Prostate Cancer Essay: Symptoms, Risk Factors, And Treatment.

1. Describe the systems major organs and normal function (physiology)
2. What is the number of new cases arising in a population at risk?
3. What is the level of existing disease in a population at a given point in time
4. What are the clinical features of the condition?
5. What are the signs and symptoms?
 Symptom: A subjective complaint that is noticed by a person with a disorder
 Sign: A manifestation noticed by an observer
6.  How does the person with the condition present?

Prostate Cancer Definition and Impact

Prostate cancer can be defined as one of most common type of non-cutaneous cancers that is abundantly in men, and it is one of the most abundantly reported cancers (Heidenreich et al., 2014). This is caused by the development of a malignant tumor in the prostate which is also one of the leading cause of mortality in the American men. With respect to the critical definition, prostate cancer can be defined as the adenocarcinoma or carcinoma of the prostate, a prominent malignant disease in men and a leading cause of death among the men.

The organ that prostate cancer affects is the prostate gland. Prostate gland is a crucial part of the male reproductive system.  Prostate glands participate in the most of the semen production of the male body. This walnut sized organ located beneath the bladder surrounds the upper part of the urethra. As a result when there is malignant growth in the prostate gland, the resultant metastasis leads to abnormal cell growth spreading to the surrounding regions such as the bladder and the urethra (Sweeney et al., 2015).

Elaborating the situation further it has to be mentioned that the prostate gland is a significant part of the male reproductive system which helps in production and storage of seminal fluid. The size of a typical prostate is 3 cm in length and about 20 gms in weight. Due to the location of prostate gland, the carcinoma in the prostate cancer often affects the urination, ejaculation, and in rare cases even the defecation. On a more elaborative note, prostate contains a large number of small glands which have been reported to produce 20% of the fluid which constitutes the semen. In case of prostate cancer on the other hand, the cells of these glands are mutated to cancerous cells, and hence, their functionality is affected as well. The prostate is a gland that is associated with producing and controlling the level of a number of hormones as well (Joniau et al., 2015). On a more elaborative note it has to be mentioned the hormones that are produced by prostate includes the androgens, such as testosterone and its different derivatives such as dihydrotesterone, which is produced by the conversion from the testosterone in the prostate itself. Hence, the prostate cancer will also cause considerable troubles with the hormonal balance in the patient as well.

The cancer can also travel through the blood stream and migrate to the blood and lymphatic system of the body affecting these organ systems of the body as well. Along with that. As the blood and the lymph are the connective tissues of the body, the cancer can also reach the bone structure as well as spreading the cancer and divulging into blood cancer and bone cancer (Epstein et al., 2016).

The Prostate Gland and its Significance

Prostate cancer is by far one of the most prevalent types of cancer in Men and countless men all across the world are suffering from this disease looking for treatment interventions. Considering the Australian context, as per the data of 2018, there are approximately 17729 cases reported of prostate cancer among the Australians, which attributes to 23.8% to the ever rising prevalence rate of the disease (Gordon et al., 2017). 

Considering the mortality rate contributed by this disease in the Australian health care, by the data of 2018, there are approximately 3500 deaths caused due to the prostate cancer which is estimated to be 12.7% of deaths caused by the disease in the year of 2018. Along with that, the prevalence rate of the disease in Australia is also alarmingly high. It has to be mentioned that the prevalence of prostate cancer is 93343, and all of the cases have been identified in the last five years. Considering the rate of increase in the incidence rate, in the year of 2014, the age adjusted incidence rate of the disease had been 140 cases per 100000 males (Zargar et al., 2017). 

Considering the prevalence of the prostate cancer further, it has to be mentioned that the impact of this particular disease on a global scale is very high. It has to be mentioned that prostate cancer is easily the second most commonly reported cancer in the world and also is the sixth leading cause of death among the men worldwide. As per the global reports that have been shared prostate cancer accounts for the 307000 deaths occurred all over the globe in the year of 2012, which reflects the alarmingly high rates of Australia as well (Luo et al., 2015). 

Along with that, reflecting similarity with the rates of Australia with respect to the affected population, the 42% of the total men suffering from prostate cancer have attested to be within the age group of 50 (Wong et al., 2016). However, the global data suggests that these population are reported to be seeking out health care support around the age of 60 or above. However, many authors have attested to the fact that there are racial and geographic differences present in the prevalence and incidence of prostate cancer among different populations (Johng et al., 2016).

