American Cancer Society Workshop on Adolescents and Young Adults with Cancer. Workgroup #3: Psychosocial and emotional issues and specialized support groups and compliance issues

Is the cancer survival improvement in European and American adolescent and young adults still lagging behind that in children?

Improvements during 1978 to 2006 in the 5-year survival rate of adolescents and young adults (AYAs, age 15-39) and children with cancers common to both age groups were evaluated for 1978 to 2006 in Europe and the USA. AYAs had absolute survival increases of 25% and 15% in Europe and the USA, respectively, but in both cases, AYA 5-year survival was, as of 2006, 4% lower than those in children. Acute lymphoblastic leukemia (ALL) explained most of the survival difference between AYAs and children on both the continents. In the USA, 20- to 39-year-olds with ALL have had less survival improvement than those in Europe.

Adherence to oral chemotherapy in childhood acute lymphoblastic leukemia: an evolutionary concept analysis

PURPOSE/OBJECTIVES

To clarify the concept of adherence to daily oral chemotherapy in children with acute lymphoblastic leukemia (ALL), to examine its implications for clinical practice, and to provide a foundation for further research and knowledge development.

DATA SOURCES

Published literature identified through the MEDLINE®, CINAHL®, PsycINFO, and ERIC databases.

DATA SYNTHESIS

Identified attributes of adherence to oral chemotherapy in childhood ALL included motivation, persistence, collaboration, mindfulness, cognitive capacity, flexibility, active participation, and identification of key participants in the process. Identified antecedents included a diagnosis of leukemia, the perceived value of adherence, and patient, family, and healthcare system-related factors. Identified consequences included the potential for maintaining optimal drug levels and improving disease outcome, as well as increased patient and caregiver esteem through active participation in the process. Adherence in the context of childhood ALL is defined as the active self-care behavior of taking (or having the responsibility for administering) daily oral chemotherapy, in collaboration with and according to the instructions of the healthcare provider over a defined, prolonged treatment period.

CONCLUSIONS

Adherence to oral chemotherapy in childhood ALL is a complex, multidimensional behavior that involves not only a willingness to follow the prescribed regimen over a prolonged period, but also the cognitive capacity and psychomotor skills to carry out the process.

IMPLICATIONS FOR NURSING

Nurses should recognize the importance of clear communication of medication instructions, reinforcement of adherence-related behaviors, and assistance with common issues such as pill-swallowing skills and reminder systems in caring for children with ALL.

Psychosocial issues of adolescents with cancer

Although researchers agree that cancer during adolescence does not lead to serious psychopathology, the adolescent patient is confronted with a number of biopsychosocial problems. This article reviews the literature on nine psychosocial issues: (1) Health concerns, (2) Family relationships, (3) Sexual and reproductive issues, (4) Peer relationships, (5) Body image, (6) School disruption, (7) Interaction with treatment team, (8) Future goals and career development, and (9) Positive life changes. Practice implications and support group interventions for this population are presented.

Health behaviors of adolescents who have been diagnosed with cancer

Many challenges related to the development and diagnosis of cancer are faced by adolescents with the disease. Adolescence is a developmental period for behaviors that risk health. The article describes behaviors that promote and risk health among adolescents who have been diagnosed with cancer. A paucity of studies exists on health-promoting and -risking behaviors among adolescents with cancer. Further studies are needed to explore and describe these adolescents' health-promoting and -risking behaviors. Health care professionals must comprehensively address these adolescents' health care needs related to the diagnosis of cancer as well as the developmental challenges of adolescence.