4. At T1 49% of women reported difficulty with recreational activities that involved "some force or impact" and 29% experienced negative changes to their involvement in leisure activities. A hierarchical multiple regression analysis found that several arm morbidity variables were significant predictors of difficulty with participation in recreational activities. A second hierarchical regression found also that arm morbidity factors were significant predictors of negative changes in leisure activities. Follow-up analyses found that arm morbidity, was most closely related to difficulty with recreational activities requiring free movement of the arm and using force.Conclusion: Many women treated for breast cancer experience arm morbidity. Arm morbidity is related to difficulties with recreational activities and negative changes in leisure activity participation.Implications: Breast cancer survivors should engage in recreational and leisure activities that are compatible with reduced range of motion and pain, and avoid those that exacerbate their arm morbidity. [ABSTRACT FROM AUTHOR]

Twenty family physicians (11 female and 9 male) were interviewed about their experiences in treating depressed patients. Interview transcripts were analyzed thematically with respect to physicians' understanding of women's depression and their treatment strategies with depressed women. Stress arising in the social context of women's lives was perceived as a key precipitant of depression in women, with familyrelated, gender-specific and practical sources of stress as the main contributors. Physicians' treatment strategies had the aims of alleviating depressive symptoms and stress reduction. Implications of the findings for primary health care delivery and community-based interventions with depressed women are discussed. [ABSTRACT FROM AUTHOR]

Objective: Little research has been undertaken regarding the psychological impact of cancer on those stricken during the young adult years. Specifically, research on the coping strategies of young adults with cancer is limited.Method: In this qualitative, Grounded Theory study, we did not set out to examine coping; rather, it emerged as a major phenomenon in the analysis of interview data from 15 young adults with cancer.Results: These young adults used various coping strategies to come to terms with the cancer diagnosis, management of the illness, its treatment, and treatment sequelae. The coping strategies varied considerably from person to person, depended on the stage(s) of the illness, and were rooted in their precancer lives. We were able to discern a pattern of coping strategies used by most participants. The prevailing goal for all participants was to achieve what they called "normalcy." For some, this meant major changes in their lives; for others it meant to "pick up" where they had left off before the cancer diagnosis.Significance Of Results: To aid the understanding of the issues that influence coping, we have developed a model to illustrate the bidirectional nature and the complexities of the coping strategies as they relate to the phases of the disease and the disease treatment. The model also affirms Folkman and Lazarus' coping theory. [ABSTRACT FROM AUTHOR]

The purpose of this study was to find out, from the patient's perspective and using qualitative methodology, how cancer follow-up care is managed in a New Brunswick health region.From focus group discussions with 23 participants 1-year post-cancer diagnosis, 3 prominent themes emerged: fear of recurrence, cancer surveillance/testing and support issues. The fear of recurrence permeates day-to-day life for many patients. To allay these fears, some patients feel a need to be subjected to extensive cancer surveillance. Emotional support, which is important for survivors, is complex.The majority of the participants in this study received cancer follow-up care from specialists. More rural than urban participants received their follow-up care from their family physicians (FPs). Participants had high expectations for follow-up care, regard-less of which type of physician -- specialist or FP -- provided it. If physicians did not provide the level and intensity of care expected by their patients, they were considered uncaring. We advocate a 'transition of care' or 'shared care' protocol between the acute cancer treatment provider and the FP, particularly in rural areas. This would ensure that cancer patients have a clear understanding of where to turn for ongoing surveillance, when they fear cancer recurrence or need support. For optimized cancer follow-up care, physicians must be cognizant that careful emotional and clinical management over an indefinite period of time is required, and they must recognize the individual needs of each patient. [ABSTRACT FROM AUTHOR]

This qualitative research aims to understand, from the standpoint of the family physician, the barriers to treating depression in the office setting. Three primary barriers to treating depression in the family physician's office were identified: systemic, physician-related, and patient-related. The systemic barriers involved the shortage of qualified, publicly-funded counsellors, lack of locally available counselling, and the cost of medication. Physician-related barriers included lack of time and expertise, and inadequacies of the reimbursement system. Patient-related barriers were rooted in the stigma attached to depression and failure to comply with treatment. [ABSTRACT FROM AUTHOR]

Postoperative nutrition is best provided enterally; however, patients often develop intolerance to enteral feedings. Our aim was to prospectively identify abdominal examination and jejunal pressure activity associated with postoperative intolerance of enteral feedings. Twenty-nine patients underwent abdominal operation and needle catheter jejunostomy placement. Elemental tube feedings were started on the day after surgery and advanced to the caloric goal rate over three days. Patients whose feedings were slowed at the attending surgeon's discretion were defined as intolerant. Jejunal manometry and a standardized abdominal exam were performed on postoperative days 1, 3, and 5. Fifteen patients (52%) were intolerant of tube feedings and had decreased jejunal motor activity but more active bowel sounds prior to feedings. After feedings, intolerant patients developed abdominal distension, but other abdominal findings were inconsistent. A marked decrease in phase II of the migrating motility complex (MMC) and the lack of a fed response were present in both groups. The overall jejunal motility present on day 1 following surgery identifies patients that will not tolerate enteral feedings. The abdominal examination, MMC parameters, and motor response to feeding did not predict feeding intolerance. [ABSTRACT FROM AUTHOR]

This study evaluated whether twice daily isotonic perfusion of the bypassed ileum for six weeks would enhance its motor activity and its absorption of fluids, electrolytes, and vitamin B12. The study also determined if patients undergoing perfusion had improved bowel function and decreased hospital stay after ileostomy closure. Following proctocolectomy, ileal pouch-anal canal anastomosis, and diverting loop ileostomy, six patients self-infused an isotonic solution (sucrose and sodium chloride) into the bypassed ileum twice daily, while seven patients did not (controls). Two months following proctocolectomy, and just prior to ileostomy closure, a manometric catheter assembly was placed into the unused distal ileum via the stoma and the distal ileum perfused with an isotonic sodium chloride solution for 3 hr during fasting and 3 hr after a meal. Absorption was measured, single and clustered pressure waves were identified, and a motility index was calculated. Water absorption, motility index, and cluster parameters did not improve in perfused patients compared to controls during fasting or after a meal, nor did perfused patients have improved vitamin B12 absorption. The perfused patients also did no better clinically following ileostomy takedown; the onset of bowel movements, their frequency, time to tolerate a diet, and hospital stay were similar to controls. We conclude that six weeks of twice daily isotonic perfusion did not improve motor activity or water, electrolyte, and vitamin B12 absorption in the bypassed distal ileum after proctocolectomy, ileal pouch-anal canal anastomosis, and loop ileostomy. The perfusion also did not improve bowel function after ileostomy takedown. [ABSTRACT FROM AUTHOR]