Symptoms can be defined as the subjective complaint that is identified by the person suffering from a disorder. Similarly, sign can be identified as a manifestation that is recognized by an observer. The most common symptoms of clinical features of the prostate cancer include faulty urine retention, extreme back pain, hematuria. Along with that other series of symptoms which have also been identified among the patients of prostate cancer include trouble in urinating, decreased force in the urine stream, incidence of blood in semen, the incidence of discomfort observed in the pelvic area, incidence of bone pain, and along with that erectile dysfunction. The person with prostate cancer appears extreme in pain and discomfort along with that the patient will also appear extremely tired and fatigued (Zumsteg et al., 2015).

Prevalence of Prostate Cancer

It has to be mentioned that in the early years prostate cancer has no clear sentence.  are the symptoms associated with prostate cancer is have been very subtle and are similar to that of benign prostatic hyperplasia prostate cancer a few decades ago was easily confused with benign prostatic hyperplasia due to this reason.  Exploring the clinical manifestations of prostate cancer can mention that prostate cancer is associated with urinary dysfunction due to the fact that it's around the prostatic urethra.  The changes brought forward by the cancer within the gland directly affect the urinary function and the functionality of the urethra as well.  It has to be mentioned in this context that as the Vas deferens deposits the seminal fluid into the prostatic urethra secretion from the prostate gland itself the semen content is also modified by the cancer (Abeshouse et al., 2015). There is mounting evidence that suggest prostate cancer can also cause different problems with sexual function on performance and lead to clinical manifestation such as difficulty achieving erection or painful ejaculation.  In case the prostate cancer spread to other parts of the body the clinical manifestations also diversify along with the spread of the cancer.  On a more elaborated note, such diversified symptoms include bone pain especially in the vertebrae pelvic or ribs.  along with that tingling leg weakness and urinary incontinence along with it due to very low levels of RBC and also included in the diversified clinical manifestations of prostate cancer that has an fast and spread into other parts of the body (Murtaza et al., 2016). 

Alike the different cancer types,  the exact causes of the prostate cancer is also not known, however, there are a few considerable theories can be discussed. As mentioned by the Mottet et al. (2017), there can be multiple factors associated with the development of the disease including genetic predisposition and exposure to various environmental factors including chemicals or radiation. Any targeted point mutation in the DNA can lead to malignant growth in the cells of the prostate gland which in turn leads to prostate cancer. 

Considering the risk factors of this disease, there are various risk factors that have been identified for this particular disease. First and foremost, family history plays a fundamental role as a decisive factor in generating the disaese in the individual. It has to be mentioned that prostate cancer can be inherited in case there is a history of prostate cancer. A few inherited genes that's have been found to be causing the disease includes RNASEL, formerly known as HPCI, BRCA1 and BRCA2, which have also been linked to breast and ovarian cancer in womenMSH2, MLH1, and other DNA mismatch repair genes

Symptoms and Clinical Features

Age is another considerable risk factor, the age group of 60-70 is the considerable age when prostate cancer is diagnosed. Other considerable risk factors to prostate cancer includes diet, race or ethnicity, and demographics also play considerable as risk factor for prostate cancer. 

Along with that smoking and drinking had been identified as considerable risk factors of acquiring prostate cancer by a variety of different authors. There are a number of studies which have identified cigarette smoking and uncontrolled consumption of alcoholic beverages to be acutely associated with heightened risk of acquiring prostate cancer. In support of this school of thought, there had been many studies which have identified tobacco usage to be a vital provocative element propelling the risk of prostate cancer in middle aged men multiple folds. 

The role of genetics or genetic predisposition is extreme in the development of prostate cancer.  As discussed by Murtaza et al. (2016), genetic background has a strong contribution to enhancing the risk of different characters including prostate cancer by the means of association with race, family, and specific gene variants. Elaborating further on the genetic risk factors authors have mentioned that men who have a first degree relative such as a father or brother with prostate cancer represent twice the risk of developing prostate cancer in the future.  similarly the main population that have to first degree relatives affected have a  risk of developing prostate cancer that is multiplied five folds as compared with men that have no history of prostate cancer in their family. 

