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DUCKWORTH, KATHARINE E., Ph.D

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DUCKWORTH, KATHARINE E., Ph.D DUCKWORTH, KATHARINE E., Ph.D. Quality of Life and Sleep Quality of Long- Term Survivors of Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy. (2010) Directed by Craig S. Cashwell, Ph.D. 275 pp. Advancements in medical technology coupled with a more thorough comprehension of oncologic diseases has resulted in a burgeoning number of aggressive treatment options available to cancer patients and a gradual loosening of the association between cancer and timely death. With the advent of extended life expectancies, however, the need to investigate the human and overall life impact of cancer diseases and treatments has increased dramatically (Langenhoff et al., 2001). This need to examine considerations of quality of life becomes even more essential in the context of high-risk treatments, such as cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CS+HIPEC), an extensive procedure offered to select candidates with peritoneal carcinomatosis from a variety of primary origins (Levine et al., 2007). A biopsychosocial model of research and clinical care (e.g. Wilson & Cleary, 1995) underscores the many levels and interrelationships of clinical, demographic, and psychosocial variables impacting survivors of such an invasive medical procedure, yet a paucity of methodologically sound psychosocial studies with these long-term CS+HIPEC survivors exists. The purpose of this investigation was to enhance our understanding of the multidimensional quality of life (QOL) and sleep quality of survivors who have lived 12 or more months post-CS+HIPEC. Additionally, the contributions of surgical and biological variables to long-term QOL were examined, as were changes in QOL scores over time in a subset of the sample. This descriptive data acquired enriches our knowledge of CS+HIPEC survivors‟ quality of survivorship, informs prospective candidates‟ treatment decision making processes, and enhances the standard of care by serving as a foundation for future psychosocial interventions. QUALITY OF LIFE AND SLEEP QUALITY OF LONG-TERM SURVIVORS OF CYTOREDUCTIVE SURGERY PLUS HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY By Katharine E. Duckworth A Dissertation Submitted to The Faculty of The Graduate School at The University of North Carolina at Greensboro in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy Greensboro 2010 Approved by __________________ Committee Chair APPROVAL PAGE This dissertation has been approved by the following committee of the Faculty of The Graduate School at The University of North Carolina at Greensboro. Committee Chair________________________________________ Dr. Craig S. Cashwell Committee Members________________________________________ Dr. Kelly Wester ________________________________________ Dr. Robert Henson ________________________________________ Nancy Callanan ___________________________ Date of Acceptance by Committee ___________________________ Date of Final Oral Examination ii ACKNOWLEDGEMENTS As I reflect upon the amount of support and guidance that I received throughout the duration of this endeavor, I am overwhelmed with gratitude. The knowledgeable and devoted faculty members who comprised my dissertation committee have served as superb mentors. The copious amounts of insight and encouragement as well as the bountiful pockets of time so generously offered by my chair, Dr. Craig Cashwell, undoubtedly deepened my knowledge base and led me across many a stepping stone. Overflowing with graciousness and compassion, my supervisor and mentor, Dr. Richard McQuellon, has been a superlative instructor in the intricacies of working with those treading through mortal time. The wisdom and clinical experience that I have amassed while under his expansive wings is precious, and his empathic demeanor and ceaseless strivings to enhance the quality of the lives of those confronting cancer forever are imprinted in my heart. The support from the rest of the CPSP team and WFUBMC biostatistician, Greg Russell has been outstanding, and I remain mindful that I am surrounded by wonderful colleagues in my work environment. Likewise, the love and support of my family has had no bounds. I am incredibly fortunate that my parents double as two of the most selfless and extraordinary people I have encountered in my life. No matter the circumstances, I have footing and a compass in this world because of them. Additionally, the many sacrifices my husband and faithful dogs have made in my honor during this time period are plentiful. I am grateful for their generosity of spirit and the love they provided and will treasure the adventures we experienced throughout this journey. Finally, I want to acknowledge the courageous patients I have met in my iii clinical encounters, especially the participants of this study. Their willingness to share so much of themselves in hopes of enriching the lives of others is moving, and I cherish the lessons they have taught me about life, living, and dying well. iv TABLE OF CONTENTS Page LIST OF TABLES ......................................................................................................... viii LIST OF FIGURES ......................................................................................................... xi CHAPTER I. INTRODUCTION ............................................................................................... 1 Quality of Life........................................................................................... 3 A Biopsychosocial Model ......................................................................... 5 CS+HIPEC as a Treatment of Peritoneal Carcinomatosis ........................ 6 Sleep Quality ............................................................................................. 9 Purpose of the Study ............................................................................... 10 Statement of the Problem ........................................................................ 11 Research Questions ................................................................................. 12 Need for the Study .................................................................................. 13 Definition of Terms................................................................................. 19 Brief Overview........................................................................................ 23 II. LITERATURE REVIEW ................................................................................... 24 Introduction ............................................................................................. 24 Prevalence and Incidence Data ............................................................... 25 Prevalence and Incidence of Peritoneal Carcinomatosis .............. 28 Cytoreductive Surgery + Hyperthermic Intraperitoneal Chemotherapy (CS+HIPEC) ......................................................................................... 30 Peritoneal Metastases .................................................................... 30 Rationale for CS+HIPEC .............................................................. 33 Cytoreductive Surgery .................................................................. 36 Intraperitoneal Chemotherapy ...................................................... 38 CS+HIPEC at Wake Forest University Baptist Medical Center ................................................................................ 41 Factors Associated with Success .................................................. 43 Risks and Toxicity ........................................................................ 44 Survivorship in Oncology ....................................................................... 47 Survivorship Research .................................................................. 49 Quality of Life (QOL) as an Outcome Measure ..................................... 51 Challenges in Researching QOL ................................................... 59 v Entry of QOL into Clinical Trials ................................................. 60 QOL of Patients Receiving CS+HIPEC ....................................... 62 Acute QOL .......................................................................... 64 Long-term QOL .................................................................. 70 The QOL of subgroups ....................................................... 72 Case study ........................................................................... 73 Sleep Quality ........................................................................................... 76 The Body During Sleep ................................................................ 80 Effects of sleep on the body ................................................ 86 Effects of the body on sleep ................................................ 88 Sleep deprivation ...................................................... 94 Sleep Quality of Cancer Survivors ............................................... 97 Sleep quality of CS+HIPEC recipients ............................. 103 The Wilson and Cleary Model .............................................................. 105 Limitations of Research on QOL in Survivors of CS+HIPEC ............. 117 Conclusion ............................................................................................ 123 III. METHODOLOGY ........................................................................................... 125 Research Questions and Hypotheses ...................................................
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