Considering race and ethnicity as a very important risk factor of prostate cancer has also been highlighted in many literature studies.  As for example it has been identified that prostate cancer commentary affects black men rather than white or Hispanic when along with that this disease has been found more that he is Impact in Black Men as well. On a contrasting note Hispanic men have one third lower incidence and mortality rates with respect to prostate cancer as compared to non Hispanic men. The mechanism of how the genetic factor involved into the scenario of prostate cancer has been elaborated by the research studies that identified the link between single nucleotide polymorphism (Kweldamet al., 2016).

There are certain studies that have identified link between medication and infection with prostate cancer.  As mentioned by different authors they have been identified from links between prostate cancer and medications along with medical procedures and medical conditions that have defused or accelerated the prostate cancer risk in the vulnerable population.  As discussed by Ost et al. (2016), the use of cholesterol lowering drugs such as statins have been identified to decrease prostate cancer risk. However infection inflammation of the prostate which is called prostatitis as well increases the risk of prostate cancer.  However there have been considerable arguments that recipes with the idea with valid argument that infection can infect help prevent prostate cancer by increasing the flow of blood in the area.  However infection with sexually transmitted diseases suggests the major of Gonorrhea on syphilis can also increase the risk of prostate cancer.  Lastly obesity

Causes and Risk Factors

and excess concentration of testosterone in the body can also enhance the risk for prostate cancer as a result that has been establishment of association between vasectomy on prostate cancer although this particular idea lacks enough literature data to support the claim.   

Progression of prostate cancer is varied. The pace of the progression depends entirely on the different factors associated with the patient. Although, some of the prostate cancer cases are aggressive, the most of the prostate cancer cases are considered to be not as life shortening as other forms of cancer. There is mounting evidence that suggests that the patients diagnosed with prostate cancer can expect a good years of life expectancy ahead of them. Although, sadly diagnosis is the key to the prognosis. In case, the prostate cancer is diagnosed in an early stage, the chances of less life shortening impact is higher. The extensive and advanced treatment Aldo helps in better symptomatic management as well. With the PSA screening policy in place, there is lesser chances of late diagnosis and the rates of late diagnosis of the disease being reported is decreasing as well. Hence, the prognosis of the disaese in optimistic and given an early detection, even recovery is not impossible (Szulkin et al., 2015)

Treatment or interventionThe treatment interventions associated with the disease depends entirely on the stage of the disease when detected. There are various treatment options available for the disease. First and foremost, surgical removal is one of the most abundantly reported treatment intervention used for prostate cancer. Surgical options include Laparoscopic radical prostatectomy, Radiosurgery, Laparoscopic surgery, Prostatectomy, and Radical retropubic prostatectomy (DeSantis det al., 2015).

The very first decision that is needed to be made while managing prostate cancer is whether treatment is required or not.  Especially for the low grades type of prostate cancer that is generally found in elderly man of encroach so very slowly that no treatment is required, although  it depends entirely on the stage of the disease, Gleason score and PSA level,  age, General Health and the personal preferences of the patient as well.  The first treatment option is generally Radiation therapy and in case it says that the Healthcare professionals also take into consideration radical prostatectomy which is very technically challenging surgical procedure.  In case the prostate cancer has turned into more aggressive. State the treatment follow the pattern of radical prostatectomy followed by Radiation therapy including brachytherapy and external beam Radiation therapy, high intensity focused ultrasound, chemotherapy, chemo therapeutic drugs, and cryosurgery (Murtaza et al., 2016). 

Genetic Predisposition and Environmental Factors

The next plausible treatmebt option that is used includes pharmacolohical treatment.  The aid of pharmacological measures such as hormone associated therapy, bone Health enhancement intervention, chemotherapy, hormone, and urinary retention medication is provided to assist the recovery of the patient.

Other more advanced therapeutic interventions used in more advanced cases include Particle therapy, Teletherapy, Brachytherapy, and Radiation therapy.

The aid of supportive care is an acute requirement for optimal recovery oriented care planning for prostate cancer. The example of supportive care taht can be successfully integrated in prostate cancer management includes Palliative care and Monitoring for changes or improvement (Kweldamet al., 2016).

References:

Abeshouse, A., Ahn, J., Akbani, R., Ally, A., Amin, S., Andry, C. D., ... & Auman, J. T. (2015). The molecular taxonomy of primary prostate cancer. Cell, 163(4), 1011-1025.

DeSantis, C. E., Lin, C. C., Mariotto, A. B., Siegel, R. L., Stein, K. D., Kramer, J. L., ... & Jemal, A. (2014). Cancer treatment and survivorship statistics, 2014. CA: a cancer journal for clinicians, 64(4), 252-271.

Epstein, J. I., Zelefsky, M. J., Sjoberg, D. D., Nelson, J. B., Egevad, L., Magi-Galluzzi, C., ... & Eastham, J. A. (2016). A contemporary prostate cancer grading system: a validated alternative to the Gleason score. European urology, 69(3), 428-435.

Gordon, L. G., James, R., Tuffaha, H. W., Lowe, A., & Yaxley, J. (2017). Cost?effectiveness analysis of multiparametric MRI with increased active surveillance for low?risk prostate cancer in Australia. Journal of Magnetic Resonance Imaging, 45(5), 1304-1315.

Heidenreich, A., Bastian, P. J., Bellmunt, J., Bolla, M., Joniau, S., van der Kwast, T., ... & Mottet, N. (2014). EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. European urology, 65(2), 467-479.

Johng, D., Haffner, M. C., Mooney, S. M., Esopi, D. M., Ewing, C. M., Chen, S., & Isaacs, W. B. (2016). Global analyses of HOXB13-regulated transcription reveal a potential link between HOXB13 G84E and prostate cancer risk.

Joniau, S., Briganti, A., Gontero, P., Gandaglia, G., Tosco, L., Fieuws, S., ... & Bader, P.

Abeshouse, A., Ahn, J., Akbani, R., Ally, A., Amin, S., Andry, C. D., ... & Auman, J. T. (2015). The molecular taxonomy of primary prostate cancer. Cell, 163(4), 1011-1025.

DeSantis, C. E., Lin, C. C., Mariotto, A. B., Siegel, R. L., Stein, K. D., Kramer, J. L., ... & Jemal, A. (2014). Cancer treatment and survivorship statistics, 2014. CA: a cancer journal for clinicians, 64(4), 252-271.

Epstein, J. I., Zelefsky, M. J., Sjoberg, D. D., Nelson, J. B., Egevad, L., Magi-Galluzzi, C., ... & Eastham, J. A. (2016). A contemporary prostate cancer grading system: a validated alternative to the Gleason score. European urology, 69(3), 428-435.

Age, Lifestyle, and Ethnicity

Gordon, L. G., James, R., Tuffaha, H. W., Lowe, A., & Yaxley, J. (2017). Cost?effectiveness analysis of multiparametric MRI with increased active surveillance for low?risk prostate cancer in Australia. Journal of Magnetic Resonance Imaging, 45(5), 1304-1315.

Heidenreich, A., Bastian, P. J., Bellmunt, J., Bolla, M., Joniau, S., van der Kwast, T., ... & Mottet, N. (2014). EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. European urology, 65(2), 467-479.

Johng, D., Haffner, M. C., Mooney, S. M., Esopi, D. M., Ewing, C. M., Chen, S., & Isaacs, W. B. (2016). Global analyses of HOXB13-regulated transcription reveal a potential link between HOXB13 G84E and prostate cancer risk.

Joniau, S., Briganti, A., Gontero, P., Gandaglia, G., Tosco, L., Fieuws, S., ... & Bader, P. (2015). Stratification of high-risk prostate cancer into prognostic categories: a European multi-institutional study. European urology, 67(1), 157-164.

Kweldam, C. F., Kümmerlin, I. P., Nieboer, D., Verhoef, E. I., Steyerberg, E. W., Van der Kwast, T. H., ... & van Leenders, G. J. (2016). Disease-specific survival of patients with invasive cribriform and intraductal prostate cancer at diagnostic biopsy. Modern Pathology, 29(6), 630.

Luo, Q., Yu, X. Q., Smith, D. P., & O’Connell, D. L. (2015). A population-based study of progression to metastatic prostate cancer in Australia. Cancer epidemiology, 39(4), 617-622.

Mottet, N., Bellmunt, J., Bolla, M., Briers, E., Cumberbatch, M. G., De Santis, M., ... & Lam, T. B. (2017). EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. European urology, 71(4), 618-629.

Murtaza, M., Salih, A. F., Illzam, E. M., & Sharifa, A. M. (2016). Prostate Cancer: Pathophysiology, Diagnosis, and Prognosis. IOSR Journal of Dental and Medical Sciences, 15, 122-126.

Ost, P., Jereczek-Fossa, B. A., Van As, N., Zilli, T., Muacevic, A., Olivier, K., ... & Brown, L. (2016). Progression-free survival following stereotactic body radiotherapy for oligometastatic prostate cancer treatment-naive recurrence: a multi-institutional analysis. European urology, 69(1), 9-12.

Sweeney, C. J., Chen, Y. H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., ... & Dreicer, R. (2015). Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. New England Journal of Medicine, 373(8), 737-746.

Szulkin, R., Whitington, T., Eklund, M., Aly, M., Eeles, R. A., Easton, D., ... & Giles, G. G. (2015). Prediction of individual genetic risk to prostate cancer using a polygenic score. The Prostate, 75(13), 1467-1474.

Wong, M. C., Goggins, W. B., Wang, H. H., Fung, F. D., Leung, C., Wong, S. Y., ... & Sung, J. J. (2016). Global incidence and mortality for prostate cancer: analysis of temporal patterns and trends in 36 countries. European urology, 70(5), 862-874.

Treatment of Prostate Cancer

Zargar, H., van den Bergh, R., Moon, D., Lawrentschuk, N., Costello, A., & Murphy, D. (2017). The impact of the United States Preventive Services Task Force (USPTSTF) recommendations against prostate?specific antigen (PSA) testing on PSA testing in Australia. BJU international, 119(1), 110-115.

Zumsteg, Z. S., Spratt, D. E., Romesser, P. B., Pei, X., Zhang, Z., Polkinghorn, W., ... & Zelefsky, M. J. (2015). The natural history and predictors of outcome following biochemical relapse in the dose escalation era for prostate cancer patients undergoing definitive external beam radiotherapy. European urology, 67(6), 1009-1016.

Occupational therapy has a strong impact in promoting participation and enhancing the meaningfulness of life for palliative patients by enhancing meaningfulness like activities. Occupational therapist salary take a holistic and client centred approach which fasters empowerment, self efficacy, and hope event with the challenges of living with a terminal disease (Taylor, 2017).  It has been mentioned in this context that occupational therapy with emphasis on palliative or hospice care can be provided in settings such as hospitals, care homes or even in homes of the patient.  There is mounting evidence that suggest occupational therapy is a prime need of patients with palliative or terminal disease.  On a more elaborative note the occupational therapist for occupational therapy practitioners have the patient by using client centred approach so that the exact needs of the client in their occupational role can be identified explode evaluated and then a text with respect to the coping strategies that are need to be incorporated with respect to the disease that the patient is suffering from (Pergolotti et al., 2015).  

There is need for the therapist to identify current and potential abilities of the patient and contrast them with the challenges on various associated with the disease so that the patient can be engaged in occupations including activities of daily living instrumental ADLs, rest,  sleep, leisure, and even social participation (Désiron et al., 2016).  Physically the aid of occupational therapist in the palliative care help in preventing contractors and enhancing joint integrity with different stretching routine, however the psychological impact of occupational therapy provides empowerment and a sense of hope investigation terminal disease which is very important aspect of care. Oncological rehabilitation has been identified as a very important on integral component of the entire palliative care program. It has become very important aspect of prostate cancer aftercare.  There is mounting evidence that suggest that the therapeutic exercises along with neuromuscular training can help in building strength and energy so that the patients are better able to continue to participate in the activities that matter to the patients (Ullrich et al., 2018).

Active Surveillance and Watchful Waiting

In this case John had been diagnosed with prostate cancer at the age of 57, which has been identified by the clinical manifestation of extreme pain in the back.  Furthermore it has to be important Li addressed that the basic understanding of the target population regarding prostate cancer is very casual and the casual approach is undoubtedly a language which is also leading to the higher mortality and hospitalization rates due to prostate cancer.  Many of the middle it's made which is the target or vulnerable populations for prostate cancer considered prostate cancer to be a silent disease which needs no treatment interventions or lifestyle changes at all. However it needs to be considered that the specified conventional ideas are the main contribution factor behind the lack of timely help seeking behaviour among the men that are having preliminary symptoms which is contributing to later diagnosis and advanced stages which had been the case for John himself. It is clear that John is disheartened and distressed by the lack of proper Diagnostic screening available in the health care system which could have enhanced his chances of habit review diagnosed the state which could have given the opportunity to treat the disease and attain recovery.  However, John has shared it can be stated that he is still hopeful and is willing to fight the disease if adequate treatment measures are taken for him (Sveistrup et al., 2016).

In case occupational help will have to build on the hope and positivity in John and his family to develop coping strategies to effectively compact with disease and lead a quality life.  In this case the orphanage in rehabilitation program for Johnson have to include variety of factors including physical therapy, occupational therapy, massage therapy, or aromatherapy, stone therapy, acupressure, acupuncture, and Soft tissue manipulation. However in this case there were the need of a process framework being used in the occupational rehabilitation planning for job and one effective Framework that can be incorporated is the PEOP model.  

Person environment occupation performance model was developed in 1985 which had been a diversion from the biomedical model which was more practitioner based into a genre of client based interventions.  PEOP model allows complete person centred approach to care delivery, in order to address the exact and individuals needs of the patient we taken into consideration with priority.  According to this model in order to align well being of the patient with enhanced quality of life the patient on the person is treated as intrinsic factor and the environment is treated as extrinsic factor.  Both of the factors airline together in order to address occupation and performance which help in establishing enhanced well being and quality of life for the patient (van Hartingsveldt et al., 2017).

Localized Treatment Options

In this case as well using this biopsychosocial approach to care delivery,  John's personal life and is occupational roll with have to be a lunch to his present embankment restrictions associated with the disease so that coping strategies can be identified that will test Both his occupational and performance related needs.  In this case the occupational therapist will have to take the help of this top-down client centred approach to collaborate with John and his family and discover the challenges and protective factors about his environment which can help and support creation of coping strategies (Wagner, Northrop & Vanderhoof, 2016). This will involve both physical therapy to enhance his mobility and subside his pain along with psychosocial therapies which will address not just the pain john had been suffering from but will also address his mood, behaviors, and his mental state. The patient education and information sharing will be a very important part of this program which will not only enhance the knowledge of the patient regarding prostate cancer with respect to up-to-date literature but will also help both John and his family identified strategies that will help him live a quality life even with his terminal disease (van Hartingsveldt et al., 2017).

References:

Désiron, H. A., Crutzen, R., Godderis, L., Van Hoof, E., & de Rijk, A. (2016). Bridging health care and the workplace: formulation of a return-to-work intervention for breast cancer patients using an intervention mapping approach. Journal of occupational rehabilitation, 26(3), 350-365.

Pergolotti, M., Deal, A. M., Lavery, J., Reeve, B. B., & Muss, H. B. (2015). The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer. Journal of geriatric oncology, 6(3), 194-201.

Pergolotti, M., Williams, G. R., Campbell, C., Munoz, L. A., & Muss, H. B. (2016). Occupational therapy for adults with cancer: why it matters. The oncologist, 21(3), 314-319.

Sveistrup, J., Mortensen, O. S., Rosenschöld, P. M., Engelholm, S. A., & Petersen, P. M. (2016). Employment and sick leave in patients with prostate cancer before, during and after radiotherapy. Scandinavian journal of urology, 50(3), 164-169.

Taylor, R. R. (2017). Kielhofner's research in occupational therapy: Methods of inquiry for enhancing practice. FA Davis.

Ullrich, A., Rath, H. M., Otto, U., Kerschgens, C., Raida, M., Hagen-Aukamp, C., & Bergelt, C. (2018). Return to work in prostate cancer survivors–findings from a prospective study on occupational reintegration following a cancer rehabilitation program. BMC cancer, 18(1), 751.

van Hartingsveldt, M., Pellegrom, S., le Granse, M., & Kinébanian, A. (2017). Het Person-Environment-Occupation-Performance (PEOP)-Model en het PEOP Occupational Therpay Proces. Grondslagen van de ergotherapie, (5e druk), 401-415.

Wagner, A., Northrop, H., & Vanderhoof, J. (2016). Comparing concepts of home among older adults living in different settings (Doctoral dissertation, Utica College).